Gestur Davidson, PhD

Upper Midwest Rural Health Research Center

Phone: 612.626.6271
E-mail: david064@umn.edu

Rural Health Research Center
University of Minnesota
420 Delaware Street, SE, Box 729
Minneapolis, MN 55455

Current Projects

The Nursing Workforce Impact on Rural Hospital Performance Improvement in the Hospital Quality Incentive Demonstration Project
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Quality, Workforce
The purpose of this project is to examine the impact of nurse staffing on hospital performance improvement in the CMS/premier Inc. Hospital Quality Incentive Demonstration project with specific interest in whether and how this relationship differs in rural hospitals as compared to urban hospitals.

Publications

• Access To Dental Care For Rural Low Income And Minority Populations
  Author(s): Michelle M. Casey, Gestur Davidson, Ira Moscovice, David Born
  Research center: Minnesota Rural Health Research Center
  Topics: Dental health, Minority health, Poverty
  Report Number: Working Paper No. 54
  Date: 09 / 2004
  Using data from the 1999 National Health Interview Survey, this study examines the relationships between rural residence, income, race/ethnicity, and access to dental care. The study confirms that rural-urban disparities in access to dental care persist, and finds significant differences by race/ethnicity and income within rural populations in utilization of dental care, affording needed dental care, and dental insurance.
• Ambulatory Care Sensitive Condition Hospitalizations Among Rural Children
  Author(s): Michelle Casey, Alana Knudson, Michele Burlew, Gestur Davidson
  Research center: Upper Midwest Rural Health Research Center
  Topics: Children, Chronic diseases and conditions, Hospitals and clinics
  Report Number: Working Paper No. 4
  Date: 02 / 2007
  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
  Research center: Upper Midwest Rural Health Research Center
  Topics: Children, Chronic diseases and conditions, Hospice and palliative care
  Report Number: Policy Brief
  Date: 06 / 2007
  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.
• Are There Geographic Disparities in Out-of-Pocket Spending by Medicare Beneficiaries?
  Author(s): Tiffany A. Radcliff, Gestur Davidson, Aram Dobalian,
  Research center: Minnesota Rural Health Research Center
  Topic: Medicare
  Date: 10 / 2003
  Describes a study comparing out-of-pocket spending among rural and urban Medicare recipients. Includes data on differences based on supplemental insurance coverage.
• Financial Benefits of Critical Access Hospital Conversion for FY 1999 and FY 2000 Converters
  Author(s): Jeffrey Stensland, Gestur Davidson, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Date: 01 / 2004
  Discusses the impact of conversion to Critical Access Hospital (CAH) status on the financial condition of rural hospitals one and two years after conversion. CAHs pre- and post-conversion revenues are compared, and CAH revenues are compared to small rural hospitals that did not convert to cost-based Medicare reimbursement.
• Financial Effects of Critical Access Hospital Conversion
  Author(s): Jeffrey Stensland, Gestur Davidson, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Report Number: Working Paper No. 44
  Date: 01 / 2003
  Describes how the first wave of conversions to Critical Access Hospital (CAH) status affected rural hospitals? financial performance and organizational structure.
• Hospital Size, Uncertainty and Pay-for-Performance
  Author(s): Gestur Davidson, Ira Moscovice, Denise Remus
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Report Number: Working Paper No. 3
  Date: 02 / 2007
  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
  Research center: Upper Midwest Rural Health Research Center
  Topics: American Indians and Alaska Natives, Health insurance and the uninsured, Minority health
  Report Number: Final Report No. 6
  Date: 10 / 2007
  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.
• 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
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
  Report Number: Working Paper No. 1
  Date: 12 / 2005
  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
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
  Citation: Journal of Rural Health, 22(4), 321-330
  Date: 2006
  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.
• Rate of Return on Capital Investments at Small Rural Hospitals
  Author(s): Jeffrey Stensland, Astrid Knott, Ira Moscovice, Gestur Davidson
  Research center: Minnesota Rural Health Research Center
  Topics: Capital funding, Hospitals and clinics
  Report Number: Working Paper No. 45
  Date: 01 / 2003
  Examines whether the aging of rural facilities, a major problem among rural hospitals, is due to a lower rate of return on capital investment at these hospitals. This paper also investigates whether membership in a hospital system improves access to capital and results in the updating of buildings and equipment. The study found that hospitals generally do no use system membership to overcome access to capital problems, most likely because investments are not readily available along this pathway. The study also found that hospitals generate 50 cents for every dollar invested in facility improvement. Although this is a way to generate revenue, the small hospitals will typically not be able to recover the costs spent in the improvement. These findings suggest that small hospitals, particularly the smallest and most rural hospitals, would need grants in order to adequately cover the costs of facility improvement.
• Rural Hospitals: New Millennium and New Challenges
  Author(s): Ira Moscovice, Gestur Davidson
  Research center: Minnesota Rural Health Research Center
  Topic: Hospitals and clinics
  Date: 02 / 2003
  Discusses the changes in rural hospitals that took place in the decade of the 1990?s and discusses some of the challenges that face rural hospitals in 2003. Includes discussion of rural hospitals' organizational structure, health service provision, payment/reimbursement, and financial performance.