Upper Midwest Rural Health Research Center

Products

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

For a complete list of publications from the Center, which may include older publications and publications funded by other sources, please see the Center's website.

2012

  • The Use of Hospitalists in Small Rural Hospitals
    Upper Midwest Rural Health Research Center
    Date: 04/2012
    This policy brief describes the results of a survey of small rural hospitals that use hospitalists, who are physicians, physician assistants or nurse practitioners who assume responsibility for patient care during inpatient hospital stays.
  • Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 03/2012

    Explores the relationship between potentially preventable readmissions (PPRs) and (a) use of outpatient follow-up care, (b) discharge destination, (c) rural versus urban residence of the patient, and (d) time to follow-up care. These factors were examined in a large population of Medicare patients with a hospital stay for one of these prevalent diagnoses: congestive heart failure or bacterial pneumonia. Differences in readmission risk associated with outpatient visits and discharge destinations were calculated. Outpatient follow-up appears to be strongly influential in reducing PPRs, though fewer than half of the patients in the study had evidence of any kind of outpatient follow-up within 30 days. Home health care appeared to have less of an effect on reducing PPRs in rural areas relative to urban areas. Swing bed destination was associated with higher PPR risk, especially for pneumonia patients. Additional research should be done on encouragement of post-discharge follow-up care and types of outpatient interventions, access to outpatient and home health care, and use of swing beds in rural areas.

  • Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia (Final Report)
    Upper Midwest Rural Health Research Center
    Date: 03/2012
    This study explored the relationship between PPRs and a) use of outpatient follow-up care, b) discharge destination, c) rural versus urban residence of the patient, and d) time to follow-up care.

2011

  • Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 09/2011

    This report and policy brief will (1) assess the financial and quality challenges and potential unintended consequences for rural providers and patients of implementing bundled payments for acute and post-acute care episodes; (2) explore the possible impact on quality of care delivered under a facility-physician bundled payment system; and (3) describe potential modifications to current bundling proposals and additional steps CMS could take that will help address rural-specific issues. Report available by contacting the Center.

  • Care Transitions: "Time to Come Home"
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 03/2011

    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.

  • Care Transitions: "Time to Come Home" (Full Report)
    Upper Midwest Rural Health Research Center
    Date: 03/2011
    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.

2010

2009

  • Potentially Preventable Readmissions in Rural Hospitals
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 08/2009

    A hospital's potentially preventable readmission rate is a quality indicator receiving considerable attention from policymakers and payers. Using 3-M algorithm software and Medicare inpatient claims data from five states, this brief examines potentially preventable readmission rates for rural and urban hospitals, and discusses the rural implications of policy initiatives to reduce readmission rates.

  • Health Information Technology Policy and Rural Hospitals
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009

    Health information technology (HIT) is a key component of plans to reform the health care system. HIT adoption among smaller rural providers has lagged behind larger urban providers, and the vast majority of research on HIT has focused on its adoption and impact in urban institutions. This brief summarizes the implementation status of key HIT applications in Critical Access Hospitals and other rural hospitals, and discusses policies for encouraging HIT adoption in rural hospitals.

  • Rural Issues Related to Bundled Payments for Acute Care Episodes
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009

    Bundling Medicare payments, i.e., providing a fixed payment for a set of acute and post-acute services, has been proposed as a way of encouraging providers to find innovative, cost reducing strategies to provide better coordinated care. This brief describes challenges to implementing bundled payments in rural settings and discusses potential contracting and reimbursement strategies to address these challenges.

  • Rural Issues Related to Comparative Effectiveness Research and Dissemination
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009

    Comparative effectiveness research, which compares the costs and benefits of different treatments for specific diseases or conditions, has the potential to improve the quality and reduce the costs of health care. This brief describes strategies for expanding clinical research in rural environments; implementing practice guidelines in rural settings; and improving access to current evidence-based information for rural health professionals and patients.

  • Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 03/2009

    Describes successful telepharmacy activities being implemented in rural hospitals and analyzes policy issues related to the implementation of telepharmacy projects in rural hospitals.

2008

2007

  • Health Insurance Coverage and Access to Health Care for American Indian and Alaska Native Elders
    Upper Midwest Rural Health Research Center
    Date: 10/2007
    Policy brief reporting findings from a study assessing health insurance coverage and access to healthcare among American Indian and Alaska Native elders (Native elders), using data from a national survey that included more than 8,300 Native elders.
  • The Impact of Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural Native American Elders
    Upper Midwest Rural Health Research Center
    Date: 10/2007
    Examines health insurance coverage and access to healthcare among American Indian and Alaska Native elders (Native elders) -- defined as 55 years or older. Young elders, 55 to 64 years of age, are most likely to be uninsured with one-third reporting having no insurance, while 15% of older elders, 65 years of age and over, report they are uninsured. Uninsured Native elders are about twice as likely as insured Native elders to indicate they have no regular provider. In addition, one out of 10 Native elders report they were not able to get care when they needed it during the preceding 12 months. Reasons cited for not getting healthcare when it was needed included long waiting times, transportation problems, and cost. The authors conclude it is essential to develop policies that address the financial, geographical, and cultural aspects that negatively impact access to culturally appropriate healthcare. Full report available on request by contacting the Center.
  • Implementing Patient Safety Initiatives in Rural Hospitals: An Evaluation of the Tennessee Rural Hospital Patient Safety Demonstration
    Upper Midwest Rural Health Research Center
    Date: 08/2007
    The Tennessee Rural Hospital Patient Safety Demonstration project included: 1) the implementation of three patient safety initiatives in eight rural Tennessee hospitals using a collaborative model and 2) an evaluation of the process and tools used in the implementation to inform future rural patient safety initiatives. Staff from the Tennessee Hospital Association, Q-Source (the state quality improvement organization), BlueCross BlueShield of Tennessee and the University of Southern Maine all provided technical assistance and resources to the hospitals. The Upper Midwest Rural Health Research Center evaluated the project. Executive summary available online. Full report available on request by contacting raasc001@umn.edu.
  • Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Brief)
    Upper Midwest Rural Health Research Center
    Date: 08/2007
    Reports results of a study of rural emergency department staffing and discusses potential implications of staffing for the quality of emergency care provided in rural areas.
  • Ambulatory Care Sensitive Condition Hospitalizations Among Rural Children (Brief)
    Upper Midwest Rural Health Research Center
    Date: 06/2007
    Reports results from a study examining children's inpatient hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs), rural residence, poverty, health insurance, and physician supply. Admission rates for five conditions were examined: asthma, diabetes short-term complications, gastroenteritis, urinary tract infection and perforated appendix.
  • Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Final Report)
    Upper Midwest Rural Health Research Center
    Date: 06/2007

    The purpose of this project was to describe rural emergency department staffing nationally and to assess the potential implications of staffing for the quality of emergency care provided in rural areas. A national telephone survey of a random sample of rural hospitals with less than 100 beds was conducted in June to August 2006. The study found that the majority of rural hospitals use more than one type of staffing to cover their Emergency Department (ED), including combinations of physicians on their own medical staff, contracts with emergency physician management groups and with individual physicians, and physician assistants and nurse practitioners. The study concluded that it is important to ensure that the family physicians, internists, PAs, NPs and nurses who staff rural EDs have the expertise and technical skills needed to provide optimal ED care, and that rural ED staff may benefit from additional continuing education opportunities, particularly in terms of specialized skills to care for pediatric emergency patients and trauma patients and training in working effectively in teams. Report available upon request by contacting the Center.

  • Does Hospital Size Affect Our Ability to Accurately Identify High Quality Care in Pay-for-Performance Programs?
    Upper Midwest Rural Health Research Center
    Date: 05/2007
    Discusses whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings. A full report is also available.
  • Hospital Size, Uncertainty and Pay-for-Performance
    Upper Midwest Rural Health Research Center
    Date: 02/2007
    Examines whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings. Using data from the Premier Hospital Quality Incentive Demonstration and the Centers for Medicare and Medicaid Services' Hospital Compare, the report found that the smallest hospitals would, on average, experience five to seven times more uncertainty than the largest hospitals concerning their true relative performance for heart failure, pneumonia, and acute myocardial infarction. The authors conclude that all estimates of rank need to include adequate measures of uncertainty of those estimates.
  • North Dakota Health Care Workforce: Planning Together to Meet Future Health Care Needs
    Upper Midwest Rural Health Research Center
    Date: 01/2007
    Policy brief which details strategies for addressing health workforce needs in North Dakota. Includes examples of state health workforce pipeline strategies used in other states.

2006

2005

  • Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
    Upper Midwest Rural Health Research Center
    Date: 12/2005
    To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
  • Prevalence of Chronic Disease Among American Indian and Alaska Native Elders
    Upper Midwest Rural Health Research Center
    Date: 10/2005
    Examines chronic disease prevalence and functional limitations among American Indian/Alaska Natives by rurality, gender, age, health care access, and health behaviors. Includes policy recommendations.
  • Suicide in North Dakota: A Dialogue Across State and Tribal Boundaries
    Upper Midwest Rural Health Research Center
    Date: 10/2005
    Compared nationally, North Dakota ranks 13th in the nation for suicide (14.4 suicides per 1000,000 people). This policy brief looks at three broad areas in addressing this preventable tragedy: 1) an understanding of factors associated with suicide; 2) information about specific trends such as race, gender, location, and costs; 3) an awareness of suicide prevention strategies that address these factors through public policy and community action.
  • Chronic Disease in American Indian/Alaska Native Elders
    Upper Midwest Rural Health Research Center
    Date: 2005
    Describes the prevalence of chronic diseases among Native American elders.
  • Comparing Patient Safety in Rural Hospitals by Bed Count
    Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 2005
    Reports results of a study to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals. The authors found that small rural hospitals had rates of potential patient safety events that were significantly lower than those of large rural hospitals for three of the 19 patient safety indicators (PSIs). The types of services offered by rural hospitals varied significantly according to bed numbers, and the likelihood of an offered service increased as bed counts increased. The types of patients treated by rural hospitals, however, did not vary significantly by bed count. The results suggest that rural hospitals differ substantially by offered services and differ somewhat in PSI rates, relative to bed counts. But given the limited information on patient severity using administrative data, future research should look to develop more effective ways to account for patient severity when measuring patient safety rates among hospitals with varying bed counts.

2004