Rural Health
Research Gateway

Health services

Completed Projects

Listed by project completion date. You can also view these projects alphabetically.

2024

  • Availability and Quality of Dialysis in Rural Counties with a High Diabetes Burden
    This project examined the degree to which counties with a high population risk for end stage renal disease, defined by high diabetes prevalence, are served by dialysis providers. It assessed the accessibility and quality of services for end stage renal disease looking for disparities associated with rural residence and racial/ethnic population composition.
    Research center: Rural and Minority Health Research Center
    Topics: Diabetes, Health disparities and health equity, Health services, Public health, Quality
  • Availability of Diabetes Self-Management Education in High Need Rural Counties
    This project examined the degree to which counties with a high need for diabetes education, defined by high diabetes prevalence, have such education available. Findings were linked to a related study that examined the availability of dialysis for end stage renal disease, a severe outcome of poorly addressed diabetes.
    Research center: Rural and Minority Health Research Center
    Topics: Diabetes, Health services
  • Clinical-Community Linkages in Non-Metropolitan and Metropolitan Hospitals: COVID-19 Impacts and Trends
    This study examined trends in partnerships between hospitals and public health departments and other community linkages in both non-metropolitan and metropolitan hospitals with a particular focus on the impact of the COVID-19 pandemic.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Coronavirus Disease 2019 (COVID-19), Critical Access Hospitals (CAHs), Health services, Hospitals and clinics, Networking and collaboration, Public health, Social determinants of health
  • Examining the Potential Impact of Multiple Payment Policies on Rural Versus Urban Home Health Agencies
    This study estimated the impact of three recent and upcoming Medicare home health payment policies (revised rural add-on payments, new prospective payment system, and value-based purchasing demonstration) on reimbursement for home health agencies based on rural-urban status, community factors, and home health agency characteristics.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Healthcare access, Healthcare financing, Home health, Medicare, Post-acute care
  • How are Rural Health Clinics Serving Pediatric and Obstetrical Medicaid Populations?
    This project examined the roles of independent and provider-based Rural Health Clinics in serving pediatric and obstetrical patients covered by state Medicaid programs.
    Research center: Maine Rural Health Research Center
    Topics: Children and adolescents, Health services, Healthcare financing, Maternal health, Medicaid and CHIP, Rural Health Clinics (RHCs), Women
  • How Does Participation in Medicare Accountable Care Organizations Affect Rural Hospital Financial Outcomes?
    This project examined the impact of Medicare Accountable Care Organizations' (ACOs') participation on rural hospitals' financial outcomes. Findings from this project provided policy-relevant information on how ACO participation affects rural hospitals' financial bottom lines, contributing to further program design.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Care management, Health reform, Health services, Hospitals and clinics, Medicare
  • Palliative Care in the Rural U.S.
    This project described the availability of palliative care services in rural hospitals and community settings using data from the American Hospital Association Annual Survey, interviews with palliative care providers, and a survey of rural hospitals without palliative care services.
    Research center: WWAMI Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospice and palliative care, Hospitals and clinics
  • Rural and Urban Cancer Survivors' Follow-Up Care Experiences
    This project examined rural vs. urban differences in cancer survivors' follow-up care experiences using the 2017 Medical Expenditure Panel Survey.
    Research center: Rural and Underserved Health Research Center
    Topics: Cancer, Care management, Health disparities and health equity, Health services, Healthcare access, Physicians, Post-acute care, Quality
  • Rural/Urban Variations in Cancer Screening During the COVID-19 Pandemic
    Using the National Cancer Institute Health Information National Trends Survey, we examined how the COVID-19 pandemic disrupted the receipt of recommended screenings for common cancers. Findings informed policymakers about potential widening of rural/urban disparities in the receipt of cancer preventive services and the potential need to target these services toward rural residents.
    Research center: Rural and Underserved Health Research Center
    Topics: Cancer, Coronavirus Disease 2019 (COVID-19), Health disparities and health equity, Health promotion and disease prevention, Health services, Healthcare access
  • Understanding Rural Non-Emergent Emergency Department Use
    Research shows rural residents use emergency departments (ED) at higher rates than urban residents. Other studies suggest rural residents are more likely to visit the ED for a non-emergent reasons. This study used the 2014-17 Medical Expenditure Panel Survey to analyze factors associated with rural versus urban residents' non-emergent use of EDs.
    Research center: Maine Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Health services, Healthcare access, Hospitals and clinics

2023

  • Diabetes Management in Urban and Rural Areas of the U.S.
    This project used the IBM MarketScan database to examine differences in type 2 diabetes prevalence and monitoring for a commercially insured sample. It also employed definitions from the Health Effectiveness Data and Information Set guidelines for comprehensive diabetes care to determine if rural residents are more or less likely to meet recommended standards for type 2 diabetes monitoring and control.
    Research center: Rural and Underserved Health Research Center
    Topics: Care management, Chronic diseases and conditions, Diabetes, Health disparities and health equity, Health promotion and disease prevention, Health services, Healthcare access, Private health insurance, Quality
  • Examining Rural-Urban Differences in Availability of Hospital Cardiac Testing Services Between 2010-2020
    This project will examine whether the availability of hospital-based cardiac testing services has changed over the past ten years in rural and urban counties and identify the characteristics of counties where service availability has changed.
    Research center: Rural and Minority Health Research Center
    Topics: Care management, Chronic diseases and conditions, Health disparities and health equity, Health services, Hospitals and clinics, Public health
  • Examining the Burden of Public Stigma Associated with Mental Illness in the Rural U.S.
    This project quantitatively examined the burden of public stigma associated with mental illness in rural versus nonrural communities using a nationally representative panel-based survey. Findings inform strategies aimed at reducing stigma and improving the lives of those experiencing mental illness in rural communities.
    Research center: Rural Health Equity Research Center
    Topics: Health services, Mental and behavioral health
  • Following the Money: Do Block Grant Resources Reach Rural Communities?
    This project applied a mixed methods design to describe the distribution of block grant resources from federal agencies through states to the local level in rural and non-rural communities in the United States. Findings could guide federal agencies and policy makers to develop strategies to more effectively target block grant resources to ensure that the needs of vulnerable rural populations are addressed.
    Research center: Rural Health Equity Research Center
    Topics: Health services, Healthcare financing, Public health, Rural statistics and demographics
  • Rural Health Access: Affordability and Barriers to Care
    Rural-urban comparisons of healthcare access and affordability predate many policy reform efforts aimed at increasing access and decreasing costs—ongoing concerns of rural families. This study used national health survey data to examine rural-urban differences in access to medical care, access to insurance, and affordability of care.
    Research center: Maine Rural Health Research Center
    Topics: Health disparities and health equity, Health reform, Health services, Healthcare access, Healthcare financing, Private health insurance, Public health, Social determinants of health
  • The Direct Care Workforce in Rural Areas
    In this study, we measured the supply of long-term care services and supports (LTSS) direct care workers relative to older adult populations in rural and urban areas and measure employer and industry turnover among LTSS direct care workers. We also explored how compensation levels – including wages and employer-based health insurance – are related to and predict worker turnover in the LTSS direct care workforce in rural and urban areas.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Allied health professionals, Health services, Home health, Long-term care, Post-acute care, Poverty, Rural statistics and demographics, Social determinants of health, Workforce

2022

  • Continuous Services in the Absence of Retail Pharmacies in Rural Communities
    This project identified communities with and without pharmacies by rurality and described the differences in population and market characteristics of communities with and without any pharmacies. Research findings regarding "pharmacy deserts" informed alternative methods of securing services based on community characteristics.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Healthcare access, Medicare Part D, Pharmacy and prescription drugs
  • Location and Characteristics of Nursing Homes in the Rural and Urban U.S.
    This project examined rural and urban nursing home availability; assessed the nursing home bed supply relative to the elderly population in rural and urban counties; summarized resident and nursing home characteristics; and analyzed the relationship between the rural location of nursing homes and resident and nursing home characteristics.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Aging, Health services, Healthcare access, Healthcare financing, Long-term care, Medicare
  • Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Provider Experience and Provision of Evidence-based Care
    This study described the relationship between prehospital emergency medical services (EMS) providers' accumulated experience and provision of evidence-based care for rural and urban populations using newly available data on EMS agencies, personnel, and patient care.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Emergency medical services (EMS) and trauma, Health services, Workforce
  • Rural-Urban Differences in Child and Adolescent Mental Health pre and during the COVID-19 Pandemic
    This project examined rural-urban differences in the prevalence and severity of anxiety and depression among children and adolescents before and during the COVID-19 pandemic, as well as examined rural-urban differences in access to mental health care professionals and the receipt of care from a mental health professional before and during the COVID-19 pandemic.
    Research center: Rural and Minority Health Research Center
    Topics: Children and adolescents, Health disparities and health equity, Health services, Mental and behavioral health, Minority health

2021

  • Do Rural Breast and Colorectal Cancer Patients Present at More Advanced Disease Stages than Their Urban Counterparts?
    Access to recommended cancer screening is more difficult for rural residents than their urban counterparts. This study used the Surveillance, Epidemiology and End Results Program (SEER) data to examine the extent to which rural residents present at more advanced disease stages for breast and colorectal cancer diagnosis than urban residents.
    Research center: WWAMI Rural Health Research Center
    Topics: Cancer, Health disparities and health equity, Health promotion and disease prevention, Health services
  • Evaluating the Rural Health Network Development Planning Grant Program
    This project identified factors that facilitate and impede success of Rural Health Network Development grantees, based on discussions with grantees from the 2019 cohort and surveys of prior grantees dating back more than 10 years, as well as with technical assistance providers.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health services, Healthcare access, Healthcare financing, Networking and collaboration, Public health, Quality
  • Geographic Access to Healthcare for Rural Medicare Beneficiaries: An Update and National Look
    This objective of this study was to compare, at a national and census division level, where rural and urban Medicare beneficiaries receive ambulatory care, which types of specialists they utilize and how far beneficiaries are traveling to obtain care.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Chronic diseases and conditions, Health services, Medicare, Workforce
  • Lung Diseases Among Coal Miners
    Coal miners are at increased risk of lung diseases. Using secondary datasets, we will assess the distribution of lung diseases across regions, identify patterns of healthcare utilization among miners relative to HRSA-funded Black Lung Clinics, and compare healthcare utilization patterns, behaviors, and comorbidities among miners and non-miners.
    Research center: Rural and Underserved Health Research Center
    Topics: Chronic diseases and conditions, Environmental and agricultural health, Health disparities and health equity, Health services
  • Post-acute Care Trajectories for Rural Medicare Beneficiaries
    Utilization and costs of post-acute care for Medicare fee-for-service beneficiaries have grown rapidly during the last decade. This study examined post-acute care utilization for rural Medicare beneficiaries following acute hospitalization, describing use of home health and skilled nursing care and trajectories of care across settings.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Allied health professionals, Health services, Home health, Hospitals and clinics, Medicare, Nurses and nurse practitioners, Post-acute care
  • Predictors and Barriers to Achieving Immunization in Rural and Urban Areas
    Prenatal and timely childhood immunizations offer the optimal strategy for preventing severe morbidity and mortality due to vaccine-preventable disease. This project evaluated possible gaps in immunization services for pregnant women and their infants in rural areas as compared to urban areas.
    Research center: Southwest Rural Health Research Center
    Topics: Children and adolescents, Health promotion and disease prevention, Health services, Maternal health
  • The Current Distribution of the General Surgery Workforce in Rural America
    This project described the current national supply and distribution of general surgeons in rural vs. urban areas of the United States as well as geographic variability in the supply of general surgeons across the rural/urban and intra-rural dimensions at the regional level.
    Research center: WWAMI Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Health services, Healthcare access, Hospitals and clinics, Physicians, Rural statistics and demographics, Workforce
  • Variations in Travel Burdens Associated with Access to Care Between Rural and Urban Residents
    This project focused on geographic access to medical and dental care, recognizing that travel time and distances can hinder individuals from obtaining necessary care. The study explored the travel time and distances to care for specific sub-populations and in specific geographic settings, particularly urban versus rural residence and region.
    Research center: Southwest Rural Health Research Center
    Topics: Health services, Healthcare access, Transportation
  • What Is the Geographic Distribution of the Workforce with a DEA Waiver to Prescribe Buprenorphine?
    This project updated statistics on the supply of providers (physicians, nurse practitioners and physician assistants) with a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine and examine supply trends over time and also established baseline numbers of other eligible providers (e.g., midwives, clinical nurse specialists).
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Healthcare access, Mental and behavioral health, Nurses and nurse practitioners, Physician assistants, Physicians, Substance use and treatment, Workforce

2020

  • Assessing Potential Unmet Need for Home Healthcare in Rural Areas
    This study estimated potential unmet need for home healthcare in rural areas for fee-for-service Medicare beneficiaries. We compared rates of home healthcare utilization in rural areas with urban areas, accounting for acute hospital discharges and utilization of inpatient rehabilitation facilities and skilled nursing facilities.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Home health, Hospitals and clinics, Medicare, Post-acute care
  • Emergency Obstetrics in Communities Without Hospital-Based Maternity Care
    The purpose of this project was to describe rural hospitals that do not provide obstetric services and to survey a sample of these hospitals regarding their capacity for emergency obstetrics locally in order to inform policy to support access to high-quality maternity care for all pregnant rural residents.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Maternal health, Quality, Women
  • Making It Work: Models of Success in Rural Maternity Care
    The purpose of this project was to update information on access to obstetric services in rural counties, to identify common factors across rural communities that have maintained local hospital-based obstetric services, and to describe best practices associated with successfully supporting birth locally in rural communities.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Maternal health, Quality, Women
  • Mental Health Treatment Access: How Do Mental Health Treatment Use and Unmet Treatment Need Vary Among Rural and Urban Adults Nationally?
    This project will estimate the prevalence and policy-modifiable correlates of unmet mental health treatment need and utilization among metropolitan, micropolitan, and other non-metropolitan adults nationally who have a mental health condition. Additionally, the study will investigate the same issues among Native Americans/American Indians.
    Research center: Rural and Underserved Health Research Center
    Topics: American Indians and Alaska Natives, Health disparities and health equity, Health services, Mental and behavioral health
  • Patterns of Inpatient Care-Seeking by Rural Residents
    This study seeks to gain an understanding of inpatient care-seeking behavior by rural residents to provide insight into drivers of bypass rates, the extent to which a community uses a hospital other than its local rural hospital.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health services, Hospitals and clinics, Medicare
  • Who Provides Mental Health Services to Rural Medicare Beneficiaries?
    Most rural counties do not have a psychiatrist to care for the common conditions of depression or anxiety. This study describes the provider workforce that cares for rural elderly patients with depression/anxiety, including regional and rural-urban variations in mental healthcare provision.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Medicare, Mental and behavioral health, Nurses and nurse practitioners, Physician assistants, Physicians, Substance use and treatment, Workforce

2019

  • Ambulatory Care Provided to Rural Medicare Beneficiaries by Rural and Urban FQHCs, RHCs, and Acute Hospitals
    This project characterized the volume, cost, and case mix of ambulatory care provided to rural Medicare beneficiaries by rural and urban federally qualified health centers (FQHCs), rural health clinics (RHCs), and acute hospitals. The study included urban-rural and geographic comparisons of volume, cost, and case mix by provider type.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health services, Hospitals and clinics, Medicare
  • Developing Rural-Relevant Strategies to Reduce Maternal Morbidity
    The purpose of this project was to distinguish and analyze predictors of maternal morbidity during childbirth hospitalization by geography and to develop recommendations to improve the safety of childbirth for rural residents. It also assessed the degree of rural focus and representation in current policy efforts to address this crisis.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Legislation and regulation, Maternal health, Quality, Women
  • Diverging Populations Served by the Medicare Home Health Benefit: Comparison of Post-acute vs. Community-entry Home Health in Rural Areas
    This study examined differences between rural, fee-for-service Medicare beneficiaries who were admitted to home health from the community (community-entry) and those who were admitted to home health following an inpatient stay (post-acute) in terms of their clinical and non-clinical characteristics as well as the communities in which they live.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Home health, Medicare, Post-acute care
  • Examining the Legal Landscape in Rural America: Implications for the Healthcare Workforce, Access to Care, and Population Health
    This project explores potential rural/urban differences in the prevalence of malpractice claims, clinical privilege actions, and state licensure actions among health care providers. We will also examine whether variations in nurse practitioner scope of practice laws affect rural residents differentially, especially with respect to preventive care.
    Research center: Southwest Rural Health Research Center
    Topics: Allied health professionals, Health services, Legislation and regulation, Nurses and nurse practitioners, Workforce
  • Predictors of Buprenorphine Prescribing by Family Physicians in Rural Areas Nationally
    This project examined how physician and practice-level characteristics are associated with family physicians prescribing buprenorphine for opioid use disorder across rural and urban areas. The study made use of a unique dataset collected among family physicians nationally in 2017.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Health services, Mental and behavioral health, Pharmacy and prescription drugs, Physicians, Substance use and treatment
  • Preventive Health Service Use Among Rural Residents
    Examining differences in rural-urban preventive health service use is critical to assessing the impact of health benefit design changes on access to preventive services and their use among rural and urban populations. We used National Health Institute Survey data to compare receipt of preventive health services among rural and urban adults.
    Research center: Maine Rural Health Research Center
    Topics: Health promotion and disease prevention, Health services, Women
  • Rural and Urban Differences in Access to Psychiatric Partial Hospitalization Programs
    The project informed policymakers about the accessibility of psychiatric partial hospitalization programs, which provide moderately intensive and structured psychiatric services in outpatient settings, particularly hospital-based outpatient clinics.
    Research center: Rural and Underserved Health Research Center
    Topics: Health services, Healthcare access, Hospitals and clinics, Mental and behavioral health
  • Substance Use, Depression, and Suicide: What Are the Individual and Policy-Modifiable Correlates Amongst Metropolitan and Non-metropolitan Adults?
    We estimated the prevalence of depression and suicidal ideation and attempts amongst metropolitan and non-metropolitan adults nationally. We also investigated how demographic, social, economic, and health (including alcohol and drug abuse) as well as healthcare access factors explain depression and suicide indicators amongst residents.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Health services, Mental and behavioral health, Substance use and treatment
  • The Rural/Urban Impact of Insurance Coverage Changes
    We examined the impacts of changes in health insurance coverage during the last several years on use of health services and health outcomes separately for rural and urban areas. Due to differences in demand and supply level factors, we hypothesized that the effects of coverage changes differ by rural/urban status.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Private health insurance

2018

  • Implications of Rural Ambulance Service Closures
    The purpose of this project was to examine closed ambulance services and those ambulance services adjacent to the closed units. The ambulance services adjacent to those which closed were examined by service area, workload, and staffing for one year prior to and one year after the adjacent service closure.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Allied health professionals, Emergency medical services (EMS) and trauma, Frontier health, Health disparities and health equity, Health services, Workforce
  • The Impact of Medicaid Expansion on Rural/Urban Variations in Access to Substance Use Treatment
    Research indicates that substance use treatment access is insufficient in rural areas. We made use of our rare access to restricted use NSDUH data to offer new insights about the impact of Medicaid expansion on access to substance abuse treatment among individuals with substance abuse disorders, analyzing 13 years (2004-2016).
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Health services, Substance use and treatment
  • Use of Home Health Services Among High Risk Rural Medicare Patients: Patient, Service, and Community Factors Associated with Outcomes of Care
    This study examined outcomes of care for rural Medicare patients who were discharged from hospitals and admitted to home healthcare for post-acute services. Outcomes included emergent care use and re-hospitalization during the home health admission and community discharge.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Home health, Medicare, Post-acute care
  • Variation in Scope of Practice and Medical Services Available at Family Physician Practices within Rural Areas
    Using data collected during recertification of family physicians by the American Board of Family Medicine, we examined variation in the scope of practice of family physicians and services available in the primary practice site by degree of rurality and within rural categories by community-level deprivation, as well as variation by Patient Centered Medical Home status.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Health services, Physicians
  • What Are Best Practices for Providing Buprenorphine Maintenance Treatment in Rural Primary Care?
    Not all physicians with a Drug Enforcement Agency waiver to prescribe buprenorphine actually provide this treatment or fully utilize their waiver capacity. This project interviewed physicians successfully using their waivers to identify best practices for prescribing buprenorphine treatment for Opioid Use Disorder.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Mental and behavioral health, Physicians, Substance use and treatment, Workforce

2017

  • Assessing the Stability of Rural Pharmacy Services
    This project's goals include deepening our understanding of economic forces beyond the immediate control of local pharmacies that are affecting their ability to remain in business, assessing the future of sole community retail pharmacies in rural places, and exploring alternative modalities for delivering pharmacy services in the absence of retail pharmacy businesses.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Pharmacy and prescription drugs, Telehealth
  • Exploring the Impact of Rural Hospital Closures on Use of Emergency Medical Services
    Using a unique national database, The Enterprise Data Trust, we will explore pre- and post-closure hospital emergency department use with specific emphasis on those who used public emergency medical transportation, testing for significant changes. This study will be the first to look at the impacts of rural hospital closure at the patient level.
    Research center: Rural and Underserved Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Health disparities and health equity, Health services, Transportation
  • Obstetric Unit and Hospital Closures and Maternal and Infant Health in Rural Communities
    This project will examine the relationship between closure of an obstetric unit or hospital and maternity care and outcomes of childbirth in rural US counties including prenatal care, distance to delivery hospital, out-of-hospital birth, and infant health outcomes.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Children and adolescents, Health services, Hospitals and clinics, Women
  • Paving the Way: Addressing Transportation as a Social Determinant of Health for Rural Residents
    This project will use a mixed-methods design to examine ways in which transportation operates as a social determinant of health for vulnerable rural residents, and to identify exemplar transportation programs that are successfully improving health and well-being of those residents.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Health services, Networking and collaboration, Transportation
  • Potential Impact of ESRD Payment Reform on Rural Dialysis Patients
    This study will estimate the potential implications of rural dialysis facility loss for rural patients. Specifically, we will identify low-volume dialysis facilities in rural areas, profile the patients they serve, and estimate the additional travel burden that these patients would experience if facilities close.
    Research center: Rural and Minority Health Research Center
    Topics: Health services, Hospitals and clinics
  • Skilled Nursing Facility Care for Rural Residents with Complex Care Needs
    This project will examine barriers to skilled nursing facility placement for rural residents with complex care needs, including obesity, dementia, and behavioral health problems, and explore potential implications for access to and quality of care.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health services, Hospitals and clinics, Long-term care

2016

  • Rural Population Hospice Care
    Relatively little is known about rural hospice care. The objectives of this project are to review and describe what is already known about rural hospices and to perform initial quantitative analyses on available data to describe the: number of rural hospices and their use patterns (e.g., length of stay and utilization rates), rural residents to urban hospice utilization, and rural versus urban resident hospice utilization rates. For this project, rural is be subdivided into categories such as large rural, small rural, isolated small rural, and frontier. To supplement this information, qualitative information was obtained and integrated into the findings report.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Aging, Health services, Quality
  • Use of Emergency Departments for Behavioral Health Related Care
    This project will study the prevalence of emergency department utilization for behavioral health diagnoses between rural and urban communities.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Emergency medical services (EMS) and trauma, Health services, Hospitals and clinics, Mental and behavioral health

2015

  • Perspectives of Rural Hospice Directors
    Rural hospice care, as it is currently configured, is under pressure by a variety of factors (e.g., policy and regulation, economic and financial, and organizational and structural) which are reviewed in this document. However, a central core element of rural hospice remains the strong sense of community that is embodied in the system (i.e., typically a small non-profit arrangement) and design (i.e., a delivery system reliant on community connections and personal relationships) of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states. Fifty-three directors or key staff members were interviewed during a three-month period in 2013.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Aging, Health services, Quality, Telehealth
  • What Factors Explain Rural Residents Seeking Care Outside of the Rural Community?
    This project will examine factors that explain rural residents seeking care outside of the rural community.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Hospitals and clinics

2014

  • Engagement of Rural Providers in Accountable Care Organizations (ACOs)
    The RUPRI Center's work assessing the development of ACOs in rural places including updating our data base showing the location of Medicare ACOs and using the data to create maps for each Census Region showing the counties in which Medicare ACOs have assigned beneficiaries.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Care management, Health services
  • Examination of Trends in Rural and Urban Health: Establishing a Baseline for Health Reform
    The purpose of this project is to update and supplement the seminal Health, United States, 2001: Urban and Rural Health Chartbook. Resulting information can not only be compared to the 2001 Chartbook but provides a baseline from which to measure future change related to the Accountable Care Act implementation. Where appropriate additional charts are included wherein rural areas are subdivided by type.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Health disparities and health equity, Health services, Public health
  • Patterns of Care in Small Rural Areas: Implications for New Models of Care Provision and Payment such as Bundled Payments and Accountable Care Organizations
    This study will describe usual patterns of care in rural areas to determine whether rural areas are part of a single service area, or whether smaller communities utilize services from a variety of larger hubs. The results of this analysis will inform a thought piece on how the concepts of bundled payments and Accountable Care Organizations might play out in small rural areas and whether small rural communities can be assigned to a single service area without major disruption of current patterns of care.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Health services

2013

  • Assessing Rural Implications of Changes in Insurance Markets
    The goal of this project is to understand and predict changes in the insurance market in which rural people will participate and how state and national policies might influence activity in that market. The specific objectives of the project are to analyze state policies designing and implementing health insurance exchanges and to model the behavior of health insurance plans as regards entering and exiting rural markets.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Private health insurance
  • Do Rural Patients with Early Stage Prostate Cancer Gain Access to All Treatment Choices?
    This research will use cancer registry data from 10 states to examine the degree to which rural residents diagnosed with early stage prostate cancer access the full range of surveillance, surgical, and radiation treatment options. Study findings will inform cancer centers, advocacy groups, rural program planners, and policymakers about services and programs needed to ensure that rural prostate cancer patients can choose from among all treatment options.
    Research center: WWAMI Rural Health Research Center
    Topics: Cancer, Chronic diseases and conditions, Health services
  • Impact of Payment Policy on Access to Physician Care in Rural America
    Profiles of physician practices will be constructed that specify the percent of payments derived from specific current procedural terminology (CPT) codes, dichotomized into evaluation and management (often considered to define primary care) or procedural. Differences across rural practices and between rural and urban practices will be analyzed, with implications for payment policies intended to reward rural primary care.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Medicare, Physicians
  • Promotion and Protection of Rural Miner Health: Are the Resources in Place?
    Miners are exposed to various potentially harmful agents and dangerous work conditions, and may have difficulty accessing care in some rural settings. The study aims to 1) Locate and map mining communities in the US and rural safety net providers (RHCs, FQHCs and Critical Access Hospitals) in those communities; and 2) Identify environmental health competencies (specifically related to miner health) in rural primary care providers practicing in identified mining communities.
    Research center: West Virginia Rural Health Research Center
    Topics: Environmental and agricultural health, Health services, Public health
  • System Integration and Rural Provider Participation in Accountable Care Organizations (ACOs)
    This project will develop a national descriptive database of both rural providers and larger (often urban) health systems participating in Medicare ACOs and health system networks. Case studies of four ACOs will generate an awareness of decisions being made that affect configuration of services in rural places and provide suggestions for further research with representative samples of ACOs.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Medicare

2012

  • Analysis of the Effects of Federal Debt Reduction and Long Term Budget Adjustment on Rural Health Care Delivery
    The RUPRI Center for Rural Health Policy Analysis will examine suggested changes in Medicare and Medicaid as stated in proposals to reduce spending as part of achieving deficit reduction.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Medicaid and CHIP, Medicare
  • Do Communities Make a Difference in Access? A National Study
    This project will examine the effect of community-level resources on an individual's access to healthcare, particularly whether urban and rural individuals' access to healthcare differs, given community differences.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topic: Health services
  • Use of Recommended Radiation Therapy in the Rural U.S.
    This study will use cancer registry data from 10 U.S. states to examine which rural cancer patients are receiving recommended radiation therapy, and what factors influence receipt of recommended treatment. Identifying gaps in radiation therapy will inform cancer centers, rural program planners, and policy makers in rural cancer service locations and cancer support program development.
    Research center: WWAMI Rural Health Research Center
    Topics: Cancer, Chronic diseases and conditions, Health services

2011

  • Examining Recent Trends and Variation in Ambulatory Care Sensitive Conditions-related Hospital Expenditures of Rural Americans with Different Health Insurance Coverage and Status
    This study documents the national time-trend and regional variation of rural Ambulatory Care Sensitive Conditions (ACSC)-related hospital expenditures by patient insurance coverage/status. The study will also compare the pattern of difference in the ACSC-related expenditures of rural patients with different insurance coverage/status by patient demographic and economic characteristics as well as hospital characteristics.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Chronic diseases and conditions, Health services, Healthcare financing, Private health insurance
  • Mini-Studies to Inform Health Reform Efforts
    Rural health care systems are far more vulnerable to changes in federal health care policy than are those in urban areas. The purpose of this project is to conduct rapid turnaround mini-studies that will be essential to maintain an effective rural voice in both the ongoing adjustments to current policies and the development of new policies.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Health services
  • Patient-Centered Medical Home: A Model for Rural Physician Practices and Communities?
    Rural practices will need to meet the expectations inherent in the patient-centered medical home (PCMH) model or lose any payment advantage that comes with participating as a PCMH. The goal of this project is to assess rural readiness to adopt services seen as part of a PCMH.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Physicians

2010

  • Analysis Related to Health Care Reform Issues
    The RUPRI Center is prepared to provide analysis of elements and/or effects of proposed or enacted health reform legislation and/or regulations to implement changes mandated by legislation.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Healthcare financing
  • Health Reform-Rapid Response
    This project will include several projects as requested by ORHP and DHHS as those agencies prepare for national health reform. Responses are primarily in the areas of health insurance and behavioral health.
    Research center: Maine Rural Health Research Center
    Topics: Health services, Healthcare financing, Mental and behavioral health
  • Policy Analyses of Rural Issues Related to Health Care Reform
    Health care reform provides an array of opportunities to improve health care access and quality for rural Americans. The WWAMI RHRC will support HRSA's efforts to inform this process by summarizing existing evidence characterizing the rural health care workforce and rural health care delivery and will conduct analyses exploring the potential impact on rural populations of proposed and newly- enacted health care reform legislation.
    Research center: WWAMI Rural Health Research Center
    Topic: Health services
  • Provision of Specialty Mental Health Services by Rural Health Clinics
    This project will document the extent to which Rural Health Clinics (RHCs) are employing mental health staff nationally, understand why more RHCs are not employing specialty mental health staff, and analyze the barriers to and opportunities for the delivery of mental health services by RHCs. The results will identify opportunities and interventions to encourage RHCs to offer this important service.
    Research center: Maine Rural Health Research Center
    Topics: Health services, Mental and behavioral health, Rural Health Clinics (RHCs), Substance use and treatment
  • 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 Implications of Health Care Reform: Issues Related to Quality of Care, Health Information Technology and Care Coordination
    The purpose of this project is to provide support to the Office of Rural Health Policy on rural health care reform issues.
    Research center: Upper Midwest Rural Health Research Center
    Topic: Health services
  • Use of Emergency Departments and Inpatient Care for Conditions Related to Poor Oral Health Care
    This study combines patient-level data from emergency departments and inpatient hospitals from selected states with data on dental HPSA designation, Medicaid dental coverage, and area population characteristics to document the extent to which ED and inpatient settings are used to treat problems related to poor oral health care, the charges for such care, and variations in the use of such services by characteristics of the patient and the area.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Health services, Oral health

2009

  • Descriptive Analysis of the Health Status of a National Asbestos-Related Cohort
    A collaborative study to establish a more comprehensive understanding of the health status and health service needs of persons exposed to Libby asbestos is being conducted by nurse researchers at Montana State University College of Nursing and healthcare providers at the Center for Asbestos Related Disease in Libby, Montana. Results of the descriptive study will provide healthcare providers and policy makers a better understanding of the health effects and healthcare needs of exposed persons.
    Research center: FORHP-funded Individual Grantees
    Topics: Cancer, Chronic diseases and conditions, Health services
  • Effect of Safety Net Providers on Ambulatory Care Sensitive Hospitalization Rates in Rural Counties
    This project will determine if the presence of a community health center or rural health clinic in a county reduces ambulatory care sensitive hospitalizations for children, working age adults, and older adults.
    Research center: Rural and Minority Health Research Center
    Topics: Chronic diseases and conditions, Federally Qualified Health Centers (FQHCs), Health services, Poverty, Rural Health Clinics (RHCs)
  • Impact of Expansion of Ambulatory Surgery Centers on Rural Hospitals and Communities
    This project will examine the extent of freestanding ambulatory surgery center (ASC) expansion into rural communities between 1998 and 2005, the market factors driving that expansion, and the impact of ASCs on the operational and financial viability of rural hospitals located in the same communities.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Health services, Healthcare financing
  • Patient Assessments and Quality of Care in Rural Hospitals
    This study will 1)analyze the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care; and 2) assess whether rural patients' perspectives of hospital quality of care are related to quality measures focused on the provision of recommended care for medical conditions.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Health services, Quality

2008

  • Impact of CAH Conversion on Hospital Costs and Mix of Services
    This study examined Medicare Cost Report and claims data for hospitals before and after CAH conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Critical Access Hospitals (CAHs), Health services, Healthcare financing
  • National Study of Substance Abuse Prevalence and Treatment Services in Rural Areas
    This project will research the prevalence of the abuse of legal and illegal substances across rural populations and geographic areas, including the extent to which rural individuals are receiving treatment for their substance abuse and barriers to the receipt of treatment.
    Research center: Maine Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Rural statistics and demographics, Substance use and treatment
  • Rural-Urban Differences in Access to Children's Mental Health Services
    This study uses data from the Urban Institute's National Survey of America's Families to examine and compare the use of mental health services by rural and urban children, age 6 to 17, relative to their need for mental health care, family income, and insurance status.
    Research center: Maine Rural Health Research Center
    Topics: Children and adolescents, Health services, Mental and behavioral health

2007

  • Describing Geographic Access to Physicians in Rural America Using Statistical Applications in GIS
    This study will use a geographically weighted regression to assess the influence of distance and travel time on the distribution of physicians in rural America. The ultimate goal of the study will be to improve our measures of access by identifying the extent to which border resources can be considered in indices of access.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health services, Physicians
  • Locating Community Pharmacies (Independent and Chain) in Rural America
    A comprehensive database of all rural U.S. pharmacies including pharmacy name, pharmacy type (chain or independent), town, ZIP code, county, state, RUCA code, and Federal Information Processing Standards will be developed. The databases will be usable in most widely used statistics and geographic information systems software packages.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Pharmacy and prescription drugs
  • Role of Inpatient Psychiatric Units in Small Rural Hospitals and Rural Mental Health Systems
    This is a descriptive, exploratory study which will investigate the role of the small rural hospital Inpatient Psychiatric Units from the perspectives of both the rural hospital, in terms of scope of services and revenue enhancement, and the regional mental health system, meeting the needs of outpatient mental health and primary care providers, law enforcement, and human services.
    Research center: Maine Rural Health Research Center
    Topics: Health services, Hospitals and clinics, Mental and behavioral health
  • Role of Rural Hospitals in Community-Centered Systems of Care: Supporting Population Health Improvement for Rural Communities
    This project will assess the degree to which rural hospitals engage in activities that facilitate community responsiveness and the provision of community-oriented services, using 1996 to 2004 data from the American Hospital Association Annual Survey and the Area Resource File.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Health services, Hospitals and clinics

2006

  • Analyzing the Relationship Among Critical Access Hospital Financial Status, Organizational Linkages, and Scope of Services
    This project will systematically analyze the relationships among pre- and post-conversion Critical Access Hospital (CAH) financial performance, the organizational linkages in which the hospital participates (e.g., health care systems and/or networks), and the scope of services (i.e., the number and type of services) provided.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Health services, Healthcare financing, Networking and collaboration
  • Database for Rural Health Research in Progress
    This searchable database of current rural health services research and policy analysis includes all ORHP-funded studies as well as research funded by other federal agencies, major private foundations and other sources.
    Research center: Maine Rural Health Research Center
    Topic: Health services
  • Mode of Travel and Actual Distance Traveled for Medical or Dental Care by Rural Residents
    This project examined the influence of race and rural isolation on distance traveled to receive medical or dental care, and how the potential interaction of these factors might exacerbate disparities in access to care.
    Research center: Rural and Minority Health Research Center
    Topics: Health disparities and health equity, Health services, Minority health, Oral health, Transportation
  • Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention
    This project drew on a survey of patients sampled from the service areas of 25 Critical Access Hospitals (CAHs) from different regions of the country. The purpose of this project is to identify policy and programmatic issues related to bypass, specifically targeting CAHs in order to offer evidence and guidance to policymakers, CAH administrators, and planners on the location of healthcare resources, factors that affect patient actions for planning programs, and the adjustment of policies in order to retain patients locally.
    Research center: FORHP-funded Individual Grantees
    Topics: Critical Access Hospitals (CAHs), Health services
  • Roadmap for the Adoption of Health Information Technology in Rural Communities
    This project developed a resource document intended to help rural health care providers of all types as they think about whether an investment in health information technology makes sense for them and work through various implementation issues. The document was distributed at the September 2006 conference entitled "Health Information Technology: A Rural Provider's Roadmap to Quality," sponsored by ORHP.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Health information technology, Health services
  • Rural Safety Net Provision and Hospital Care in 11 States
    This project evaluated whether access to primary care is more effective at improving health outcomes and reducing costs in rural than urban markets, and identified the characteristics of communities which contribute to improved health outcomes and reducing preventable hospitalizations. This research informs policy relating funding access provision through public clinics to reduce the burden of uncompensated or under-compensated care on financially strained rural hospitals.
    Research center: FORHP-funded Individual Grantees
    Topics: Chronic diseases and conditions, Health services, Hospitals and clinics
  • Urban and Rural Differences in Access to Care and Treatment for Medicare Beneficiaries with Cancer
    Little is known about the differences in the diagnosis, treatment and outcomes of care for cancer patients across urban and rural regions of the country. This study will extend our understanding of the challenge of providing high-quality cancer care to Medicare beneficiaries and how provider availability influences access to needed care in urban and rural areas.
    Research center: FORHP-funded Individual Grantees
    Topics: Cancer, Chronic diseases and conditions, Health services, Medicare, Quality

2005

  • 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
  • Access to Physician Care for the Rural Medicare Elderly
    This study described where Medicare beneficiaries in five states obtain their health care, how far they travel for that care, and the mix of physician specialties from which they obtain ambulatory care. Special attention was paid to beneficiaries who have dual Medicare-Medicaid status, who reside in poorer income areas, and who live in designated Health Professional Shortage Areas.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Chronic diseases and conditions, Health services, Medicare, Physicians, Poverty
  • Mental Health Risk Factors, Unmet Needs and Provider Availability for Rural Children
    The study will examine the prevalence of subclinical problems in rural children, assess risk factors associated with problems in children, and assess the influence of local provider availability on healthcare provider contact.
    Research center: Rural and Minority Health Research Center
    Topics: Children and adolescents, Health services, Mental and behavioral health
  • Mental Health Services: The Effect of Variations in State Policies
    This study will identify variations in state licensure and payment or coverage polices and examine the effect of these variations on the availability of mental health services in rural areas.
    Research center: Southwest Rural Health Research Center
    Topics: Health services, Mental and behavioral health
  • National Study of Home Health Access in Rural America
    This project will develop home health care service areas that will allow for the measurement of access to home health care for rural Medicare beneficiaries who die of cancer, and recommend options for increasing access to home health care in underserved rural areas.
    Research center: FORHP-funded Individual Grantees
    Topics: Cancer, Health services, Home health, Hospice and palliative care, Medicare
  • Role of Intensive Care Units in Critical Access Hospitals
    This project will examine the role that intensive care units (ICUs) play in Critical Access Hospitals (CAHs). The number and geographic distribution of CAH with ICUs will be described, and types of services provided in these units discussed.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Health services

2004

2003

2002

2001

2000

1999

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  • Access to Cancer Services for Rural Colorectal Cancer Medicare Patients: A Multi-State Study
    This study examined a comprehensive database to quantify the distance and access to four types of cancer services in a sample of rural, Medicare-insured, CRC patients of different racial and ethnic groups, and will inform future work designed to understand discrepancies in cancer service use by the rural elderly in different racial and ethnic groups.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Cancer, Chronic diseases and conditions, Health services, Medicare, Minority health
  • Acute and Post-Acute Care Bundled Payments and Care Coordination in Rural Environments
    The purpose of this project is to: 1) Identify opportunities and potential unintended consequences for rural providers of current proposals for implementing bundled payments for acute and post-acute care episodes; 2) Describe modifications to current bundling proposals that will address rural-specific issues; and 3) Identify quality measures related to care coordination that are relevant for rural patients whose services are reimbursed by a bundled payment.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Health services, Post-acute care, Quality