Astrid Knott, PhD

Phone: 612.624.3566
E-mail: knott008@umn.edu

Rural Health Research Center
University of Minnesota
420 Delaware Street, SE, Box 729
Minneapolis, MN 55455-0392

Completed Projects

Access to Emergency Medical Services in Rural Areas, Lead researcher
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Health services

Evaluating the Financial Impact of Critical Access Hospital Conversion Over Time, Lead researcher
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
Using Medicare cost report data, this project will analyze changes in several key financial and organizational indicators that may be affected by CAH conversion, and produce annual reports describing the financial status of CAHs.

Evolving Practice of Rural Primary Care Physicians
Research center: Minnesota Rural Health Research Center
Funder: Robert Wood Johnson Foundation (RWJF)
Topics: Physicians, Workforce

Factors Shaping Rural Hospital Managed Care Strategies, Lead researcher
Research center: Minnesota Rural Health Research Center
Funder: Agency for Health Care Policy and Research (AHCPR)
Topics: Health care financing, Hospitals and clinics

Implementing Quality Assessment and Performance Improvement Systems in Rural Health Clinics: Clinic and State Agency Responses, Lead researcher
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Legislation and regulation, Quality, Rural Health Clinics (RHCs)

Rural Hospitals' Access to Capital
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Capital funding, Hospitals and clinics

Publications

• Access to Emergency Medical Services in Rural Areas: The Supporting Role of State EMS Agencies
  Author(s): Astrid Knott
  Research center: Minnesota Rural Health Research Center
  Topics: Emergency medical services (EMS), Health services
  Report Number: Working Paper No. 38
  Date: 02 / 2002
  Reports the findings of a survey of state EMS directors regarding access to rural EMS; programs and initiatives by state EMS agencies that target rural and volunteer EMS providers; integration initiatives by rural EMS providers; issues in medical direction for rural EMS; and anticipated effects of the new Medicare fee schedule on rural EMS providers. Findings include: there is substantial state-by-state variation in the approach to EMS issues; EMS system development has not been a priority in state efforts; state EMS agencies address rural EMS provider needs in a limited manner; medical direction in rural EMS is a major issue in most states, but few states place a high priority on it; and EMS integration is sometimes seen as a panacea, but is not easily accomplished. Concludes that the time is right for a new national initiative to address EMS issues and to stimulate the development of EMS as a system, beyond its current fragmented state.
• Comparing Patient Safety in Rural Hospitals by Bed Count
  Author(s): Stephenie L. Loux, Susan M. C. Payne, Astrid Knott
  Research centers: Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  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
  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.
• Grantee Sustainability in the Rural Health Outreach Grant Program
  Author(s): Walter Gregg, Astrid Knott, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topic: Health services
  Date: 12 / 2003
  Describes a study of the post-grant experiences of 99 Rural Health Outreach Grant recipients. Focuses on the extent to which programs were able to maintain or expand services after their grants ended and characteristics that helped programs succeed in the post-grant period.
• Implementing Quality Assessment and Performance Improvement Systems in Rural Health Clinics: Clinic and State Agency Responses
  Author(s): Astrid Knott, Karen Travers
  Research center: Minnesota Rural Health Research Center
  Topics: Quality, Rural Health Clinics (RHCs)
  Report Number: Working Paper No. 42
  Date: 08 / 2002
  Assesses the potential of a diverse set of Rural Health Clinics to comply with the quality assessment and performance improvement program (QAPI) requirements and the capacity of state agencies to provide RHCs with technical assistance in their QAPI implementation. Finds that more information and guidance on QAPI requirements is needed to make the program a success, and that to make QAPI useful to RHCs, RHCs need technical assistance in all aspects of quality assurance. Also finds that QAPI implementation could hamper care in resource-strapped RHCs if implementation is too costly or if clinics decide to withdraw from the RHC program because of QAPI.
• Measuring Rural Hospital Quality
  Author(s): Ira Moscovice, Douglas R. Wholey, Jill Klingner, Astrid Knott
  Research center: Minnesota Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Report Number: Working Paper No. 53
  Date: 04 / 2004
  This paper seeks to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive to the rural hospital context. A conceptual model is developed for measuring rural hospital quality. Hospital quality measures from national and rural organizations are reviewed for their fit to rural hospitals, with a recommendation for an initial core set of quality measures relevant for rural hospitals with less than 50 beds. Finally, avenues for future quality measure development are suggested.
• 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 Government Role in Medicaid Managed Care: The Development of County-Based Purchasing in Minnesota
  Author(s): Astrid Knott, Jon B. Christianson
  Research center: Minnesota Rural Health Research Center
  Topics: Health care financing, Medicaid and S-CHIP
  Report Number: Working Paper No. 35
  Date: 01 / 2001
  Describes the development and implementation in Minnesota of a model for rural county government participation in Medicaid managed care initiatives. The model-called County-Based Purchasing-allows county governments the option of functioning as direct purchasers of health care for the Medicaid beneficiaries in their area, accepting financial risk for service delivery. Concludes that if the model is to be used nationally, several issues must be addressed including, the federal approval process for similar initiatives, the relationship between state and county agencies, and sources of funding.
• Rural Hospital Access to Capital: Issues and Recommendations
  Author(s): Walter Gregg, Astrid Knott, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Capital funding, Hospitals and clinics
  Report Number: Working Paper No. 41
  Date: 07 / 2002
  Identifies federal and state programs that have assisted or could assist rural hospitals in meeting their capital needs; assesses whether rural hospital borrowers have difficulty in meeting their capital needs under existing grant, loan, and mortgage insurance programs; and discusses potential options for improving access to capital for rural hospitals. Offers regulatory, programmatic, and policy recommendations to improve the HUD 242 Program and the USDA Community Facilities Program-two federal programs that have been able to assist some of the less creditworthy hospitals over the last three decades.
• Sustaining Community Health Services Over Time: Models from the Rural Health Outreach Grant Program
  Author(s): Walter R. Gregg, Astrid Knott, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Federally Qualified Health Centers (FQHCs), Health services
  Date: 11 / 2004
  Discusses post-grant sustainability of services provided by recipients of Rural Health Outreach Grant Program projects. Based on site visits to a medical rehabilitation project in Wyoming, a prenatal outreach project in Maryland, and a community health center in Oregon.