Upper Midwest Rural Health Research Center

Publications

Alphabetical list. You can also view by publication date.

Access to Health Care for Rural America: Why It Matters
Date: 02 / 2006
Author(s): Mary Wakefield, Brad Gibbens
Citation: Around the Kitchen Table, Issue 14
Topic: Health services
Overview of issues related to rural health care access and the importance of health care access to rural communities.
Ambulatory Care Sensitive Condition Hospitalizations Among Rural Children
Date: 02 / 2007
Author(s): Michelle Casey, Alana Knudson, Michele Burlew, Gestur Davidson
Report Number: Working Paper No. 4
Topics: Children, Chronic diseases and conditions, Hospitals and clinics
Ambulatory care sensitive conditions (ACSCs) are conditions for which inpatient hospital admissions could potentially be avoided through better outpatient care. Using hospital inpatient discharge data from six states, this study examined the relationships between children's inpatient hospitalizations for ACSCs, rural residence, poverty, health insurance, and physician supply. Admission rates for five conditions were examined: asthma, diabetes short-term complications, gastroenteritis, urinary tract infection and perforated appendix. Hospitalization rates for four of the five conditions are significantly higher for children living in rural areas than in urban areas. Condition-specific ACSC hospitalization rates for children also vary significantly across states, even after adjusting for rurality, poverty, uninsurance, and physician supply.
Ambulatory Care Sensitive Condition Hospitalizations Among Rural Children (Brief)
Date: 06 / 2007
Author(s): Michelle Casey, Alana Knudson, Michele Burlew, Gestur Davidson
Report Number: Policy Brief
Topics: Children, Chronic diseases and conditions, Hospitals and clinics
Reports results from a study examining children's inpatient hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs), rural residence, poverty, health insurance, and physician supply. Admission rates for five conditions were examined: asthma, diabetes short-term complications, gastroenteritis, urinary tract infection and perforated appendix.
Analysis of CAH Inpatient Hospitalizations and Transfers: Implications for National Quality Measurement and Reporting
Date: 12 / 2006
Author(s): Michelle Casey, Michele Burlew
Report Number: Flex Monitoring Team Briefing Paper No. 13
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
Care Transitions: "Time to Come Home" (Full Report)
Date: 03 / 2011
Author(s): Shailendra Prasad, Jill M. Klingner, Ira Moscovice
Topics: Health services, Hospitals and clinics, Quality
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.
Care Transitions: “Time to Come Home” (Policy Brief)
Date: 03 / 2011
Author(s): Shailendra Prasad, Jill M. Klingner, Ira Moscovice
Topics: Health services, Hospitals and clinics, Quality
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.
Chronic Disease and Functional Limitation Among American Indian and Alaska Native Elders
Date: 2005
Author(s): Leander McDonald, Richard Ludtke, Kyle Muus
Citation: Journal of Native Aging and Health, November-December 2005
Topics: American Indians and Alaska Natives, Chronic diseases and conditions, Minority health
Reports the results of an analysis of chronic disease's effect on functional limitation from a survey of 7,107 Native elders representing 143 tribes from 77 sites.
Chronic Disease in American Indian/Alaska Native Elders
Date: 2005
Author(s): Patricia L. Moulton, Leander R. McDonald, Kyle J. Muus, Alana D. Knudson, Richard L. Ludtke
Citation: The IHS Primary Care Provider, 30(5), 53-54
Topics: American Indians and Alaska Natives, Chronic diseases and conditions, Minority health
Describes the prevalence of chronic diseases among Native American elders.
Comparing Patient Safety in Rural Hospitals by Bed Count
Date: 2005
Author(s): Stephenie L. Loux, Susan M. C. Payne, Astrid Knott
Citation: Advances in Patient Safety: From Research to Implementation. (Vols. 1-4), (pp. 391-402). Rockville, MD: Agency for Healthcare Research and Quality.
Topics: Hospitals and clinics, Quality
Reports results of a study to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals. The authors found that small rural hospitals had rates of potential patient safety events that were significantly lower than those of large rural hospitals for three of the 19 patient safety indicators (PSIs). The types of services offered by rural hospitals varied significantly according to bed numbers, and the likelihood of an offered service increased as bed counts increased. The types of patients treated by rural hospitals, however, did not vary significantly by bed count. The results suggest that rural hospitals differ substantially by offered services and differ somewhat in PSI rates, relative to bed counts. But given the limited information on patient severity using administrative data, future research should look to develop more effective ways to account for patient severity when measuring patient safety rates among hospitals with varying bed counts.
Defining the Term "Frontier Area" for Programs Implemented through the Office for the Advancement of Telehealth
Date: 05 / 2006
Author(s): University of North Dakota Center for Rural Health
Topics: Defining rural, Frontier health, Telehealth
An expert panel report to the Office for the Advancement of Telehealth, Health Resources and Services Administration, U.S. Department of Health and Human Services. 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.
Do Rural Elders Have Limited Access to Medicare Hospice Services?
Date: 2004
Author(s): Beth A. Virnig, Ira S. Moscovice, Sara B. Durham, Michelle M. Casey
Citation: Journal of the American Geriatrics Society, 52(5), 731-5
Topics: Aging, Hospice and palliative care, Medicare
The authors examined whether there are urban-rural differences in use of the Medicare hospice benefit before death and whether those differences suggest that there is a problem with access to hospice care for rural Medicare beneficiaries. Rates of hospice care before death were negatively associated with degree of rurality. The lowest rate of hospice use, 15.2% of deaths, was seen in rural areas not adjacent to an urban area. The highest rate of use, 22.2% of deaths, was seen in urban areas. Rural areas adjacent to urban areas had an intermediate level of hospice use (17.0% of deaths). Hospices based in rural areas had a smaller number of elderly patients each year than hospices based in urban areas, and were more likely to have very low volumes. The authors conclude that the consistently lower use of Medicare hospice services before death and smaller sizes of rural hospices suggests that the combination of Medicare hospice payment policies and hospice volumes are problematic for rural hospices. Adjusting Medicare payment policies might be a critical step to assure availability of hospice services for terminally ill beneficiaries regardless of where they live.
Does Hospital Size Affect Our Ability to Accurately Identify High Quality Care in Pay-for-Performance Programs?
Date: 05 / 2007
Report Number: Policy Brief
Topics: Hospitals and clinics, Quality
Discusses whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings. A full report is also available.
Factors Associated With Incidence of Inappropriate Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children
Date: 2005
Author(s): Dmitri Poltavski, Kyle Muus
Citation: Journal of Rural Health, 21(3), 272-277
Topics: Children, Emergency medical services (EMS)
An analysis was conducted to identify a set of significant predictors of cases of inappropriate deliveries to acute care facilities with no trauma-center designation of any level. Greater distance (mean = 19.96 miles) to the nearest trauma center and shorter distance traveled by the ambulance squad to the receiving facility (mean = 19.07 miles) corresponded to higher probabilities of mistriage, especially when a child was Native American (16 times more likely) and the transportation was conducted in the winter (9 times more likely).
Far From the City: Community Orientation and Responsiveness of Rural Hospitals
Date: 05 / 2008
Author(s): Walter Gregg, Douglas Wholey
Topics: Health services, Hospitals and clinics
Reports the findings of a national study focused on variation in hospital community orientation and responsiveness across differing rural contexts. Study findings suggest that measures of community orientation and responsiveness differ between urban and rural hospitals, and further research is needed to develop an improved, context specific, model for community benefits.
Geographic Differences in Potentially Preventable Readmission Rates in Rural and Urban Hospitals (Final Report)
Date: 11 / 2010
Author(s): Marilyn G. Klug, Alana Knudson, Kyle Muus
Topic: Hospitals and clinics
Potentially preventable hospital readmissions (PPRs) among Medicare patients are examples of inefficiencies in the health care system. Policymakers are considering efforts to measure and publicly report preventable readmission rates and target hospitals with high rates for improvement by means of payment policy and technical assistance. To help inform the policy debate about readmissions of rural patients, this study estimated PPRs in three types of acute care hospitals: urban prospective payment system (PPS) hospitals, rural PPS hospitals and Critical Access Hospitals (CAHs).
Health Information Technology Policy and Rural Hospitals (Policy Brief)
Date: 06 / 2009
Author(s): Jeffrey McCullough, Michelle Casey, Ira Moscovice
Topics: Health information technology, Hospitals and clinics
Health information technology (HIT) is a key component of plans to reform the health care system. HIT adoption among smaller rural providers has lagged behind larger urban providers, and the vast majority of research on HIT has focused on its adoption and impact in urban institutions. This brief summarizes the implementation status of key HIT applications in Critical Access Hospitals and other rural hospitals, and discusses policies for encouraging HIT adoption in rural hospitals.
Health Insurance Coverage and Access to Health Care for American Indian and Alaska Native Elders
Date: 10 / 2007
Topics: Aging, American Indians and Alaska Natives, Health insurance and the uninsured, Minority health
Policy brief reporting findings from a study assessing health insurance coverage and access to health care among American Indian and Alaska Native elders (Native elders), using data from a national survey that included more than 8,300 Native elders.
Health Risks Factors Among American Indians and Alaska Native Elders
Date: 2006
Author(s): Leander McDonald, Richard Ludtke, Kyle Muus
Citation: Journal of Native Aging and Health, July-August 2006, 1(2), 17-24
Topics: Aging, American Indians and Alaska Natives, Minority health
Chronic disease rates are higher among American Indian and Alaska Native elders although they exercise more and have higher rates of participation in multiple exercise activities. Research concerning the relationship between chronic disease and health risk factors is limited for American Indian and Alaska Native elder populations. This paper indicated results of an analysis of the effect of risk factors on chronic disease from a survey of 9,296 Native elders, representing 171 tribes from 88 sites. The sampling design employed systematic random sampling for larger tribes, with smaller tribes (fewer than 200) interviewing all or the majority of their elders. The data suggest that smokers, drinkers, and non-exercisers are at increase risk for chronic disease.
Hospital Size, Uncertainty and Pay-for-Performance
Date: 02 / 2007
Author(s): Gestur Davidson, Ira Moscovice, Denise Remus
Report Number: Working Paper No. 3
Topics: Hospitals and clinics, Quality
Examines whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings. Using data from the Premier Hospital Quality Incentive Demonstration and the Centers for Medicare and Medicaid Services' Hospital Compare, the report found that the smallest hospitals would, on average, experience five to seven times more uncertainty than the largest hospitals concerning their true relative performance for heart failure, pneumonia, and acute myocardial infarction. The authors conclude that all estimates of rank need to include adequate measures of uncertainty of those estimates.
Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006 (Final Report)
Date: 10 / 2010
Author(s): Walter Gregg, Douglas Wholey, Ira Moscovice
Report Number: Final Report #11
Topics: Health services, Hospitals and clinics
Describes the impact of Ambulatory Surgery Centers (ASCs) on rural hospital markets.
Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006 (Policy Brief)
Date: 10 / 2010
Author(s): Walter Gregg, Douglas Wholey, Ira Moscovice
Topic: Hospitals and clinics
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.
Impact of Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural Native American Elders
Date: 10 / 2007
Author(s): Alana Knudson, Mary Wakefield, Kyle Muus, Jacque Gray, Leander McDonald, Richard Ludtke, Gestur Davidson
Report Number: Final Report No. 6
Topics: American Indians and Alaska Natives, Health insurance and the uninsured, Minority health
Examines health insurance coverage and access to health care among American Indian and Alaska Native elders (Native elders) -- defined as 55 years or older. Young elders, 55 to 64 years of age, are most likely to be uninsured with one-third reporting having no insurance, while 15% of older elders, 65 years of age and over, report they are uninsured. Uninsured Native elders are about twice as likely as insured Native elders to indicate they have no regular provider. In addition, one out of 10 Native elders report they were not able to get care when they needed it during the preceding 12 months. Reasons cited for not getting health care when it was needed included long waiting times, transportation problems, and cost. The authors conclude it is essential to develop policies that address the financial, geographical, and cultural aspects that negatively impact access to culturally appropriate healthcare. Full report available on request by contacting wopsahl@medicine.nodak.edu.
Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project (Brief)
Date: 11 / 2006
Author(s): Walter Gregg, Ira Moscovice, Denise Remus
Report Number: Policy Brief No. 2
Topics: Health care financing, Hospitals and clinics, Quality
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 (HQID) project.
Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project (Full Report)
Date: 09 / 2006
Author(s): Walter Gregg, Ira Moscovice, Denise Remus
Report Number: Working Paper No. 2
Topics: Hospitals and clinics, Quality
Reports 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.
Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Final Report)
Date: 12 / 2008
Author(s): Michelle Casey, Walter Elias, Alana Knudson, Walter Gregg
Report Number: Final Report #8
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Telehealth
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.
Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Policy Brief)
Date: 03 / 2009
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Telehealth
Describes successful telepharmacy activities being implemented in rural hospitals and analyzes policy issues related to the implementation of telepharmacy projects in rural hospitals.
Implementing Patient Safety Initiatives in Rural Hospitals: An Evaluation of the Tennessee Rural Hospital Patient Safety Demonstration
Date: 08 / 2007
Author(s): Jill Klingner, Ira Moscovice, Mary Wakefield, Marlene Miller
Topics: Hospitals and clinics, Quality
The Tennessee Rural Hospital Patient Safety Demonstration project included: 1) the implementation of three patient safety initiatives in eight rural Tennessee hospitals using a collaborative model and 2) an evaluation of the process and tools used in the implementation to inform future rural patient safety initiatives. Staff from the Tennessee Hospital Association, Q-Source (the state quality improvement organization), BlueCross BlueShield of Tennessee and the University of Southern Maine all provided technical assistance and resources to the hospitals. The Upper Midwest Rural Health Research Center evaluated the project. Executive summary available online. Full report available on request by contacting raasc001@umn.edu.
Indian Health Care Improvement Act: Implications for North Dakota Tribes
Date: 11 / 2004
Author(s): Francine McDonald
Topics: American Indians and Alaska Natives, Legislation and regulation, Minority health
Policy brief providing an overview of health care issues facing American Indians in North Dakota, with discussion of the impact of the Indian Health Care Improvement Act.
More Culturally Sensitive Neuropsychological Tests (and Normative Data) Needed
Date: 2005
Author(s): F. Richard Ferraro, Leander R. McDonald
Citation: Alzheimer Disease and Associated Disorders, 19(2), 53
Topics: American Indians and Alaska Natives, Cultural competency, Minority health
Discusses the need for culturally sensitive tests and normative data regarding the Native elder population.
North Dakota Health Care Workforce: Planning Together to Meet Future Health Care Needs
Date: 01 / 2007
Author(s): Mary Wakefield, Mary Amundson, Patricia Moulton, Brad Gibbens
Report Number: Policy Brief
Topic: Workforce
Policy brief which details strategies for addressing health workforce needs in North Dakota. Includes examples of state health workforce pipeline strategies used in other states.
North Dakota's Uninsured and Uncompensated Care: Costs and Coverage Options
Date: 11 / 2004
Author(s): Garth Kruger
Report Number: Policy Brief
Topic: Health insurance and the uninsured
Policy brief on health insurance coverage and the uninsured in North Dakota. Discusses the financial impact of uncompensated care on the health care system and describes several methods for expanding health insurance coverage.
Nurse Staffing and Rural Hospital Performance (Policy Brief)
Date: 12 / 2010
Author(s): Gestur Davidson, Kathy Belk, Ira Moscovice
Topics: Hospitals and clinics, Nurses, Quality
Examines the impact of nurse staffing on rural hospital performance improvement in the CMS/Premier Inc. Hospital Quality Incentive Demonstration project.
Patient Assessments and Quality of Care in Rural Hospitals (Final Report)
Date: 06 / 2010
Author(s): Michelle Casey, Gestur Davidson
Topics: Hospitals and clinics, Quality
Analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care. It assesses whether rural patients' perspectives of hospital quality of care are related to quality measures focused on the provision of recommended care for medical conditions.
Patient Assessments and Quality of Care in Rural Hospitals (Policy Brief)
Date: 06 / 2010
Author(s): Michelle Casey, Gestur Davidson
Topics: Hospitals and clinics, Quality
Analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care.
Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Brief)
Date: 01 / 2006
Report Number: Policy Brief No. 1
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve. A full report is also available.
Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
Date: 12 / 2005
Author(s): Michelle M. Casey, Ira Moscovice, Gestur Davidson
Report Number: Working Paper No. 1
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using 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
Date: 2006
Author(s): Michelle Casey, Ira Moscovice, Gestur Davidson
Citation: Journal of Rural Health, 22(4), 321-330
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
Reports the results of a study that assessed the capacity of small rural hospitals to implement medication safety practices, with a focus on pharmacist staffing and the availability of technology.
Potentially Preventable Readmissions in Rural Hospitals (Policy Brief)
Date: 08 / 2009
Author(s): Marilyn G. Klug, Kyle Muus, Michelle Casey, Ira Moscovice
Topic: Hospitals and clinics
A hospital's potentially preventable readmission rate is a quality indicator receiving considerable attention from policymakers and payers. 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.
Prevalence of Chronic Disease Among American Indian and Alaska Native Elders
Date: 10 / 2005
Author(s): Patricia Moulton, Leander McDonald, Kyle Muus, Alana Knudson, Mary Wakefield, Richard Ludtke
Topics: Aging, American Indians and Alaska Natives, Chronic diseases and conditions, Minority health
Examines chronic disease prevalence and functional limitations among American Indian/Alaska Natives by rurality, gender, age, health care access, and health behaviors. Includes policy recommendations.
Prioritizing Patient Safety Interventions in Small Rural Hospitals
Date: 12 / 2006
Author(s): Michelle Casey, Mary Wakefield, Andrew F. Coburn, Ira Moscovice, Stephanie Loux
Citation: Joint Commission Journal on Quality and Patient Safety, 32(12), 693-702
Topics: Hospitals and clinics, Quality
Reports the results of a study seeking to determine 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 in small rural facilities in Maine, Minnesota, Montana, North Dakota, Pennsylvania, and Tennessee. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
Role of Rural Hospitals in Community-Centered Systems of Care
Date: 02 / 2007
Author(s): Walter Gregg, D. Wholey
Report Number: Working Paper No. 5
Topic: Hospitals and clinics
Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Brief)
Date: 08 / 2007
Topics: Emergency medical services (EMS), Quality
Reports results of a study of rural emergency department staffing and discusses potential implications of staffing for the quality of emergency care provided in rural areas.
Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Final Report)
Date: 06 / 2007
Author(s): Michelle M. Casey, D. Wholey, Ira Moscovice
Topics: Emergency medical services (EMS), Quality
The purpose of this project was to describe rural emergency department staffing nationally and to assess the potential implications of staffing for the quality of emergency care provided in rural areas. A national telephone survey of a random sample of rural hospitals with less than 100 beds was conducted in June to August 2006. The study found that the majority of rural hospitals use more than one type of staffing to cover their Emergency Department (ED), including combinations of physicians on their own medical staff, contracts with emergency physician management groups and with individual physicians, and physician assistants and nurse practitioners. The study concluded that it is important to ensure that the family physicians, internists, PAs, NPs and nurses who staff rural EDs have the expertise and technical skills needed to provide optimal ED care, and that rural ED staff may benefit from additional continuing education opportunities, particularly in terms of specialized skills to care for pediatric emergency patients and trauma patients and training in working effectively in teams. Report available upon request by emailing the author at: mcasey@umn.edu.
Rural Healthcare Quality Agenda
Date: 2006
Author(s): Mary Wakefield
Citation: Journal for Healthcare Quality, 28(5): 2, 57
Topic: Quality
An editorial that highlights aspects of the Institute of Medicines' report "Quality Through Collaboration: The Future of Rural Health," known as the "rural report." The editorial serves as an introduction to the journal's special issue on healthcare quality in rural health.
Rural Issues Related to Bundled Payments for Acute Care Episodes (Policy Brief)
Date: 06 / 2009
Author(s): Robert Town, Walter Gregg, Ira Moscovice, Shailendra Prasad, Jill Klingner, Christopher Dickerson
Topics: Hospitals and clinics, Medicare
Bundling Medicare payments, i.e., providing a fixed payment for a set of acute and post-acute services, 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 these challenges.
Rural Issues Related to Comparative Effectiveness Research and Dissemination (Policy Brief)
Date: 06 / 2009
Author(s): Ira Moscovice, Michelle Casey
Topics: Health policy, Rural statistics and demographics
Comparative effectiveness research, which compares the costs and benefits of different treatments for specific diseases or conditions, has the potential to improve the quality and reduce the costs of health care. This brief describes strategies for expanding clinical research in rural environments; implementing practice guidelines in rural settings; and improving access to current evidence-based information for rural health professionals and patients.
Suicide in North Dakota: A Dialogue Across State and Tribal Boundaries
Date: 10 / 2005
Author(s): Garth Kruger, Jacque Gray
Report Number: Policy Brief
Topics: Mental health, Minority health
Compared nationally, North Dakota ranks 13th in the nation for suicide (14.4 suicides per 1000,000 people). This policy brief looks at three broad areas in addressing this preventable tragedy: 1) an understanding of factors associated with suicide; 2) information about specific trends such as race, gender, location, and costs; 3) an awareness of suicide prevention strategies that address these factors through public policy and community action.
Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
Date: 2005
Author(s): Keith J. Mueller, Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin, Mary K. Wakefield
Citation: Journal of Rural Health, 21(3), 194-197
Topics: Health policy, Legislation and regulation, Medicare, Pharmacy and prescription drugs
The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in September 2004 to identify a set of researchable questions concerning the impact of the MMA on rural health care. This paper presents research questions in the following areas that congressional staff identified as having the highest priority: access to health plans and pharmacy services, beneficiary outreach and enrollment, technology capacity, provider payment policy, and demonstration projects.
Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients (Policy Brief)
Date: 09 / 2011
Author(s): Robert Town, Walter Gregg, Ira Moscovice, Shailendra Prasad, Jill Klingner
Topics: Health policy, Hospitals and clinics, Quality
This report and policy brief will (1) assess the financial and quality challenges—and potential unintended consequences for rural providers and patients—of implementing bundled payments for acute and post-acute care episodes; (2) explore the possible impact on quality of care delivered under a facility-physician bundled payment system; and (3) describe potential modifications to current bundling proposals and additional steps CMS could take that will help address rural-specific issues.

Topics Centers Researchers Other Resources Search		Upper Midwest Rural Health Research Center Publications Alphabetical list. You can also view by publication date. Access to Health Care for Rural America: Why It Matters Date: 02 / 2006 Author(s): Mary Wakefield, Brad Gibbens Citation: Around the Kitchen Table, Issue 14 Topic: Health services Overview of issues related to rural health care access and the importance of health care access to rural communities. Ambulatory Care Sensitive Condition Hospitalizations Among Rural Children Date: 02 / 2007 Author(s): Michelle Casey, Alana Knudson, Michele Burlew, Gestur Davidson Report Number: Working Paper No. 4 Topics: Children, Chronic diseases and conditions, Hospitals and clinics Ambulatory care sensitive conditions (ACSCs) are conditions for which inpatient hospital admissions could potentially be avoided through better outpatient care. Using hospital inpatient discharge data from six states, this study examined the relationships between children's inpatient hospitalizations for ACSCs, rural residence, poverty, health insurance, and physician supply. Admission rates for five conditions were examined: asthma, diabetes short-term complications, gastroenteritis, urinary tract infection and perforated appendix. Hospitalization rates for four of the five conditions are significantly higher for children living in rural areas than in urban areas. Condition-specific ACSC hospitalization rates for children also vary significantly across states, even after adjusting for rurality, poverty, uninsurance, and physician supply. Ambulatory Care Sensitive Condition Hospitalizations Among Rural Children (Brief) Date: 06 / 2007 Author(s): Michelle Casey, Alana Knudson, Michele Burlew, Gestur Davidson Report Number: Policy Brief Topics: Children, Chronic diseases and conditions, Hospitals and clinics Reports results from a study examining children's inpatient hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs), rural residence, poverty, health insurance, and physician supply. Admission rates for five conditions were examined: asthma, diabetes short-term complications, gastroenteritis, urinary tract infection and perforated appendix. Analysis of CAH Inpatient Hospitalizations and Transfers: Implications for National Quality Measurement and Reporting Date: 12 / 2006 Author(s): Michelle Casey, Michele Burlew Report Number: Flex Monitoring Team Briefing Paper No. 13 Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy. Care Transitions: "Time to Come Home" (Full Report) Date: 03 / 2011 Author(s): Shailendra Prasad, Jill M. Klingner, Ira Moscovice Topics: Health services, Hospitals and clinics, Quality 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. Care Transitions: “Time to Come Home” (Policy Brief) Date: 03 / 2011 Author(s): Shailendra Prasad, Jill M. Klingner, Ira Moscovice Topics: Health services, Hospitals and clinics, Quality 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. Chronic Disease and Functional Limitation Among American Indian and Alaska Native Elders Date: 2005 Author(s): Leander McDonald, Richard Ludtke, Kyle Muus Citation: Journal of Native Aging and Health, November-December 2005 Topics: American Indians and Alaska Natives, Chronic diseases and conditions, Minority health Reports the results of an analysis of chronic disease's effect on functional limitation from a survey of 7,107 Native elders representing 143 tribes from 77 sites. Chronic Disease in American Indian/Alaska Native Elders Date: 2005 Author(s): Patricia L. Moulton, Leander R. McDonald, Kyle J. Muus, Alana D. Knudson, Richard L. Ludtke Citation: The IHS Primary Care Provider, 30(5), 53-54 Topics: American Indians and Alaska Natives, Chronic diseases and conditions, Minority health Describes the prevalence of chronic diseases among Native American elders. Comparing Patient Safety in Rural Hospitals by Bed Count Date: 2005 Author(s): Stephenie L. Loux, Susan M. C. Payne, Astrid Knott Citation: Advances in Patient Safety: From Research to Implementation. (Vols. 1-4), (pp. 391-402). Rockville, MD: Agency for Healthcare Research and Quality. Topics: Hospitals and clinics, Quality Reports results of a study to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals. The authors found that small rural hospitals had rates of potential patient safety events that were significantly lower than those of large rural hospitals for three of the 19 patient safety indicators (PSIs). The types of services offered by rural hospitals varied significantly according to bed numbers, and the likelihood of an offered service increased as bed counts increased. The types of patients treated by rural hospitals, however, did not vary significantly by bed count. The results suggest that rural hospitals differ substantially by offered services and differ somewhat in PSI rates, relative to bed counts. But given the limited information on patient severity using administrative data, future research should look to develop more effective ways to account for patient severity when measuring patient safety rates among hospitals with varying bed counts. Defining the Term "Frontier Area" for Programs Implemented through the Office for the Advancement of Telehealth Date: 05 / 2006 Author(s): University of North Dakota Center for Rural Health Topics: Defining rural, Frontier health, Telehealth An expert panel report to the Office for the Advancement of Telehealth, Health Resources and Services Administration, U.S. Department of Health and Human Services. 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. Do Rural Elders Have Limited Access to Medicare Hospice Services? Date: 2004 Author(s): Beth A. Virnig, Ira S. Moscovice, Sara B. Durham, Michelle M. Casey Citation: Journal of the American Geriatrics Society, 52(5), 731-5 Topics: Aging, Hospice and palliative care, Medicare The authors examined whether there are urban-rural differences in use of the Medicare hospice benefit before death and whether those differences suggest that there is a problem with access to hospice care for rural Medicare beneficiaries. Rates of hospice care before death were negatively associated with degree of rurality. The lowest rate of hospice use, 15.2% of deaths, was seen in rural areas not adjacent to an urban area. The highest rate of use, 22.2% of deaths, was seen in urban areas. Rural areas adjacent to urban areas had an intermediate level of hospice use (17.0% of deaths). Hospices based in rural areas had a smaller number of elderly patients each year than hospices based in urban areas, and were more likely to have very low volumes. The authors conclude that the consistently lower use of Medicare hospice services before death and smaller sizes of rural hospices suggests that the combination of Medicare hospice payment policies and hospice volumes are problematic for rural hospices. Adjusting Medicare payment policies might be a critical step to assure availability of hospice services for terminally ill beneficiaries regardless of where they live. Does Hospital Size Affect Our Ability to Accurately Identify High Quality Care in Pay-for-Performance Programs? Date: 05 / 2007 Report Number: Policy Brief Topics: Hospitals and clinics, Quality Discusses whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings. A full report is also available. Factors Associated With Incidence of Inappropriate Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children Date: 2005 Author(s): Dmitri Poltavski, Kyle Muus Citation: Journal of Rural Health, 21(3), 272-277 Topics: Children, Emergency medical services (EMS) An analysis was conducted to identify a set of significant predictors of cases of inappropriate deliveries to acute care facilities with no trauma-center designation of any level. Greater distance (mean = 19.96 miles) to the nearest trauma center and shorter distance traveled by the ambulance squad to the receiving facility (mean = 19.07 miles) corresponded to higher probabilities of mistriage, especially when a child was Native American (16 times more likely) and the transportation was conducted in the winter (9 times more likely). Far From the City: Community Orientation and Responsiveness of Rural Hospitals Date: 05 / 2008 Author(s): Walter Gregg, Douglas Wholey Topics: Health services, Hospitals and clinics Reports the findings of a national study focused on variation in hospital community orientation and responsiveness across differing rural contexts. Study findings suggest that measures of community orientation and responsiveness differ between urban and rural hospitals, and further research is needed to develop an improved, context specific, model for community benefits. Geographic Differences in Potentially Preventable Readmission Rates in Rural and Urban Hospitals (Final Report) Date: 11 / 2010 Author(s): Marilyn G. Klug, Alana Knudson, Kyle Muus Topic: Hospitals and clinics Potentially preventable hospital readmissions (PPRs) among Medicare patients are examples of inefficiencies in the health care system. Policymakers are considering efforts to measure and publicly report preventable readmission rates and target hospitals with high rates for improvement by means of payment policy and technical assistance. To help inform the policy debate about readmissions of rural patients, this study estimated PPRs in three types of acute care hospitals: urban prospective payment system (PPS) hospitals, rural PPS hospitals and Critical Access Hospitals (CAHs). Health Information Technology Policy and Rural Hospitals (Policy Brief) Date: 06 / 2009 Author(s): Jeffrey McCullough, Michelle Casey, Ira Moscovice Topics: Health information technology, Hospitals and clinics Health information technology (HIT) is a key component of plans to reform the health care system. HIT adoption among smaller rural providers has lagged behind larger urban providers, and the vast majority of research on HIT has focused on its adoption and impact in urban institutions. This brief summarizes the implementation status of key HIT applications in Critical Access Hospitals and other rural hospitals, and discusses policies for encouraging HIT adoption in rural hospitals. Health Insurance Coverage and Access to Health Care for American Indian and Alaska Native Elders Date: 10 / 2007 Topics: Aging, American Indians and Alaska Natives, Health insurance and the uninsured, Minority health Policy brief reporting findings from a study assessing health insurance coverage and access to health care among American Indian and Alaska Native elders (Native elders), using data from a national survey that included more than 8,300 Native elders. Health Risks Factors Among American Indians and Alaska Native Elders Date: 2006 Author(s): Leander McDonald, Richard Ludtke, Kyle Muus Citation: Journal of Native Aging and Health, July-August 2006, 1(2), 17-24 Topics: Aging, American Indians and Alaska Natives, Minority health Chronic disease rates are higher among American Indian and Alaska Native elders although they exercise more and have higher rates of participation in multiple exercise activities. Research concerning the relationship between chronic disease and health risk factors is limited for American Indian and Alaska Native elder populations. This paper indicated results of an analysis of the effect of risk factors on chronic disease from a survey of 9,296 Native elders, representing 171 tribes from 88 sites. The sampling design employed systematic random sampling for larger tribes, with smaller tribes (fewer than 200) interviewing all or the majority of their elders. The data suggest that smokers, drinkers, and non-exercisers are at increase risk for chronic disease. Hospital Size, Uncertainty and Pay-for-Performance Date: 02 / 2007 Author(s): Gestur Davidson, Ira Moscovice, Denise Remus Report Number: Working Paper No. 3 Topics: Hospitals and clinics, Quality Examines whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings. Using data from the Premier Hospital Quality Incentive Demonstration and the Centers for Medicare and Medicaid Services' Hospital Compare, the report found that the smallest hospitals would, on average, experience five to seven times more uncertainty than the largest hospitals concerning their true relative performance for heart failure, pneumonia, and acute myocardial infarction. The authors conclude that all estimates of rank need to include adequate measures of uncertainty of those estimates. Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006 (Final Report) Date: 10 / 2010 Author(s): Walter Gregg, Douglas Wholey, Ira Moscovice Report Number: Final Report #11 Topics: Health services, Hospitals and clinics Describes the impact of Ambulatory Surgery Centers (ASCs) on rural hospital markets. Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006 (Policy Brief) Date: 10 / 2010 Author(s): Walter Gregg, Douglas Wholey, Ira Moscovice Topic: Hospitals and clinics 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. Impact of Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural Native American Elders Date: 10 / 2007 Author(s): Alana Knudson, Mary Wakefield, Kyle Muus, Jacque Gray, Leander McDonald, Richard Ludtke, Gestur Davidson Report Number: Final Report No. 6 Topics: American Indians and Alaska Natives, Health insurance and the uninsured, Minority health Examines health insurance coverage and access to health care among American Indian and Alaska Native elders (Native elders) -- defined as 55 years or older. Young elders, 55 to 64 years of age, are most likely to be uninsured with one-third reporting having no insurance, while 15% of older elders, 65 years of age and over, report they are uninsured. Uninsured Native elders are about twice as likely as insured Native elders to indicate they have no regular provider. In addition, one out of 10 Native elders report they were not able to get care when they needed it during the preceding 12 months. Reasons cited for not getting health care when it was needed included long waiting times, transportation problems, and cost. The authors conclude it is essential to develop policies that address the financial, geographical, and cultural aspects that negatively impact access to culturally appropriate healthcare. Full report available on request by contacting wopsahl@medicine.nodak.edu. Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project (Brief) Date: 11 / 2006 Author(s): Walter Gregg, Ira Moscovice, Denise Remus Report Number: Policy Brief No. 2 Topics: Health care financing, Hospitals and clinics, Quality 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 (HQID) project. Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project (Full Report) Date: 09 / 2006 Author(s): Walter Gregg, Ira Moscovice, Denise Remus Report Number: Working Paper No. 2 Topics: Hospitals and clinics, Quality Reports 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. Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Final Report) Date: 12 / 2008 Author(s): Michelle Casey, Walter Elias, Alana Knudson, Walter Gregg Report Number: Final Report #8 Topics: Hospitals and clinics, Pharmacy and prescription drugs, Telehealth 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. Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Policy Brief) Date: 03 / 2009 Topics: Hospitals and clinics, Pharmacy and prescription drugs, Telehealth Describes successful telepharmacy activities being implemented in rural hospitals and analyzes policy issues related to the implementation of telepharmacy projects in rural hospitals. Implementing Patient Safety Initiatives in Rural Hospitals: An Evaluation of the Tennessee Rural Hospital Patient Safety Demonstration Date: 08 / 2007 Author(s): Jill Klingner, Ira Moscovice, Mary Wakefield, Marlene Miller Topics: Hospitals and clinics, Quality The Tennessee Rural Hospital Patient Safety Demonstration project included: 1) the implementation of three patient safety initiatives in eight rural Tennessee hospitals using a collaborative model and 2) an evaluation of the process and tools used in the implementation to inform future rural patient safety initiatives. Staff from the Tennessee Hospital Association, Q-Source (the state quality improvement organization), BlueCross BlueShield of Tennessee and the University of Southern Maine all provided technical assistance and resources to the hospitals. The Upper Midwest Rural Health Research Center evaluated the project. Executive summary available online. Full report available on request by contacting raasc001@umn.edu. Indian Health Care Improvement Act: Implications for North Dakota Tribes Date: 11 / 2004 Author(s): Francine McDonald Topics: American Indians and Alaska Natives, Legislation and regulation, Minority health Policy brief providing an overview of health care issues facing American Indians in North Dakota, with discussion of the impact of the Indian Health Care Improvement Act. More Culturally Sensitive Neuropsychological Tests (and Normative Data) Needed Date: 2005 Author(s): F. Richard Ferraro, Leander R. McDonald Citation: Alzheimer Disease and Associated Disorders, 19(2), 53 Topics: American Indians and Alaska Natives, Cultural competency, Minority health Discusses the need for culturally sensitive tests and normative data regarding the Native elder population. North Dakota Health Care Workforce: Planning Together to Meet Future Health Care Needs Date: 01 / 2007 Author(s): Mary Wakefield, Mary Amundson, Patricia Moulton, Brad Gibbens Report Number: Policy Brief Topic: Workforce Policy brief which details strategies for addressing health workforce needs in North Dakota. Includes examples of state health workforce pipeline strategies used in other states. North Dakota's Uninsured and Uncompensated Care: Costs and Coverage Options Date: 11 / 2004 Author(s): Garth Kruger Report Number: Policy Brief Topic: Health insurance and the uninsured Policy brief on health insurance coverage and the uninsured in North Dakota. Discusses the financial impact of uncompensated care on the health care system and describes several methods for expanding health insurance coverage. Nurse Staffing and Rural Hospital Performance (Policy Brief) Date: 12 / 2010 Author(s): Gestur Davidson, Kathy Belk, Ira Moscovice Topics: Hospitals and clinics, Nurses, Quality Examines the impact of nurse staffing on rural hospital performance improvement in the CMS/Premier Inc. Hospital Quality Incentive Demonstration project. Patient Assessments and Quality of Care in Rural Hospitals (Final Report) Date: 06 / 2010 Author(s): Michelle Casey, Gestur Davidson Topics: Hospitals and clinics, Quality Analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care. It assesses whether rural patients' perspectives of hospital quality of care are related to quality measures focused on the provision of recommended care for medical conditions. Patient Assessments and Quality of Care in Rural Hospitals (Policy Brief) Date: 06 / 2010 Author(s): Michelle Casey, Gestur Davidson Topics: Hospitals and clinics, Quality Analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care. Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Brief) Date: 01 / 2006 Report Number: Policy Brief No. 1 Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve. A full report is also available. Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report) Date: 12 / 2005 Author(s): Michelle M. Casey, Ira Moscovice, Gestur Davidson Report Number: Working Paper No. 1 Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using 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 Date: 2006 Author(s): Michelle Casey, Ira Moscovice, Gestur Davidson Citation: Journal of Rural Health, 22(4), 321-330 Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology Reports the results of a study that assessed the capacity of small rural hospitals to implement medication safety practices, with a focus on pharmacist staffing and the availability of technology. Potentially Preventable Readmissions in Rural Hospitals (Policy Brief) Date: 08 / 2009 Author(s): Marilyn G. Klug, Kyle Muus, Michelle Casey, Ira Moscovice Topic: Hospitals and clinics A hospital's potentially preventable readmission rate is a quality indicator receiving considerable attention from policymakers and payers. 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. Prevalence of Chronic Disease Among American Indian and Alaska Native Elders Date: 10 / 2005 Author(s): Patricia Moulton, Leander McDonald, Kyle Muus, Alana Knudson, Mary Wakefield, Richard Ludtke Topics: Aging, American Indians and Alaska Natives, Chronic diseases and conditions, Minority health Examines chronic disease prevalence and functional limitations among American Indian/Alaska Natives by rurality, gender, age, health care access, and health behaviors. Includes policy recommendations. Prioritizing Patient Safety Interventions in Small Rural Hospitals Date: 12 / 2006 Author(s): Michelle Casey, Mary Wakefield, Andrew F. Coburn, Ira Moscovice, Stephanie Loux Citation: Joint Commission Journal on Quality and Patient Safety, 32(12), 693-702 Topics: Hospitals and clinics, Quality Reports the results of a study seeking to determine 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 in small rural facilities in Maine, Minnesota, Montana, North Dakota, Pennsylvania, and Tennessee. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy. Role of Rural Hospitals in Community-Centered Systems of Care Date: 02 / 2007 Author(s): Walter Gregg, D. Wholey Report Number: Working Paper No. 5 Topic: Hospitals and clinics Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Brief) Date: 08 / 2007 Topics: Emergency medical services (EMS), Quality Reports results of a study of rural emergency department staffing and discusses potential implications of staffing for the quality of emergency care provided in rural areas. Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Final Report) Date: 06 / 2007 Author(s): Michelle M. Casey, D. Wholey, Ira Moscovice Topics: Emergency medical services (EMS), Quality The purpose of this project was to describe rural emergency department staffing nationally and to assess the potential implications of staffing for the quality of emergency care provided in rural areas. A national telephone survey of a random sample of rural hospitals with less than 100 beds was conducted in June to August 2006. The study found that the majority of rural hospitals use more than one type of staffing to cover their Emergency Department (ED), including combinations of physicians on their own medical staff, contracts with emergency physician management groups and with individual physicians, and physician assistants and nurse practitioners. The study concluded that it is important to ensure that the family physicians, internists, PAs, NPs and nurses who staff rural EDs have the expertise and technical skills needed to provide optimal ED care, and that rural ED staff may benefit from additional continuing education opportunities, particularly in terms of specialized skills to care for pediatric emergency patients and trauma patients and training in working effectively in teams. Report available upon request by emailing the author at: mcasey@umn.edu. Rural Healthcare Quality Agenda Date: 2006 Author(s): Mary Wakefield Citation: Journal for Healthcare Quality, 28(5): 2, 57 Topic: Quality An editorial that highlights aspects of the Institute of Medicines' report "Quality Through Collaboration: The Future of Rural Health," known as the "rural report." The editorial serves as an introduction to the journal's special issue on healthcare quality in rural health. Rural Issues Related to Bundled Payments for Acute Care Episodes (Policy Brief) Date: 06 / 2009 Author(s): Robert Town, Walter Gregg, Ira Moscovice, Shailendra Prasad, Jill Klingner, Christopher Dickerson Topics: Hospitals and clinics, Medicare Bundling Medicare payments, i.e., providing a fixed payment for a set of acute and post-acute services, 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 these challenges. Rural Issues Related to Comparative Effectiveness Research and Dissemination (Policy Brief) Date: 06 / 2009 Author(s): Ira Moscovice, Michelle Casey Topics: Health policy, Rural statistics and demographics Comparative effectiveness research, which compares the costs and benefits of different treatments for specific diseases or conditions, has the potential to improve the quality and reduce the costs of health care. This brief describes strategies for expanding clinical research in rural environments; implementing practice guidelines in rural settings; and improving access to current evidence-based information for rural health professionals and patients. Suicide in North Dakota: A Dialogue Across State and Tribal Boundaries Date: 10 / 2005 Author(s): Garth Kruger, Jacque Gray Report Number: Policy Brief Topics: Mental health, Minority health Compared nationally, North Dakota ranks 13th in the nation for suicide (14.4 suicides per 1000,000 people). This policy brief looks at three broad areas in addressing this preventable tragedy: 1) an understanding of factors associated with suicide; 2) information about specific trends such as race, gender, location, and costs; 3) an awareness of suicide prevention strategies that address these factors through public policy and community action. Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff Date: 2005 Author(s): Keith J. Mueller, Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin, Mary K. Wakefield Citation: Journal of Rural Health, 21(3), 194-197 Topics: Health policy, Legislation and regulation, Medicare, Pharmacy and prescription drugs The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in September 2004 to identify a set of researchable questions concerning the impact of the MMA on rural health care. This paper presents research questions in the following areas that congressional staff identified as having the highest priority: access to health plans and pharmacy services, beneficiary outreach and enrollment, technology capacity, provider payment policy, and demonstration projects. Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients (Policy Brief) Date: 09 / 2011 Author(s): Robert Town, Walter Gregg, Ira Moscovice, Shailendra Prasad, Jill Klingner Topics: Health policy, Hospitals and clinics, Quality This report and policy brief will (1) assess the financial and quality challenges—and potential unintended consequences for rural providers and patients—of implementing bundled payments for acute and post-acute care episodes; (2) explore the possible impact on quality of care delivered under a facility-physician bundled payment system; and (3) describe potential modifications to current bundling proposals and additional steps CMS could take that will help address rural-specific issues.