Telehealth: Rural Health Research Products & Journal Articles

2024

Understanding the Rise of Ransomware Attacks on Rural Hospitals
Policy Brief
University of Minnesota Rural Health Research Center
Date: 06/2024
This policy brief presents findings from a novel database of hospital ransomware attacks, focusing on the frequency and characteristics of ransomware attacks on rural hospitals.
Satisfaction With Care Among Cancer Survivors With Medicare Coverage: Are There Rural vs. Urban Inequities?
Journal Article
Rural and Underserved Health Research Center
Date: 03/2024
This article examines satisfaction with health care among rural vs urban Medicare cancer survivors. Researchers looked at nine dimensions of health care and tested for rural/urban differences, adjusting for demographic factors, health insurance, and self-rated health.

2023

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.
Eight Postpartum Support Programs in Rural Communities Across the United States
University of Minnesota Rural Health Research Center
Date: 08/2023
This case study series highlights locally focused organizations working to improve postpartum health for rural residents across the United States. Interviews were conducted with eight unique organizations working in their local rural communities to support postpartum health.
Two National-Level Organizations Supporting Rural Postpartum Health Across the United States
University of Minnesota Rural Health Research Center
Date: 07/2023
The purpose of this case study series is to highlight national-level organizations working in innovative ways to improve postpartum health for rural residents across the United States. These may serve as examples to others considering this work.

2022

Rural and Urban Pharmacy Presence – Pharmacy Deserts
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 08/2022
This policy brief continues the RUPRI Center's ongoing examination of the availability of community pharmacies and their provided services in rural areas of the U.S. The brief also provides a deeper analysis of counties with no retail pharmacies (i.e. pharmacy deserts) based on metropolitan/nonmetropolitan locations.

2021

Implementation of Telehealth Services in Rural Schools: A Qualitative Assessment
Journal Article
Rural Telehealth Research Center
Date: 11/2021
This study explores facilitators and barriers to implementation of telehealth programs in rural schools and identifies strategies for successful implementation to inform future school-based telehealth initiatives. Researchers conducted semi-structured interviews with 50 key personnel involved in the School-Based Telehealth Network Grant Program.
Using CPT Charges as an Economic Proxy for Telehealth and Non-Telehealth Emergency Department Utilization
Policy Brief
Rural Telehealth Research Center
Date: 11/2021
This brief examines economic data on emergency department visits from unrelated rural hospitals. By using the reported Current Procedural Terminology code and associated charge, we explore the characteristics of the resulting dataset in terms of distribution and association with related variables.
HRSA's Evidence-Based Tele-Emergency Network Grant Program: Multi-Site Prospective Cohort Analysis Across Six Rural Emergency Department Telemedicine Networks
Journal Article
Rural Telehealth Research Center
Date: 01/2021
The Health Resources and Services Administration funded six grantees to provide telehealth services in rural emergency departments (tele-ED) and gather data for the telehealth evidence base. This paper examines trends across multiple tele-ED networks and heterogeneity in processes and outcomes.

2020

Telehealth Use in a Rural State: A Mixed Methods Study Using Maine's All-Payer Claims Database
Journal Article
Rural Telehealth Research Center
Date: 10/2020
This study examines trends in telehealth use in Maine and identifies barriers and facilitators to its adoption. While telehealth appears to improve access to behavioral health and speech therapy services, provider shortages, lack of broadband, and restrictive Medicare and commercial coverage plans limit telehealth services use in rural areas.
Telebehavioral Health Use Among Rural Medicaid Beneficiaries: Relationships With Telehealth Policies
Journal Article
Rural Telehealth Research Center
Date: 09/2020
This study assesses policy levers potentially supporting sustained use of telehealth services. Among rural Medicaid fee-for-service beneficiaries with behavioral health needs, engaging patients through informed consent within provider settings that receive facility fees may facilitate improved access to telebehavioral health services.
Averted Transfers in Rural Emergency Departments Using Telemedicine: Rates and Costs Across Six Networks
Journal Article
Rural Telehealth Research Center
Date: 08/2020
In a cohort of 4,324 tele-ED cases across 26 months in 65 hospitals in 6 tele-ED networks, 20% were averted transfers, and 43% of those were then routinely discharged rather than being transferred. Averted transfers saved on average $2,673 in avoidable transport costs per patient, with 63.6% of these cost savings accruing to public insurance.
Telepharmacy Rules and Statutes: A 3-Year Update for All 50 States
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 07/2020
This policy brief analyzed administrative rules and legislative statutes governing each state's pharmacy practice. Key features of telepharmacy regulations were investigated for comparative analysis. Twenty-one states currently authorize retail telepharmacy, but between these states the regulatory activity varies considerably.
Process of Identifying Measures and Data Elements for the HRSA School-Based Telehealth Network Grant Program
Policy Brief
Rural Telehealth Research Center
Date: 06/2020
This brief details work to identify measures and develop data elements appropriate to school-based telehealth, create an Excel-based tool, and systematically collect data from grantees in the Health Resources and Services Administration's School-Based Telehealth Network Grant Program.
Measure and Data Element Identification for the HRSA Evidence-Based Tele-Behavioral Health Network Program and the HRSA Substance Abuse Treatment Telehealth Network Grant Program
Policy Brief
Rural Telehealth Research Center
Date: 04/2020
This brief details work to identify measures and develop data elements appropriate to tele-behavioral health, create an Excel-based tool, and collect data from grantees in the Health Resources and Services Administration's Evidence-Based Tele-Behavioral Health Network Grant Program and Substance Abuse Treatment Telehealth Network Grant Program.
Identifying Measures and Data Elements for the HRSA Evidence-Based Tele-Emergency Network Grant Program
Policy Brief
Rural Telehealth Research Center
Date: 03/2020
This brief details multi-project work to identify measures and develop data elements appropriate to emergency department-based telehealth, create an Excel-based tool, and systematically collect data from grantees in the Health Resources and Services Administration Evidence-Based Tele-Emergency Network Grant Program.
Emergency Department Telemedicine Consults Are Associated With Faster Time-to-ECG and Time-to-Fibrinolysis for Myocardial Infarction Patients
Journal Article
Rural Telehealth Research Center
Date: 02/2020
Acute myocardial infarction (AMI) is a common, deadly emergency requiring rapid diagnosis and treatment. In this rural cohort, emergency department-based telemedicine was associated with improved timeliness of electrocardiogram and fibrinolysis. This study adds to evidence that telemedicine can improve timeliness of AMI care in rural hospitals.
Provider-to-Provider Telemedicine Improves Adherence to Sepsis Bundle Care in Community Emergency Departments
Journal Article
Rural Telehealth Research Center
Date: 01/2020
Sepsis is a life-threatening emergency, and timely "bundled" care improves survival. In this rural cohort, telemedicine in the emergency department (tele-ED) improved sepsis bundle adherence, including timely fluid resuscitation and antibiotic administration. Tele-ED may be a scalable intervention to improve sepsis emergency care in rural EDs.

2019

Strategic Choice in Developing Telemedicine - Observations From Three Organizations
Report
RUPRI Center for Rural Health Policy Analysis
Date: 12/2019
Advances in technology have made it easier to provide telemedicine services, but the actual value of telemedicine programs for health systems providing those services or for patients has not been firmly established. This paper explores organizational motivations of three large health systems for incorporating telemedicine patient care services.
The Development of Telehealth Laws in the U.S. from 2008 to 2015: A Legal Landscape
Policy Brief
Southwest Rural Health Research Center
Date: 11/2019
This study examines the scope and evolving nature of telehealth statutes and regulations in the U.S. Our research aims to understand changes in telehealth laws over time (2008-2015), variations in legal frameworks established across the U.S., and the extent that state laws regulate the primary care delivery through the use of telehealth.
Emergency Department Telemedicine Consults Decrease Time to Interpret Computed Tomography of the Head in a Multi-Network Cohort
Journal Article
Rural Telehealth Research Center
Date: 11/2019
This was a study of emergency telemedicine (tele-ED) for stroke care in four tele-ED networks. Tele-ED was associated with decreased time to diagnostic imaging interpretation and time to thrombolytic medication. The effect of tele-ED varied by network, suggesting network characteristics may influence the realized tele-ED benefit for stroke care.
Tele-Emergency Behavioral Health in Rural and Underserved Areas
Journal Article
Rural Telehealth Research Center
Date: 11/2019
This paper describes how two distinct tele-emergency department (ED) behavioral health models address challenges in access and placement for patients in rural and underserved areas presenting to EDs. The notable difference in disposition rates between cases and controls shows the impact each model is having on care practices and processes.
Pediatric Tele-Emergency Care: A Study of Two Delivery Models
Journal Article
Rural Telehealth Research Center
Date: 04/2019
This study describes two tele-emergency programs that provide care to pediatric populations. Qualitative descriptions of the two tele-emergency department (ED) models and key characteristics of the patient populations served by tele-ED are presented. The study informs others about evaluative measures and how tele-ED works in practice.

2018

Patterns of Telehealth Use Among Rural Medicaid Beneficiaries
Journal Article
Rural Telehealth Research Center
Date: 10/2018
This study uses data from the 2011 Medicaid Analytic eXtract (MAX) to examine the prevalence of telehealth use among rural and urban Medicaid beneficiaries, characteristics of telehealth users, types of telehealth services provided, and diagnoses associated with telehealth use.
Implementation Strategies for Telestroke: A Qualitative Study of Telestroke Networks in North Carolina
Journal Article
Rural Telehealth Research Center
Date: 09/2018
Through semi-structured interviews with 24 telestroke representatives, this study examines the adoption decision process and strategies employed during telestroke network development, implementation, and sustainability. We found differences across networks in terms of network structure, quality monitoring, and performance feedback.
Telepharmacy Rules and Statutes: A 50-State Survey (Journal Article)
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 05/2018
Peer-reviewed paper identifying state-enacted regulations and legislation authorizing use of community telepharmacy initiatives and describing implications for patients in underserved rural communities. Also provides a table listing states that permit telepharmacy, and pilot programs and waivers that enable telepharmacy initiatives.
Telestroke Adoption Among Community Hospitals in North Carolina: A Cross-Sectional Study
Journal Article
Rural Telehealth Research Center
Date: 05/2018
This study identifies community and hospital characteristics associated with the adoption of telestroke among acute care hospitals in North Carolina.
Serum Anion Gap Predicts Lactate Poorly, but May Be Used to Identify Sepsis Patients at Risk for Death: A Cohort Study
Journal Article
Rural Telehealth Research Center
Date: 04/2018
Our study of 4,159 emergency department patients determined anion gap and serum bicarbonate poorly predict changes in lactate and mortality. In resource-limited settings where lactate is unavailable, anion gap ≥ 20 mEq/L may be used to further risk-stratify patients for ongoing sepsis care, but lactate remains a preferred biomarker.

2017

Improving Access to High Quality Sepsis Care in a South Dakota Emergency Telemedicine Network
Policy Brief
Rural Telehealth Research Center
Date: 08/2017
This brief describes an implementation initiative designed to increase use of emergency department-based telemedicine consultation for patients with severe sepsis or septic shock. This initiative is the first step of an analysis to estimate the effect of telemedicine on sepsis care and outcomes.
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.
Telepharmacy Rules and Statutes: A 50-State Survey
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2017
This is summary analysis reviews administrative rules and legislative statutes governing the practice of telepharmacy in all 50 states. Telepharmacy is specifically authorized in 23 states and 16 states have no rules or legislation authorizing telepharmacy. Other states have pilot programs or waivers that would enable telepharmacy.

2016

Telemedicine Penetration and Consultation Among Rural Trauma Patients in Critical Access Hospital Emergency Departments in North Dakota
Policy Brief
Rural Telehealth Research Center
Date: 09/2016
This study describes the penetration of ED-based telemedicine in North Dakota critical access hospitals and its use for rural trauma patients. Investigators showed that telemedicine subscription increased to 81 percent of rural North Dakota hospitals, and 11 percent of patients in a telemedicine-capable ED used telemedicine as part of their care.
Understanding the Business Case for Telemental Health in Rural Communities
Journal Article
Maine Rural Health Research Center
Date: 07/2016
This article describes the current landscape and characteristics of rural telemental health programs and then examines their business case.

2015

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.
The Rural Obstetric Workforce in U.S. Hospitals: Challenges and Opportunities
Journal Article
University of Minnesota Rural Health Research Center
Date: 03/2015
Describes the healthcare and clinician types who are delivering babies in rural hospitals, such as family physicians, general surgeons, obstetricians, and midwives. Discusses the relationship between hospital birth volume and staffing models.

2014

Extent of Telehealth Use in Rural and Urban Hospitals
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2014
This brief provides discussion with statistics on the use of telehealth in rural hospitals and the opportunities telehealth can bring to supporting healthcare in rural communities.

2013

Telemental Health in Today's Rural Health System
Maine Rural Health Research Center
Date: 12/2013
This policy brief describes the organizational setting, services provided, and staff used in 53 telemental rural health programs. It also outlines the opportunities and challenges for telemental health in the rural health system.

2009

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.

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.

2006

Defining the Term "Frontier Area" for Programs Implemented Through the Office for the Advancement of Telehealth
Upper Midwest Rural Health Research Center
Date: 05/2006
This report provides an overview of current frontier definitions and describes the process used to develop a new frontier area definition that could be applied to telehealth programs.
Rural and Frontier Mental and Behavioral Health Care: Barriers, Effective Policy Strategies, Best Practices
Maine Rural Health Research Center
Date: 2006
This report discusses barriers to mental and behavioral health service delivery in rural America. It includes model programs and model policy strategies for rural mental and behavioral healthcare delivery and discusses the roles that telehealth and that the State Offices of Rural Health should play in service delivery.

2002

Essential Research Issues in Rural Health: The State Rural Health Directors' Perspective
NORC Walsh Center for Rural Health Analysis
Date: 03/2002
This policy brief describes the key issues confronting state rural health directors. Issues repeatedly raised by directors from a wide variety of states included workforce, telemedicine, emergency medical services, mental health, and lack of local data.