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Rural Health
Research Gateway

Hospitals and clinics

Research Products & Journal Articles

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

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

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

2024

  • 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.
  • News Media Coverage of Rural Hospital Closures and the Causes
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 10/2024
    This study augments previous research with findings from a structured framework of attributed causes of rural hospital closures through the analysis of news media reports.
  • 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.
  • The Low-Volume Hospital Adjustment Before and During COVID-19
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2024
    This brief uses current low-volume hospital adjustment qualifying criteria to compare low-volume hospitals to other rural hospitals and explores the effect of removing the adjustment before COVID-19 and during COVID.
  • 2018-23 Profitability of Rural and Urban Hospitals by Medicare Payment Designation
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 06/2024
    This study compares profitability of three types of hospitals in both urban and rural locations: Critical Access Hospitals, Prospective Payment System-only (PPS) hospitals by number of acute beds, and PPS hospitals with special payment designations hospitals over a five-year period.
  • 2018-23 Profitability of Rural Hospitals by Ownership and System Affiliation
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 06/2024
    This study compares the 2018-23 profitability of rural hospitals based on ownership and system affiliation status. The purpose of this brief is to describe the profitability of rural hospitals over a five-year period consisting of two years before and three years after COVID-19.
  • 2018-23 Profitability of Rural Hospitals by With and Without Rural Health Clinics and Long-Term Care
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 06/2024
    This study compares the 2018-23 profitability of rural hospitals for hospitals that provide and do not provide long-term care, and that operate and do not operate rural health clinics.
  • Differences in Measurement of Operating Margin: An Update
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 05/2024
    This study uses recent Medicare Cost Report data to compare rural and urban hospitals using the three definitions for operating margin. Researchers assess the distribution and extent of extreme values of operating margin.
  • 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.
  • Using the Updated Financial Distress Index to Describe Relative Risk of Hospital Financial Distress
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2024
    Using a recent revision of the Financial Distress Index (FDI) model, this study aimed to describe the relative risk of experiencing financial distress for rural hospitals and selected urban hospitals.
  • COVID-19 Affected Rural and Urban Hospital Uncompensated Care
    Fact Sheet
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2024
    The purpose of this infographic is to illustrate the impact COVID-19 had on uncompensated care and operating margin among rural and urban hospitals.
  • A Comparison of 2017-19 Uncompensated Care of Rural and Urban Hospitals by Net Patient Revenue, System Affiliation, and Ownership
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2024
    The purpose of this study is to better understand patterns of uncompensated care. It extends a 2018 study of geographic variation in uncompensated care between rural and urban hospitals. Specifically, researchers investigate the association of uncompensated care with net patient revenue, system affiliation, and ownership.

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.
  • Characteristics of Short-Term Acute Care Hospitals That Experienced a Ransomware Attack From 2016 to 2021
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 08/2023
    Ransomware is a type of malicious software designed to block access to a computer system until a sum of money is paid. In this paper, researchers compare the characteristics (including rurality) of ransomware-attacked and non-attacked hospitals in the U.S. in order to understand which hospitals may be most vulnerable to cybercrime.
  • 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.
  • Rural and Urban Differences in Insurance Coverage at Prepregnancy, Birth, and Postpartum
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 03/2023
    In this manuscript, the research team used data from the Pregnancy Risk Assessment Monitoring System to measure insurance coverage at prepregnancy, birth, and postpartum, and insurance coverage continuity across these periods among rural and urban U.S. residents.

2022

2021

  • Medicare Covers a Lower Percentage of Outpatient Costs in Hospitals Located in Rural Areas
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 09/2021
    The purpose of this brief is to describe differences in Medicare Outpatient Prospective Payment System (OPPS) payments between rural and urban hospitals by Medicare payment classification and by number of acute beds.
  • 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.
  • How Many Hospitals Might Convert to a Rural Emergency Hospital?
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2021
    In this study, three measures were used to predict the number of rural hospitals with 50 beds or less that are likely to consider conversion to a Rural Emergency Hospital: 1) three years negative total margin; 2) average daily census (acute + swing) less than three; and 3) net patient revenue less than $20 million.
  • Changes in Provision of Selected Services by Rural and Urban Hospitals Between 2009 and 2017
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2021
    The purpose of this study is to gain a better understanding of recent trends in hospital service provision and whether there were disparities between rural and urban hospitals. This brief describes and compares the changes in service provision for rural and urban hospitals between 2009 and 2017.
  • Alternatives to Hospital Closure: Findings From a National Survey of CAH Executives
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2021
    Despite the many challenges of operating a Critical Access Hospital (CAH), little research examines the perspectives of CAH executives on potential community healthcare options if the CAH closed. This brief provides policymakers with a better understanding of what CAH executives think about the viability of various alternatives to closure.
  • Health System Challenges for Critical Access Hospitals: Findings From a National Survey of CAH Executives
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2021
    Despite the numerous challenges of operating a Critical Access Hospital (CAH), there is little research examining the perspectives of CAH executives on potential community healthcare options if the CAH closed. This brief presents a subset of results from a national survey of CAH executive perspectives on pressing challenges.
  • 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.
  • Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 11/2020
    As increasing numbers of rural hospitals stop offering maternity care, limited information is available about local preparedness to address obstetric emergencies. This paper explores the capacity to treat obstetric emergencies encountered among rural hospitals without obstetric units.
  • 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.
  • Urban Hospitals With a High Percentage of Inpatient Days for Rural Patients
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 09/2020
    The purpose of this brief is to describe characteristics of urban hospitals with a high percentage of inpatient days for rural patients and to compare how they differ from urban hospitals with lower percentages of rural inpatient days.
  • Characteristics of U.S. Rural Hospitals by Obstetric Service Availability, 2017
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 08/2020
    This study described characteristics of rural U.S. hospitals by whether they provide labor and delivery care for pregnant patients. Researchers used the 2017 American Hospital Association Annual Survey to identify rural hospitals and detail their characteristics based on whether they provide obstetric services.
  • Changes in Care-Seeking After Rural Hospitals Merge
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2020
    Rural hospital mergers have increased significantly since 2010. Enhanced financial performance and improved quality are often cited as benefits, but hospital mergers can also lead to changes in the services provided by acquired hospitals. This brief estimates the use of inpatient services delivered by acquired rural hospitals following a merger.
  • Changes in Hospital-Based Obstetric Services in Rural U.S. Counties, 2014-2018
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 07/2020
    In 2014, 54% of rural U.S. counties had no hospital-based obstetric services, following a steady decrease during the previous decade. Loss of rural maternity care is tied to adverse maternal and infant health outcomes. This study shares hospital-based obstetric service losses in rural U.S. counties from 2014 to 2018.
  • Estimated Reduction in CAH Profitability From Loss of Cost‐Based Reimbursement for Swing Beds
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2020
    The purpose of this study was to estimate the impact of potential loss of cost-based reimbursement for swing beds on Critical Access Hospital (CAH) profitability and to examine the characteristics of CAHs that would be most affected by such a change in reimbursement.
  • Most Rural Hospitals Have Little Cash Going Into COVID
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2020
    This infographic uses Medicare Cost Report data to illustrate the type of rural hospitals most likely to struggle financially during the pandemic as measured by lower median days cash on hand.
  • 2016-18 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2020
    This study compares the 2016-18 profitability of urban Prospective Payment System (PPS) hospitals to that of rural hospitals. Rural hospitals are further divided by size of rural PPS hospitals and by the rural Medicare payment classifications.
  • Rural Hospitals With Long-Term Unprofitability
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 04/2020
    The purpose of this study is to examine the characteristics of rural hospitals that had negative total margins in 2016, 2017, and 2018. We examined net patient revenue, Medicare payment classification, region, and state for 311 rural hospitals.
  • Understanding the Broader Context of Rural Hospitals and Profitability
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 04/2020
    The intent of this infographic is to quantify rural hospital profitability in the broader context of all hospitals. This infographic compares the number of rural and urban hospitals and rural and urban operating revenue and operating income.

2019

2018

2017

2016

2015

2014

2012

2011

2010

2009

  • Implementing Patient Safety Initiatives in Rural Hospitals
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 09/2009
    This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for patient safety initiatives in eight small Tennessee rural hospitals using a multi-organizational collaborative model. The demonstration identified and facilitated implementation of three patient safety interventions.
  • 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

2007

2006

2005

2004

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

2000