Policy-relevant research publications from the Rural Health Research and Policy Centers, funded by the federal Office on Rural Health Policy Copyright 2012 Rural Health Research Gateway http://www.ruralhealthresearch.org/ This policy brief describes the results of a survey of small rural hospitals that use hospitalists, who are physicians, physician assistants or nurse practitioners who assume responsibility for patient care during inpatient hospital stays. 04 / 2012 http://www.uppermidwestrhrc.org/pdf/hospitalist_policy_brief.pdf 2012-04-27 http://www.uppermidwestrhrc.org/pdf/hospitalist_policy_brief.pdf In this study we interview hospital administrators and staff about the use of swing beds. Topics include the role of swing beds in patient care, swing bed volume and financial considerations, swing beds in the context of all community post-acute skilled care and swing beds as a benefit for community residents. 04 / 2012 http://www.shepscenter.unc.edu/research_programs/rural_program/pubs/finding_brief/FB105.pdf 2012-04-23 http://www.shepscenter.unc.edu/research_programs/rural_program/pubs/finding_brief/FB105.pdf Investigates the availability of fluoridated water across urban and rural settings. 01 / 2012 http://wvrhrc.hsc.wvu.edu/docs/2011_fluoridation_policy_brief.pdf 2012-04-11 http://wvrhrc.hsc.wvu.edu/docs/2011_fluoridation_policy_brief.pdf Addresses preventive dental care disparities forrural children by studying access to fluoride varnish applications and the extent that dental hygienists can provide select preventive dental services in primary care safety net settings. 03 / 2012 http://rhr.sph.sc.edu/report/State%20Policy%20Levers%20and%20Dental%20Care%20Disparities.pdf 2012-03-23 http://rhr.sph.sc.edu/report/State%20Policy%20Levers%20and%20Dental%20Care%20Disparities.pdf This findings brief explores the potential consequences of termination of the MDH program by comparing MDHs to rural prospective payment system hospitals (R-PPS) in terms of utilization and the characteristics of the communities they serve. 03 / 2012 http://www.shepscenter.unc.edu/research_programs/rural_program/pubs/finding_brief/FB104.pdf 2012-03-13 http://www.shepscenter.unc.edu/research_programs/rural_program/pubs/finding_brief/FB104.pdf Explores the relationship between potentially preventable readmissions (PPRs) and (a) use of outpatient follow-up care, (b) discharge destination, (c) rural versus urban residence of the patient, and (d) time to follow-up care. These factors were examined in a large population of Medicare patients with a hospital stay for one of these prevalent diagnoses: congestive heart failure or bacterial pneumonia. Differences in readmission risk associated with outpatient visits and discharge destinations were calculated. Outpatient follow-up appears to be strongly influential in reducing PPRs, though fewer than half of the patients in the study had evidence of any kind of outpatient follow-up within 30 days. Home health care appeared to have less of an effect on reducing PPRs in rural areas relative to urban areas. Swing bed destination was associated with higher PPR risk, especially for pneumonia patients. Additional research should be done on encouragement of post-discharge follow-up care and types of outpatient interventions, access to outpatient and home health care, and use of swing beds in rural areas. 03 / 2012 http://www.uppermidwestrhrc.org/pdf/ppr_march12.pdf 2012-03-13 http://www.uppermidwestrhrc.org/pdf/ppr_march12.pdf This study explored the relationship between PPRs and a) use of outpatient follow-up care, b) discharge destination, c) rural versus urban residence of the patient, and d) time to follow-up care. 03 / 2012 http://www.uppermidwestrhrc.org/pdf/readmission_with_outpatient_visits_and_destination.pdf 2012-03-13 http://www.uppermidwestrhrc.org/pdf/readmission_with_outpatient_visits_and_destination.pdf This study investigated the availability of fluoridated water across urban-rural settings, and relates measures of fluoride availability to national survey measures of dental health in adults and children. 11 / 2011 http://wvrhrc.hsc.wvu.edu/docs/2011_fluoridation_final_report.pdf 2012-01-25 http://wvrhrc.hsc.wvu.edu/docs/2011_fluoridation_final_report.pdf This project analyzed the environmental workforce characteristics of the rural public health sector to inform policy relative to coordination of rural environmental health services. Environmental risks to rural populations are understudied relative to urban areas despite increasing recognition that rural populations are potentially exposed to these risks from agricultural, mining, industrial or other sources. These environmental risks and associated health problems carry corresponding implications for public health programs and services, and highlight the need for a rural public health workforce that includes appropriate environmental health specialists. 12 / 2011 http://wvrhrc.hsc.wvu.edu/docs/2010_persily_policy_brief.pdf 2012-01-12 http://wvrhrc.hsc.wvu.edu/docs/2010_persily_policy_brief.pdf This project analyzed the environmental workforce characteristics of the rural public health sector to inform policy relative to coordination of rural environmental health services. Environmental risks to rural populations are understudied relative to urban areas despite increasing recognition that rural populations are potentially exposed to these risks from agricultural, mining, industrial, or other sources. These environmental risks and associated health problems carry corresponding implications for public health programs and services, and highlight the need for a rural public health workforce that includes appropriate environmental health specialists. 12 / 2011 http://wvrhrc.hsc.wvu.edu/docs/2010_persily_final_report.pdf 2012-01-12 http://wvrhrc.hsc.wvu.edu/docs/2010_persily_final_report.pdf This analysis estimates the average net cost to Medicare of a SNF swing day by simulating the elimination of all Medicare SNF swing bed days in CAHs in 2009. 12 / 2011 http://www.shepscenter.unc.edu/research_programs/rural_program/pubs/finding_brief/FB103.pdf 2011-12-20 http://www.shepscenter.unc.edu/research_programs/rural_program/pubs/finding_brief/FB103.pdf Using data from the 2002-2007 Medical Expenditure Panel Survey (MEPS), this study examined access to care and service use among non-elderly, uninsured rural and urban residents. Key Findings include:Uninsured residents of both rural and urban areas face serious barriers to care compared to those with health insurance coverage. The rural uninsured are more likely to have a usual source of care and to have used ambulatory care in the past year than the urban uninsured. Insured or not, rural residents have difficulty accessing after hours care and traveling to see their usual provider 11 / 2011 http://muskie.usm.maine.edu/Publications/rural/pb/Rural-Healthcare-Access-Use.pdf 2011-12-13 http://muskie.usm.maine.edu/Publications/rural/pb/Rural-Healthcare-Access-Use.pdf This paper report findings from analysis of the Centers for Medicare and Medicaid Services data to examine the trends and geographic variations in Medicare Advantage (MA) plan enrollment, premiums and market concentration by firm. MA enrollment in rural areas remains strong and continues to grow in 2011, despite the recent shift in enrollment from private fee-for-service plans to preferred provider organization plans. The data presented in this policy brief provide an overview of the Medicare Advantage program in rural America and highlight key rural/urban differences within the program. 10 / 2011 http://cph.uiowa.edu/rupri/publications/policypapers/NOV.MA%20Overview%20October%202011%20FINAL.pdf 2011-11-08 http://cph.uiowa.edu/rupri/publications/policypapers/NOV.MA%20Overview%20October%202011%20FINAL.pdf Shows increases in enrollment into Medicare Advantage plans in rural America. The enrollment is concentrated in plans offered by three firms, especially in the types of plans with high rural enrollment which are preferred provider organizations and private fee-for-service plans. 09 / 2011 http://www.public-health.uiowa.edu/rupri/publications/policybriefs/2011/June%202011%20-%20one-pager1%20km.pdf 2011-11-02 http://www.public-health.uiowa.edu/rupri/publications/policybriefs/2011/June%202011%20-%20one-pager1%20km.pdf Discusses survey responses from 29 rural physician practices from around the country. When asked about their use of specific policies and procedures that are included as criteria to certify patient-centered medical homes, fewer of them would qualify in each of five domains, including access to care, population-based, quality, care management, and clinical information management. 09 / 2011 http://cph.uiowa.edu/rupri/publications/policybriefs/2011/09082011_PCMH_Survey_Brief_082311_FINAL.pdf 2011-11-02 http://cph.uiowa.edu/rupri/publications/policybriefs/2011/09082011_PCMH_Survey_Brief_082311_FINAL.pdf The rural community of Libby, Montana is the epidemiologicalepicenter of asbestos-related disease with mortality rates 4080 times higher when compared to rates in Montana and the USA. 05 / 2011 2011-10-27 Explores the degree to which lack of health insurance may contribute to high mortality rates among rural minority men and women aged 45-64. 10 / 2011 2011-10-18 Uses information regarding Medicare beneficiaries with diabetes to examine the provision of care in rural America. 10 / 2011 http://rhr.sph.sc.edu/report/%288-3%29Handlingthehandoff.pdf 2011-10-18 http://rhr.sph.sc.edu/report/%288-3%29Handlingthehandoff.pdf Identifies how the Patient Protection and Affordable Care Act of 2010 (ACA) can influence the determinants of health and contribute to the prosperity, equity, sustainability, and livability of rural places. 03 / 2011 http://www.rupri.org/Forms/HHSPanels_Integration_March2011.pdf 2011-10-13 http://www.rupri.org/Forms/HHSPanels_Integration_March2011.pdf The ACA calls for the development of a National Health Care Quality Strategy and Plan (National Quality Strategy) that will affect health care that is delivered to millions of Americans who live in rural areas and thousands of health care providers who care for them. 12 / 2010 http://www.rupri.org/Forms/HealthPanel_ACA_Dec2010.pdf 2011-10-13 http://www.rupri.org/Forms/HealthPanel_ACA_Dec2010.pdf Summarizes six issue areas of the Affordable Care Act (ACA) and discusses implications for access to services and improving the health status of rural residents. These issue areas are: health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care. 09 / 2010 http://www.rupri.org/Forms/Health_PPACAImpacts_Sept2010.pdf 2011-10-13 http://www.rupri.org/Forms/Health_PPACAImpacts_Sept2010.pdf Presents findings from a 2008 survey of 401 pharmacist-owners of sole community independent pharmacies. 03 / 2010 http://www.shepscenter.unc.edu/research_programs/rural_program/pubs/finding_brief/FB93.pdf 2011-10-13 http://www.shepscenter.unc.edu/research_programs/rural_program/pubs/finding_brief/FB93.pdf This report and policy brief will (1) assess the financial and quality challengesand potential unintended consequences for rural providers and patientsof 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. 09 / 2011 http://www.uppermidwestrhrc.org/pdf/bundling.pdf 2011-09-28 http://www.uppermidwestrhrc.org/pdf/bundling.pdf Diabetes is one of the most common chronic diseases, affecting an estimated 23.6 million people in the United States (7.8% of the total population). Rural African American and Hispanic residents with diabetes are less likely to exhibit good control of their condition, putting them at greater risk for the consequences of this disease, such as kidney failure, blindness and amputation. Effective outpatient care is key to diabetes management. Absence of such care, conversely, may play a role in poorer diabetes control in rural areas. The present report uses information regarding Medicare beneficiaries with diabetes to examine the provision of care in rural America. It provides estimates of hospital admission rates for rural Medicare beneficiaries with diabetes, tracks the proportion of patients who receive adequate outpatient care post discharge, and assesses subsequent readmissions to the hospital. It also explores the potential for race-based disparities in care for diabetes. 09 / 2011 http://rhr.sph.sc.edu/report/Handling%20the%20handoff%20September%202011.pdf 2011-09-21 http://rhr.sph.sc.edu/report/Handling%20the%20handoff%20September%202011.pdf This findings brief looks at if the the availability of post-acute skilled care stabilized, and how and where is it being provided today now that the reimbursement policy changes begun in the late 1990s have been fully implemented. 08 / 2011 http://www.shepscenter.unc.edu/research_programs/rural_program/pubs/finding_brief/FB102.pdf 2011-09-08 http://www.shepscenter.unc.edu/research_programs/rural_program/pubs/finding_brief/FB102.pdf Describes trends in the provision of surgery by rural hospitals. 07 / 2011 http://www.shepscenter.unc.edu/research_programs/rural_program/pubs/finding_brief/FB101.pdf 2011-09-08 http://www.shepscenter.unc.edu/research_programs/rural_program/pubs/finding_brief/FB101.pdf Rural areas, especially in the Southeast, Appalachia and parts of the West, have worse VRI (Vulnerability and Resiliency Index) scores which are a measure of six socioeconomic indicators across counties in the United States. Better VRI scores were associated with better health outcomes (lower heart disease, cancer, and stroke death rates) across the rural-urban continuum. These analyses provide evidence to support the development of programs and policies that foster educational development, and economic diversity and vitality, as means of public health improvement, especially in rural areas in selected regions of the country. 07 / 2011 http://wvrhrc.hsc.wvu.edu/docs/2009_halverson_policy_brief.pdf 2011-08-25 http://wvrhrc.hsc.wvu.edu/docs/2009_halverson_policy_brief.pdf Rural areas, especially in the Southeast, Appalachia and parts of the West, have worse VRI (Vulnerability and Resiliency Index) scores which are a measure of six socioeconomic indicators across counties in the United States. 03 / 2011 http://wvrhrc.hsc.wvu.edu/docs/2009_halverson_final_report.pdf 2011-08-25 http://wvrhrc.hsc.wvu.edu/docs/2009_halverson_final_report.pdf Rural counties are disproportionately associated with high food insecurity risk relative to urban counties. Programs and policies may focus on improving food availability and access for rural populations. More research, with multivariate analyses across regions, can shed additional light on the impact of food insecurity on the health of the population, especially for those living in rural areas. 06 / 2011 http://wvrhrc.hsc.wvu.edu/docs/2010_halverson_final_report.pdf 2011-08-16 http://wvrhrc.hsc.wvu.edu/docs/2010_halverson_final_report.pdf In this policy brief, we report findings from a study that used nationwide hospital inpatient discharge data to examine the trends and regional variations of rural hospital charges due to ambulatory care sensitive conditions (ACSCs) in the United States, by insurance type, from 2000 to 2004. Hospital charges due to ACSCs are reported by region and payment source. Changes in the percentage of hospital charges generated by ACSCs may indicate opportunities for cost savings through use of care management. The data presented in this policy brief indicate potential benefit from targeting resources designed to support ambulatory primary care. 08 / 2011 http://cph.uiowa.edu/rupri/publications/policybriefs/2011/ACSC_Trends_by_Payer%20072811.pdf 2011-08-16 http://cph.uiowa.edu/rupri/publications/policybriefs/2011/ACSC_Trends_by_Payer%20072811.pdf