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Rural Health
Research Gateway

Healthcare access

Completed Projects

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

2025

  • Characteristics of Buprenorphine Therapy Among Commercially-Insured Pregnant and Postpartum Women
    This project analyzed claims from a national commercial insurance database to characterize buprenorphine therapy initiation persistence and adherence among pregnant and postpartum women with opioid use disorder (OUD) and assessed differences in buprenorphine OUD treatment characteristics among rural and urban pregnant/postpartum women.
    Research center: ETSU/NORC Rural Health Research Center
    Topics: Healthcare access, Maternal health, Substance use and treatment
  • Examining Differences in Rural and Urban Medicare FFS Beneficiaries' Emergency Department Use Pre-COVID-19 and During COVID-19
    This study described and compared the differences in the utilization of emergency department (ED) services among rural and urban Medicare Fee-For-Service enrollees during 2018-2021. Researchers identified factors associated with differences in ED use, including shifts in volume, primary diagnoses, and admission source, before and since the COVID-19 public health emergency in rural and urban areas.
    Research center: ETSU/NORC Rural Health Research Center
    Topics: Coronavirus Disease 2019 (COVID-19), Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Healthcare access, Hospitals and clinics, Medicare, Social determinants of health

2024

  • 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
  • Rural Premiums, Issuer Participation, and Enrollment in Health Insurance Marketplaces: An Updated Analysis
    The project described variations in Health Insurance Marketplace plan design and availability, total and net-of-subsidy premium trends, and enrollment over time between rural and urban areas and identified associations between these factors and several key policy differences and changes, controlling for economic and demographic variation.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health reform, Healthcare access, Private health insurance, Rural statistics and demographics, Uninsured and underinsured
  • Trends in Health Workforce Supply in the Rural U.S.
    Rural communities in the U.S. have struggled to recruit and sustain sufficient health professionals to ensure adequate access to care. This study used multiple sources of data to describe the geographic distribution (rural/urban, regional, and intra-rural) of numerous types of health professionals.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Healthcare access, Mental and behavioral health, Nurses and nurse practitioners, Oral health, Physician assistants, Physicians
  • 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

  • Ambulance Deserts: Addressing Geographic Disparities in the Provision of Ambulance Services
    This two-year study aimed to identify geographic disparities in accessing ambulance services by building a database of ambulance service locations in year one and identifying and creating maps of ambulance deserts within each of the states in year two.
    Research center: Maine Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Healthcare access, Rural statistics and demographics, Transportation
  • Overcoming Barriers to Providing Rural Obstetrical Training for Physicians
    Rural communities struggle to maintain obstetrical (OB) services, due in part to scarce rural training opportunities for obstetricians and family physicians. This study described the availability, characteristics, and output of residency and fellowship programs offering rural OB training and identified solutions to support this training.
    Research center: WWAMI Rural Health Research Center
    Topics: Healthcare access, Maternal health, Physicians, Women, Workforce
  • 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 reform, Health services, Healthcare access, Healthcare financing, Private health insurance, Public health, Social determinants of health

2022

  • Change in Service Provision at Rural Hospitals
    The purpose of this study was to compare the services offered by rural hospitals (to urban hospitals) over time (2009-2017) and among rural hospitals of different size, region, rurality, and payment type.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare access, Hospitals and clinics
  • 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
  • Healthcare Use and Expenditures Among Rural and Urban Medicare Beneficiaries Aged 85 and Over
    The proportion of U.S. residents ages 85+ is expected to grow substantially in the coming decades with the impact of this growth in rural areas likely to be pronounced. This project used data from the Medicare Current Beneficiary Survey to examine rural-urban differences in healthcare use and expenditures among Medicare enrollees ages 85+.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Healthcare access, Long-term care, Medicare
  • 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
  • Rural Hospital Closure and Effect on Local Economies
    Several research projects have analyzed the health effects of rural hospital closures. However, highly cited evidence on the economic effects of rural hospital closures is more than a decade old. The purpose of this study was to quantify the economic impact rural hospital closures have on communities.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health reform, Healthcare access, Healthcare financing, Hospitals and clinics, Medicare

2021

  • Capacity of Rural Counties to Respond to an HIV or Hepatitis C Outbreak
    Rural counties may be potentially vulnerable to an HIV or Hepatitis C outbreak among persons who inject drugs. Using mixed methods, we provided an understanding of the rural areas at risk of an outbreak based on their state and county characteristics and an assessment of their public health infrastructure.
    Research center: Maine Rural Health Research Center
    Topics: Healthcare access, Public health, Substance use and treatment
  • Comparison of Rural Hospital Closures and the Communities Served, 1990-2020
    This project examined rural hospital closures during three decades to profile community characteristics, health status, health care services, and resources available in communities where rural hospitals have closed.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health reform, Healthcare access, Healthcare financing, Hospitals and clinics, Medicare
  • Decline in Inpatient Volume at Rural Hospitals
    The purpose of this study was to compare the decline in inpatient volume of rural hospitals to urban hospitals and among rural hospitals of different size, region, rurality, and payment type.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare access, Hospitals and clinics
  • Estimating the Number of Hospitals that Might Convert to Rural Emergency Hospitals
    This project reviewed the literature to establish what is known about freestanding emergency centers (FECs) and implications for a rural community. The number and types of rural hospitals that would be eligible to convert to an FEC as an alternative to closure of acute inpatient care was estimated.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health reform, Healthcare access, Healthcare financing, Hospitals and clinics, Medicare
  • Rural Nursing Home Closures - Trends, Characteristics, and Impact on Access
    This project built a database of nursing home closures across rural and urban areas in the U.S. and evaluated the changes in access to post-acute and/or long-term care providers. It also described the differences in organizational, financial, and market characteristics between open vs. closed nursing homes in rural vs. urban areas.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Aging, Healthcare access, Long-term care, Medicare
  • 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
  • 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

  • Changes in Care-Seeking After Rural Hospitals Merge
    This project seeks to understand how mergers affect the inpatient care-seeking of markets served by merging hospitals.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare access, Hospitals and clinics
  • Continuing Data Collection on a Common Set of Measures for the School-Based TNGP Grantees
    The primary purpose of this project is to continue data collection from School-Based Telehealth Network Grant Program (SB TNGP) grantees to evaluate school-based telehealth using a common set of measures that will help build the evidence base and inform future policy changes and sustainability efforts.
    Research center: Rural Telehealth Research Center
    Topics: Healthcare access, Telehealth
  • Investigating Differences in School-Based Telehealth Implementation and Services in the School-Based TNGP Grantees
    The principal goal of this project is to gather contextual information from School-Based Telehealth Network Grant Program (SB TNGP) grantees regarding project design and implementation, and the practicalities of delivering telehealth services in school settings that will help explain the heterogeneity found in the data across the grantees.
    Research center: Rural Telehealth Research Center
    Topics: Healthcare access, Telehealth
  • The Supply and Rural-Urban Distribution of the Obstetrical Care Workforce in the U.S.
    This project will use multiple data sources to characterize the distribution of the obstetrical care workforce in the U.S., comparing health professional-to-population ratios in rural and urban areas. Health professionals examined in this study include obstetricians, family physicians, and certified nurse midwives.
    Research center: WWAMI Rural Health Research Center
    Topics: Healthcare access, Maternal health, Physicians, Workforce

2019

2018

  • Health Insurance Marketplaces, Medicaid, and Uncompensated Care: The Rural Impact
    This project provides an in-depth analysis of Health Insurance Marketplace (HIM) plan design, specifically measuring the availability and prevalence of high-deductible plans in rural as compared to urban areas.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Healthcare access, Medicaid and CHIP, Uninsured and underinsured

2015

  • Rural Health Clinics: Medicare & Medicaid Profile
    This study builds on our work with the 2009 RHC Medicare claims. This project will result in the development of a longitudinal data collection/tracking mechanism of key RHC Medicare claims data and cost report elements (provider-based cost reports only at this point in time). RHC Medicaid data for a sample of states will be requested and analyzed to determine utilization patterns and identification of potential quality metrics.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare access, Medicare, Rural Health Clinics (RHCs)

2006