Rural Health Research Gateway

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
    Author(s): Mary Wakefield, Brad Gibbens
    Citation: Around the Kitchen Table, Issue 14
    Date: 02 / 2006
    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
    Author(s): Michelle Casey, Alana Knudson, Michele Burlew, Gestur Davidson
    Report Number: Working Paper No. 4
    Date: 02 / 2007
    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)
    Author(s): Michelle Casey, Alana Knudson, Michele Burlew, Gestur Davidson
    Report Number: Policy Brief
    Date: 06 / 2007
    Topics: Children, Chronic diseases and conditions, Hospice and palliative care
    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
    Author(s): Michelle Casey, Michele Burlew
    Report Number: Flex Monitoring Team Briefing Paper No. 13
    Date: 12 / 2006
    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.
  • Chronic Disease and Functional Limitation Among American Indian and Alaska Native Elders
    Author(s): Leander McDonald, Richard Ludtke, Kyle Muus
    Citation: Journal of Native Aging and Health, November-December 2005
    Date: 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
    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
    Date: 2005
    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
    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.
    Date: 2005
    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
    Author(s): University of North Dakota Center for Rural Health
    Date: 05 / 2006
    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?
    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
    Date: 2004
    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?
    Report Number: Policy Brief
    Date: 05 / 2007
    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
    Author(s): Dmitri Poltavski, Kyle Muus
    Citation: Journal of Rural Health, 21(3), 272-277
    Date: 2005
    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
    Author(s): Walter Gregg, Douglas Wholey
    Date: 05 / 2008
    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.
  • 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
    Author(s): Leander McDonald, Richard Ludtke, Kyle Muus
    Citation: Journal of Native Aging and Health, July-August 2006, 1(2), 17-24
    Date: 2006
    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
    Author(s): Gestur Davidson, Ira Moscovice, Denise Remus
    Report Number: Working Paper No. 3
    Date: 02 / 2007
    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 Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural Native American Elders
    Author(s): Alana Knudson, Mary Wakefield, Kyle Muus, Jacque Gray, Leander McDonald, Richard Ludtke, Gestur Davidson
    Report Number: Final Report No. 6
    Date: 10 / 2007
    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 aknudson@medicine.nodak.edu.
  • Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project (Brief)
    Author(s): Walter Gregg, Ira Moscovice, Denise Remus
    Report Number: Policy Brief No. 2
    Date: 11 / 2006
    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)
    Author(s): Walter Gregg, Ira Moscovice, Denise Remus
    Report Number: Working Paper No. 2
    Date: 09 / 2006
    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.
  • Implementing Patient Safety Initiatives in Rural Hospitals: An Evaluation of the Tennessee Rural Hospital Patient Safety Demonstration
    Author(s): Jill Klingner, Ira Moscovice, Mary Wakefield, Marlene Miller
    Date: 08 / 2007
    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
    Author(s): Francine McDonald
    Date: 11 / 2004
    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
    Author(s): F. Richard Ferraro, Leander R. McDonald
    Citation: Alzheimer Disease and Associated Disorders, 19(2), 53
    Date: 2005
    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
    Author(s): Mary Wakefield, Mary Amundson, Patricia Moulton, Brad Gibbens
    Report Number: Policy Brief
    Date: 01 / 2007
    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
    Author(s): Garth Kruger
    Report Number: Policy Brief
    Date: 11 / 2004
    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.
  • Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Brief)
    Report Number: Policy Brief No. 1
    Date: 01 / 2006
    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)
    Author(s): Michelle M. Casey, Ira Moscovice, Gestur Davidson
    Report Number: Working Paper No. 1
    Date: 12 / 2005
    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
    Author(s): Michelle Casey, Ira Moscovice, Gestur Davidson
    Citation: Journal of Rural Health, 22(4), 321-330
    Date: 2006
    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.
  • Prevalence of Chronic Disease Among American Indian and Alaska Native Elders
    Author(s): Patricia Moulton, Leander McDonald, Kyle Muus, Alana Knudson, Mary Wakefield, Richard Ludtke
    Date: 10 / 2005
    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
    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
    Date: 12 / 2006
    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
    Author(s): Walter Gregg, D. Wholey
    Report Number: Working Paper No. 5
    Date: 02 / 2007
    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)
    Author(s): Michelle M. Casey, D. Wholey, Ira Moscovice
    Date: 06 / 2007
    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 calling 701.777.3848 or email raasc001@umn.edu.
  • Rural Healthcare Quality Agenda
    Author(s): Mary Wakefield
    Citation: Journal for Healthcare Quality, 28(5): 2, 57
    Date: 2006
    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.
  • Suicide in North Dakota: A Dialogue Across State and Tribal Boundaries
    Author(s): Garth Kruger, Jacque Gray
    Report Number: Policy Brief
    Date: 10 / 2005
    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
    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
    Date: 2005
    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.

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