Rural Health
Research Gateway

Victoria Freeman, DrPH, RN

North Carolina Rural Health Research and Policy Analysis Center

Phone: 919.966.6168
Email: victoria_freeman@unc.edu

University of North Carolina - Chapel Hill

Completed Projects - (7)

  • 21st Century Rural Hospital: Outpatient Services and Access to Care
    The rural hospital has changed dramatically with hospitals becoming increasingly outpatient-centered. This project is designed to inform policymakers about rural hospitals' provision of outpatient care, including publication of a Primer, detailing the variability in outpatient services provision by key characteristics that can be used to examine the potential impact of proposed policy changes on patients' ability to access different services.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Hospitals and clinics
  • Access to Health Care for Young Rural Medicaid Beneficiaries
    This study examined access to health care among rural children ages 0-17 who are enrolled in some type of Medicaid managed care program, and will compare this access across types of programs and, within program type, to that of urban beneficiaries.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Children and adolescents, Health services, Medicaid and CHIP, Oral health, Transportation
  • Comprehensive Study of Swing Bed Use in Rural Hospitals
    This project will comprehensively address questions about how swing beds are used by rural hospitals. Questions to be answered include whether decision about use are driven by patient need, community resources, hospital operational concerns or some combination of these factors; the cost implications of swing bed use in critical access hospitals to the Medicare program; and whether patients served in swing beds differ in meaningful ways from those in skilled nursing facilities.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS)
  • Factors Associated with Provision of Ambulance Services by Rural Hospitals
    This two-part study will use existing national data to determine how many hospitals have regularly offered ambulance services as well as how many have recently acquired or discontinued such services. In-depth interviews with selected rural hospital administrators will explore the factors related to a hospital's decision regarding these important health care services.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Emergency medical services (EMS) and trauma
  • Rural Emergency Department Preparedness for Pediatric Care
    While many large cities have dedicated children's hospitals or facilities with pediatric emergency departments, many general hospitals do not have either the equipment necessary to provide optimal pediatric emergency care nor staff that is specifically trained in the care of pediatric emergencies. This project will use secondary data analysis and semi-structured interviews with emergency room directors in order to address how the availability of pediatric services, expertise and supplies in U.S. emergency departments differs between urban and rural facilities, and to determine which factors impede the availability of pediatric services, expertise, and supplies in rural emergency departments.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Children and adolescents, Health services, Hospitals and clinics
  • Rural Emergency Medical Services: Workforce and Medical Direction
    This two year study will examine the status of medical direction for rural EMS systems and the nature of the challenges and impediments to obtaining adequate medical direction in rural areas across the country. In addition, the study will address issues surrounding the recruitment and retention of paid and volunteer staff for rural EMS systems.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Emergency medical services (EMS) and trauma, Workforce
  • Volunteerism in Rural EMS
    Semi-structured telephone interviews will be used to examine issues facing rural emergency medical services (EMS) that have converted or are considering converting from volunteer services to paid services. Respondents will be queried regarding their conversion or consideration of conversion and the effect on their ability to recruit and retain personnel, their relationship with other agencies such as fire departments and hospitals, and the overall availability of EMS.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Emergency medical services (EMS) and trauma, Healthcare financing, Workforce

Publications - (32)

2015

  • The 21st Century Rural Hospital: A Chart Book
    Chartbook
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2015
    This chartbook presents a broad profile of rural hospitals and includes information on location, who they serve, services they provide, how they ensure outpatient services for their communities, other community benefits they provide, and financial performance. Each page includes charts comparing rural hospitals to each other and to urban hospitals.

2014

  • Geographic Variation in Plan Uptake in the Federally Facilitated Marketplace
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2014
    This brief combines the data on plan selection in the federally facilitated marketplaces with estimates of those likely to qualify for the marketplace to calculate the percentage of potential eligible individuals who chose a health insurance plan (the uptake rate). It contains a heat map showing the variation in uptake rates across the country.
  • Safety Net Clinics Serving the Elderly in Rural Areas: Rural Health Clinic Patients Compared to Federally Qualified Health Center Patients
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2014
    This brief, the third and final in a series on rural health centers (RHC), uses data from 2009 Medicare outpatient provider claims to look at clinic locations, number of beneficiaries served, and number of/cost per claim for each type of rural safety net clinic, as well as beneficiaries' ages, health problems, and distance traveled for care.
  • Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where?
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2014
    This brief examines health conditions of patients discharged from rural prospective payment system (PPS) hospitals and critical access hospitals (CAHs) to swing beds and skilled nursing facilities (SNFs).

2013

  • Implications for Beneficiary Travel Time if Financially-Vulnerable Critical Access Hospitals Close
    Rapid Response to Requests for Rural Data Analysis
    Date: 12/2013
    Changes to Critical Access Hospitals' reimbursement may spur some to close. This analysis considers the communities served by the 93 CAHs with the lowest profitability and therefore most likely to close due to a change in Medicare reimbursement.
  • Rural/Urban Differences in Inpatient Related Costs and Use Among Medicare Beneficiaries
    Rapid Response to Requests for Rural Data Analysis
    Date: 12/2013
    Medicare beneficiaries who are admitted to rural hospitals tend to have lower outpatient costs than their counterparts at urban hospitals. The differences are due to multiple factors. The analysis suggests that consideration of the total cost of an acute episode of care might be considered, not just the cost of the acute inpatient stay.
  • Geographic Variation in the Profitability of Critical Access Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2013
    This study describes geographic variation in the profitability of Critical Access Hospitals (CAHs) in 2012 to understand some of the regional differences in the potential effects of implementing policy proposals impacting CAHs.
  • Profitability of Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2013
    This study compares the profitability between 2010 and 2012 of urban and rural hospitals paid under the Medicare Prospective Payment System (U-PPS and R-PPS, respectively) to rural hospitals with special Medicare payment provisions.

2012

  • Why Use Swing Beds? Conversations With Hospital Administrators and Staff (Findings Brief)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2012
    In this study, we interview hospital administrators and staff about the use of swing beds. Topics include the role of swing beds in patient care, swing bed volume and financial considerations, swing beds in the context of all community post-acute skilled care, and swing beds as a benefit for community residents.

2011

2010

  • Rural Hospital Support for Emergency Medical Services (Final Report)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2010
    This report shares information on rural hospitals related to these questions: what proportion support/operate emergency medical services (EMS) units; has this changed; what are the characteristics of the hospitals that support/operate EMS; what investments were made in EMS; and what describes the communities where the hospitals are located?
  • Rural Hospital Support for Emergency Medical Services (Findings Brief)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2010
    This study looked at rural hospitals to answer these questions: what proportion support/operate emergency medical services (EMS) units; has this changed; what are the characteristics of the hospitals that support/operate EMS; what financial investments were made in EMS; and what describes the communities where the hospitals are located?
  • Rural Volunteer EMS: Reports From the Field (Findings Brief)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2010
    This report explores the current state of rural EMS by interviewing 49 local directors from all-volunteer rural services in 23 states. Respondents were encouraged to speculate on the future viability of their local service, describe the challenges they face, and what they need to ensure continuance.
  • Rural Volunteer EMS: Reports From the Field (Final Report)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2010
    This report explores the current state of rural EMS by interviewing 49 local directors from all-volunteer rural services in 23 states. Respondents were encouraged to speculate on the future viability of their local service, describe the challenges they face, and what they need to ensure continuance.
  • Pediatric Care in Rural Hospital Emergency Departments (Final Report)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2010
    This report analyzes data from the Emergency Pediatric Services and Equipment Supplement to the National Hospital Ambulatory Medicare Care Survey to compare rural and urban hospitals' responses on various dimensions of pediatric emergency department care.
  • Pediatric Care in Rural Hospital Emergency Departments (Findings Brief)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2010
    This brief analyzes data from the Emergency Pediatric Services and Equipment Supplement to the National Hospital Ambulatory Medical Care Survey. Rural/urban hospitals' responses on pediatric emergency department (ED) care were compared. Rural ED directors also were surveyed to further explore rural pediatric ED care in more detail.

2009

2008

2007

  • Becoming an Emergency Medical Technician: Urban-Rural Differences in Motivation and Job Satisfaction
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2007
    This study uses cross-sectional data from the 2003 national Longitudinal Emergency Medical Technician Attributes and Demographic Study Project to explore urban-rural differences in why emergency medical technicians enter the field, what is important in their jobs, and whether they are satisfied with their profession.
  • The Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 02/2007
    This policy brief discusses the findings of a project to understand the community involvement and impact of critical access hospitals and the Medicare Rural Hospital Flexibility Program (Flex Program).
  • Exploring the Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 01/2007
    This paper reports on a series of site visits to six diverse rural communities and critical access hospitals to assess the experiences and impact of these hospitals in responding to their community's health infrastructure needs.
  • Intensive Care in Critical Access Hospitals
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2007
    Describes the facilities, equipment, and staffing used by Critical Access Hospitals (CAHs) for intensive care, the types of patients receiving ICU care, and the perceived impact of closing the ICU on CAH staff and the local community.

2005

  • Rural and Urban Parents Report on Access to Health Care for Their Children With Medicaid Managed Care
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2005
    This study considers rural beneficiaries' perspectives to broaden understanding of whether Medicaid-managed care programs provide acceptable access to healthcare services for children.
  • Cesarean Section Rates in Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2005
    This findings brief examines childbirth delivery patterns in rural hospitals and compares the C-section rate in rural hospitals to that in urban hospitals using the Nationwide Inpatient Sample.
  • Intensive Care in Critical Access Hospitals (Working Paper)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2005
    This paper describes what officials at critical access hospitals mean when they report that they provide intensive care and the importance of these services to the hospital and the community it serves.

2004