Victoria Freeman, DrPH, RN

North Carolina Rural Health Research and Policy Analysis Center

Phone: 919.966.6168
E-mail: victoria_freeman@unc.edu

University of North Carolina - Chapel Hill

Current Projects

Factors Associated with Provision of Ambulance Services by Rural Hospitals
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Emergency medical services (EMS)
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.

Volunteerism in Rural EMS
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Health care financing, Workforce
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.

Completed Projects

Access to Health Care for Young Rural Medicaid Beneficiaries, Lead researcher
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Dental health, Health services, Medicaid and S-CHIP
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.

Rural Emergency Department Preparedness for Pediatric Care, Lead researcher
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Health services, Hospitals and clinics
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.

Rural Emergency Medical Services: Workforce and Medical Direction
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Workforce
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.

Publications

• Becoming an Emergency Medical Technician: Urban-Rural Differences in Motivation and Job Satisfaction
  Author(s): P. Daniel Patterson, Victoria A Freeman, Charity G. Moore, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Emergency medical services (EMS), Workforce
  Report Number: Working Paper No. 89
  Date: 03 / 2007
  This study uses cross-sectional data from the 2003 national Longitudinal Emergency Medical Technician Attributes and Demographic Study (LEADS) Project to explore urban-rural differences in why EMTs enter the field, what is important in their jobs, and whether they are satisfied with their profession.
• Cesarean Section Patterns In Rural Hospitals
  Author(s): Sandra B. Greene, George M. Holmes, Rebecca Slifkin, Victoria Freeman, Hilda Ann Howard
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Maternal and child health
  Report Number: Working Paper No. 80
  Date: 11 / 2004
  Examines childbirth delivery patterns in rural hospitals and compares the cesarean section (c-section) rate in rural hospitals to that in urban hospitals. The c-section rate for rural hospitals was well above the 10-15% rate recommended by the World Health Organization, and was higher (but not statistically significant) in rural hospitals than in urban hospitals. A Findings Brief on this topic is also available.
• Cesarean Section Rates in Rural Hospitals
  Author(s): Sandra Greene, George Holmes, Rebecca Slifkin, Victoria Freeman, Hilda Ann Howard
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Maternal and child health
  Report Number: Findings Brief No. 79
  Date: 03 / 2005
  Findings Brief examining childbirth delivery patterns in rural hospitals and comparing the C-section rate in rural hospitals to that in urban hospitals using the Nationwide Inpatient Sample (NIS). Working Paper No. 80 on this topic is also available.
• Challenges for Rural Emergency Medical Services: Medical Oversight
  Author(s): Victoria Freeman, DrPH; Rebecca Slifkin, PhD; Daniel Patterson, PhD
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Emergency medical services (EMS), Workforce
  Report Number: Findings Brief 85
  Date: 05 / 2008
  This Findings Brief examines the challenges faced by local rural EMS agencies in obtaining a medical director and ensuring medical oversight for EMS personnel, and also describes how the challenges faced in rural areas differ from those in urban ones. The data are from a national survey of 1,425 local EMS directors that was conducted in 2006-2007.
• Community Impact of Critical Access Hospitals
  Author(s): John A. Gale, Andrew F. Coburn, Victoria Freeman, Walter R. Gregg, 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: Policy Brief No. 2
  Date: 02 / 2007
  Discusses the findings of a project to understand the community involvement and impact of Critical Access Hospitals (CAHs) and the Medicare Rural Hospital Flexibility Program (Flex Program). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Exploring the Community Impact of Critical Access Hospitals
  Author(s): John Gale, Andrew Coburn, Walt Gregg, Rebecca Slifkin, Victoria Freeman
  Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center , North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Report Number: Flex Monitoring Team Briefing Paper No. 14
  Date: 01 / 2007
  Reports on a series of site visits to six diverse rural communities and Critical Access Hospitals (CAHs) to assess the experiences and impact of these hospitals in responding to their community’s health infrastructure needs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Intensive Care In Critical Access Hospitals
  Author(s): Victoria Freeman, Joan Walsh, Matthew Rudolf, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health services, Hospitals and clinics
  Report Number: Working Paper No. 81
  Date: 03 / 2005
  Describes what officials at Critical Access Hospitals (CAHs) mean when they report that they provide intensive care and the importance of these services to the hospital and the community it serves. Semi-structured interviews were conducted with Directors of Nursing at 63 CAHs in 27 states. Respondents described the physical structure of the intensive care area, equipment and staffing available for such care, types of patients who receive intensive care, transfer patterns, the role of intensive care in the decision to convert to CAH status, and the perceived value of this service to the community and hospital.
• Intensive Care in Critical Access Hospitals
  Author(s): Victoria A. Freeman, Joan Walsh, Matthew Rudolf, Rebecca T. Slifkin, Asheley Cockrell Skinner
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Citation: Journal of Rural Health, 23(2), 116-123
  Date: 2007
  Describes the facilities, equipment, and staffing used by Critical Access Hospitals (CAHs) for intensive care, the types of patients receiving ICU care, and the perceived impact of closing the ICU on CAH staff and the local community.
• Issues in Staffing Emergency Medical Services: A National Survey of Local Rural and Urban EMS Directors
  Author(s): Victoria Freeman, DrPH; Rebecca Slifkin, PhD; Daniel Patterson, PhD
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Emergency medical services (EMS), Workforce
  Report Number: Final Report No. 93
  Date: 05 / 2008
  This report explores rural-urban differences in medical oversight and the recruitment and retention of emergency medical technicians (EMTs)and paramedics as reported by a survey of 1,425 local EMS directors.
• Medicare Beneficiaries’ Access to Pharmacy Services in Small Rural Towns: Implications of Contracting Patterns of Sole Community Pharmacies with Part D Plans
  Author(s): Victoria A Freeman, Indira Richardson, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
  Report Number: Final Report No. 95
  Date: 01 / 2009
  Describes the contracting patterns of sole rural community pharmacies to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state.
• Pediatric Care in Rural Hospital Emergency Departments (Final Report)
  Author(s): Victoria A. Freeman, Randy K. Randolph, Stephanie Poley, Sarah Friedman, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Children, Emergency medical services (EMS), Hospitals and clinics
  Report Number: 97
  Date: 05 / 2010
  Analyzes data from the Emergency Pediatric Services and Equipment Supplement (EPSES) to the National Hospital Ambulatory Medicare Care Survey to compare rural and urban hospitals’ responses on various dimensions of pediatric Emergency Department care.
• Pediatric Care in Rural Hospital Emergency Departments (Findings Brief)
  Author(s): Victoria A. Freeman, Randy K. Randolph, Stephanie Poley, Sarah Friedman, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Children, Emergency medical services (EMS), Hospitals and clinics
  Date: 05 / 2010
  Analyzes data from the Emergency Pediatric Services and Equipment Supplement(EPSES) to the National Hospital Ambulatory Medical Care Survey (NHAMCS). Rural and urban hospitals’ responses were compared on various dimensions of pediatric ED care. We also surveyed 65 ED directors at rural hospitals in a separate process to explore rural pediatric ED care in more detail and to obtain the opinion of rural ED administrators regarding ways to assure quality emergency care for children.
• Reducing Mortality from Motor Vehicle Crashes for Children 0 through 14 Years of Age: Success in New York and North Dakota
  Author(s): Victoria Freeman
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topic: Children
  Date: 12 / 2004
  Reviews effective interventions to reduce motor vehicle crash mortality among children. Explores what is happening in New York and North Dakota that contributes to their success in being among the best performing states in regard to this measure of child health.
• Rural and Urban Parents Report on Access to Health Care for their Children with Medicaid Managed Care
  Author(s): Victoria Freeman, Rebecca Slifkin, Asheley Skinner, Robert Schwartz
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Children, Medicaid and S-CHIP
  Report Number: Working Paper No. 84
  Date: 12 / 2005
  There has been little previous research on rural beneficiaries' perspectives on access to care under Medicaid managed care. The study reported here considers the perspective of the rural beneficiary in four states in order to broaden understanding of whether Medicaid managed care programs provide acceptable access to health care services. The study examines access to health care among rural children ages 0-17 who are enrolled in either fully capitated (New Mexico and Washington) or primary care case management (PCCM) Medicaid managed care plans (North Carolina and North Dakota), and compares this access to that of urban beneficiaries. Overall, this study finds that parents of children living in the rural areas who are enrolled in a Medicaid managed care program are almost always able to get the medical care they need. Rural children who are Medicaid enrollees have primary care providers, their parents know how to access care when needed after hours, and although rural children sometimes use the ER, they do not rely on that source of care more than urban parents do. Where barriers to medical care are reported, they are often consistent with those barriers reported for rural residents generally, and do not appear to be related to restrictions from managed care programs. Access to dental services remains a substantial problem, not just for children in rural areas, but for all Medicaid enrollees. 2004
• Rural-Urban Differences in Characteristics of Local EMS Agencies
  Author(s): Victoria Freeman, DrPH; Rebecca Slifkin, PhD; Daniel Patterson, PhD
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Emergency medical services (EMS), Workforce
  Report Number: Findings Brief 84
  Date: 05 / 2008
  This Findings Brief describes the general characteristics of local rural EMS agencies and important ways that they differ from the characteristics of agencies located in urban areas. The data are from a national survey of 1,425 local EMS directors that was conducted in 2006-2007.
• Sole Community Pharmacies and Part D Participation: Implications for Rural Residents (Findings Brief)
  Author(s): Victoria Freeman, Indira Richardson, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Medicare Part D, Pharmacy and prescription drugs
  Date: 02 / 2009
  This findings brief describes the contracting rates of sole rural community pharmacies in 16 states to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state.