This website is being reviewed for updates. Some information is offline. We apologize for any inconvenience.
Rural Health
Research Gateway

Health services

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

2024

2023

  • Medicare Advantage Enrollment Update 2023
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
    Date: 11/2023
    This policy brief continues RUPRI Center's annual update of Medicare Advantage (MA) enrollment including the changes in enrollment in types of MA plans, and health policy changes that may have had an impact.
  • Rural Emergency Hospital Map and Data
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 10/2023
    This interactive map tracks hospitals that have converted to Rural Emergency Hospitals since January 2023.
  • Suitability of Low-Volume Rural Emergency Departments to New Rural Emergency Hospital Designation
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 09/2023
    The Rural Emergency Hospital is a new Medicare payment model that requires hospitals to focus on emergency, observation, and outpatient services in lieu of inpatient care. This study's exploratory objective was to examine care delivery from eligible hospitals to assess their fit with the new payment model.
  • Colorectal Cancer Screening in Rural and Urban Primary Care Practices Amid Implementation of the Medicare Access and CHIP Reauthorization Act
    Journal Article
    Rural and Underserved Health Research Center
    Date: 06/2023
    This study examined whether colorectal cancer screening rates improved among rural and urban primary care practices amid implementation of the Medicare Access and CHIP Reauthorization Act. Researchers tested for rural/urban differences and changes in screening rates between 2016 and 2020.
  • Changes in Service Offerings Post-System Affiliation in Rural Hospitals
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2023
    This policy brief aims to understand the range of effects on service offerings after rural hospitals become part of, or leave, a regional or national healthcare system.

2022

  • Patterns of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 and Older, 2010-2017
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2022
    This study examines rural-urban differences in health care use among Medicare beneficiaries age 85+.
  • Changes in the Supply and Rural-Urban Distribution of Counselors in the U.S., 2014-2021
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of counselors by rural-urban status and Census Division.
  • Changes in the Supply and Rural-Urban Distribution of Psychiatric Nurse Practitioners in the U.S., 2014-2021
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of psychiatric nurse practitioners by rural-urban status and Census Division.
  • Changes in the Supply and Rural-Urban Distribution of Psychiatrists in the U.S., 1995-2019
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of psychiatrists by rural-urban status and Census Division.
  • Changes in the Supply and Rural-Urban Distribution of Psychologists in the U.S., 2014-2021
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of psychologists by rural-urban status and Census Division.
  • Changes in the Supply and Rural-Urban Distribution of Social Workers in the U.S., 2014-2021
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of social workers by rural-urban status and Census Division.
  • Review of Rural U.S. Economic and Health Care Trends
    Report
    Center for Economic Analysis of Rural Health
    Date: 09/2022
    This report reviews recent literature and publicly available data to explore important issues at the nexus of health care and local economic vibrancy. The report also explores the economic implications associated with COVID-19, however full impacts will not be known for several years.
  • Predictors of Hospital Bypass for Rural Residents Seeking Common Elective Surgery
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 08/2022
    This article used Healthcare Cost and Utilization Project State Inpatient Databases to evaluate rates and predictors for patients bypassing rural hospitals for common procedures.
  • Rural and Urban Pharmacy Presence – Pharmacy Deserts
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2022
    This policy brief continues the RUPRI Center's ongoing examination of the availability of community pharmacies and their provided services in rural areas of the U.S. The brief also provides a deeper analysis of counties with no retail pharmacies (i.e. pharmacy deserts) based on metropolitan/nonmetropolitan locations.
  • County-Level Availability of Obstetric Care and Economic Implications of Hospital Closures on Obstetric Care
    Policy Brief
    Center for Economic Analysis of Rural Health
    Date: 07/2022
    This policy brief draws out demographic and economic differences between counties with obstetric care facilities and those without. It provides descriptive data on the economic changes underway in counties that lost obstetric care facilities between 2012 and 2019.
  • Nursing Homes in Rural America: A Chartbook
    Chartbook
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2022
    Closure of nursing homes and hospitals with swing beds in recent years has changed the availability of post-acute and long-term care services in rural areas. This study examines the availability of post-acute and long-term care services as well as characteristics of residents and nursing homes in noncore, micropolitan, and metropolitan counties.
  • Medicare Accountable Care Organization Characteristics Associated With Participation in 2‐Sided Risk
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2022
    This study examined the associations of accountable care organization (ACO) characteristics with the likelihood of participation in 2-sided risk tracks in the Medicare Shared Savings Program. Small and rural ACOs were found to be less prepared to transition into 2-sided risk tracks than their urban counterparts.
  • Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Professional Experience and Provision of Evidence-Based Care
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 05/2022
    This policy brief examines the effects of emergency medical services (EMS) personnel level of experience and agency rurality on the provision of evidenced-based care. Compared with urban-serving EMS agencies, rural-serving agencies provided evidence-based care less often for stroke, hypoglycemia, and trauma but more often for seizures.
  • Quality of Home Health Agencies Serving Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2022
    This policy brief describes the quality of home health agencies (HHAs) by rural-serving status. While quality of patient care star ratings were not associated with rural-serving status, rural HHAs and urban HHAs that serve rural patients had higher patient experience star ratings than urban HHAs that do not serve rural patients.
  • Quality of Skilled Nursing Facilities Serving Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2022
    This policy brief describes the quality of skilled nursing facilities (SNFs) by rural-serving status. While overall star ratings and staffing star ratings were not associated with rural-serving status, rural SNFs and urban SNFs that serve rural patients had lower quality star ratings compared to urban SNFs that do not serve rural patients.
  • High-Performing Rural Health System
    Policy Brief
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 01/2022
    This document updates the RUPRI Health Panel's framework, for a high-performing rural health system, originally published in 2011. It offers a revised vision statement and updates the high-performing rural health system pillars (access, affordability, community health, and quality) and describes an underlying base of equity considerations.

2021

2020

2019

2018

  • Service Provision and Quality Outcomes in Home Health for Rural Medicare Beneficiaries at High Risk for Unplanned Care
    Journal Article
    WWAMI Rural Health Research Center
    Date: 06/2018
    This study examined service provision and quality outcomes among rural Medicare beneficiaries who used home health from 2011-2013 and were at high risk for unplanned care. More skilled nursing visits and visits by more types of providers were associated with higher hospital readmission and emergency department use and lower community discharge.
  • Telepharmacy Rules and Statutes: A 50-State Survey (Journal Article)
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2018
    Peer-reviewed paper identifying state-enacted regulations and legislation authorizing use of community telepharmacy initiatives and describing implications for patients in underserved rural communities. Also provides a table listing states that permit telepharmacy, and pilot programs and waivers that enable telepharmacy initiatives.

2017

2016

2015

  • Medicare Value-Based Payment Reform: Priorities for Transforming Rural Health Systems
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 11/2015
    As Medicare moves to value-based payment, healthcare groups are made more accountable for patient health. But the changes have been concentrated in urban areas. Policies meant to strengthen rural health systems are complicating payment and delivery system reform in rural areas. This study examines ways to include rural areas in the changes.
  • Rural Bypass for Elective Surgeries
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2015
    Describes the elective surgical bypass rate, the procedures most commonly bypassed by rural residents, the distribution of volume among Critical Access Hospitals (CAHs) that offer elective surgical services, and factors predictive of bypass.
  • Prehospital Emergency Medical Services Personnel in Rural Areas: Results From a Survey in Nine States
    Report
    WWAMI Rural Health Research Center
    Date: 08/2015
    This study examines supply and demand for emergency response personnel, the involvement of medical directors, and the availability of medical consultation in rural and urban emergency service personnel (EMS) agencies in nine states.
  • Perspectives of Rural Hospice Directors
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 03/2015
    Rural hospice care is under pressure by a variety of factors that 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 and design of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states.
  • Developmental Strategies and Challenges for Rural Accountable Care Organizations
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2015
    This brief offers insights into the initial strategic decisions and challenges of four accountable care organizations (ACOs) with rural presences. These ACOs were formed as a step toward a value-driven rural delivery system. While several challenges need to be addressed, these insights can inform development of other rural ACOs.
  • Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 02/2015
    This brief describes the variation in emergency department use for non-emergent health conditions across rural and urban areas as well as by U.S. Census regions. Potential risk factors, including patients' socioeconomic characteristics and levels of primary care resources, are identified. Quality of care indicators are also addressed.

2014

  • Facilitating the Formation of Accountable Care Organizations in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2014
    This brief shows characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries, one each of the four census regions. The findings can help rural providers interested in forming/participating in an ACO assess the status and potential gaps of their core structures and capabilities.
  • Integrated Care Management in Rural Communities
    Maine Rural Health Research Center
    Date: 05/2014
    This study reviews the opportunities and challenges reform initiatives under the Affordable Care Act present for rural communities. The study assesses four types of organizational models for delivering integrated care management. Each model has different strengths and drawbacks, weighing for and against implementation in rural areas.
  • Do Rural Patients With Early-Stage Prostate Cancer Gain Access to All Treatment Choices? (Final Report)
    Report
    WWAMI Rural Health Research Center
    Date: 02/2014
    This report compares rates of receipt of prostate cancer treatments and of the treatment options between early-stage prostate cancer patients living in urban and four levels of rural counties.

2013

  • Promotion and Protection of Rural Miner Health: Are the Resources in Place? (Final Report)
    West Virginia Rural Health Research Center
    Date: 06/2013
    This report shows that mining areas in the United States, compared to non-mining areas, have on average better supplies of safety net providers, hospitals, and practicing primary care physicians. However, the study results support the need to examine the availability of safety net provider types in selected geographic areas where mining is done.
  • Rural Implications of the Primary Care Incentive Payment Program
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2013
    This policy brief reports on eligibility among rural primary care providers for the Primary Care Incentive Payments established in the Patient Protection and Affordable Care Act.

2012

2011

2010

2009

2008

2007

  • Access to Cancer Services for Rural Colorectal Cancer Patients (Project Summary)
    WWAMI Rural Health Research Center
    Date: 10/2007
    This summary provides a brief overview of findings from a study to determine how far rural and urban colorectal cancer patients travel to three types of specialty cancer care services: surgery, medical oncology consultation, and radiation oncology consultation.
  • Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum
    Maine Rural Health Research Center
    Date: 10/2007
    This study examines the distribution of substance abuse treatment services across the continuum of rural and urban counties, identifying the type and intensity of services provided.
  • Rural Inpatient Psychiatric Units Improve Access to Community-Based Mental Health Services, but Medicare Payment Policy a Barrier
    Maine Rural Health Research Center
    Date: 08/2007
    This study investigates the characteristics/admission processes of inpatient psychiatric units (IPUs) in rural hospitals with less than 50 beds and the community-based services available to them when discharging patients. Reasons for developing IPUs, barriers to opening and operating a rural IPU, and factors leading some to close are also explored.
  • Why Are Fewer Hospitals in the Delivery Business?
    NORC Walsh Center for Rural Health Analysis
    Date: 04/2007
    This study examines the declining availability of hospital-based obstetric services in rural areas from the mid-1980s to the early 2000s. It looks at potential causes for this trend and explores the effects of medical malpractice reforms.
  • 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.
  • Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention
    Journal Article
    FORHP-funded Individual Grantees
    Date: 2007
    Describes the results of a study to assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally.

2006

  • Wyoming Physicians Are Significant Providers of Safety Net Care
    Journal Article
    WWAMI Rural Health Research Center
    Date: 11/2006
    Describes the contributions of family and general practice physicians from Wyoming to the health care safety net.
  • Care Across the Continuum: Access to Health Care Services in Rural America (2006)
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 2006
    The article is divided into 3 sections: 1) basic principles that determine services to be included in the continuum and how success in providing those services is judged; 2) definition of the continuum and its basic stages based on the health systems research literature; 3) applications of the continuum and policy implications of the framework.
  • Mental Healthcare in Rural Communities: The Once and Future Role of Primary Care
    Journal Article
    Maine Rural Health Research Center
    Date: 2006
    Discusses issues related to the delivery of mental health services in the United States. Addresses how these issues complicate the delivery of services in rural areas. Offers an argument for integrating primary care and mental health in rural areas.

2005

2004

  • Access To Primary Care and Quality of Care in Rural America
    NORC Walsh Center for Rural Health Analysis
    Date: 06/2004
    This report provides findings from a population-based study addressing the impact of the availability of healthcare resources on the rate of potentially avoidable hospitalizations. It suggests shortcomings with previous research conducted in communities that experienced problems accessing primary care services.

2003

  • Care Across the Continuum: Access to Health Care Services in Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2003
    This paper proposes that a continuum of care serve as the framework with which to consider rural healthcare policies, focusing on people and on places where people live rather than on the wants of providers and constituencies.
  • Who Receives Inpatient Charity Care in California?
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2003
    This policy analysis brief examines the results of a study regarding how California hospitals determine charity care.
  • The Characteristics and Roles of Rural Health Clinics in the United States: A Chartbook
    Chartbook
    Maine Rural Health Research Center
    Date: 01/2003
    This chartbook reports on a rural health clinics (RHCs) survey. Information was collected on many topics, including their characteristics/operations; their location relative to the underservice problems/rural access needs; their safety net functions; staffing, recruitment, and financial issues; and involvement in training healthcare professionals.

2002

  • Health Services at Risk in "Vulnerable" Rural Places
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2002
    This brief discusses implications of a method to identify places in rural America at risk of being without healthcare services because they may lack a sufficient number of people to support a practice/provider, they are able to pay the full cost of care, or the population size/composition doesn't warrant the level of services currently available.
  • Impact of National Policy on Access to Health Care: The Rural Perspective
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2002
    This document discusses the current state of financial and geographic access to healthcare in the United States and federal policy.

1997