Healthcare access

Current Projects

• Access to and Provision of Child and Youth Behavioral Health Services in the Rural and Urban U.S.
  The need for behavioral health treatment for youth has been exacerbated by the COVID-19 pandemic. Little is known about the availability of youth behavioral health providers in rural areas. This study will investigate who provides behavioral health services to youth, how the workforce is distributed, and gaps in service availability.
  Research center: WWAMI Rural Health Research Center
  Topics: Allied health professionals, Children and adolescents, Health services, Healthcare access, Mental and behavioral health, Nurses and nurse practitioners, Pharmacy and prescription drugs, Physician assistants, Physicians, Substance use and treatment, Workforce
  
• Assessing Access to Medication Treatment for Opioid Use Disorder in Rural Communities Influenced by the Rural Communities Opioid Response Program (RCORP)
  This project will use national prescription claims data to compare access to buprenorphine treatment for opioid use disorder in rural counties with and without Rural Communities Opioid Response Program (RCORP) funding and urban counties. An accurate understanding of access to buprenorphine treatment is essential for determining the influence of RCORP funding on a critical strategy for curbing the opioid epidemic.
  Research center: WWAMI Rural Health Research Center
  Topics: Health services, Healthcare access, Mental and behavioral health, Pharmacy and prescription drugs, Substance use and treatment, Workforce
  
• Availability, Care Practices, and Quality of Hospice Providers Serving Rural versus Urban Communities
  This project will examine differences in availability of hospice care in rural versus urban communities as well as provider-level quality and care practices by rural-urban status of hospices. Findings will highlight potential rural-urban disparities in hospice care that can be used to inform future Medicare policy.
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Coronavirus Disease 2019 (COVID-19), Health services, Healthcare access, Hospice and palliative care, Medicare, Quality
  
• Barriers and Facilitators to Providing Rural Clinical Training for Health Professions Students and Residents
  Scarce rural clinical training sites are the top barrier preventing medical schools, residencies, and nurse practitioner and physician assistant education programs, among other health professional training programs, from providing rural training to their students. This study aims to describe the barriers to offering rural clinical training and the potential solutions for establishing and sustaining interdisciplinary rural clinical training.
  Research center: WWAMI Rural Health Research Center
  Topics: Allied health professionals, Healthcare access, Nurses and nurse practitioners, Physician assistants, Physicians, Workforce
  
• Causal Effect of Nursing Home Closure on Resident Outcomes in Rural Areas
  We will evaluate the causal impact of nursing home closure on two key outcomes: distance to the transitioned nursing home, and resident physical and mental health outcomes. We will compare the effect of closures on outcomes for rural and urban areas using resident-level data from 2010-2019 and advanced difference-in-differences regression methods.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Aging, Health services, Healthcare access, Long-term care, Post-acute care, Quality
  
• Comparing Utilization and Quality of Home Health Care Between Medicare Fee-for-Service and Medicare Advantage Beneficiaries by Rural-Urban Status
  This project examines differences in home health use and quality by enrollment in Medicare Fee-for-Service (FFS) versus Medicare Advantage (MA) plans. Findings will include information on rural-urban and intra-rural variation in home health care to inform policies on access, payment, and quality for Medicare FFS and MA plans.
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Allied health professionals, Health services, Healthcare access, Healthcare financing, Home health, Medicare, Medicare Advantage (MA), Post-acute care, Quality
  
• Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents: Exploring Changes in the Past 15 Years
  This project will describe the national supply of the rural and urban dental workforce and investigate whether rural adults, compared to urban adults, report lower dental care utilization, higher prevalence of dental disease or both. This study will also look at whether disparities in oral health care and supply have changed over the past 15 years.
  Research center: WWAMI Rural Health Research Center
  Topics: Allied health professionals, Health services, Healthcare access, Oral health, Workforce
  
• Did Hospitals That Converted to Rural Emergency Hospital (REH) Avoid Closure?
  The goal of the Rural Emergency Hospital (REH) is to preserve access to essential services for rural residents, and to decrease the likelihood of hospital closures; some worry that the REH offers an option for otherwise financially strong hospitals to shed services. This study will investigate whether hospitals that converted to an REH in 2023 and 2024 would have likely closed in the absence of the REH designation.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Healthcare access, Healthcare financing, Hospitals and clinics, Medicare, Rural Emergency Hospitals (REHs)
  
• Hierarchical Condition Category (HCC) Risk Scores: Designed to Predict Future Cost and Health Care Resource Use – Do They Also Accurately Reflect Differences in Health Status between Rural and Urban Beneficiaries?
  This CMS Hierarchical Condition Category (CMS-HCC) risk score study will investigate differences in underlying health between rural and urban populations using recent data and analyze which factors drive observed differences.
  Research center: ETSU/NORC Rural Health Research Center
  Topics: Health services, Healthcare access, Hospitals and clinics, Medicaid and CHIP, Medicare, Medicare Advantage (MA)
  
• Identifying Characteristics Associated With Rural and Urban Medicare Beneficiaries Bypassing Local Skilled Nursing Facilities for Post-Acute Care
  This project will compare how often rural versus urban beneficiaries receive post-acute care from skilled nursing facilities (SNFs) outside of their local communities, and which patient, provider, and community characteristics are associated with bypass of local SNFs, informing policies to support SNFs in rural communities.
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Healthcare access, Long-term care, Medicare, Post-acute care
  
• Mortality Risks Associated With Living in Ambulance Deserts
  This project will use ambulance data from the Maine Rural Health Research Center and from CDC WONDER to assess whether living in an ambulance desert is associated with higher mortality rates among rural and urban populations.
  Research center: Maine Rural Health Research Center
  Topics: Emergency medical services (EMS) and trauma, Healthcare access
  
• Non-Metropolitan/Metropolitan Differences in Barriers to Care and Utilization of Preventive Care and Wellness Visits Among Traditional Medicare and Medicare Advantage
  This project proposes to use the Medicare Current Beneficiaries Survey to examine differences across geography and plan type (Medicare Advantage vs. traditional) with regards to barriers to care (e.g., costs) and use of preventive services (e.g., flu shot).
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Health services, Healthcare access, Medicare Advantage (MA)
  
• Out-of-Pocket Spending Among Privately Insured Rural and Urban Residents
  Out-of-pocket spending for healthcare services has been on the rise as deductibles and other cost-sharing requirements among the privately insured increase. This study compares rural and urban out-of-pocket healthcare spending to identify whether rural residents have been disproportionately affected by this trend.
  Research center: Maine Rural Health Research Center
  Topics: Healthcare access, Healthcare financing, Private health insurance, Public health, Uninsured and underinsured
  
• Psychiatric Bed Closures in Rural Hospitals: An Assessment of Trends, Impact, and Policy Strategies
  This study will examine trends in the closure of psychiatric beds by rural hospitals using the Substance Abuse and Mental Health Services Administration Treatment Services Locator; the American Hospital Association Annual Survey of Hospitals (2010-2017); and the Area Health Resources File.
  Research center: Maine Rural Health Research Center
  Topics: Healthcare access, Hospitals and clinics, Mental and behavioral health
  
• Rural and Urban Medical School Programs that Demonstrate a Commitment to Producing Rural Physicians
  Studies of individual medical schools have identified characteristics associated with working in rural areas, but little is known about which organizational factors are the most significant predictors of rural practice. This project will examine characteristics of medical schools' missions and organizational commitments to promote physician practice in rural communities.
  Research center: WWAMI Rural Health Research Center
  Topics: Health services, Healthcare access, Physicians, Workforce
  
• Socioeconomic Profiles and Market Characteristics Associated with Ambulance Deserts
  We will address the extent to which vulnerable, aging populations live in ambulance deserts and identify ambulance desert populations facing additional barriers to healthcare access. We will also assess the impact of hospital closures on travel distances to the nearest health care facilities.
  Research center: Maine Rural Health Research Center
  Topics: Emergency medical services (EMS) and trauma, Healthcare access, Rural statistics and demographics, Social determinants of health, Transportation
  
• Specialist Physicians in the Rural and Urban U.S.: Supply, Distribution, and Access
  This project will describe the geographic distribution (rural/urban, regional, and intra-rural) of specialist physicians who care for patients experiencing conditions that account for the top four leading causes of rural mortality. It will also explore how patients in rural communities that lack these specialists obtain needed care.
  Research center: WWAMI Rural Health Research Center
  Topics: Cancer, Care management, Chronic diseases and conditions, Frontier health, Health services, Healthcare access, Physicians, Social determinants of health, Telehealth, Workforce
  
• Suicide Mortality: A Comparison of Urban and Rural Rates
  Suicide contributes to significant mortality in the United States. This project will examine the differences in suicide rates by geography and explore its driving factors among urban and rural areas in the United States from 2018 to 2021. The research design of this study will adopt a cross-sectional, retrospective approach, using secondary data.
  Research center: ETSU/NORC Rural Health Research Center
  Topics: Healthcare access, Mental and behavioral health, Public health, Rural statistics and demographics, Uninsured and underinsured
  
• The Emerging Landscape of Rural Family Medicine Residency Training: Defining Models and Assessing Their Value
  Rural residency training options for family physicians are growing, as is the evidence for rural training in promoting rural practice choice. This study aims to use a new classification of six residency program types to describe and quantify programs and positions by type and compare relative effectiveness in producing rural physicians.
  Research center: WWAMI Rural Health Research Center
  Topics: Health services, Healthcare access, Physicians, Workforce
  
• The Impact of Rural Surgery Training on General Surgeon Supply in Rural Communities
  A growing number of general surgery programs offer rural training that aims to address the dwindling supply of rural surgeons. This study aims to describe program models for providing rural general surgery training; quantify the availability of programs; and compare the models' effectiveness in producing rural surgeons.
  Research center: WWAMI Rural Health Research Center
  Topics: Health services, Healthcare access, Physicians, Workforce
  
• The Nursing Home and Skilled Nursing Facility Workforce in the Rural and Urban U.S.
  This project will describe the rural and urban distribution of nursing and non-nursing staff in U.S. long-term care facilities and investigate how the workforce varies by facility and community characteristics.
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Healthcare access, Long-term care, Workforce
  
• Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder Across the U.S.
  This study describes and compares the treatment that rural and urban patients with opioid use disorder (OUD) receive, documenting the workforce providing care, distance that patients travel to receive care, and cost of care. Findings will inform policies to ensure that rural patients with OUD have access to care from local healthcare providers.
  Research center: WWAMI Rural Health Research Center
  Topics: Health services, Healthcare access, Healthcare financing, Mental and behavioral health, Nurses and nurse practitioners, Pharmacy and prescription drugs, Physician assistants, Physicians, Substance use and treatment, Telehealth
  
• Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder and Medicaid Insurance Across the U.S.
  This project will analyze Medicaid claims data to compare the treatment that rural and urban patients with opioid use disorder receive, documenting the workforce providing care, the distance that patients travel to receive care, and the cost of care. Findings from this study can be used to improve policies regarding opioid use disorder treatment.
  Research center: WWAMI Rural Health Research Center
  Topics: Health services, Healthcare access, Healthcare financing, Legislation and regulation, Medicaid and CHIP, Mental and behavioral health, Nurses and nurse practitioners, Pharmacy and prescription drugs, Physician assistants, Physicians, Substance use and treatment, Telehealth, Workforce
  
• Unmet Health and Social Needs of Rural Residents with Disability
  We will assess rural-urban differences in access to health care and social wellbeing for rural residents with a disability. Disability rates are often higher in rural areas and, given growing evidence of COVID-related disability, this study will provide critical information about the pre-pandemic status of unmet health and social needs among disabled persons to enable future planning.
  Research center: Maine Rural Health Research Center
  Topics: Coronavirus Disease 2019 (COVID-19), Disabilities, Healthcare access
  
• Usual Source of Primary Care for Rural Medicare Beneficiaries Before and During COVID-19
  The global pandemic was highly disruptive to existing health care use patterns, potentially affecting rural America more than urban communities. This study will describe the usual sources of primary care (USC) for rural Medicare beneficiaries before and during COVID-19 to provide insight into how COVID-19 affected USC of Medicare beneficiaries.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Federally Qualified Health Centers (FQHCs), Healthcare access, Hospitals and clinics, Medicare, Rural Health Clinics (RHCs)