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Rural Health
Research Gateway

Hospitals and clinics

Completed Projects

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

2025

  • 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

  • A Comparison of 2017-2019 Uncompensated Care of Rural and Urban Hospitals and a First Look at Uncompensated Care in 2020 and 2021
    This project compared 2017-2019 uncompensated care as a percent of operating expense for rural and urban hospitals and investigated uncompensated care data for 2020 and 2021.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare
  • Developing a Post-COVID Financial Distress Index
    This project updated and improved the North Carolina Rural Health Research Program's Financial Distress Index, which uses historical data about hospital financial performance, government reimbursement, organizational characteristics, and market characteristics to predict the current risk of financial distress.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare
  • 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
  • Low Volume Hospitals
    This analysis compared rural low-volume hospitals (LVHs) to non-LVH characteristics and estimate the financial impact of eliminating the LVH program and reverting to the original (2005) LVH classification and payment adjustment.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare
  • 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

  • Changes in Hospital Services Offered After Mergers, Acquisition and Affiliations
    Hospitals have affiliated with systems in increasing numbers since 2007, as of 2016 reaching 56.1 percent of nonmetropolitan prospective payment system hospitals and 42.8 percent of critical access hospitals. This project examined resulting changes in services offered by rural hospitals, hypothesizing shifts of some services to regional hospitals and growth in some service lines.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Critical Access Hospitals (CAHs), Hospitals and clinics, Networking and collaboration

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
  • Estimation of the Fixed and Variable Costs of a Rural Emergency Hospital
    This project: 1) informed the design of CMS Rural Emergency Hospital (REH) payment methods, particularly the Medicare monthly additional facility payment; 2) estimated patient break-even volumes for the long-run financial sustainability of REHs; and; 3) provided a tool that rural hospitals can use to estimate the cost of operating a REH.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Legislation and regulation, Medicare
  • Factors Predicting Swing Bed Versus Skilled Nursing Facility Use
    This project updated our 2014 brief: Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where? In addition to examining health conditions of patients discharged from rural Prospective Payment System hospitals and Critical Access Hospitals to swing beds and skilled nursing facilities, this project also looked to see what has changed over time and whether demographic factors explain differences.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Long-term care, Medicare
  • How Have the Sources of Revenue for Rural Hospitals Changed Since 2005?
    Rural hospitals have seen a steadily decreasing average acute daily census. If outpatient revenue is not expanding to fill that decrease, the decrease in patient revenue could further threaten hospital viability.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare financing, Hospitals and clinics, 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
  • Three Models of a Rural Emergency Hospital
    This project used secondary data about small rural emergency departments and expert opinion to develop three clinical and operational models of a Rural Emergency Hospital (REH). The REH models were based on case mix, service mix, patient volume, clinical staffing, and technology.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Legislation and regulation, Medicare

2021

  • 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
  • Current and Longer Term Challenges of Rural Hospitals: A Survey of Rural Hospital Executives
    This project involved surveying rural hospital executives about how they will respond to current and long-term challenges related to financial and regulatory burdens.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health reform, 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
  • How Medicare Payment Standardization Affects the Perceived "Cost" of Post-Acute Care Provided in Critical Access Hospital Swing Beds
    Medicare-allowed charges are adjusted for geographic cost differences and payments that support larger Medicare program goals. This study aimed to identify the effects of the payment standardization method on the perceived "cost" of post-acute care provided in Critical Access Hospital swing beds.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Hospitals and clinics, Medicare, Post-acute care
  • 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
  • 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

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
  • 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
  • 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
  • Rural Community Response to Hospital Closure
    The Rural Community Response to Hospital Closure project will study how rural communities adapt to local hospital closure. Within selected communities, the project will evaluate the impact of hospital closure on multiple community health-related services and characteristics.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Healthcare financing, Hospitals and clinics

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
  • Exploring Global Budgets as a New Reimbursement Model for Low-Volume Critical Access Hospitals
    Given the complexity of the Global Budget reimbursement model, we were interested to learn if there are aspects of the model that could be applied to consolidate reimbursement across rural and frontier health care settings, particularly for CAHs with low-volume (e.g., < 5 acute patients as a daily census).
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Hospitals and clinics
  • How Rural Communities Respond and Recover after a Hospital Closure
    Current rates of rural hospital closures are the highest seen in the last few decades. What can we learn from the experiences of communities experiencing hospital closures?
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Workforce
  • Utilization of Hospital Care for Rural Medicare Beneficiaries
    This project examines where rural and frontier Medicare beneficiaries access hospital care. Specifically, it explores the different types of inpatient care sought in local rural communities and at tertiary providers. Beneficiary patterns of care by condition, location type and other factors will be examined. The study will also focus on the bypassing behavior of rural residents when being hospitalized. Analysis sensitivity analyses are being performed regarding small travel time differences per alternative hospitals.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Frontier health, Hospitals and clinics, Medicare

2018

  • Post-Acute Care for Rural Medicare Beneficiaries
    This project described the variation in the volume, mix and financial importance of post-acute services to rural hospitals; identified hospital and community characteristics associated with variation in post-acute services provided by rural hospitals; and determined where rural Medicare beneficiaries receive post-acute services.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Long-term care, Post-acute care

2017

  • After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care
    This paper describes opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from centering on inpatient hospital-based care to new models of care delivery in rural places.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Hospitals and clinics, Quality
  • Characteristics of Rural Hospitals at High Risk of Financial Distress
    Updates the Financial Distress Index Model with current hospital and market data. Evaluates changes in risk status and geographic distribution over time. Conducts an in-depth analysis of high risk hospitals.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare financing, Hospitals and clinics
  • Do Rural Health Clinics (RHCs) Provide Services that Lower Rates of Preventable Hospitalizations?
    This project uses 3 years of individual-level Medicare claims data to analyze the relationship between receiving care at a Rural Health Clinic (RHC) and the likelihood of potentially preventable hospitalization and/or potentially preventable emergency department (ED) visits. The project will explore this relationship among both fee-for-service Medicare enrollees and Medicare-Medicaid dual eligibles.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Hospitals and clinics, Rural Health Clinics (RHCs)
  • The Financial and Community Experience of Sole Community Hospitals in Comparison to Other Rural Hospitals
    This research will investigate the financial and community experience of Sole Community Hospitals (SCHs) in comparison with other rural hospitals. The availability of alternative facilities, and the socioeconomic and demographic characteristics of SCH service areas will be compared to other rural hospital service areas.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS), Rural statistics and demographics

2016

  • Can a Model Predict Financial Distress Among Rural Hospitals?
    This project will extend an existing model of CAH financial distress to other types of rural hospitals. A valid model would be helpful to ORHP and state Offices of rural Health interested in predicting financial distress or closure of rural hospitals.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Hospitals and clinics
  • Designing a Study for Collection of Uniform Measures by the EB TNGP Grantees
    The Federal Office of Rural Health Policy funded six grantees through the Evidence-Based Telehealth Network Grant Program to implement and evaluate tele-emergency services in rural areas.
    Research center: Rural Telehealth Research Center
    Topic: Hospitals and clinics
  • How Have Changes in Insurance Coverage Under Health Reform Affected Uncompensated Care and Financial Performance in Rural Hospitals?
    This two-year project will explore the effects of changes in insurance coverage under health reform on the following outcomes in rural hospitals: (1) bad debt; (2) charity care; (3) payer mix (Medicare, Medicaid, other); (3) financial performance; and (4) hospital revenue cycle management. Results will inform federal and state agencies, rural providers and communities as to how implementation of the Patient Protection and Affordable Care Act is impacting reimbursement and financial performance of rural hospitals, allowing the Office of Rural Health Policy to identify emerging challenges and develop strategies or policy changes needed to deal with any unintended consequences.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health reform, Hospitals and clinics, Private health insurance, Uninsured and underinsured
  • Launch of a Study for Collection of Uniform Measures by the EB TNGP Grantees
    Study concepts were vetted, protocols were developed, and this project launched a study where the Evidence-Based Tele-Emergency Network Grant Program grantees began to collect data on a uniform set of measures to help establish the evidence base for tele-ED.
    Research center: Rural Telehealth Research Center
    Topic: Hospitals and clinics
  • Policy Analysis Using the Financial Distress Model: Does Medicaid Expansion Affect the Risk of Hospital Financial Distress and Closure?
    This study will build on the 2014-15 approved project entitled "Can a Model Predict Financial Distress among Rural Hospitals?" The newly developed model uses current financial performance and market characteristic data to assign rural hospitals to one of four categories of risk of financial distress. The study will use Medicare Cost Report data for 2014, if available. Otherwise, simulation will be used to estimate the effects on financial distress.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicaid and CHIP
  • The Impact of Emergency Telemedicine on Timeliness, Process of Care, and Clinical Outcomes in Rural North Dakota Trauma Care
    This project was a comparative effectiveness study of North Dakota trauma patients to measure the impact of telemedicine-enabled emergency care between 2008-2014 on a number of issues.
    Research center: Rural Telehealth Research Center
    Topics: Emergency medical services (EMS) and trauma, Emergency preparedness and response, Hospitals and clinics
  • 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
  • Use of Home Health Services Among High Risk Rural Medicare Patients: Patient, Service, and Community Factors Associated with Hospital Readmission
    This study will examine the 60-day post-acute care outcomes of rural Medicare patients who were discharged from hospitals and admitted to home healthcare services. Key predictors include home health services provided, type of Medicare home health reimbursement, and available community healthcare resources.
    Research center: WWAMI Rural Health Research Center
    Topics: Home health, Hospitals and clinics, Medicare, Post-acute care
  • What Would be the Financial Consequence of Eliminating Low Volume Hospital Payments?
    Analysis will include comparison of the long-term profitability of low-volume hospitals to other rural hospitals and estimation of the potential profitability consequences of eliminating the payment classification altogether.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS)

2015

  • 21st Century Rural Hospital: Outpatient Services and Access to Care
    The rural hospital has changed dramatically with hospitals becoming increasingly outpatient-centered. This project is designed to inform policymakers about rural hospitals' provision of outpatient care, including publication of a Primer, detailing the variability in outpatient services provision by key characteristics that can be used to examine the potential impact of proposed policy changes on patients' ability to access different services.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Hospitals and clinics
  • Early Rural Experiences of Changes to Medicaid
    This project will 1) develop baseline state-level snapshots of rural enrollment in Medicaid and 2) estimate and model enrollment expansion in each state. We will also conduct a baseline provider key informant interviews in late 2013 to gauge expected effects, with follow up interviews in Summer 2014 as a sentinel warning system of early effects of changes to Medicaid in order to inform timely policy development.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Federally Qualified Health Centers (FQHCs), Hospitals and clinics, Medicaid and CHIP
  • Identifying Limitations of PPS Reimbursement for Rural Hospitals
    This project will investigate the potential financial and access consequences of returning rural hospitals to PPS payment. Characteristics of the hospitals and communities at highest risk of adverse consequences will be identified.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare financing, Hospitals and clinics
  • Quality of Surgical Care services in Critical Access Hospitals (CAHs)
    This project builds on prior work examining rural residents' bypass behavior of their local CAH to hospitals outside their community. Using recently identified inpatient surgical procedures that are commonly performed in CAHs, we will examine and compare outcomes (e.g. post-surgical complication rates, adverse events) of these procedures between CAHs and non-CAHs.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Critical Access Hospitals (CAHs), Hospitals and clinics
  • 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
  • What Happens after Acute Inpatient Care is No Longer Provided by a Rural Hospital?
    This project will investigate the precursors to closure of acute inpatient care by rural hospitals and the post-closure configuration of health care services in the community.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Hospitals and clinics

2014

  • Comprehensive Study of Swing Bed Use in Rural Hospitals
    This project will comprehensively address questions about how swing beds are used by rural hospitals. Questions to be answered include whether decision about use are driven by patient need, community resources, hospital operational concerns or some combination of these factors; the cost implications of swing bed use in critical access hospitals to the Medicare program; and whether patients served in swing beds differ in meaningful ways from those in skilled nursing facilities.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS)
  • Rural Hospital Mergers and Acquisitions - Who is Being Acquired and What Happens Afterwards?
    This study compares the financial and market characteristics of recently acquired rural hospitals to other rural hospitals and investigates the post-acquisition change in services and financial performance of these hospitals. This study will inform rural advocates, federal and state agencies, and regulators as to how mergers and acquisitions (M&amp;As) of small rural hospitals affect access to care for Medicare beneficiaries, and the potential financial consequences of M&amp;As to small rural hospitals.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare financing, Hospitals and clinics, Medicare

2012

2011

  • Assessing the Rural Relevance of Hospital Outpatient Quality Measures
    The purpose of this project is to: 1) determine the diagnoses that are most commonly treated and the procedures most commonly performed in rural hospital outpatient settings; and 2) to evaluate the rural relevance of the proposed new CMS outpatient quality measures and other potential outpatient quality measures.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality
  • Importance of Surgery to Rural Hospital Financial Condition and Market Share
    This study explores the provision of surgical services in rural hospitals and its relationship to financial performance. The percentage of rural hospitals that offer surgical services and the number that have discontinued surgical services over the last decade will be described, and, for those that have discontinued services, the impact on financial condition will be explored.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Hospitals and clinics

2010

  • Nursing Workforce Impact on Rural Hospital Performance Improvement in the Hospital Quality Incentive Demonstration Project
    The purpose of this project is to examine the impact of nurse staffing on hospital performance improvement in the CMS/premier Inc. Hospital Quality Incentive Demonstration project with specific interest in whether and how this relationship differs in rural hospitals as compared to urban hospitals.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality, Workforce
  • Outpatient Payment Policy Under Medicare: Recent Policy Developments from the Rural Perspective
    This study was designed to examine outpatient payment options for rural hospitals, the advantages and disadvantages of each, and their potential impact on hospital revenue and rural access to health services.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Healthcare financing, Hospitals and clinics
  • Potentially Preventable Rural Hospital Readmissions
    This project focuses on the analysis of potentially preventable rural hospital readmissions, a potential quality indicator receiving considerable attention from policymakers and payers. Using 3-M algorithm software and MedPAR inpatient claims data from 9 geographically representative states, this study will explore the relationship between readmission rates and geographic regions, categories of rural hospitals, discharge destination, clinical diagnoses and patient attributes.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality
  • 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-urban Comparison of Hospital Financial Performance by Medicare Payment Classification
    This project will compare the financial performance of rural and urban short term general hospitals by Medicare payment classifications (PPS only, Medicare dependent hospitals, sole community hospitals, rural referral centers, and critical access hospitals).
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare

2009

  • Health Information Technology and Quality in Rural Hospitals
    The purpose of this project is to: 1) examine the adoption of health information technology (HIT) among rural hospitals and identify hospital and market characteristics that facilitate or impede HIT diffusion; 2) measure the effect of HIT on clinical quality in rural hospitals; and 3) identify technologies that may be promoted to improve quality of care in rural areas.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Health information technology, Hospitals and clinics, Quality
  • Improvement in the Quality of Care for Acute Myocardial Infarction (AMI): Have Rural Hospitals Followed National Trends?
    This project will determine whether overall improvements in the quality of care for AMI among Medicare patients, as measured by adherence to guidelines, have taken place in both rural and urban hospital settings.
    Research center: WWAMI Rural Health Research Center
    Topics: Hospitals and clinics, Quality

2008

  • Advantages and Disadvantages of Hospital-Based Emergency Medical Services in Rural Areas
    This project sought to clarify issues surrounding hospital decisions to acquire and maintain ownership of community ambulance services.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Emergency medical services (EMS) and trauma, Hospitals and clinics
  • Examining the Magnitudes, Geographic Variations, and Determinants Of Expenditures Due to Ambulatory Care Sensitive Conditions in Rural Hospitals
    This project will document the magnitude of and variation in ambulatory care sensitive condition (ACSC) expenditures of rural hospitals and explore the relationships between rural hospital ACSC expenditure and its key determinants in the areas of population demand, health care system supply, and provider practice style.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Chronic diseases and conditions, Healthcare financing, Hospitals and clinics
  • Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety
    The purpose of this project is to describe successful telepharmacy activities and to analyze policy issues related to the implementation of telepharmacy projects in rural hospitals. These policy issues include the potential impact of telepharmacy use on the quality of pharmaceutical services and medication safety for rural patients.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Telehealth
  • Quality Improvement Organizations' Contributions to Rural Hospital Performance
    This qualitative study is designed to gather information on best-practices in Quality Improvement Organization (QIO)-rural hospital partnerships. Specifically, this study will identify successful and replicable examples in which QIOs have worked with rural and critical access hospitals to improve processes of care, implement health information technology and promote organizational safety culture.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Critical Access Hospitals (CAHs), Health information technology, Hospitals and clinics, Quality
  • Rural Provider Participation in a Statewide Health Information Project
    Nebraska has recently constructed a communication infrastructure that links all the hospitals in the state with broadband, high-speed systems (using T1 lines to the Critical Access Hospitals). That infrastructure is considered to be the backbone for a statewide health information network being designed by a coalition of organizations. The aim of this project is to delineate reasons for rural providers to participate in the coalition by assessing the associated costs and benefits.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health information technology, Hospitals and clinics, Networking and collaboration

2007

  • Assessment of Small Rural Hospital Activities to Report Medication Errors
    This research will determine how small rural hospitals have responded to the environmental pressure to improve patient safety and quality by implementing safe medication practices and by reporting and monitoring medication errors.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality
  • Beyond Simple Ranking: Identifying and Empirically Testing Alternative Approaches for Recognizing Quality in Rural Hospitals
    The purpose of this project is to explore several alternative methods for assessing the relative quality of hospitals using data from the Hospital Quality Incentive Demonstration Project and Hospital Compare.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality
  • Investments in Health Information Technology by Rural Hospitals
    This study involved a national survey of rural hospitals conducted in late spring 2006 to gather data about readiness to adopt health IT, current use of different technologies, perceptions about the benefits and barriers to health IT adoption, future implementation plans, use of Federal programs designed to facilitate IT adoption, and interest in various health IT policy options.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Health information technology, Hospitals and clinics
  • Occupational Mix Differences Across PPS Hospitals: Analysis of Hospital Occupation Mix Survey Data and Implications for Rural Hospital Payments
    This study addresses the occupation-mix adjustment that has recently been added to the computation of the area wage index used to adjust Medicare prospective rates for all institutional healthcare providers. The study will review the policy objectives as well as the mechanics of the adjustment, and then analyze the data from the most recent occupation-mix survey to obtain a better understanding of occupation mix differences across labor markets and hospital types.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare Prospective Payment System (PPS), Workforce
  • Pay-for-Performance and Quality Improvement in Rural Hospitals
    This project will estimate the impact on rural hospitals in the U.S. of a pay-for-performance (PFP) program similar to the CMS-sponsored Premier, Inc. Hospital Quality Incentive Demonstration; synthesize the major factors that will influence the inclusion of rural hospitals in PFP programs; and make recommendations for the design of PFP programs that will appropriately reward rural hospitals for improving quality.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Healthcare financing, Hospitals and clinics, Quality
  • Rapid Response: Elimination of Bad Debt Payments to Rural PPS Hospitals
    The purpose of this project is to examine: (1) the extent to which elimination of Medicare Bad Debt payments will reduce reimbursement to rural prospective payment system (PPS) hospitals and (2) how rural hospitals would respond to this reduction in reimbursement.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Healthcare financing, Hospitals and clinics, Medicare Prospective Payment System (PPS)
  • 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
  • Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas
    This project will describe emergency department (ED) staffing patterns in rural hospitals; determine how the certification, training, and experience of ED physicians and other providers in different ED staffing models vary; and assess the implications of rural ED staffing for the quality of emergency care in rural areas, continuity of care, and rural EDs' role as safety net providers.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Hospitals and clinics, Quality, Workforce
  • Rural Hospital Participation in the 340B Drug Discount Program
    The 340B drug discount program enables certain types of safety net organizations to obtain deeply discounted medications, at prices below the 'best price' typically offered to Medicaid agencies. This study used telephone interviews and mail surveys to explore the experiences that rural hospitals have had in seeking 340B eligibility status.
    Research centers: NORC Walsh Center for Rural Health Analysis, North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Pharmacy and prescription drugs

2006

  • Declining Access to Hospital-based Obstetric Services in Rural Areas: Causes and Impact
    This study examines the declining availability of hospital-based obstetric services in rural areas from the mid-1980s to the early 2000s. It examines potential causes for this trend and explores the effects of medical malpractice reforms.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Hospitals and clinics, Legislation and regulation, Maternal health, Women
  • 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

2005

2004

2003

2002

2001