Health services

Publications

Listed by publication date. You can also view these publications alphabetically.

2011

• Health Care Access and Use Among the Rural Uninsured (Policy Brief)
  Date: 11 / 2011
  Author(s): Erika C. Ziller, Jennifer D. Lenardson, Andrew F. Coburn
  Research center: Maine Rural Health Research Center
  Topics: Health insurance and the uninsured, Health services
  Using data from the 2002-2007 Medical Expenditure Panel Survey (MEPS), this study examined access to care and service use among non-elderly, uninsured rural and urban residents. Key Findings include:
  • Uninsured residents of both rural and urban areas face serious barriers to care compared to those with health insurance coverage.
  • The rural uninsured are more likely to have a usual source of care and to have used ambulatory care in the past year than the urban uninsured.
  • Insured or not, rural residents have difficulty accessing after hours care and traveling to see their usual provider
• Patient-Centered Medical Home Services in 29 Rural Primary Care Practices: A Work in Progress
  Date: 09 / 2011
  Author(s): A. Clinton MacKinney, Fred Ullrich, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health services, Physicians
  Discusses survey responses from 29 rural physician practices from around the country. When asked about their use of specific policies and procedures that are included as criteria to certify patient-centered medical homes, fewer of them would qualify in each of five domains, including access to care, population-based, quality, care management, and clinical information management.
• Use of Health Information Technology in Support of Patient-Centered Medical Homes Is Low Among Non-metropolitan Family Medicine Practices
  Date: 04 / 2011
  Author(s): Keith J. Mueller, Fred Ullrich, A. Clinton MacKinney
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health services, Physicians
  By creating a medical home program within Medicare, the Patient Protection and Affordable Care Act of 2010 gave momentum to growing interest in the concept of a patient-centered medical home (PCMH). Are physician practices, especially non-metropolitan primary care practices, ready to become PCMHs? We use a nationwide survey of physician practices to partially answer this question, focusing on the use of health information technology.
• Trends in Skilled Nursing Facility and Swing Bed Use in Rural Areas Following the Medicare Modernization Act of 2003 (Final Report)
  Date: 04 / 2011
  Author(s): Kristin L. Reiter, Victoria A. Freeman
  Research center: Rapid Response to Requests for Rural Data Analysis
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services, Medicare
  Provides descriptive evidence on current trends in the availability and use of swing beds and skilled nursing facility services in rural areas.
• Care Transitions: "Time to Come Home" (Full Report)
  Date: 03 / 2011
  Author(s): Shailendra Prasad, Jill M. Klingner, Ira Moscovice
  Research center: Upper Midwest Rural Health Research Center
  Topics: Health services, Hospitals and clinics, Quality
  Looks at care coordination for rural patients, with a focus on transitions from inpatient care back to the rural community and suggests ways of measuring the quality of care coordination on discharge from the hospital.
• Care Transitions: “Time to Come Home” (Policy Brief)
  Date: 03 / 2011
  Author(s): Shailendra Prasad, Jill M. Klingner, Ira Moscovice
  Research center: Upper Midwest Rural Health Research Center
  Topics: Health services, Hospitals and clinics, Quality
  Examines care coordination with a focus on the transitions from inpatient care back to the rural community and suggests ways of measuring the quality of care coordination on discharge from the hospital.
• Medicare Beneficiary Access to Primary Care Physicians -- Better in Rural, but Still Worrisome (Policy Brief)
  Date: 01 / 2011
  Author(s): A. Clinton MacKinney, Liyan Xu, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health services, Medicare, Physicians
  Primary care is the foundation of the rural U.S. health care system. Thus, the willingness of rural primary care physicians to accept new Medicare patients is critically important to the Medicare program and to rural America’s elderly. In this policy brief, results from a large national physician survey are used to assess U.S. primary care physician and general surgeon willingness to accept Medicare patients and physician-reported reasons for not accepting Medicare patients.

2010

• Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006 (Final Report)
  Date: 10 / 2010
  Author(s): Walter Gregg, Douglas Wholey, Ira Moscovice
  Research center: Upper Midwest Rural Health Research Center
  Topics: Health services, Hospitals and clinics
  Report Number: Final Report #11
  Describes the impact of Ambulatory Surgery Centers (ASCs) on rural hospital markets.
• Rural Health Snapshot 2010
  Date: 08 / 2010
  Research center: Rapid Response to Requests for Rural Data Analysis
  Topics: Health services, Rural statistics and demographics
  The Rural Health Snapshot displays selected indicators of access to health care, health behavior/risk factors, and mortality rates, comparing rural to urban residents.

2009

• Persistent Primary Care Health Professional Shortage Areas (HPSAs) and Health Care Access in Rural America (Policy Brief)
  Date: 09 / 2009
  Author(s): Mark P. Doescher, Meredith A. Fordyce, Susan M. Skillman, J. Elizabeth Jackson, Roger A. Rosenblatt
  Research center: WWAMI Rural Health Research Center
  Topics: Health policy, Health services
  Resources are needed to increase and sustain the number of primary care providers and reduce financial barriers to care in all rural primary care HPSAs.
• Cost of Inaction to Rural Communities: The Urgent Need for Health Care Reform Leake County, Mississippi
  Date: 08 / 2009
  Author(s): Kelly Shaw-Sutherland, Anh Nguyen, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Health policy, Health services
  Report Number: 2009-9
  The U.S. health care crisis is especially strong in rural communities. The experience of Leake County, a rural Mississippi county, embodies these problems.
• Cost of Inaction to Rural Communities: The Urgent Need for Health Care Reform Walthall County, Mississippi
  Date: 08 / 2009
  Author(s): Anh Nguyen, Kelly Shaw-Sutherland, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Health policy, Health services
  Report Number: 2009-10
  The U.S. health care crisis is especially strong in rural communities. The experience of Walthall County, a small county located in southwestern Mississippi, exemplifies these problems.
• Cost of Inaction to Rural Communities: The Urgent Need for Health Care Reform Nemaha County, Nebraska
  Date: 08 / 2009
  Author(s): Anh Nguyen, Kelly Shaw-Sutherland, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Health policy, Health services
  Report Number: 2009-11
  The U.S. health care crisis is especially strong in rural communities. The experience of Nemaha County, a small county located in southeastern Nebraska, illustrates the reach of these problems into counties that are somewhat stable during times of economic turbulence.
• Rural-Urban Differences in Health Care Access Vary Across Measures
  Date: 06 / 2009
  Author(s): Erika Ziller, Jennifer Lenardson
  Research center: Maine Rural Health Research Center
  Topic: Health services
  Higher uninsured rates and workforce shortages in rural areas suggest that rural residents face greater barriers to accessing health care than their urban counterparts. Analysis of the 2006 Medical Expenditure Panel Survey found mixed results. Rural residents were more likely than urban residents to have a usual source of health care (USC), particularly among the uninsured. Despite this, rural adults were somewhat less likely to receive certain preventive care services compared to urban adults. Additionally, rural residents were somewhat more likely to report long travel times to reach their USC and greater difficulty in reaching their provider after hours.

2008

• Impact of CAH Conversion on Hospital Finances and Mix of Inpatient Services (Final Report)
  Date: 08 / 2008
  Author(s): Julie Schoenman and Janet Sutton
  Research center: Walsh Center for Rural Health Analysis
  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.
• Far From the City: Community Orientation and Responsiveness of Rural Hospitals
  Date: 05 / 2008
  Author(s): Walter Gregg, Douglas Wholey
  Research center: Upper Midwest Rural Health Research Center
  Topics: Health services, Hospitals and clinics
  Reports the findings of a national study focused on variation in hospital community orientation and responsiveness across differing rural contexts. Study findings suggest that measures of community orientation and responsiveness differ between urban and rural hospitals, and further research is needed to develop an improved, context specific, model for community benefits.
• Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum (Research & Policy Brief No. 35B)
  Date: 02 / 2008
  Author(s): Jennifer D. Lenardson, John A. Gale
  Research center: Maine Rural Health Research Center
  Topics: Health disparities, Health services, Rural statistics and demographics, Substance abuse
  This Research & Policy Brief highlights findings from a recent study examining the distribution of substance abuse treatment facilities in rural and urban counties and identifying the type and intensity of services provided. Key findings include:
  • Access to substance abuse treatment is limited in rural areas by fewer treatment beds.
  • Less populated rural areas contain a small proportion of facilities offering a range of core services and varying levels of outpatient and intensive services.
  • Opiod treatment programs are nearly absent in rural areas.
• Access to Specialty Health Care for Rural American Indians in Two States
  Date: 2008
  Author(s): Baldwin LM, Hollow WB, Casey S, Hart LG, Larson EH, Moore K, Lewis E, Andrilla CHA, Grossman DC
  Research center: WWAMI Rural Health Research Center
  Topics: American Indians and Alaska Natives, Health services, Minority health
  Citation: Journal of Rural Health 24(3), 269-278
  The Indian Health Service (IHS), whose per capita expenditure for American Indian and Alaska Native (AI/AN) health services is about half that of the US civilian population, is the only source of health care funding for many rural AI/ANs. Specialty services, largely funded through contracts with outside practitioners, may be limited by low IHS funding levels. This study outlines the examination of specialty service access among rural Indian populations in two states. Results indicate that limitations in specialty care access for rural Indian clinic patients appear to be influenced by financial constraints. Health care systems factors may play a role in perceived differences in specialty access between rural Indian and non-Indian clinic patients.
• Access to Cancer Services for Rural Colorectal Cancer Patients
  Date: 2008
  Author(s): Baldwin LM, Cai Y, Larson EH, Dobie SA, Wright GE, Goodman DC, Matthews M, Hart LG
  Research center: WWAMI Rural Health Research Center
  Topic: Health services
  Citation: Journal of Rural Health. Fall 2008;24(4):390-399.
  Includes findings from a study to determine how far rural and urban colorectal cancer (CRC) patients travel to three types of specialty cancer care services�surgery, medical oncology consultation, and radiation oncology consultation.

2007

• Access to Cancer Services for Rural Colorectal Cancer Patients (Project Summary)
  Date: 10 / 2007
  Research center: WWAMI Rural Health Research Center
  Topic: Health services
  Brief overview of findings from a study to determine how far rural and urban colorectal cancer (CRC) patients travel to three types of specialty cancer care services�surgery, medical oncology consultation, and radiation oncology consultation.
• Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum
  Date: 10 / 2007
  Author(s): Jennifer D. Lenardson, John A. Gale
  Research center: Maine Rural Health Research Center
  Topics: Health disparities, Health services, Rural statistics and demographics, Substance abuse
  Report Number: Working Paper No. 35
  Considering recent growth in substance abuse among rural populations and the documented scarcity of rural health resources, this study examines the distribution of substance abuse treatment services across the continuum of rural and urban counties, identifying the type and intensity of services provided. Using the 2004 National Survey of Substance Abuse Treatment Services linked to the 2003 Rural-Urban Continuum Codes, we found few substance abuse treatment facilities operating outside of urban and rural adjacent areas and limited availability of intensive services across rural areas. This situation is particularly striking for opioid treatment programs, which are nearly absent in rural areas. The narrow range of services available in rural areas may preclude an individualized treatment approach and long-term follow-up recommended by professional organizations and other experts. The greater proportion of rural-based facilities accepting public payers and providing discounted care may reflect higher rates of uninsurance and underinsurance.
• Rural Inpatient Psychiatric Units Improve Access to Community-Based Mental Health Services, but Medicare Payment Policy a Barrier
  Date: 08 / 2007
  Author(s): Stephenie Loux, David Hartley, David Lambert
  Research center: Maine Rural Health Research Center
  Topics: Health services, Hospitals and clinics, Mental health
  Inpatient Psychiatric Units (IPUs) may not only be an important source of care for rural residents, but may also assist in the development of community-based services and the recruitment of mental health professionals. This study investigates the typical characteristics and admission processes of IPUs in rural hospitals with less than 50 beds, as well as the community-based services available to them when discharging patients. Reasons for developing these IPUs as well as the barriers to opening and operating a rural IPU and factors that have led some to close are also explored.
• Status and Future of Health Care Delivery in Rural Wyoming
  Date: 06 / 2007
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health services, Rural statistics and demographics, Workforce
  Provides findings from an analysis of health care service delivery in rural Wyoming. Includes an overview of Wyoming's population and the health care service delivery system. Covers workforce recruitment and retention, the economic impact of the health care system, and other topics.
• Why Are Fewer Hospitals in the Delivery Business?
  Date: 04 / 2007
  Author(s): Lan Zhao
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health services, Hospitals and clinics, Maternal and child health
  Examines the declining availability of hospital-based obstetric services in rural areas from the mid-1980s to the early 2000s. Examines potential causes for this trend and explores the effects of medical malpractice reforms.
• Delivering the U.S. Preventive Services Task Force Recommendations in a Rural Health Plan
  Date: 02 / 2007
  Author(s): Alycia Infante, Michael Meit
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health promotion and disease prevention, Health services
  Report Number: Research Brief, W Series No. 8
  Explores the challenges that one health plan faces in delivering the U.S. Preventive Services Task Force (USPSTF) recommendations to its rural patient population.
• Evaluation of the U.S. Preventive Services Task Force Recommendations for Clinical Preventive Services
  Date: 02 / 2007
  Author(s): Alycia Infante, Michael Meit, Thomas Briggs, Caitlin Oppenheimer, Jennifer Benz
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health promotion and disease prevention, Health services
  Report Number: Final Report
  Reports findings addressing the adoption, integration, delivery, and dissemination of the U.S. Preventive Services Task Force (USPSTF) recommendations for clinical preventive services in different types of health plans.
• Exploring the Community Impact of Critical Access Hospitals
  Date: 01 / 2007
  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
  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.
• Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention
  Date: 2007
  Author(s): Jiexin (Jason) Liu, Gail R. Bellamy, Melissa McCormick
  Research center: ORHP-funded Individual Grantees
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Citation: Journal of Rural Health, 23(1), 17-24
  Describes the results of a study to assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally.
• Intensive Care in Critical Access Hospitals
  Date: 2007
  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
  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.
• Status and Future of Health Care Delivery in Rural Wyoming: A Summary Report
  Date: 2007
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Health services
  Provides recommendations for improving the health care delivery system in rural Wyoming.

2006

• Wyoming Physicians Are Significant Providers of Safety Net Care
  Date: 11 / 2006
  Author(s): Sharon A. Dobie, Amy Hagopian, Beth A. Kirlin, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Health services, Physicians, Workforce
  Citation: Journal of the American Board of Family Practice, 18(6), 470-477
  Describes the contributions of family and general practice physicians from Wyoming to the health care safety net.
• Trends over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals
  Date: 02 / 2006
  Author(s): Kathleen Dalton, Rebecca Slifkin, Jeongyoung Park, and Hilda Ann Howard
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Report Number: Findings Brief No. 81
  Examines trends in the delivery of skilled nursing facility services in both hospital-based units and swing beds during a period of dramatic change in Medicare payments for post-acute care, focusing on Critical Access Hospitals (CAHs).
• Access to Health Care for Rural America: Why It Matters
  Date: 02 / 2006
  Author(s): Mary Wakefield, Brad Gibbens
  Research center: Upper Midwest Rural Health Research Center
  Topic: Health services
  Citation: Around the Kitchen Table, Issue 14
  Overview of issues related to rural health care access and the importance of health care access to rural communities.
• Care Across the Continuum: Access to Health Care Services in Rural America
  Date: 2006
  Author(s): Keith J. Mueller, A. Clinton MacKinney
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Health services
  Citation: Journal of Rural Health, 22(1), 43-49
  Proposes a continuum of care that serves as a framework with which to assess public and private policies designed to ensure that rural residents receive appropriate health care services, in a timely manner, and in a place that optimizes care effectiveness. Community leaders and policymakers can use this health care continuum as a design framework to help reduce system complexity and implement a patient- and community-focused, rather than provider-focused, health care system. The article is divided into 3 sections: 1) basic principles that determine services to be included in the continuum and how success in providing those services is judged; 2) definition of the continuum and its basic stages based on the health systems research literature; 3) applications of the continuum and policy implications of the framework.
• How Adults' Access to Outpatient Physician Services Relates to the Local Supply of Primary Care Physicians in the Rural Southeast
  Date: 2006
  Author(s): Donald E. Pathman, Thomas C. Ricketts, Thomas R. Konrad
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health services, Physicians
  Citation: Health Services Research, 41(1), 79-102
  For adults as a whole in the rural South and for the elderly there, low local primary care physician densities are associated with travel inconvenience but not convincingly with other aspects of access to outpatient care. Access for those insured under Medicaid and the uninsured, however, is in more ways sensitive to local physician densities.
• Geographic Access to Health Care for Rural Medicare Beneficiaries
  Date: 2006
  Author(s): Leighton Chan, L. Gary Hart, David C. Goodman
  Research center: WWAMI Rural Health Research Center
  Topics: Health services, Medicare, Physicians
  Citation: Journal of Rural Health 22(2),140-146
  Describes the results of a study comparing the travel times, distances, and physician specialty mix of all Medicare patients living in Alaska, Idaho, North Carolina, South Carolina, and Washington.
• Mental Health Care in Rural Communities: the Once and Future Role of Primary Care
  Date: 2006
  Author(s): John A.Gale, David Lambert,
  Research center: Maine Rural Health Research Center
  Topics: Health services, Mental health
  Citation: North Carolina Medical Journal, 67(1), 66-70
  Discusses issues related to the delivery of mental health services in the United States. Addresses how these issues complicate the delivery of services in rural areas. Offers an argument for integrating primary care and mental health in rural areas.

2005

• Trends in Skilled Nursing and Swing-bed Use in Rural Areas, 1996-2003
  Date: 12 / 2005
  Author(s): Kathleen Dalton, Jeongyoung Park, Ann Howard, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health services, Hospitals and clinics, Medicare
  Report Number: Working Paper No. 83
  Examines trends in the delivery of skilled nursing facility (SNF) services in rural areas during a period of dramatic change in Medicare payments for both acute and post-acute care, focusing on the role of rural hospitals in providing SNF services as they respond to the new reimbursement environment. The authors examined changes in the number and types of facilities providing this level of care, and computed comparative statistics on Medicare utilization, case mix, ancillary service use and per diem costs across the three different institutional settings where inpatient skilled nursing services can be provided-freestanding SNFs, hospital-based units, and swing beds in acute care hospitals.
• Is Large Really Beautiful? Physician Practice in Small versus Large Scale Communities
  Date: 09 / 2005
  Author(s): George E. Wright, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Health services, Physicians
  Report Number: Working Paper No. 56
  Examines the effect of community size on how physicians view their practices as reported by respondents to two waves (1996-97 and 1998-1999) of a national sample survey conducted as part of the Community Tracking Study (CTS). Results suggest that bigger is not necessarily better when it comes to physicians' perceptions of their practice. A key challenge is whether larger urban-based practices can be decomposed into smaller clinical microsystems that can benefit from the strengths of physician practices in small city or rural settings yet retain the presumed benefits of larger scale organizations.
• Geographic Access to Health Care for Rural Medicare Beneficiaries
  Date: 04 / 2005
  Author(s): Leighton Chan, L. Gary Hart, David C. Goodman
  Research center: WWAMI Rural Health Research Center
  Topics: Health services, Medicare
  Report Number: Working Paper No. 97
  This study looked at where Medicare beneficiaries of five states obtain their care, how far they travel for that care, and the mix of physician specialties from whom they obtain their ambulatory care. Findings from this study suggest that rural residents do not rely on urban areas for the majority of their care. Those living in small and isolated rural areas have decreased geographic access to health care providers, particularly specialists, and rely heavily on generalists for the majority of their care. Additionally, results of the study suggest that these individuals have few visits overall and must travel longer distances to access certain types of care. These findings have policy implications for geographic reimbursement differentials, telehealth networks, and graduate medical education. Report available upon request by contacting rhrc@fammed.washington.edu.
• Scope of Services Offered by Critical Access Hospitals: Results of the 2004 National CAH Survey
  Date: 03 / 2005
  Author(s): David Hartley, Stephenie Loux
  Research center: Maine Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Report Number: Flex Monitoring Team Briefing Paper No. 5
  Three years of national survey data (2000, 2002, and 2004) were used to examine the scope of services offered by Critical Access Hospitals (CAHs). The authors investigated how the services offered by CAHs have changed, the role of network affiliations in these changes, and the reasons administrators gave for reported service expansions. Additionally, the authors looked at how services in CAHs have changed over time. Consistent with findings in previous surveys conducted by the Flex Team, conversion to CAH status has not led to downsizing of services. Most CAHs offer a core set of services including radiology, laboratory services, emergency rooms, swing beds, pharmacy, outpatient rehabilitation, outpatient surgery, and specialty clinics. While this core has not changed significantly over the period of three surveys, many CAHs have added or expanded services not dependent on inpatient capacity Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Intensive Care In Critical Access Hospitals
  Date: 03 / 2005
  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
  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.
• Providing Hospice Care in Rural Areas: Challenges and Strategies to Address Them
  Date: 2005
  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
  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.
• Does Improving Geographic Access to VA Primary Care Services Impact Patients' Patterns of Utilization and Costs?
  Date: 2005
  Author(s): John C. Fortney, Matt L. Maciejewski, J. Warren, James F. Burgess Jr.
  Research center: WICHE Center for Rural Mental Health Research
  Topics: Health services, Veterans
  Citation: Inquiry, 42(1), 29-42
  The Department of Veterans Affairs (VA) has been establishing community-based outpatient clinics (CBOCs) across the country to improve veterans' access to and use of primary care services, thereby decreasing the need for costly specialty outpatient and inpatient care. Using a quasi-experimental, pre-post study design, the authors examined whether the establishment of CBOCs has affected access, use, and costs for VA patients residing in their catchment areas. Most patients residing in CBOC catchment areas did not receive care at CBOCs, resulting in only small increases in primary care utilization. While CBOCs improved veterans' access, they had little impact on overall patterns of utilization and cost.
• Are Primary Care Services a Substitute or Complement for Specialty and Inpatient Services?
  Date: 2005
  Author(s): John C. Fortney, Diane E. Steffick, James F. Burgess Jr., Matt L. Maciejewski, Laura A. Petersen
  Research center: WICHE Center for Rural Mental Health Research
  Topic: Health services
  Citation: Health Services Research, 40(5, Part 1), 1422-42
  Change in distance to primary care was a significant and substantial predictor of change in primary care visits. Analyses indicated that an increase in primary care service use was associated with increases in the use of all specialty outpatient services and inpatient services, as well as increases in inpatient and outpatient costs. Results provide evidence that health systems can implement strategies to encourage their members to use more primary care services without driving up physical health costs.
• Delivery Complications Associated With Prenatal Care Access for Medicaid-Insured Mothers in Rural and Urban Hospitals
  Date: 2005
  Author(s): Sarah B. Laditka, James N. Laditka, Kevin J. Bennett, Janice C. Probst
  Research center: South Carolina Rural Health Research Center
  Topics: African Americans, Health services, Maternal and child health, Medicaid and S-CHIP, Women
  Citation: Journal of Rural Health, 21(2), 158-66
  Examined access to health care during pregnancy for mothers insured by Medicaid as well as the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals. In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites. The authors conclude that providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.
• More May Be Better: Evidence of a Negative Relationship Between Physician Supply and Hospitalization for Ambulatory Care Sensitive Conditions
  Date: 2005
  Author(s): James N. Laditka, Sarah B. Laditka, Janice C. Probst
  Research center: South Carolina Rural Health Research Center
  Topics: Chronic diseases and conditions, Health services, Physicians
  Citation: Health Services Research, 40(4), 1148-1166
  The authors conducted an empirical test of the relationship between physician supply and hospitalization for ambulatory care sensitive conditions (ACSH). Principal findings showed that in the urban models for ages 0-17 physician supply has the largest negative adjusted relationship with ACSH. For ages 18-39 and 40-64, physician supply has the second largest negative adjusted relationship with ACSH. Physician supply was not associated with ACSH in rural areas. The authors conclude that physician supply is positively associated with the overall performance of the primary health care system in a large sample of urban counties of the United States.
• Effects of Rural Residence and Other Social Vulnerabilities on Subjective Measures of Unmet Need
  Date: 2005
  Author(s): Michelle L. Mayer, Rebecca T. Slifkin, Asheley Cockrell Skinner
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Children, Disabilities, Health services, Poverty
  Citation: Medical Care Research and Review, 62(5), 617-628
  To determine whether self-reports of unmet need are biased measures of access to health care, the authors examined the relationship between rural residence and perceived need for physician services. Logistic regression analyses was performed to examine the likelihood of reporting a need for routine preventive care and/or specialty care using data from the National Survey of Children with Special Health Care Needs. Even after controlling for factors known to be associated with evaluated need, parents of rural children were less likely to report a need for routine or specialty services. Poor children, those whose mothers had less education, and those who were uninsured in the previous year were also less likely to perceive a need for physician services. Findings suggest that rural residence and other social vulnerabilities are associated with decreased perception of need, which may bias subjective measurements of unmet need for these populations.
• Explaining Black-White Differences in Receipt of Recommended Colon Cancer Treatment
  Date: 2005
  Author(s): Laura-Mae Baldwin, Sharon A. Dobie, Kevin Billingsley, Yong Cai, George E. Wright, Jason A. Dominitz, William Barlow, Joan L. Warren, Stephen H. Taplin
  Research center: WWAMI Rural Health Research Center
  Topics: African Americans, Health services
  Citation: Journal of the National Cancer Institute, 97(16), 1211-12210
  Black-white disparities exist in receipt of recommended medical care, including colorectal cancer treatment. This retrospective cohort study examines the degree to which health systems (e.g., physician, hospital) factors explain black-white disparities in colon cancer care. Black and white Medicare-insured colon cancer patients have an equal opportunity to learn about adjuvant chemotherapy from a medical oncologist but do not receive chemotherapy equally. Little disparity was explained by health systems; more was explained by illness severity, social support, and environment. Further qualitative research is needed to understand the factors that influence the lower receipt of chemotherapy by black patients.

2004

• Sustaining Community Health Services Over Time: Models from the Rural Health Outreach Grant Program
  Date: 11 / 2004
  Author(s): Walter R. Gregg, Astrid Knott, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Federally Qualified Health Centers (FQHCs), Health services
  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.
• Access to Specialty Health Care for Rural American Indians: Provider Perceptions in Two States
  Date: 10 / 2004
  Author(s): Laura-Mae Baldwin, Waler B. Hollow, Susan Casey, L. Gary Hart, Eric H. Larson, Kelly Moore, Ervin Lewis, David C. Grossman
  Research center: WWAMI Rural Health Research Center
  Topics: American Indians and Alaska Natives, Health services, Minority health, Physicians
  Report Number: Working Paper No. 78
  Examines access to specialty services among rural Indian populations in Montana and New Mexico, based on a survey sent to primary care providers addressing access to specialty physicians, perceived barriers to access, and access to nonphysician clinical services. Report available upon request by contacting rhrc@fammed.washington.edu.
• Access To Primary Care And Quality Of Care In Rural America
  Date: 06 / 2004
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health services, Quality
  Provides findings from a population-based study addressing the impact of the availability of health care resources on the rate of potentially avoidable hospitalizations. It suggests shortcomings with previous research conducted in communities that experienced problems accessing primary care services.
• Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 3
  Date: 04 / 2004
  Author(s): Larry D. Gamm, Linnae L. Hutchison, eds.
  Research center: Southwest Rural Health Research Center
  Topics: Health promotion and disease prevention, Health services, Healthy People 2010 (Rural), Long term care, Physical abuse and domestic violence, Public health
  Report Number: Updated February 2005
  Includes the overview of research and accompanying models for practice on 5 new focus areas in Rural Healthy People 2010, along with the more detailed literature reviews for each. The focus areas are: Access to Quality Health Services in Rural Areas/Access to Long-term Care; Educational and Community-based Programs in Rural Areas; Immunizations and Infectious Diseases in Rural Areas; Injury and Violence Prevention in Rural Areas; and Rural Public Health Infrastructure.

2003

• Care Across the Continuum: Access to Health Care Services in Rural America
  Date: 12 / 2003
  Author(s): Keith J. Mueller, A. Clinton MacKinney
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Health services
  Report Number: Working Policy Paper P2003-10
  Proposes that a continuum of care serve as the framework with which to consider rural health care policies, focusing on people and on places where people live rather than on the wants of providers and constituencies. The continuum of care describes the breadth of health care services in seven stages, from personal behavior to palliative care. The framework helps establish which health care services should be provided locally and which provided at a distance, emphasizing seamless linkages between all stages of the continuum.
• Grantee Sustainability in the Rural Health Outreach Grant Program
  Date: 12 / 2003
  Author(s): Walter Gregg, Astrid Knott, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topic: Health services
  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.
• Who Receives Inpatient Charity Care in California?
  Date: 08 / 2003
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health services, Hospitals and clinics
  Results of a study regarding how California hospitals determine charity care. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
• Emergency Department Use By Medically Indigent Rural Residents
  Date: 07 / 2003
  Author(s): Kevin Bennett, Janice C. Probst, Charity G. Moore, Judith A. Shinogle
  Research center: South Carolina Rural Health Research Center
  Topics: Emergency medical services (EMS), Federally Qualified Health Centers (FQHCs), Health services, Hospitals and clinics
  Examined emergency department (ED) use, combining national data and South Carolina state data to estimate the uncompensated charges in rural EDs nationally and the ameliorating effects of rural community health centers on ED use by rural residents.
• Characteristics and Roles of Rural Health Clinics in the United States: A Chartbook
  Date: 01 / 2003
  Author(s): John A. Gale, Andrew F. Coburn
  Research center: Maine Rural Health Research Center
  Topics: Health services, Rural Health Clinics (RHCs)
  Reports on the results of a national survey of Rural Health Clinics (RHCs). Information was collected on a wide range of topics of concern to RHCs including: 1) the characteristics and operations of the clinics; 2) their location relative to the underservice problems and access needs of rural areas; 3) safety net functions of RHCs; 4) staffing, recruitment and financial issues; and 5) involvement in the training of health care professionals. Among the findings: most RHCs continue to serve rural, underserved communities; RHCs are filling a valuable safety net role by serving Medicaid, uninsured, and low-income patients and providing free and reduced cost care; recruitment and retention is a problem for RHCs, and some RHCs face continued financial challenges despite cost-based reimbursement. RHCs continue to be an important source of primary care and safety net services in rural communities. Legislative efforts to address concerns about the program have included the refinement of the shortage area criteria used by the RHC program (Balanced Budget Act of 1997) and the implementation of a Medicaid prospective payment system (Benefits Improvement and Protection Act of 2000). Additional research is needed to understand the impact of these changes on the RHCs and the residents of rural communities served by them.
• Access to Care among Rural Minorities: Working Age Adults
  Date: 01 / 2003
  Author(s): Janice C. Probst, Michael E. Samuels, Charity G. Moore
  Research center: South Carolina Rural Health Research Center
  Topics: Health services, Minority health, Poverty
  Examines the prevalence of health insurance and the use of physician services in rural areas. Findings include that rural minorities are handicapped by poverty and lack of education; low income and low education levels in non-metro areas translate into jobs that do not offer health insurance; and although non-metro adults were less likely to have insurance than metropolitan residents, they were not less likely to see a physician, with some exceptions.

2002

• Health Services at Risk in "Vulnerable" Rural Places
  Date: 10 / 2002
  Author(s): Michael D. Shambaugh-Miller, Julie Stoner, Louis Pol, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Health services
  Report Number: Rural Policy Brief Vol. 7, Number 5 (PB2002-5)
  Describes, applies, and discusses implications of a method to identify places in rural America that are at risk of (vulnerable to) being without adequate health care services because 1) they lack a sufficient number of people to support a practice/provider, 2) they lack a sufficient number of people who are able to pay the full cost of care, 3) the population size and composition do not warrant the level of services currently available.
• Impact of National Policy on Access to Health Care: The Rural Perspective
  Date: 10 / 2002
  Author(s): Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health policy, Health services
  Current state of financial and geographic access to health care in the U.S. and federal policy
• Financial Incentives for Rural Hospitals to Expand the Scope of Their Services
  Date: 06 / 2002
  Author(s): Jeffrey Stensland, Michelle Brasure, Ira Moscovice, Tiffany Radcliff
  Research center: Minnesota Rural Health Research Center
  Topics: Health care financing, Health services, Hospitals and clinics
  Report Number: Working Paper No. 40
  This paper examines the financial incentives that rural hospitals have to conduct surgery and treat more complex medical conditions. The objective is to evaluate whether rural hospitals that offer broader services are more profitable than hospitals with very limited inpatient services. A low-volume adjustment considered by the Medicare Payment Advisory Commissions (MedPAC) is discussed.
• Access to Emergency Medical Services in Rural Areas: The Supporting Role of State EMS Agencies
  Date: 02 / 2002
  Author(s): Astrid Knott
  Research center: Minnesota Rural Health Research Center
  Topics: Emergency medical services (EMS), Health services
  Report Number: Working Paper No. 38
  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.

2001

• Access to Rural Pharmacy Services in Minnesota, North Dakota, and South Dakota
  Date: 07 / 2001
  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
  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.
• Proximity of Rural African American and Hispanic/Latino Communities to Physicians and Hospital Services
  Date: 06 / 2001
  Author(s): Donald E. Pathman, Thomas R. Konrad, Robert Schwartz
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: African Americans, Health services, Hispanics, Minority health, Physicians
  Report Number: Working Paper No. 72
  Assesses how local physician concentrations and distances to hospitals differ for rural communities of varying African American and Hispanic/Latino compositions. Uses data at the town-area level for nine southern and six western states to compare town-areas with low, medium, and high proportions of African Americans and Hispanics on their local physician-to-population ratios and distances to nearest hospital offering each of four levels of services. Among the findings are that rural Hispanics, but not African Americans, face longer travel distances to physicians, and both groups face longer distances to some types of hospital services than do non-minority rural individuals.
• Proximity of Rural Black and Hispanic/Latino Communities to Physicians and Hospital Services
  Date: 05 / 2001
  Author(s): Donald E. Pathman, Thomas R. Konrad, Robert Schwartz
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: African Americans, Health services, Hispanics, Hospitals and clinics, Minority health, Physicians
  This brief reports the findings of a study of how the African American and Hispanic/ Latino composition of rural communities relates to local physician concentrations, and relates to distances to hospitals offering various levels of services.

1997

• Access to Maternity Care in Rural Washington: Its Effect on Neonatal Outcomes and Resource Use
  Date: 01 / 1997
  Author(s): Thomas S. Nesbitt, Eric H. Larson Roger A. Rosenblatt, L Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Children, Health services, Maternal and child health
  Citation: American Journal of Public Health, 87(1), 85-90
  Compares birth outcomes for areas with poor health care access to those with adequate health care access in rural Washington state.