Health services

Completed Projects

Access to Cancer Services for Rural Colorectal Cancer Medicare Patients: A Multi-State Study
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Aging, Chronic diseases and conditions, Health services, Medicare, Minority health
This study examined a comprehensive database to quantify the distance and access to four types of cancer services in a sample of rural, Medicare-insured, CRC patients of different racial and ethnic groups, and will inform future work designed to understand discrepancies in cancer service use by the rural elderly in different racial and ethnic groups.

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

Access to Health Care for Young Rural Medicaid Beneficiaries
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.

Access to Physician Care for the Rural Medicare Elderly
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Aging, Chronic diseases and conditions, Health services, Medicare, Physicians, Poverty
This study described where Medicare beneficiaries in five states obtain their health care, how far they travel for that care, and the mix of physician specialties from which they obtain ambulatory care. Special attention was paid to beneficiaries who have dual Medicare-Medicaid status, who reside in poorer income areas, and who live in designated Health Professional Shortage Areas.

Access to Services Across a Continuum of Care for Rural Beneficiaries
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topic: Health services

Acute and Post-Acute Care Bundled Payments and Care Coordination in Rural Environments
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Quality
The purpose of this project is to: 1) Identify opportunities and potential unintended consequences for rural providers of current proposals for implementing bundled payments for acute and post-acute care episodes; 2) Describe modifications to current bundling proposals that will address rural-specific issues; and 3) Identify quality measures related to care coordination that are relevant for rural patients whose services are reimbursed by a bundled payment.

Ambulatory Care and the Rural Elderly
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Aging, Chronic diseases and conditions, Health services

Analysis Related to Health Care Reform Issues
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health policy, Health services
The RUPRI Center is prepared to provide analysis of elements and/or effects of proposed or enacted health reform legislation and/or regulations to implement changes mandated by legislation.

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.

Are Rural Perinatal Care Systems Deregionalizing?
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Health services, Maternal and child health

Availability of Specialty Health Care for Rural American Indians and Alaska Natives
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: American Indians and Alaska Natives, Health services, Minority health

Describing Geographic Access to Physicians in Rural America Using Statistical Applications in GIS
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Physicians
This study will use a geographically weighted regression to assess the influence of distance and travel time on the distribution of physicians in rural America. The ultimate goal of the study will be to improve our measures of access by identifying the extent to which border resources can be considered in indices of access.

Descriptive Analysis of the Health Status of a National Asbestos-Related Cohort
Research center: ORHP-funded Individual Grantees
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Health services
A collaborative study to establish a more comprehensive understanding of the health status and health service needs of persons exposed to Libby asbestos is being conducted by nurse researchers at Montana State University College of Nursing and health care providers at the Center for Asbestos Related Disease in Libby, Montana. Results of the descriptive study will provide health care providers and policy makers a better understanding of the health effects and health care needs of exposed persons.

Determinants of Quality of Care in Rural Communities: How Does The Health Care Infrastructure Affect Quality of Care in Rural America?
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Quality, Workforce

Distribution and Retention of General Surgeons in Rural Areas of the U.S.
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Physicians, Workforce

Effect of Safety Net Providers on Ambulatory Care Sensitive Hospitalization Rates in Rural Counties
Research center: South Carolina Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Federally Qualified Health Centers (FQHCs), Health services, Poverty, Rural Health Clinics (RHCs)
This project will determine if the presence of a community health center or rural health clinic in a county reduces ambulatory care sensitive hospitalizations for children, working age adults, and older adults.

Effects of Scope of Service and Reimbursement on Access to Mental Health Services in Rural Areas
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Health services, Mental health

Examining Recent Trends and Variation in Ambulatory Care Sensitive Conditions-related Hospital Expenditures of Rural Americans with Different Health Insurance Coverage and Status
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Health care financing, Health insurance and the uninsured, Health services
This study documents the national time-trend and regional variation of rural Ambulatory Care Sensitive Conditions (ACSC)-related hospital expenditures by patient insurance coverage/status. The study will also compare the pattern of difference in the ACSC-related expenditures of rural patients with different insurance coverage/status by patient demographic and economic characteristics as well as hospital characteristics.

Federal Rural Health Outreach Grant Program: The Impact and Sustainability of Grantees
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Networking and collaboration

Health Insurance Coverage and Access to Health Services for the Rural Near Elderly
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Aging, Health insurance and the uninsured, Health services

Health Reform�Rapid Response
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health policy, Health services, Mental health
This project will include several projects as requested by ORHP and DHHS as those agencies prepare for national health reform. Responses are primarily in the areas of health insurance and behavioral health.

Human Services Project: Health & Human Services Integration: Challenges and Opportunities for Rural Service Providers and Communities
Research center: Rural Policy Analysis and Applications
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Health services
The Panel is undertaking a project to understand effective efforts to integrate health and human services through federal grant programs.

Impact of CAH Conversion on Hospital Costs and Mix of Services
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Health services
This study examined Medicare Cost Report and claims data for hospitals before and after CAH conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility.

Impact of Expansion of Ambulatory Surgery Centers on Rural Hospitals and Communities
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health services
This project will examine the extent of freestanding ambulatory surgery center (ASC) expansion into rural communities between 1998 and 2005, the market factors driving that expansion, and the impact of ASCs on the operational and financial viability of rural hospitals located in the same communities.

Locating Community Pharmacies (Independent and Chain) in Rural America
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Pharmacy and prescription drugs
A comprehensive database of all rural U.S. pharmacies including pharmacy name, pharmacy type (chain or independent), town, ZIP code, county, state, RUCA code, and Federal Information Processing Standards will be developed. The databases will be usable in most widely used statistics and geographic information systems software packages.

Mental Health Risk Factors, Unmet Needs and Provider Availability for Rural Children
Research center: South Carolina Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Health services, Mental health
The study will examine the prevalence of subclinical problems in rural children, assess risk factors associated with problems in children, and assess the influence of local provider availability on healthcare provider contact.

Mental Health Services: The Effect of Variations in State Policies
Research center: Southwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Health services, Mental health
This study will identify variations in state licensure and payment or coverage polices and examine the effect of these variations on the availability of mental health services in rural areas.

Mini-Studies to Inform Health Reform Efforts
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Health services
Rural health care systems are far more vulnerable to changes in federal health care policy than are those in urban areas. The purpose of this project is to conduct rapid turnaround mini-studies that will be essential to maintain an effective rural voice in both the ongoing adjustments to current policies and the development of new policies.

Mode of Travel and Actual Distance Traveled for Medical or Dental Care by Rural Residents
Research center: South Carolina Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Dental health, Health disparities, Health services, Minority health
This project examined the influence of race and rural isolation on distance traveled to receive medical or dental care, and how the potential interaction of these factors might exacerbate disparities in access to care.

National Rural General Surgeon Project
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Physicians, Workforce

National Study of Home Health Access in Rural America
Research center: ORHP-funded Individual Grantees
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Home health, Hospice and palliative care, Medicare
This project will develop home health care service areas that will allow for the measurement of access to home health care for rural Medicare beneficiaries who die of cancer, and recommend options for increasing access to home health care in underserved rural areas.

National Study of Rural Health Clinics
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Rural Health Clinics (RHCs)

National Study of Substance Abuse Prevalence and Treatment Services in Rural Areas
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health disparities, Health services, Rural statistics and demographics, Substance abuse
This project will research the prevalence of the abuse of legal and illegal substances across rural populations and geographic areas, including the extent to which rural individuals are receiving treatment for their substance abuse and barriers to the receipt of treatment.

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.

Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention
Research center: ORHP-funded Individual Grantees
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
This project drew on a survey of patients sampled from the service areas of 25 Critical Access Hospitals (CAHs) from different regions of the country. The purpose of this project is to identify policy and programmatic issues related to bypass, specifically targeting CAHs in order to offer evidence and guidance to policymakers, CAH administrators, and planners on the location of healthcare resources, factors that affect patient actions for planning programs, and the adjustment of policies in order to retain patients locally.

Patient-Centered Medical Home: A Model for Rural Physician Practices and Communities?
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Physicians
Rural practices will need to meet the expectations inherent in the patient-centered medical home (PCMH) model or lose any payment advantage that comes with participating as a PCMH. The goal of this project is to assess rural readiness to adopt services seen as part of a PCMH.

Policy Analyses of Rural Issues Related to Health Care Reform
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Health services
Health care reform provides an array of opportunities to improve health care access and quality for rural Americans. The WWAMI RHRC will support HRSA's efforts to inform this process by summarizing existing evidence characterizing the rural health care workforce and rural health care delivery and will conduct analyses exploring the potential impact on rural populations of proposed and newly- enacted health care reform legislation.

Provision of Specialty Mental Health Services by Rural Health Clinics
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Mental health, Rural Health Clinics (RHCs), Substance abuse
This project will document the extent to which Rural Health Clinics (RHCs) are employing mental health staff nationally, understand why more RHCs are not employing specialty mental health staff, and analyze the barriers to and opportunities for the delivery of mental health services by RHCs. The results will identify opportunities and interventions to encourage RHCs to offer this important service.

Recent History of Federal Funding for EMS in the United States
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Health care financing, Health services

Roadmap for the Adoption of Health Information Technology in Rural Communities
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health information technology, Health services
This project developed a resource document intended to help rural health care providers of all types as they think about whether an investment in health information technology makes sense for them and work through various implementation issues. The document was distributed at the September 2006 conference entitled "Health Information Technology: A Rural Provider's Roadmap to Quality," sponsored by ORHP.

Role of Inpatient Psychiatric Units in Small Rural Hospitals and Rural Mental Health Systems
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Hospitals and clinics, Mental health
This is a descriptive, exploratory study which will investigate the role of the small rural hospital IPU from the perspectives of both the rural hospital, in terms of scope of services and revenue enhancement, and the regional mental health system, meeting the needs of outpatient mental health and primary care providers, law enforcement, and human services.

Role of Intensive Care Units in Critical Access Hospitals
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
This project will examine the role that intensive care units (ICUs) play in Critical Access Hospitals (CAHs). The number and geographic distribution of CAH with ICUs will be described, and types of services provided in these units discussed.

Role of Rural Hospitals in Community-Centered Systems of Care: Supporting Population Health Improvement for Rural Communities
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Hospitals and clinics
This project will assess the degree to which rural hospitals engage in activities that facilitate community responsiveness and the provision of community-oriented services, using 1996 to 2004 data from the American Hospital Association Annual Survey and the Area Resource File.

Rural Emergency Department Preparedness for Pediatric Care
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 Healthy People 2010 Expansion: Access to Long-Term Care and Rehabilitation Services, Educational and Community-Based Programs, and Public Health Infrastructure
Research center: Southwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Healthy People 2010 (Rural), Long term care, Public health
This project expanded the work of Healthy People 2010 by adding three additional chapters and associated models for practice: Access to Long-Term Care and Rehabilitation Services, Educational and Community-Based Programs, and Public Health Infrastructure.

View the models for practice and literature reviews on the Rural Health People 2010 website at http://srph.tamhsc.edu/centers/rhp2010/.

Rural Hospitals' Strategic Response to PPS for Outpatient, SNF, and HH Services
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Home health, Hospitals and clinics, Long term care, Medicare Prospective Payment System (PPS)

Rural Implications of Health Care Reform: Issues Related to Quality of Care, Health Information Technology and Care Coordination
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Health services
The purpose of this project is to provide support to the Office of Rural Health Policy on rural health care reform issues.

Rural Informal Safety Net: The Development of a Research and Evaluation Design and a Preliminary Assessment
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health insurance and the uninsured, Health services

Rural Safety Net Provision and Hospital Care in 11 States
Research center: ORHP-funded Individual Grantees
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Health services, Hospitals and clinics
This project evaluated whether access to primary care is more effective at improving health outcomes and reducing costs in rural than urban markets, and identified the characteristics of communities which contribute to improved health outcomes and reducing preventable hospitalizations. This research informs policy relating funding access provision through public clinics to reduce the burden of uncompensated or under-compensated care on financially strained rural hospitals.

Rural-Urban Differences in Access to Children's Mental Health Services
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Health services, Mental health
This study uses data from the Urban Institute's National Survey of America's Families to examine and compare the use of mental health services by rural and urban children, age 6 to 17, relative to their need for mental health care, family income, and insurance status.

Unmet Needs for Health Care Services: An Analysis of Children with Special Health Care Needs in Rural Areas
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Dental health, Disabilities, Health services
This project will study whether parents of children with special health care needs (CSHCN) who live in rural areas are less likely to perceive the need for routine and specialty medical care than their metropolitan counterparts, and whether CSHCN that live in rural areas face a greater risk of having unmet needs for health care services than their metropolitan counterparts.

Urban and Rural Differences in Access to Care and Treatment for Medicare Beneficiaries with Cancer
Research center: ORHP-funded Individual Grantees
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Health services, Medicare, Quality
Little is known about the differences in the diagnosis, treatment and outcomes of care for cancer patients across urban and rural regions of the country. This study will extend our understanding of the challenge of providing high-quality cancer care to Medicare beneficiaries and how provider availability influences access to needed care in urban and rural areas.

Use and Effect on Patients of Disease Management in Rural Areas
Research center: Southwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Health services

Use of Emergency Departments and Inpatient Care for Conditions Related to Poor Oral Health Care
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Dental health, Health services
This study combines patient-level data from emergency departments and inpatient hospitals from selected states with data on dental HPSA designation, Medicaid dental coverage, and area population characteristics to document the extent to which ED and inpatient settings are used to treat problems related to poor oral health care, the charges for such care, and variations in the use of such services by characteristics of the patient and the area.