Michelle Casey, MS

Upper Midwest Rural Health Research Center

Phone: 612.626.6252
Fax: 612.624.2196
E-mail: mcasey@umn.edu

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

Current Projects

Measuring Quality Performance in CAHs
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
The purpose of the project is to update our previous analyses of CAH participation in Hospital Compare, analyze trends over time, and explore additional sources of quality data for CAHs.

Patient Assessments and Quality of Care in Rural Hospitals
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Quality
This study will 1)analyze the relationships between rural patients’ perspectives of hospital quality of care and key hospital characteristics that may influence patients’ experiences of hospital care; and 2) assess whether rural patients’ perspectives of hospital quality of care are related to quality measures focused on the provision of recommended care for medical conditions.

Completed Projects

Analysis of Critical Access Hospital Inpatient Hospitalizations and Transfers from CAHs to Other Acute and Post-Acute Care Settings Using State Inpatient Databases
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality, Technology
The purpose of this project is to analyze Critical Access Hospital (CAH) inpatient hospitalizations and transfers from CAHs in order to help inform the development of quality indicators for CAHs, especially quality indicators focused on the transfer process.

Analyzing the Relationship Among Critical Access Hospital Financial Status, Organizational Linkages, and Scope of Services
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Health services, Networking and collaboration
This project will systematically analyze the relationships among pre- and post-conversion Critical Access Hospital (CAH) financial performance, the organizational linkages in which the hospital participates (e.g., health care systems and/or networks), and the scope of services (i.e., the number and type of services) provided.

Critical Access Hospital Participation in the Hospital Quality Alliance and Initial Quality Measure Results
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
This project examined the participation of Critical Access Hospitals (CAHs) in public reporting of quality measures in the Centers for Medicare and Medicaid Services Hospital Compare database. It presented the initial Hospital Compare results for CAHs and comparisons with other groups of hospitals on quality measures for three conditions: acute myocardial infarction (heart attack), heart failure and pneumonia.

Dental Care For Rural Low Income And Minority Populations, Lead researcher
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Dental health, Minority health, Poverty

End-of-Life Care for Rural Medicare Beneficiaries, Lead researcher
Research center: Minnesota Rural Health Research Center
Funder: Robert Wood Johnson Foundation (RWJF)
Topics: Home health, Hospice and palliative care, Medicare

Expansion of Managed Care in Rural Areas, Lead researcher
Research center: Minnesota Rural Health Research Center
Funder: Robert Wood Johnson Foundation (RWJF)
Topic: Health care financing

Health Care System Response to a Growing Latino Population in Rural America, Lead researcher
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Cultural competency, Hispanics, Minority health, Rural statistics and demographics

Hospitalizations of Rural Children for Ambulatory Care Sensitive Conditions
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Chronic diseases and conditions
This project uses state inpatient discharge data from six states, data from the Area Resource File and the AHRQ Pediatric Quality Indicators to examine Ambulatory Care Sensitive Condition admission rates for rural children.

Impact of Risk Plan Withdrawals on Rural Medicare Beneficiaries, Lead researcher
Research center: Minnesota Rural Health Research Center
Funder: Robert Wood Johnson Foundation (RWJF)
Topic: Medicare

Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Telehealth
The purpose of this project is to describe successful telepharmacy activities and to analyze policy issues related to the implementation of telepharmacy projects in rural hospitals. These policy issues include the potential impact of telepharmacy use on the quality of pharmaceutical services and medication safety for rural patients.

Measuring Quality in Rural Health Services: Are Hospital and Health Plan Accreditation Standards Appropriate for Rural Areas?
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Quality

Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Hospitals and clinics, Quality, Workforce
This project will describe emergency department (ED) staffing patterns in rural hospitals; determine how the certification, training, and experience of ED physicians and other providers in different ED staffing models vary; and assess the implications of rural ED staffing for the quality of emergency care in rural areas, continuity of care, and rural EDs’ role as safety net providers.

Successful Implementation of Medication Safety Initiatives in Rural Hospitals: The Role of Pharmacists and Technology
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
This project will assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, and will identify factors that facilitate successful implementation of medication safety practices in rural hospitals.

Publications

• 2004 CAH Survey National Data
  Author(s): Michelle Casey, Jill Klingner
  Research center: Minnesota Rural Health Research Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Date: 08 / 2004
  As part of the monitoring efforts for the Medicare Rural Hospital Flexibility Program (Flex Program), the Flex Monitoring Team conducted a national telephone survey of 500 CAH administrators between January and April 2004. The purpose of the survey was to document the program-related experiences of CAHs over the past two years, in order to help shape public policy to improve the effectiveness of the Flex Program and CAHs. The CAH survey was developed by the Flex Monitoring Team members at the Universities of Minnesota, North Carolina, and Southern Maine and fielded by the Survey Research Center in the Division of Health Services Research and Policy at the University of Minnesota. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• 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.
• Access to Rural Pharmacy Services in Minnesota, North Dakota, and South Dakota
  Author(s): Michelle M. Casey, Jill Klingner, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Health services, Legislation and regulation, Medicare Part D, Pharmacy and prescription drugs, Workforce
  Report Number: Working Paper No. 36
  Date: 07 / 2001
  Describes the current status of rural retail pharmacies in the three states; examines the availability of pharmacy services in rural areas of the states; and analyzes regulatory and policy issues that affect the delivery of pharmacy services in rural areas. Among the findings are that pharmacy access problems in the states are not primarily due to closure of rural pharmacies in recent years; relief coverage is a major concern for many rural pharmacies; financial access to pharmacy services is a major concern in rural areas of the states; the financial viability of rural pharmacies is a key policy issue; and the addition of a Medicare prescription benefit may have a substantial negative impact on the financial status of rural pharmacies. Makes several recommendations pertaining to the capacity of colleges of pharmacy to produce an adequate supply of rural pharmacists; options for providing affordable relief coverage for rural pharmacists; financial access to prescription drug coverage for the elderly and other vulnerable populations; and the potential financial impact of a Medicare prescription benefit on rural pharmacies.
• 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.
• Analysis of CAH Inpatient Hospitalizations and Transfers: Implications for National Quality Measurement and Reporting
  Author(s): Michelle Casey, Michele Burlew
  Research center: Upper Midwest Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 13
  Date: 12 / 2006
  Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• CAH Participation in Hospital Compare and Initial Results
  Author(s): Michelle Casey, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 9
  Date: 02 / 2006
  Examines the participation of Critical Access Hospitals (CAHs) in public reporting of quality measures in the Centers for Medicare and Medicaid Services Hospital Compare database. It presents the initial Hospital Compare results for CAHs and comparisons with other groups of hospitals on quality measures for three conditions: acute myocardial infarction (heart attack), heart failure and pneumonia. Although CAHs do not face the same financial incentives as Prospective Payment System hospitals to participate, the Hospital Compare initiative provides an important opportunity for CAHs to assess and improve their performance on national standards of care. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Critical Access Hospital Patient Safety Priorities and Initiatives: Results of the 2004 National CAH Survey
  Author(s): Michelle Casey, Ira Moscovice, Jill Klingner
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Briefing Paper No. 3
  Date: 09 / 2004
  Describes the patient safety results from a national phone survey of 474 CAH administrators conducted in 2004. Survey respondents were queried regarding top patient safety priorities, familiarity with the Joint Commission on Accreditation of Healthcare Organization (JCAHO) and implementation of initiatives related to the goals, factors that limit or support their ability to implement patient safety interventions, and pharmacist staffing and computer software to improve medication safety. The survey findings provide encouraging evidence of CAH interest in patient safety, but should be interpreted cautiously because of the significant number of CAHs which reported that financial resources, staff time, and technology are limiting factors in their ability to implement patient safety interventions. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results
  Author(s): Michelle Casey, Michele Burlew, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 16
  Date: 04 / 2007
  Examines the second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database for hospital quality measures. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results (Policy Brief)
  Author(s): Michelle Casey, Michele Burlew, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Policy Brief No. 4
  Date: 05 / 2007
  Policy brief examining the second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database. A full report is also available. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Current Status of Health Information Technology Use in CAHs
  Author(s): Michelle Casey, Jill Klingner, Walt Gregg, Ira Moscovice, Emily Nicholson, Tami Lichtenberg, Terry Hill
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health information technology
  Report Number: Briefing Paper No. 11
  Date: 05 / 2006
  Both the public and private sectors have focused considerable attention on health information technology (HIT) as a potential means of improving the quality, safety, and efficiency of health care. The purpose of this briefing paper is to assess the current status of HIT use in Critical Access Hospitals (CAHs) nationally. This project is part of the federal Office of Rural Health Policy's initiative to implement national performance measures for the Medicare Rural Hospital Flexibility Program. It was conducted by the Flex Monitoring Team in collaboration with the Technical Assistance and Services Center (TASC) at the Rural Health Resource Center in Duluth, Minnesota. Data for the study came from a national survey of CAHs conducted in March and April 2006. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Do Rural Elders Have Limited Access to Medicare Hospice Services?
  Author(s): Beth A. Virnig, Ira S. Moscovice, Sara B. Durham, Michelle M. Casey
  Research centers: Minnesota Rural Health Research Center , Upper Midwest Rural Health Research Center
  Topics: Aging, Hospice and palliative care, Medicare
  Citation: Journal of the American Geriatrics Society, 52(5), 731-5
  Date: 2004
  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.
• Influence of Rural Residence on the Use of Preventative Health Care Services
  Author(s): Michelle M. Casey, Kathleen Thiede Call, Jill Klingner
  Research center: Minnesota Rural Health Research Center
  Topics: Health promotion and disease prevention, Rural statistics and demographics
  Report Number: Working Paper No. 34
  Date: 11 / 2000
  Study of the utilization of specific preventive health care services by rural women and men, and to assess the impact of rural residence, the availability of health care providers and technology, demographic factors, and health insurance status on the likelihood of obtaining the following preventive health care services: blood pressure screening, cholesterol screening, colon cancer screening, Pap smears, mammograms, flu shots, and pneumonia vaccinations.
• 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.
• Prioritizing Patient Safety Interventions in Small Rural Hospitals
  Author(s): Michelle Casey, Mary Wakefield, Andrew F. Coburn, Ira Moscovice, Stephanie Loux
  Research centers: Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Citation: Joint Commission Journal on Quality and Patient Safety, 32(12), 693-702
  Date: 12 / 2006
  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.
• Providing Hospice Care in Rural Areas: Challenges and Strategies to Address Them
  Author(s): Michelle M. Casey, Ira S. Moscovice, Beth A. Virnig, Sara B. Durham
  Research center: Minnesota Rural Health Research Center
  Topics: Health services, Hospice and palliative care
  Citation: American Journal of Hospice and Palliative Medicine, 22(5), 363-8
  Date: 2005
  Hospices in rural settings face challenges in the provision of hospice care as a result of their location and the size of their service area population. To ascertain the challenges that hospices face in serving rural communities, researchers conducted in-depth case studies of four different models of hospice care in rural areas. The authors describe strategies used by the case study hospices and recommend policies that could increase access to hospice care for rural Medicare beneficiaries and other rural residents. National initiatives to improve end-of-life care need to consider the special challenges faced by rural hospices.
• Quality Improvement Activities in Critical Access Hospitals: Results of the 2004 National CAH Survey
  Author(s): Michelle Casey, Ira Moscovice, Jill Klingner
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 2
  Date: 09 / 2004
  Describes quality improvement efforts in Critical Access Hospitals (CAHs) based on a 2004 survey of 474 CAH administrators. Includes data on the use of clinical guidelines and quality measures in CAHs, and the role of Medicare Quality Improvement Organizations (QIOs). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Quality Improvement Strategies and Best Practices in Critical Access Hospitals
  Author(s): Michelle Casey, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Working Paper No. 52
  Date: 01 / 2004
  Describes Critical Access Hospital (CAH) quality improvement (QI) initiatives, with examples of best practices from two CAHs that have innovative QI programs. Includes lists of changes made to staffing, training, equipment and other issues related to quality improvement.
• Response of Local Health Care Systems in the Rural Midwest to a Growing Latino Population
  Author(s): Michelle Casey, Lynn Blewett, Kathleen Call
  Research center: Minnesota Rural Health Research Center
  Topics: Cultural competency, Hispanics, Minority health
  Report Number: Working Paper No. 48
  Date: 08 / 2003
  Reports on the case studies of rural communities in Iowa, Kansas, and Nebraska, documenting successful strategies that could be adopted by other communities facing challenges to their local rural health care system in meeting the needs of a growing Latino population. High rates of uninsurance for Latinos, along with language and cultural barriers to care, have contributed to difficulties accessing health care in these communities.
• 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
  Research center: Upper Midwest Rural Health Research Center
  Topics: Emergency medical services (EMS), Quality
  Date: 06 / 2007
  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.
• State Flex Program at 10 Years: Strengthening Critical Access Hospitals and Rural Communities
  Author(s): John A. Gale, Jennifer Lenardson, Walter R. Gregg, Michelle Casey, Indira Richardson, Stephen Rutledge
  Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center , North Carolina Rural Health Research and Policy Analysis Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Flex Monitoring Team Policy Brief No. 3
  Date: 04 / 2007
  To understand the priorities and accomplishments of state Flex Grant Programs, members of the Flex Monitoring Team asked Flex Coordinators to identify and discuss their states’ three most successful initiatives in the past two years. Interviews were conducted during February 2007 with Flex Coordinators and State Office of Rural Health staff (SORH) in all 45 states. The listed publication is a policy brief; the full report will be available in the fall of 2007. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program
  Author(s): John Gale, Jennifer Lenardson, Walt Gregg, Michelle Casey, Indira Richardson, Stephen Rutledge, Rebecca Slifkin
  Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center , North Carolina Rural Health Research and Policy Analysis Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Flex Monitoring Team Briefing Paper No. 15
  Date: 10 / 2007
  Explores activities funded by the Medicare Rural Hospital Flexibility Program (Flex Program) to strengthen the rural health care infrastructure and discusses which activities were considered most successful by State Flex Coordinators. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Use of the Hospice Benefit by Rural Medicare Beneficiaries
  Author(s): Beth Virnig, Ira Moscovice, Sara Kind, Michelle Casey
  Research center: Minnesota Rural Health Research Center
  Topics: Hospice and palliative care, Medicare
  Report Number: Working Paper No. 43
  Date: 08 / 2002
  Identifies urban-rural differences in hospice use in rural service areas.