North Carolina Rural Health Research and Policy Analysis Center

Completed Projects

Access to Health Care for Young Rural Medicaid Beneficiaries
This study examined access to health care among rural children ages 0-17 who are enrolled in some type of Medicaid managed care program, and will compare this access across types of programs and, within program type, to that of urban beneficiaries.
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Dental health, Health services, Medicaid and S-CHIP

Analysis of Options for Criteria to Determine Underservice
Funder: Office of Rural Health Policy (ORHP)
Topic: Workforce

Analysis of Options for Revisions to the Criteria for Designation for Medically Underserved Areas (MUAs) and Health Professional Shortage Areas (HPSAs)
Funder: Office of Rural Health Policy (ORHP)
Topic: Workforce

Analysis of the Cesarean Section Rates in Rural Hospitals
This project will describe the practice patterns for deliveries in rural hospitals. Cesarean section rates in rural hospitals will be compared to urban hospitals and the national rate.
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Maternal and child health

Analytic Capacity to Respond to Changes in Medicare and Medicaid, Data Assistance to Policy Staff at the Federal Office of Rural Health Policy, and Production of Short Policy Briefs
This project will produce short policy briefs on a variety of topics related to proposed and enacted changes in Medicare and Medicaid, as requested by policy staff at the federal Office of Rural Health Policy.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Legislation and regulation, Medicaid and S-CHIP, Medicare

Arguing for Rural Health: Justice and Fairness in Advocating for Rural Health Policy
Funder: Office of Rural Health Policy (ORHP)
Topic: Health policy

Assessing the Impact of Transfer of Pharmacy Services for Dual Eligible Beneficiaries to Medicare Part D
This project will focus on the implementation of the new Part D benefit for those dually eligible for Medicare and Medicaid. The study will examine the impact on rural dual eligibles and their local pharmacies of the transfer to Part D coverage. The project is a joint undertaking with the RUPRI Center, taking advantage of unique data sets held at each center, the analytical and programming resources of both centers, and the ability to conduct qualitative analysis in multiple states efficiently.
Funder: Office of Rural Health Policy (ORHP)
Topics: Medicaid and S-CHIP, Medicare Part D, Pharmacy and prescription drugs

Background Paper on Skilled Nursing Facilities in Rural Areas
Funder: Office of Rural Health Policy (ORHP)
Topic: Long term care

Changes in the Supply, Distribution, Workload and Reimbursement Patterns of Pharmacists in Rural Areas
This study will examine the supply, distribution, workload, and reimbursement patterns of pharmacists in rural areas. The study will also examine pharmacy licensure data in rural vs. urban areas to study trends in pharmacy ownership patterns.
Funder: Office of Rural Health Policy (ORHP)
Topics: Pharmacy and prescription drugs, Workforce

Community Impact Assessment
This project will evaluate the impact of the Flex program on local communities. Activities will focus on identifying the ways in which the program could have a measurable effect, as well as the ways in which Flex program coordinators intended to affect community health. A briefing paper that integrates information on scope of services, networking, and quality will be produced. Additionally, case studies will be conducted in six CAH communities.
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Networking and collaboration

Critical Access Hospital Conversion Tracking
Information regarding new CAH conversions will be gathered from Flex coordinators and CMS, and added to the CAH management information dataset that is housed at UNC. Flex coordinators will also be queried regarding topics of interest to the coordinators, the monitoring team, and the federal Office of Rural Health Policy.
Funder: Office of Rural Health Policy (ORHP)
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program

Describing Geographic Access to Physicians in Rural America Using Statistical Applications in GIS
This study will use a geographically weighted regression to assess the influence of distance and travel time on the distribution of physicians in rural America. The ultimate goal of the study will be to improve our measures of access by identifying the extent to which border resources can be considered in indices of access.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Physicians

Describing the Health Care Infrastructure in Rural Towns
Funder: Office of Rural Health Policy (ORHP)
Topics: Federally Qualified Health Centers (FQHCs), Hospitals and clinics, Mid-level practitioners, Physicians, Rural Health Clinics (RHCs), Rural statistics and demographics

Developing a Financial Performance Measurement System for Critical Access Hospitals
This project uses research and expert opinion to select dimensions and indicators of financial performance, develop appropriate bases or methods of peer comparison, investigate the relationship between quality of care and financial performance, and identify characteristics of high performing CAHs.
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing

Evaluation of the Medicare Rural Hospital Flexibility Program
Funder: Office of Rural Health Policy (ORHP)
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program

Evaluation of the Rural Hospital Flexibility Act and the Critical Access Hospital Program
Funder: Office of Rural Health Policy (ORHP)
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program

Factors Associated with Provision of Ambulance Services by Rural Hospitals
This two-part study will use existing national data to determine how many hospitals have regularly offered ambulance services as well as how many have recently acquired or discontinued such services. In-depth interviews with selected rural hospital administrators will explore the factors related to a hospital's decision regarding these important health care services.
Funder: Office of Rural Health Policy (ORHP)
Topic: Emergency medical services (EMS)

Factors Contributing to Unit Cost Instability in the Low-Volume Hospital
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Medicare Prospective Payment System (PPS)

Financial Performance of Critical Access Hospitals, Pre- and Post-Conversion
Making use of the financial indicators developed by project staff, the focus of this project is a longitudinal analysis of the dimensions and indicators of financial performance. Descriptive analyses are used to capture changes in all dimensions of financial performance pre- and post-conversion.
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Medicare Prospective Payment System (PPS)

Impact of The Medicaid Budget Crisis on Rural Communities: A 50-State Survey
The impact of the Medicaid budgetary crisis on rural communities across the US will be assessed through a 50-state survey of state Medicaid agencies, state Offices of Rural Health and state rural health associations.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Medicaid and S-CHIP

Impacts of Multiple Race Reporting
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Minority health

Importance of Surgery to Rural Hospital Financial Condition and Market Share
This study explores the provision of surgical services in rural hospitals and its relationship to financial performance. The percentage of rural hospitals that offer surgical services and the number that have discontinued surgical services over the last decade will be described, and, for those that have discontinued services, the impact on financial condition will be explored.
Funder: Office of Rural Health Policy (ORHP)
Topic: Hospitals and clinics

Information Technology Engineering Support for Health Resources and Services Administration Data Systems/Geospatial Data Warehouse, GIS Technologies, GEMS Support and General Office of Information Technology Systems Support
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Technology, Workforce

Labor Costs and the Area Wage Index in Skilled Nursing Facilities
Funder: Office of Rural Health Policy (ORHP)
Topics: Long term care, Medicare Wage Index

Medicaid and SCHIP Participation in Rural and Urban Areas
This project examines state-level Medicaid and SCHIP participation rates for children in rural and urban areas. It also updates the State Profiles of Medicaid and SCHIP in Rural and Urban Areas web site and documents changes in program characteristics relevant to rural areas over the past few years.
Funder: Office of Rural Health Policy (ORHP)
Topic: Medicaid and S-CHIP

Medicaid Managed Care in Rural Areas: Innovative Case Management Strategies
Funder: Office of Rural Health Policy (ORHP)
Topic: Medicaid and S-CHIP

Mini-Studies to Inform Health Reform Efforts
Rural health care systems are far more vulnerable to changes in federal health care policy than are those in urban areas. The purpose of this project is to conduct rapid turnaround mini-studies that will be essential to maintain an effective rural voice in both the ongoing adjustments to current policies and the development of new policies.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Health services

Move Toward Clinical Doctorates in the Allied Health Professions: Implications for Rural Areas
Allied health occupations play a major role in health care delivery and comprise a significant proportion of the health care workforce in the United States. Researchers have found empirical evidence of allied health shortages in many states. Given the longstanding history of health professional shortages facing rural areas, there are concerns that the existing and impending shortages in allied health professions may be particularly acute in rural areas. This study will synthesize information on allied health professions, such as credentialing requirements and wage comparisons, with telephone and in-person interviews of rural health care employers, educators, and practitioners in order to assess the degree of alignment between community needs for allied health care services and existing and proposed certification and educational training for these health care providers.
Funder: Office of Rural Health Policy (ORHP)
Topics: Allied health professionals, Workforce

National Rural Hospital Flexibility Program Review
Funder: Office of Rural Health Policy (ORHP)
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program

Occupational Mix Differences Across PPS Hospitals: Analysis of Hospital Occupation Mix Survey Data and Implications for Rural Hospital Payments
This study addresses the occupation-mix adjustment that has recently been added to the computation of the area wage index used to adjust Medicare prospective rates for all institutional health care providers. The study will review the policy objectives as well as the mechanics of the adjustment, and then analyze the data from the most recent occupation-mix survey to obtain a better understanding of occupation mix differences across labor markets and hospital types.
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Medicare Prospective Payment System (PPS), Workforce

Premium Assistance Programs: Exploring Public-Private Partnerships as a Vehicle for Expanding Health Insurance to Rural Uninsured
This project examines the experience of states that have implemented premium assistance programs in rural areas to determine whether there are certain design features or certain types of rural communities where these programs may be more feasible.
Funder: Office of Rural Health Policy (ORHP)
Topic: Health insurance and the uninsured

Quality and Financial Status of Critical Access Hospitals: A Preliminary Analysis
The purpose of this project is to continue to investigate the relationship between CAH financial performance and quality of care. UMN and UNC will jointly develop hypotheses related to the finance-quality link and statistical models suitable for testing hypotheses.
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Quality

Rapid and Flexible Analysis of Data from Centers for Medicare and Medicaid Services
Project staff will provide rapid and flexible analysis of CMS data in response to requests from ORHP staff. Work will be ongoing throughout the contract year, with the design of individual products determined in response to ORHP staff needs.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Medicare, Rural statistics and demographics

Role of Intensive Care Units in Critical Access Hospitals
This project will examine the role that intensive care units (ICUs) play in Critical Access Hospitals (CAHs). The number and geographic distribution of CAH with ICUs will be described, and types of services provided in these units discussed.
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services

Rural Emergency Department Preparedness for Pediatric Care
While many large cities have dedicated children's hospitals or facilities with pediatric emergency departments, many general hospitals do not have either the equipment necessary to provide optimal pediatric emergency care nor staff that is specifically trained in the care of pediatric emergencies. This project will use secondary data analysis and semi-structured interviews with emergency room directors in order to address how the availability of pediatric services, expertise and supplies in U.S. emergency departments differs between urban and rural facilities, and to determine which factors impede the availability of pediatric services, expertise, and supplies in rural emergency departments.
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Health services, Hospitals and clinics

Rural Emergency Medical Services: Workforce and Medical Direction
This two year study will examine the status of medical direction for rural EMS systems and the nature of the challenges and impediments to obtaining adequate medical direction in rural areas across the country. In addition, the study will address issues surrounding the recruitment and retention of paid and volunteer staff for rural EMS systems.
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Workforce

Rural Hospital Closures, 1990-2000: Community Profiles and Economic Indicators Before and After the Event
This study investigated the economic impact of hospital closures in non- metropolitan counties, taking into account the economic characteristics and employment trends that may have preceded the event.
Funder: Office of Rural Health Policy (ORHP)
Topics: Economic development, Hospitals and clinics

Rural Hospital Flexibility Performance Monitoring Project- Grant Years 2003-2008
Under contract with the federal Office of Rural Health Policy, the Rural Health Research Centers at the Universities of Minnesota, North Carolina, and Southern Maine are cooperatively conducting a performance monitoring project for the Medicare Rural Hospital Flexibility Program (Flex Program). The monitoring project will assess the impact of the Flex Program on rural hospitals and communities and the role of states in achieving overall program objectives, including improving access to and the quality of health care services; improving the financial performance of Critical Access Hospitals; and engaging rural communities in health care system development.
Funder: Office of Rural Health Policy (ORHP)
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program

Rural Hospital Participation in the 340B Drug Discount Program
The 340B drug discount program enables certain types of safety net organizations to obtain deeply discounted medications, at prices below the 'best price' typically offered to Medicaid agencies. This study used telephone interviews and mail surveys to explore the experiences that rural hospitals have had in seeking 340B eligibility status.
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Pharmacy and prescription drugs

Rural Hospital Wages and the Prospective Payment System Wage Index: 1990-1997
Funder: Office of Rural Health Policy (ORHP)
Topics: Medicare Prospective Payment System (PPS), Medicare Wage Index

Rural Informal Safety Net: The Development of a Research and Evaluation Design and a Preliminary Assessment
Funder: Office of Rural Health Policy (ORHP)
Topics: Health insurance and the uninsured, Health services

Rural Medicaid and CHIP Mini-Studies
Medicaid and the Children's Health Insurance Program (CHIP) are important sources of health insurance coverage in rural communities and it is likely that the importance of Medicaid/CHIP will grow as job-based health insurance coverage continues to erode and policymakers pursue the goal of expanding coverage. This project is composed of three mini-studies that: 1) Update our State Profiles of Medicaid and CHIP in Rural and Urban Areas website, adding information on Medicaid Disproportionate Share Hospital (DSH) payments to rural hospitals; 2) Analyze trends in Medicaid/CHIP enrollment in rural and urban areas over the past two to three years; and 3) Explore the future role of CHIP given increasing levels of childhood poverty.
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Medicaid and S-CHIP

Rural Population and Providers: Mapping the 2000 Census
Funder: Office of Rural Health Policy (ORHP)
Topics: Rural statistics and demographics, Workforce

Rural-urban Comparison of Hospital Financial Performance by Medicare Payment Classification
This project will compare the financial performance of rural and urban short term general hospitals by Medicare payment classifications (PPS only, Medicare dependent hospitals, sole community hospitals, rural referral centers, and critical access hospitals).
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Medicare

Special Study of EMS Issues
This study will focus on state, community, and hospital level initiatives designed to build the infrastructure to support EMS service capacity and encourage the integration of these services into the rural healthcare infrastructure in the areas of quality improvement, financing, staffing, medical control, and networking and integration.
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Networking and collaboration

State Facts about Medicaid: Rural Specific Data
This project will develop state-specific fact sheets which will include information on the groups covered (and income eligibility), structure of the state's SCHIP program, services covered, delivery system, some provider payment information for certain safety net providers, and percentage of the state's rural and urban population that are enrolled in Medicaid. Additional information comparing urban and rural areas of the state will be provided, when available. The rural and urban comparisons will include total numbers of Medicaid recipients, Medicaid expenditures, and enrollment in different types of managed care plans.
Funder: Office of Rural Health Policy (ORHP)
Topics: Medicaid and S-CHIP, Rural statistics and demographics

Tracking the Implementation of Medicaid Managed Care in Rural Areas
Funder: Office of Rural Health Policy (ORHP)
Topic: Medicaid and S-CHIP

Trends in Swing Bed and Skilled Nursing Facility Use in Rural Hospitals, 1996-2003
This study will examine trends in the distribution of skilled nursing facility (SNF) services in rural hospitals during a period of dramatic change in Medicare reimbursement, most notably the transition from cost-based reimbursement to SNF prospective payment system (PPS).
Funder: Office of Rural Health Policy (ORHP)
Topics: Aging, Hospitals and clinics, Long term care, Medicare Prospective Payment System (PPS)

Unmet Needs for Health Care Services: An Analysis of Children with Special Health Care Needs in Rural Areas
This project will study whether parents of children with special health care needs (CSHCN) who live in rural areas are less likely to perceive the need for routine and specialty medical care than their metropolitan counterparts, and whether CSHCN that live in rural areas face a greater risk of having unmet needs for health care services than their metropolitan counterparts.
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Dental health, Disabilities, Health services

Volunteerism in Rural EMS
Semi-structured telephone interviews will be used to examine issues facing rural EMS services that have converted or are considering converting from volunteer services to paid services. Respondents will be queried regarding their conversion or consideration of conversion and the effect on their ability to recruit and retain personnel, their relationship with other agencies such as fire departments and hospitals, and the overall availability of EMS services.
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Health care financing, Workforce