Hospitals and clinics: Rural Health Research Products & Journal Articles

2024

Geographic Disparities in Availability of Hospital-Based Cardiac Services Across the United States
Journal Article
University of South Carolina Rural Health Research Center
Date: 12/2024
This project examined geographic disparities in the availability of essential cardiac care in counties across the United States.
An Updated Model of Rural Hospital Financial Distress
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 10/2024
In fall 2024, the North Carolina Rural Health Research Program completed a study modeling financial distress among rural hospitals, "An Updated Model of Rural Hospital Financial Distress." The model updates a 2016 version, by adding recent changes in the operating environment.
Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 09/2024
This brief presents financial performance trends of hospitals who participated in Medicare's Shared Savings Program (SSP) from 2011 to 2018. Trends in six financial outcomes are compared between SSP and non-SSP hospitals over time and between rural and urban hospitals.
Non-Urgent Use of Emergency Departments by Rural and Urban Adults
Policy Brief
Maine Rural Health Research Center
Date: 04/2024
This study provides updated information and addresses gaps in knowledge about rural non-urgent emergency department (ED) use. Understanding the rates of non-urgent ED use among rural adults and the factors associated with this use can inform policy and practice efforts to reduce inappropriate use of EDs in rural communities.

2023

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.
Policy Implications of Fixed-to-Total-Cost Ratio Variation Across Rural and Urban Hospitals
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 05/2023
This article utilizes hospital cost report data to estimate the relationship between adjusted volume and total costs of patient care. These results are used to estimate fixed-to-total-cost ratios for all nonfederal, short-term acute care hospitals in the U.S. These ratios were then stratified by rurality and Critical Access Hospital status.

2022

Community Sociodemographics and Rural Hospital Survival
Journal Article
Center for Economic Analysis of Rural Health
Date: 12/2022
This study examines whether community sociodemographic factors are associated with the survival or closure of rural hospitals at risk of financial distress between 2010 and 2019.
The Impact of Medicare Shared Savings Program Participation on Hospital Financial Performance: An Event-Study Analysis
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 10/2022
This study evaluated the extent to which Medicare Shared Savings Program participation affected hospital financial outcomes, including patient revenue, operating margin, different revenue source shares, and allowance and discount rate.
Availability of Hospital-Based Cancer Services Before and After Rural Hospital Closure, 2008-2017
Journal Article
University of South Carolina Rural Health Research Center
Date: 09/2022
Using American Hospital Association survey data from 2008 to 2017, the changes in access to cancer-related screening and treatment services were examined to determine the impact of hospital closures across hospital service areas.
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.
Changes in Access to Community Health Services Among Rural Areas Affected and Unaffected by Hospital Closures Between 2006 and 2018: A Comparative Interrupted Time Series Study
Journal Article
University of South Carolina Rural Health Research Center
Date: 07/2022
In this article, investigators compared access to Federally Qualified Health Centers and Rural Health Clinics by those in rural areas affected versus those in rural areas unaffected by hospital closures.
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.
Higher Electronic Health Record Functionality Is Associated With Lower Operating Costs in Urban—but Not Rural—Hospitals
Journal Article
Center for Economic Analysis of Rural Health
Date: 07/2022
This study examines the relationship between electronic health record use/functionality and hospital operating costs and compares the results across rural and urban facilities.
The Economic Effects of Rural Hospital Closures
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2022
This study updates previous research (Holmes, et al. 2006) on the economic effects of rural hospital closures by measuring the economic changes over time among U.S. rural counties that had a hospital closure from 2001-2018.

2021

Trends in Cancer Treatment Service Availability Across Critical Access Hospitals and Prospective Payment System Hospitals
Journal Article
University of South Carolina Rural Health Research Center
Date: 08/2021
This study investigated trends in cancer services availability in urban and rural Prospective Payment System (PPS) hospitals and Critical Access Hospitals (CAHs). Compared with all PPS hospitals, CAHs offered fewer cancer treatment services and experienced a decline in service capability over time.
Opioid-Related Visits to Rural Emergency Departments
Policy Brief
Maine Rural Health Research Center
Date: 02/2021
The purpose of this project was to compare rural and urban opioid-related emergency department visits. Data from the Nationwide Emergency Department Sample were used to examine rural and urban opioid-related visits over time and to compare the outcomes of these visits.

2020

Decline in Inpatient Volume at Rural Hospitals
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 12/2020
This study examined inpatient volume in rural hospitals between 2011 and 2017. Patient population and the organizational and geographic characteristics of hospitals that were significant predictors of inpatient volume included census region, Medicare payment type, ownership type, total margin, and percent of the population in poverty.
A Comparison of Rural and Urban Specialty Hospitals
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 09/2020
This brief describes key differences between specialty hospitals located in rural versus urban areas.

2019

Impact of the Medicare Disproportionate Share Hospital Payment Cap on Urban and Rural Hospitals
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 12/2019
The Medicare Disproportionate Share Hospital payment adjustment is intended to compensate hospitals serving a disproportionate number of low-income patients. This policy brief describes the number and location of urban and rural hospitals affected by a 12% payment cap established by the Medicare Modernization Act of 2003.
2019 Wage Index Differences and Selected Characteristics of Rural and Urban Hospitals
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 05/2019
This brief characterizes rural/urban disparities in the 2019 Centers for Medicare & Medicaid Services hospital wage index by describing and comparing the wage indices of rural and urban hospitals by the number of beds, the amount of net patient revenue, and Medicare payment classification.
Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 05/2019
This brief describes the geographic variation of the 2019 Centers for Medicare & Medicaid Services hospital wage index by rural/urban definition, census region, Frontier and Remote Area codes and state.
Geographic Variation in the 2019 Risk of Financial Distress Among Rural Hospitals
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 04/2019
This brief investigates 2019 geographic variation in risk of financial distress among rural hospitals.
Trends in Risk of Financial Distress Among Rural Hospitals, 2015 to 2019
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 04/2019
This brief investigates 2015 to 2019 trends in risk of financial distress among rural hospitals by census region and Medicare payment classification.

2018

Trends in Hospital System Affiliation, 2007-2016
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2018
This policy brief updates a RUPRI Center brief published in 2014 and documents the continued growth in system affiliation by both metropolitan and non-metropolitan hospitals.

2017

Distribution of Disproportionate Share Hospital Payments to Rural and Critical Access Hospitals
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2017
This policy brief provides information about the potential impact of scheduled changes in Medicaid Disproportionate Share Hospital (DSH) payment on hospitals in 47 states. We expect variation across states, because of differences in state policies allocating DSH payments, as well as geographic variation by census region.
Identifying Variability in Patient Characteristics and Prevalence of Emergency Department Utilization for Mental Health Diagnoses in Rural and Urban Communities
Journal Article
North Dakota and NORC Rural Health Reform Policy Research Center
Date: 10/2017
Patients needing behavioral healthcare can get more appropriate, cost-effective treatment if they are redirected from emergency departments (EDs). This study examined whether a larger proportion of rural versus urban patients went to went to EDs.
The Relationship Between Rural Health Clinic Use and Potentially Preventable Hospitalizations and Emergency Department Visits Among Medicare Beneficiaries
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 07/2017
Uses 2007-2010 Medicare data to examine the relationship between Rural Health Clinic (RHC) use and potentially preventable hospitalizations and emergency department (ED) visits. RHC use was associated with an increase in both preventable hospitalizations and ED visits among all Medicare enrollees, regardless of their reason for eligibility.
Telemedicine Use Decreases Rural Emergency Department Length of Stay for Transferred North Dakota Trauma Patients
Journal Article
Rural Telehealth Research Center
Date: 07/2017
This article examines the use of telemedicine to help improve care for trauma patients and to try to close the gap between rural and urban outcomes for these patients. The study involved patients treated in critical access hospitals and emergency departments.
After Hospital Closure: Pursuing High Performance Rural Health Systems Without Inpatient Care
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 06/2017
A new paper describing 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 hospital-based locus of care to new models of care delivery in rural places.
CMS Hospital Quality Star Rating: For 762 Rural Hospitals, No Stars Is the Problem
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 06/2017
The purpose of this brief is to look more closely at the characteristics of rural hospitals with and without CMS Hospital Quality Star Ratings to help inform ongoing discussions about the usefulness of the quality star rating for comparing hospital quality and possible ways to improve the star rating initiative.
Predicting Financial Distress and Closure in Rural Hospitals
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 06/2017
Examines the financial distress of rural hospitals to better predict closures within two years.
Rural and Urban Utilization of the Emergency Department for Mental Health and Substance Abuse
Policy Brief
North Dakota and NORC Rural Health Reform Policy Research Center
Date: 06/2017
Utilizes data from the Healthcare Cost and Utilization Project's (HCUP's) State Emergency Department Databases (SEDD) for seven states. Researchers explore, and describe in this brief, the use of the Emergency Department for mental health and substance abuse among Urban, Large Rural, Small Rural, and Isolated Small Rural residents.
Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study
Journal Article
Rural Telehealth Research Center
Date: 02/2017
Traumatic injury is a leading cause of death in the U.S. Rural residents have limited access to trauma care, and telemedicine has been proposed to improve trauma care locally. This study describes patient-level factors associated with telemedicine and measures the association between telemedicine consultation and interhospital transfer.

2016

How Would Rural Hospitals Be Affected by Loss of the Affordable Care Act's Medicare Low-Volume Hospital Adjustment?
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 11/2016
Using data from the Hospital Market Service Area File, the Hospital Cost Report Information System, and Nielsen-Claritas Pop-Facts, this study examined the effect the low-volume hospital payment adjustment has on a hospital's finances. It also looked at the effects of losing the payment adjustment.
To What Extent Do Community Characteristics Explain Differences in Closure Among Financially Distressed Rural Hospitals?
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 11/2016
This study examined the differences between rural hospitals at high risk of financial distress that stayed open and those that closed.
Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare?
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 02/2016
Examines how Critical Access Hospitals perform compared to Prospective Payment System hospitals on measures of quality.

2015

Rural Hospital Mergers and Acquisitions: Which Hospitals Are Being Acquired and How Are They Performing Afterward?
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 11/2015
Examines characteristics of rural hospitals that have merged or were acquired during 2005 and 2012. Also compares the change is rural hospital finances, staffing, or services after the merger or acquisition.
Uncompensated Care Burden May Mean Financial Vulnerability for Rural Hospitals in States That Did Not Expand Medicaid
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 10/2015
Explores the differences of rural hospitals in states with Medicaid expansion and those with nonexpansion, in terms of the amount of uncompensated care they provided and their profitability and market characteristics in 2013.
The Rising Rate of Rural Hospital Closures
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2015
Discusses the increase in rural hospital closure rates, including the causes of closures and its impact on rural communities.
Characteristics of Rural Accountable Care Organizations (ACOs) - A Survey of Medicare ACOs With Rural Presence
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2015
In this policy brief, we present the findings of a survey of 27 rural accountable care organizations, focusing on characteristics important to their formation and operation.
Hospital Views of Factors Affecting Telemedicine Use
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2015
This brief expands upon previous research by examining hospital-based use of telemedicine by determining the type of use by hospitals, whether it be providing services as a hub or receiving services as a spoke, and then identifying factors from the hospitals' perspectives that affect use.
Variability in General Surgical Procedures in Rural and Urban U.S. Hospital Inpatient Settings
Report
WWAMI Rural Health Research Center
Date: 03/2015
This report addresses rural/urban differences in surgical practices in commonly performed inpatient surgical procedures that are typically handled by general surgeons. Findings indicate that rural hospitals concentrated on relatively common, low complexity procedures that can be handled by general surgeons.
Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace
Policy Brief
Maine Rural Health Research Center
Date: 02/2015
This policy brief reports findings from a survey of rural health clinics (RHC) that examined their capacity to meet the National Council for Quality Assurance patient-centered medical home requirements and discusses the implications of the findings for efforts to support RHC capacity development.
Surgical Services in Critical Access Hospitals, 2011
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2015
This brief describes the types and volume of major surgical services provided in critical access hospitals across four regionally representative states in 2011.
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.
Financially Fragile Hospitals: Mergers and Closures
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2015
Evaluates the causes of financial stress in rural hospitals, and describes the impact rural hospitals have on their communities. Also discusses the ways in which rural hospitals and communities have responded to this financial stress.
The Effect of Surgery on the Profitability of Rural Hospitals
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 2015
Presents research on the effect of providing surgery in rural hospitals. Examines the availability of surgery's effect on trauma outcomes and economies in rural communities.

2014

From Health Care Volume to Health Care Value - Success Strategies for Rural Health Care Providers
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 04/2014
Examines strategies that rural healthcare providers can use to improve healthcare quality for patients.
Trends in Hospital Network Participation and System Affiliation, 2007-2012
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 2014
Network participation and system affiliation are two ways for hospitals to build and/or access necessary capacities to engage in the transformation to an integrated, patient-centered, pay-for-value care delivery model. This brief tracks trends in network participation and system affiliation among U.S. general community hospitals from 2007 to 2012.

2012

The Use of Hospitalists in Small Rural Hospitals
Upper Midwest Rural Health Research Center
Date: 04/2012
This policy brief describes the results of a survey of small rural hospitals that use hospitalists, who are physicians, physician assistants, or nurse practitioners who assume responsibility for patient care during inpatient hospital stays.
Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia
Policy Brief
Upper Midwest Rural Health Research Center
Date: 03/2012
This brief explores the relationship between potentially preventable readmissions and use of outpatient follow-up care, discharge destination, rural versus urban patients, and time to follow-up care. These factors were examined in a large population of Medicare patients with hospital stays for congestive heart failure or bacterial pneumonia.
Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia (Final Report)
Upper Midwest Rural Health Research Center
Date: 03/2012
This study explored the relationship between potentially preventable readmissions and use of outpatient follow-up care, discharge destination, rural versus urban residence of the patient, and time to follow-up care.
Lower Rehospitalization Rates Among Rural Medicare Beneficiaries With Diabetes
Journal Article
University of South Carolina Rural Health Research Center
Date: 2012
Evaluates 30-day readmission rates of Medicare beneficiaries with diabetes in rural areas.

2011

Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients
Policy Brief
Upper Midwest Rural Health Research Center
Date: 09/2011
This report assesses the challenges and consequences for rural providers and patients of implementing bundled payments for acute and post-acute care episodes; explores impacts on care quality under a facility-physician bundled payment system; and describes potential modifications to bundling proposals and steps that could address rural issues.
Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions in the United States, by Insurance Type, 2000 to 2004
RUPRI Center for Rural Health Policy Analysis
Date: 08/2011
In this policy brief, we report findings from a study that used nationwide hospital inpatient discharge data to examine the trends and regional variations of rural hospital charges due to ambulatory care sensitive conditions in the United States, by insurance type, from 2000 to 2004.
Care Transitions: "Time to Come Home"
Policy Brief
Upper Midwest Rural Health Research Center
Date: 03/2011
This policy brief examines care coordination, with a focus on the transitions from inpatient care back to the rural community, and suggests ways of measuring the quality of care coordination on discharge from the hospital.
Care Transitions: "Time to Come Home" (Full Report)
Upper Midwest Rural Health Research Center
Date: 03/2011
This report looks at care coordination for rural patients, with a focus on transitions from inpatient care back to the rural community, and suggests ways of measuring the quality of care coordination on discharge from the hospital.

2010

Nurse Staffing and Rural Hospital Performance
Policy Brief
Upper Midwest Rural Health Research Center
Date: 12/2010
This policy brief examines the impact of nurse staffing on rural hospital performance improvement in the CMS/Premier Inc. Hospital Quality Incentive Demonstration project.
Geographic Differences in Potentially Preventable Readmission Rates in Rural and Urban Hospitals (Final Report)
Upper Midwest Rural Health Research Center
Date: 11/2010
Potentially preventable readmissions (PPRs) among Medicare patients are examples of inefficiencies in the healthcare system. This study estimated PPRs in three types of acute care hospitals: urban prospective payment system (PPS), rural PPS, and Critical Access Hospitals.
The Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006
Policy Brief
Upper Midwest Rural Health Research Center
Date: 10/2010
This policy brief uses a retrospective analysis of data on rural hospital, ambulatory surgery center (ASC), and market characteristics for the years 1997 through 2006 to assess the impact of freestanding ASCs on rural hospital performance.
The Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006 (Final Report)
Upper Midwest Rural Health Research Center
Date: 10/2010
This policy brief describes the impact of ambulatory surgery centers on rural hospital markets.
Patient Assessments and Quality of Care in Rural Hospitals
Policy Brief
Upper Midwest Rural Health Research Center
Date: 06/2010
This policy brief analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care.
Patient Assessments and Quality of Care in Rural Hospitals (Final Report)
Upper Midwest Rural Health Research Center
Date: 06/2010
This report analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences. It assesses whether rural patients' perspectives of quality of care are related to quality measures focused on the provision of recommended care for medical conditions.
Alternatives to the Outpatient Prospective Payment System: Assessing the Impact on Rural Hospitals
NORC Walsh Center for Rural Health Analysis
Date: 04/2010
The purpose of this policy brief is to explore alternatives to the outpatient prospective system and how these options would affect rural hospitals.
Quality of Care for Acute Myocardial Infarction: Are the Gaps Between Rural and Urban Hospitals Closing?
Policy Brief
WWAMI Rural Health Research Center
Date: 03/2010
Overall, there has been improvement in acute myocardial infarction quality measures and persistent rural-urban disparities in only a few. Particularly in small/remote small rural locations, developing strategies to increase use of beneficial discharge medications is important.
Quality of Care for Myocardial Infarction in Rural and Urban Hospitals
Journal Article
WWAMI Rural Health Research Center
Date: 2010
In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted.

2009

Potentially Preventable Readmissions in Rural Hospitals
Policy Brief
Upper Midwest Rural Health Research Center
Date: 08/2009
Using 3-M algorithm software and Medicare inpatient claims data from five states, this brief examines potentially preventable readmission rates for rural and urban hospitals and discusses the rural implications of policy initiatives to reduce readmission rates.
Health Information Technology Policy and Rural Hospitals
Policy Brief
Upper Midwest Rural Health Research Center
Date: 06/2009
This brief summarizes the implementation status of key health information technology (HIT) applications in critical access hospitals and other rural hospitals and discusses policies for encouraging HIT adoption in rural hospitals.
Rural Issues Related to Bundled Payments for Acute Care Episodes
Policy Brief
Upper Midwest Rural Health Research Center
Date: 06/2009
Bundling Medicare payments has been proposed as a way of encouraging providers to find innovative, cost-reducing strategies to provide better coordinated care. This brief describes challenges to implementing bundled payments in rural settings and discusses potential contracting and reimbursement strategies to address the challenges.
Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety
Policy Brief
Upper Midwest Rural Health Research Center
Date: 03/2009
This policy brief describes successful telepharmacy activities being implemented in rural hospitals and analyzes policy issues related to the implementation of telepharmacy projects in rural hospitals.
Achieving Success in QIO and Rural Hospital Partnerships (Final Report)
NORC Walsh Center for Rural Health Analysis
Date: 02/2009
This report describes four case studies that highlight the strategies employed by Quality Improvement Organizations (QIOs) to help small rural hospitals implement successful quality-improvement initiatives.

2008

Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Final Report)
Upper Midwest Rural Health Research Center
Date: 12/2008
Findings from this report describe successful telepharmacy activities being implemented in rural hospitals and analyze policy issues related to the implementation of telepharmacy projects in rural hospitals.
Electronic Health Records Adoption: Rural Providers' Decision-Making Process
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 10/2008
This brief reports findings of a study that examined the decision-making process that small rural physician clinics and hospitals use as they investigate and select an electronic health record system.
Far From the City: Community Orientation and Responsiveness of Rural Hospitals
Upper Midwest Rural Health Research Center
Date: 05/2008
This policy brief reports the findings of a national study focused on variation in hospital community orientation and responsiveness across differing rural contexts.
Prevalence of Evidence-Based Safe Medication Practices in Small Rural Hospitals
RUPRI Center for Rural Health Policy Analysis
Date: 04/2008
This issue brief presents the findings of a national survey whose purpose was to describe the prevalence of evidence-based, safe medication practices, including the use of voluntary medication error reporting, in the nation's smallest hospitals.
Critical Access Hospitals' Experience With Medicare Advantage Plans
NORC Walsh Center for Rural Health Analysis, RUPRI Center for Rural Health Policy Analysis
Date: 03/2008
This report details findings from a survey of 60 critical access hospital (CAH) administrators regarding their experiences with Medicare Advantage plans.

2007

National Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions
RUPRI Center for Rural Health Policy Analysis
Date: 12/2007
This policy brief documents the national magnitude of charges associated with hospitalizations due to ambulatory care sensitive conditions in rural hospitals.
Regional Variation in Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 12/2007
This policy brief estimates and documents the regional magnitude of charges associated with hospitalizations due to ambulatory care sensitive conditions in rural hospitals.
Implementing Patient Safety Initiatives in Rural Hospitals: An Evaluation of the Tennessee Rural Hospital Patient Safety Demonstration
Upper Midwest Rural Health Research Center
Date: 08/2007
The Tennessee Rural Hospital Patient Safety Demonstration project included the implementation of three patient-safety initiatives in eight rural Tennessee hospitals using a collaborative model and an evaluation of the process and tools used in the implementation to inform future rural patient safety initiatives.
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.
How Will Elimination of Hospital Bad Debt Reimbursement Affect Rural PPS Hospitals?
Policy Brief
NORC Walsh Center for Rural Health Analysis
Date: 07/2007
This policy brief examines the financial effect that changes in current Medicare bad debt payment policy, as proposed in the FY2007 budget, might have on rural hospitals.
Ambulatory Care Sensitive Condition Hospitalizations Among Rural Children (Brief)
Upper Midwest Rural Health Research Center
Date: 06/2007
This brief reports results from a study examining children's inpatient hospitalizations for ambulatory care sensitive conditions, rural residence, poverty, health insurance, and physician supply. Admission rates were examined for asthma, diabetes short-term complications, gastroenteritis, urinary tract infection, and perforated appendix.
Does Hospital Size Affect Our Ability to Accurately Identify High Quality Care in Pay-for-Performance Programs?
Upper Midwest Rural Health Research Center
Date: 05/2007
This policy brief discusses whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings.
Small, Stand-Alone, and Struggling: The Adoption of Health Information Technology by Rural Hospitals
Policy Brief
NORC Walsh Center for Rural Health Analysis
Date: 04/2007
This policy brief reports findings from a national survey of rural hospitals designed to investigate how differences among the hospitals affect their implementation of health information technology.
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.
Hospital Size, Uncertainty and Pay-for-Performance
Upper Midwest Rural Health Research Center
Date: 02/2007
This report examines whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings.
Small, Stand-Alone, and Struggling: The Adoption of Health Information Technology by Rural Hospitals (Working Paper)
NORC Walsh Center for Rural Health Analysis
Date: 02/2007
This paper reports the full findings from a national survey of rural hospitals designed to investigate how differences among the hospitals affect their implementation of health information technology.

2006

Prioritizing Patient Safety Interventions in Small Rural Hospitals
Journal Article
Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
Date: 12/2006
Determines if 26 patient safety practices recommended by an expert panel as relevant to rural hospitals would be validated in terms of rural relevance and implementability by administrators and quality managers. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
Implementation of Pay-for-Performance in Rural Hospitals: Lessons From the Hospital Quality Incentive Demonstration Project
Policy Brief
Upper Midwest Rural Health Research Center
Date: 11/2006
This paper provides an overview of findings of a national study to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration project.
Implementation of Pay-for-Performance in Rural Hospitals: Lessons From the Hospital Quality Incentive Demonstration Project (Full Report)
Upper Midwest Rural Health Research Center
Date: 09/2006
This report shares the findings of a national study designed to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration Project.
The Effect of Rural Hospital Closures on Community Economic Health
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2006
This article describes the effect of hospital closures on the local economies based on a study of county-level economic data for 1990-2000 in rural counties experiencing hospital closures.
Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Brief)
Policy Brief
Upper Midwest Rural Health Research Center
Date: 01/2006
This study's results indicate that many small rural hospitals have limited hours of onsite pharmacist coverage and many either don't have a pharmacy computer or don't use it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
Pharmacist Staffing, Technology Use and Implementation of Medication Safety Practices in Rural Hospitals
Journal Article
Upper Midwest Rural Health Research Center
Date: 2006
Reports the capacity of small rural hospitals to implement medication safety practices, with a focus on pharmacist staffing and the availability of technology.
Rural Hospitals and Long-Term Care: the Challenges of Diversification and Integration Strategies
Maine Rural Health Research Center
Date: 2006
There are many contemporary challenges experienced by older rural residents and their communities in accessing and providing services. However, the issue is not in comparing rural older adults to their urban counterparts; rather, it is that rural people have unique characteristics that must be considered when planning and providing services.
Smallest Rural Hospitals Treat Mental Health Emergencies
Maine Rural Health Research Center
Date: 2006
This research and policy brief discusses the extent to which rural emergency rooms encounter and treat mental health patients.

2005

Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
Upper Midwest Rural Health Research Center
Date: 12/2005
This study's results show that many small rural hospitals have limited hours of onsite pharmacist coverage and a significant number don't have a pharmacy computer or don't use one for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
Assessing the Financial Effect of Medicare Payment on Rural Hospitals: Does the Source of Data Change the Results?
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2005
This policy brief explores how predictions of changes in hospital financial performance differ when comparing results using data from the Medicare Cost Report (MCR) to data from the audited hospital financial statement (FS). Results indicate that using the MCR rather than FS data is more valid.
Washington State Hospitals: Results of the 2005 Workforce Survey
WWAMI Rural Health Research Center
Date: 10/2005
A survey of nonfederal acute care hospitals found growth in Washington's hospital sector is keeping demand for healthcare occupations high, even when vacancy rates for some jobs appear to be lower than in the past. This growth, and the shift away from contracting employees, should be considered in future workforce supply and demand projections.
Revisions to Medicare's Disproportionate Share Payment Policy to Incorporate Bad Debt and Charity Care
NORC Walsh Center for Rural Health Analysis
Date: 09/2005
This report investigates the impact of possible changes to the Medicare disproportionate share payment policy, designed to incorporate information on the hospital's uncompensated care burden as well as to improve the payment formulae.
Rural Health Research in Progress in the Rural Health Research Centers Program, 9th Edition
Maine Rural Health Research Center
Date: 02/2005
This book provides policymakers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current that affects rural health services and populations.
Comparing Patient Safety in Rural Hospitals by Bed Count
Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
Date: 2005
This report shares the results of a study to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals.

2004

Exploring the Impact of Medicare's Post-Acute Care Transfer Payment Policy on Rural Hospitals
NORC Walsh Center for Rural Health Analysis
Date: 07/2004
This policy analysis brief describes a change in Medicare post-acute transfer payment policy and its impact on rural and urban hospitals. It includes data on the financial impact and hospital discharge behavior before and after the change.
An Analysis of the Agreement of Financial Data Between the Medicare Cost Report and the Audited Hospital Financial Statement
RUPRI Center for Rural Health Policy Analysis
Date: 05/2004
Few studies have examined the discrepancies between the Medicare Cost Report (MCR) and the audited hospital financial statement (FS). Findings from this study, which focused on the MCR and FS for rural hospitals, suggest that relying on a single source of financial data to assess the financial performance of rural hospitals may be inappropriate.
Perspectives of Rural Hospitals on Bioterrorism Preparedness Planning
NORC Walsh Center for Rural Health Analysis
Date: 04/2004
Representatives from several rural hospitals met to discuss various aspects of bioterrorist preparedness in terms of workforce and training, physical capacity and supplies, communication, and coordination with other entities.
Understanding the Role of the Rural Hospital Emergency Department in Responding to Bioterrorist Attacks and Other Emergencies: A Review of the Literature and Guide to the Issues
NORC Walsh Center for Rural Health Analysis
Date: 04/2004
This report reviews issues affecting rural hospitals' levels of readiness for a bioterrorist attack. Issues examined include physical capacity, sufficiency of health personnel, preparedness plans, disease surveillance systems, and communication/coordination. Concerns about funding cut across all the issues of preparedness.
Rural Hospitals' Strategies for Achieving Compliance With HIPAA Privacy Requirements
NORC Walsh Center for Rural Health Analysis
Date: 03/2004
Rural hospitals in this study recognized the importance of ensuring the confidentiality of patient health information and have made substantial progress in achieving compliance with HIPAA privacy standards. Each recognized that additional work will be required to effectively secure patient privacy.
Rural Health Research in Progress in the Rural Health Research Centers Program, 8th Edition
Maine Rural Health Research Center
Date: 02/2004
This book provides policy makers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current and proposed that affects rural health services and populations.
Financially Distressed Rural Hospitals in Four States
NORC Walsh Center for Rural Health Analysis
Date: 01/2004
The effect of the outpatient prospective payment system on the financial performance of rural hospitals was simulated in four states: Iowa, Texas, Washington, and West Virginia.
Quality of Care for Acute Myocardial Infarction in Rural and Urban U.S. Hospitals
Journal Article
WWAMI Rural Health Research Center
Date: 2004
Acute myocardial infarction (AMI) is a common and important cause of admission to rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. This study examines the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers.

2003

Rural Hospitals' Strategies for Achieving Compliance With HIPAA Privacy Regulations: Case Studies of Rural Hospitals
NORC Walsh Center for Rural Health Analysis
Date: 08/2003
Rural hospitals in this study recognized the importance of ensuring the confidentiality of patient health information and have made substantial progress in achieving compliance with HIPAA privacy standards. Each recognized that additional work will be required to effectively secure patient privacy.
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.
Rural Hospital HIPAA Readiness and Resource Needs
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2003
This rural policy brief presents a survey of rural hospitals regarding the extent of their preparation for HIPAA requirements and their need for resources to implement them.
2003 Index of Hospital Quality
NORC Walsh Center for Rural Health Analysis
Date: 2003
Published annually by U.S. News & World Report, this report describes a series of factors regarding ranking of measuring hospital quality.

2002

Capital Needs of Small Rural Hospitals
NORC Walsh Center for Rural Health Analysis
Date: 05/2002
This report examines the capital situation of rural hospitals with fewer than 50 beds to determine the total cost of bringing each facility into compliance with current laws, as well as the facilities' cost of borrowing and ability to borrow.
Variance in the Profitability of Small-Town Rural Hospitals (Policy Brief)
NORC Walsh Center for Rural Health Analysis
Date: 04/2002
This policy brief discusses why some rural small-town hospitals are financially successful and others struggle with persistent financial difficulties.
Variance in the Profitability of Small-Town Rural Hospitals (Full Report)
NORC Walsh Center for Rural Health Analysis
Date: 02/2002
This report documents the variance in profitability among small-town rural hospitals and evaluates the characteristics that distinguish highly profitable small-town hospitals from struggling ones. It also reports on strategies that small-town hospital administrators are using to achieve financial success.

2001

Is the Rural Safety Net at Risk? Analyses of Charity and Uncompensated Care Provided by Rural Hospitals in Washington, West Virginia, Texas, Iowa, and Vermont
NORC Walsh Center for Rural Health Analysis
Date: 01/2001
This study examines recent trends in the provision of charity care and uncompensated care by rural hospitals in five states. It also identifies rural communities whose charity and uncompensated care may diminish if their hospitals face more intense financial pressures as a result of the Balanced Budget Act.
Will the Outpatient Prospective Payment System Increase the Number of Distressed Rural Hospitals in Iowa, Texas, Washington, and West Virginia?
NORC Walsh Center for Rural Health Analysis
Date: 01/2001
This study simulates the financial impact of the outpatient prospective payment system rates and estimates the number and type of rural hospitals in the five states likely to become financially distressed as a result of its implementation.

2000

Data Sources for Studying Uncompensated Care Provided by Rural Hospitals
NORC Walsh Center for Rural Health Analysis
Date: 08/2000
This policy analysis brief discusses data sources related to hospitals' provision of charity and uncompensated care.
Calculating and Using the Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 06/2000
This policy brief explains how the area wage index is calculated and used and identifies the major unresolved issues related to its calculation and use.
Emergency Department Use by the Rural Elderly
Journal Article
WWAMI Rural Health Research Center
Date: 2000
This study uses Medicare data to compare emergency department (ED) use by rural and urban elderly beneficiaries. Given the similarity of diagnostic conditions associated with ED visits, rural EDs must be capable of dealing with the same range of emergency conditions as urban EDs.