University of Minnesota Rural Health Research Center: Rural Health Research Products & Journal Articles

2024

Variation in Elder Abuse State Statutes by State Level of Rurality
Policy Brief
Date: 12/2024
This policy brief examines elements of state-level elder abuse statutes' definitions and reporting requirements to investigate potential differences in these policies by state rurality that could influence one's understanding of elder abuse among rural and urban areas.
Triad Program Perspectives on Preventing and Addressing Elder Abuse in Rural Communities
Policy Brief
Date: 11/2024
Elder abuse is a widespread issue and rural communities face unique risks to preventing, identifying, and addressing it. This brief shares results from key informant interviews with representatives of rural Triads (multi-sectoral community-based partnerships that address elder abuse) to illuminate rural-specific dimensions of this issue.
Understanding the Impact of Medical Debt in Rural Communities: Perspectives From Rural Hospital Administrators
Policy Brief
Date: 11/2024
This policy brief presents findings from key informant interviews with nine administrators representing rural hospitals in seven states. Using content analysis of interview data, researchers share findings around hospital and community-level implications of medical debt, and policies that may help or hinder this issue.
Health Care Affordability and Medical Debt: Differences by Rurality, Region, and Socio-Demographic Characteristics
Policy Brief
Date: 09/2024
This policy brief examines rural/urban differences in rates of health care (un)affordability, as well as among rural residents by key socio-demographic characteristics.
Loss of Hospital-Based Obstetric Services in Rural Counties in the United States, 2010-2022
Date: 07/2024
The purpose of this infographic is to show the loss of hospital-based obstetric services in rural counties from 2010 to 2022, and how this differs by rural county type (micropolitan vs. noncore).
Rural-Urban Differences in Midwifery Care During Childbirth in the U.S.
Date: 07/2024
This infographic provides a snapshot of rural-urban differences in midwife-attended births, including changes over time as access to rural obstetric care declined and severe maternal morbidity and mortality rose across the United States.
Rural-Urban Differences in Housing Cost Burden Across the U.S.
Policy Brief
Date: 03/2024
Housing is closely tied to health and well-being, but affordable housing is out of reach for many households. This policy brief examines the proportion of households who are housing cost burdened by rural-urban location across different U.S. geographic spaces in order to identify how housing affordability varies by location.

2023

Key Informant Perspectives on Rural Housing and Health
Policy Brief
Date: 10/2023
In this policy brief, using content analysis of interview data, researchers share rural-specific housing barriers, including those that are related to health, as well as policy recommendations for addressing housing challenges to improve rural health.
Unmet Needs for Help With Mobility Limitations Among Older Adults Aging in Place: The Role of Rurality
Journal Article
Date: 10/2023
This study identifies differences in unmet mobility needs among older adults by rurality. It uses data from the National Health and Aging Trends Study, limiting analyses to respondents who had not moved since baseline (average housing tenure of 27 years; n = 3343).
Characteristics of Short-Term Acute Care Hospitals That Experienced a Ransomware Attack From 2016 to 2021
Journal Article
Date: 08/2023
Ransomware is a type of malicious software designed to block access to a computer system until a sum of money is paid. In this paper, researchers compare the characteristics (including rurality) of ransomware-attacked and non-attacked hospitals in the U.S. in order to understand which hospitals may be most vulnerable to cybercrime.
Multi-Sector Collaboration to Support Rural Aging
Journal Article
Date: 08/2023
In this paper, researchers examine the lessons rural areas present for supporting aging, including the role that aging and social services, public health systems, and health care have to play.
Rural/Urban Differences in Rates and Predictors of Intimate Partner Violence and Abuse Screening Among Pregnant and Postpartum United States Residents
Journal Article
Date: 08/2023
This paper uses the 2016-2020 Pregnancy Risk Assessment Monitoring System (PRAMS) data to describe rates and predictors of perinatal intimate partner violence (IPV) and rates and predictors of not being screened for abuse among rural and urban IPV victims who gave birth.
Rural and Urban Differences in Insurance Coverage at Prepregnancy, Birth, and Postpartum
Journal Article
Date: 03/2023
In this manuscript, the research team used data from the Pregnancy Risk Assessment Monitoring System to measure insurance coverage at prepregnancy, birth, and postpartum, and insurance coverage continuity across these periods among rural and urban U.S. residents.
Advancing the Age-Friendly Movement in Rural Communities
Journal Article
Date: 02/2023
The research team looked at the role of Aging Life Care Managers® to help support the age-friendly movement in rural areas. The team explored ways in which Aging Life Care Managers® could advocate for the needs and interests of their clients, help them access care and support, and involve rural communities in the age-friendly movement.
Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas (journal article)
Journal Article
Date: 02/2023
In this manuscript, the research team used data from the 2021 Occupational Employment and Wage Statistics dataset to calculate the ratio of direct care workers relative to the population of older adults (ages 65+) across rural and urban areas in the US.

2022

Approaches to Serving Rural Older Adults in State Plans on Aging: A Policy Content Evaluation
Journal Article
Date: 05/2022
In this article, we share a policy content evaluation of State Plans on Aging from all 50 U.S. states, focusing on how the states will serve older adults and including common and innovative approaches to doing so.
Social Isolation and Safety Issues Among Rural Older Adults Living Alone: Perspectives of Meals on Wheels Programs
Journal Article
Date: 05/2022
In this article, we share results from a survey of 42 Meals on Wheels programs in rural areas across the US. Respondents highlighted challenges to meeting both social and safety needs of rural older adults living alone, as well as policy recommendations to improve the health and safety of older adults living alone in rural areas.
Rural Hospital Administrators' Beliefs About Safety, Financial Viability, and Community Need for Offering Obstetric Care
Journal Article
Date: 03/2022
This study offers results from a national survey of a sample of 292 rural hospitals that provided obstetric services in 2021. Obstetric unit administrators shared about their experiences, the challenges they face, and the decisions that factor into providing labor and birth care for their rural communities.
Contact by Collection Agencies for Medical Debt: Rural-Urban Differences Among Older and Younger Medicare Beneficiaries
Journal Article
Date: 02/2022
This study uses data from the 2016 Medicare Current Beneficiary Survey (n = 12,688 U.S. community-dwelling beneficiaries) to understand the impact of medical debt for rural residents. The study analyzed rural-urban differences in rates of collection agency contact for unpaid medical bills.
An Enhanced Method for Identifying Hospital-Based Obstetric Unit Status
Date: 01/2022
The purpose of this methodology brief is to describe an enhanced method for identifying hospital-based obstetric unit status and for identifying closures of obstetric units.

2021

"They're Not Leaving Their Home; This Is Where They Were Born, This Is Where They Will Die.": Key Informant Perspectives From the U.S. Counties With the Greatest Concentration of the Oldest Old
Journal Article
Date: 07/2021
Researchers share interview results with key informants from 50 rural U.S. counties with the highest percentage of the residents ages 85 and older or the "oldest old." Respondents shared unique challenges to serving this population, as well as positive attributes of rural communities that make them attractive places for growing older.
Characteristics of Rural and Urban U.S. Hospitals Based on Obstetric Services
Date: 04/2021
This infographic provides an overview of characteristics of rural and urban hospitals in the United States that provide obstetric services, as well as rural hospitals that recently closed their obstetric units.
Demographics and Disability Status of Adults Living Alone in Rural Areas
Policy Brief
Date: 04/2021
This policy brief examines how the types of people who live alone differ between urban and rural areas, focusing on differences in age and disability status.

2020

Emergency Obstetric Training Needed in Rural Hospitals Without Obstetric Units
Policy Brief
Date: 11/2020
This policy brief discusses the types of training identified by respondents and how those trainings may or may not meet the needs of those managing emergency obstetric situations in rural communities.
Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services
Journal Article
Date: 11/2020
As increasing numbers of rural hospitals stop offering maternity care, limited information is available about local preparedness to address obstetric emergencies. This paper explores the capacity to treat obstetric emergencies encountered among rural hospitals without obstetric units.
Making It Work: Models of Success in Rural Maternity Care
Date: 11/2020
The goal of this case series is to describe key factors that underlie three successful models of rural maternity care and to inform communities, clinicians, and hospitals that wish to keep obstetric services available locally.
Characteristics of U.S. Rural Hospitals by Obstetric Service Availability, 2017
Journal Article
Date: 08/2020
This study described characteristics of rural U.S. hospitals by whether they provide labor and delivery care for pregnant patients. Researchers used the 2017 American Hospital Association Annual Survey to identify rural hospitals and detail their characteristics based on whether they provide obstetric services.
Changes in Hospital-Based Obstetric Services in Rural U.S. Counties, 2014-2018
Journal Article
Date: 07/2020
In 2014, 54% of rural U.S. counties had no hospital-based obstetric services, following a steady decrease during the previous decade. Loss of rural maternity care is tied to adverse maternal and infant health outcomes. This study shares hospital-based obstetric service losses in rural U.S. counties from 2014 to 2018.
Loss of Hospital-Based Obstetric Services in Rural Counties in the United States, 2004-2018
Date: 07/2020
The purpose of this infographic is to show the loss of hospital-based obstetric services from 2004-2018 and how this differs by county type (micropolitan vs. noncore).
Nurse Practitioner Autonomy and Complexity of Care in Rural Primary Care
Journal Article
Date: 07/2020
The increasing number of nurse practitioners (NPs) in the rural U.S. has the potential to help alleviate primary care shortages. Using a nationwide source of claims and Electronic Health Record data from 2017, this study constructs measures of NP clinical autonomy and complexity of care.
Supporting the Health and Wellbeing of Middle-Aged Adults Living Alone in Rural Counties
Date: 06/2020
This report shares insights from healthcare providers in 14 rural counties with the highest rates of middle-aged adults living alone in order to inform policy and practice in how best to support the health and well-being of this demographic.
The Unique Impact of COVID-19 on Older Adults in Rural Areas
Journal Article
Date: 06/2020
Older adults in rural areas of the U.S. face unique risks related to COVID-19, which puts them at risk of not only the virus, but of not being able to meet their healthcare, social, and basic needs.
Differences by Rurality in Satisfaction With Care Among Medicare Beneficiaries
Journal Article
Date: 05/2020
There are stark differences between rural and urban areas in demographic characteristics, health status, and healthcare. Yet less is known about rural‐urban differences in Medicare beneficiaries' satisfaction with care. We seek to understand rural‐urban differences in satisfaction with care for Medicare beneficiaries.
Rates of Living Alone by Rurality and Age
Date: 04/2020
In this infographic, we identify rates of living alone for all adults and within specific age groups using two classifications of rurality.

2019

Rural-Urban Differences in Severe Maternal Morbidity and Mortality in the U.S., 2007-15
Journal Article
Date: 12/2019
In the U.S., severe maternal morbidity and mortality (SMMM) is climbing—a reality that is especially challenging for rural communities, which face declining access to obstetric services. Using data for 2007-15 from the National Inpatient Sample, we analyzed SMMM during childbirth hospitalizations among rural and urban residents.
Quality Measures for Critical Access Hospital Swing Bed Patients
Policy Brief
Date: 10/2019
This study identified measures to be used to assess the quality of care provided to Critical Access Hospital (CAH) swing bed patients with the goal of having these measures endorsed by the National Quality Forum and used by policymakers to help assess the value of CAH swing beds.
Rural Focus and Representation in State Maternal Mortality Review Committees: Review of Policy and Legislation
Journal Article
Date: 08/2019
Between 1990 and 2013, maternal mortality nearly doubled in the U.S., and rural residents experienced decreasing access to obstetric care. To improve maternal health, many states have established maternal mortality and morbidity review committees (MMRCs). We assessed the extent of rural representation in state policy efforts related to MMRCs.
Unmet Need for Personal Care Assistance Among Rural and Urban Older Adults
Policy Brief
Date: 06/2019
This brief presents data on rural-urban differences in unmet need for personal care among older adults with functional limitations.

2018

Rural-Urban Differences in Risk Factors for Motor Vehicle Fatalities
Journal Article
Date: 09/2018
This study uses 2017 County Health Rankings data to run stratified regression models to estimate county-level correlates of motor vehicle fatalities (MVFs) by rural and urban location. We found that rural counties have higher rates of MVFs than urban counties (22 vs. 14 per 100,000, p<0.001).
A National Examination of Caregiver Use of and Preferences for Support Services: Does Rurality Matter?
Journal Article
Date: 07/2018
The objective of this study was to assess rural-urban differences in caregiver use of and preferences for support services.
Rural-Urban Difference in Workplace Supports and Impacts for Employed Caregivers
Journal Article
Date: 06/2018
This study finds that employed rural caregivers had significantly fewer workplace benefits available to them compared with urban caregivers. In particular, employed rural caregivers were less likely to have access to telecommuting, employee assistance programs, and paid leave.
Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States
Journal Article
Date: 03/2018
This study examines whether the loss of obstetric services in hospitals in rural U.S. counties led to changes in childbirth outcomes or locations.
Beyond Clinical Complexity: Nonmedical Barriers to Nursing Home Care for Rural Residents
Journal Article
Date: 02/2018
Using data from interviews with rural hospital discharge planners, we identified four themes around nonmedical barriers to rural nursing home placement with particular salience in rural areas: financial issues, transportation, nursing home availability and infrastructure, and timeliness. We also identified policy and programmatic interventions.

2017

Barriers to Nursing Home Care for Nonelderly Rural Residents
Journal Article
Date: 12/2017
This study uses data from 23 semi-structured interviews with rural hospital discharge planners in five states to identify specific barriers to finding nursing home care for nonelderly rural residents. We found three primary themes—payment status, fit, and medical complexity—as well as two minor themes—caregivers and bureaucratic processes.
Access to Obstetric Services in Rural Counties Still Declining, With 9 Percent Losing Services, 2004-14
Journal Article
Date: 09/2017
Providing access to obstetric care in rural areas is a growing concern. By 2014, about 54% of rural counties in the United States did not have hospital obstetric services.
Rural-Urban Differences in Medicare Quality Outcomes and the Impact of Risk Adjustment
Journal Article
Date: 09/2017
This study examined the differences in quality of care outcomes between rural and urban Medicare beneficiaries. It concluded that rurality should be considered when discussing risk-adjustment procedures.
The Maternity Care Nurse Workforce in Rural U.S. Hospitals
Journal Article
Date: 05/2017
Findings are shared from a study examining the maternity care nursing workforce in rural hospital in the United States.
Rural Hospital Employment of Physicians and Use of Cesareans and Nonindicated Labor Induction
Journal Article
Date: 03/2017
Findings are shared from a study that discovered the types of doctors employed at rural hospitals may make a difference in the rates of cesarean births.

2016

Relationship Between Hospital Policies for Labor Induction and Cesarean Delivery and Perinatal Care Quality Among Rural U.S. Hospitals
Journal Article
Date: 11/2016
This study focused on maternity care quality by taking a look at hospitals' policies regarding induced labor and Cesarean deliveries.
Why Are Obstetric Units in Rural Hospitals Closing Their Doors?
Journal Article
Date: 08/2016
Analyzes the reasons behind hospital- and county-level factors for rural obstetric unit closures.
Factors Associated With High-Risk Rural Women Giving Birth in Non-NICU Hospital Settings
Journal Article
Date: 07/2016
Identifies risk factors for childbirth in facilities without neonatal intensive care unit (NICU) capacities among high-risk rural women. The study found that rural women with preterm birthday and multiple gestation pregnancies were less likely to give birth in a hospital with NICU capacity if no local hospital had this capacity.
The Practice of Midwifery in Rural U.S. Hospitals
Journal Article
Date: 07/2016
Analyzes the role of certified nurse-midwives (CNMs) in providing maternity care in rural US hospitals and to examine state-level variations on rural CNM practice. CNMs play an important role in the maternity care workforce in rural US hospitals.
Rural Enrollment in the Federally Facilitated Marketplace
Journal Article
Date: 06/2016
Analyzes the differences in rural and urban enrollment rates in counties across 32 states by using data from the Assistant Secretary for Planning and Evaluation of the US Department of Health and Human Services.
Ensuring Access to High-Quality Maternity Care in Rural America
Journal Article
Date: 05/2016
Examines the access to high-quality for rural women care during pregnancy and childbirth. Policy interventions at the local, state, and federal levels could help to address maternity care workforce shortages and improve quality of care available to the one-half million rural U.S. women who give birth each year.
Location of Childbirth for Rural Women: Implications for Maternal Levels of Care
Journal Article
Date: 05/2016
This study looks into the rate at which rural women give birth at nonlocal hospitals. Approximately 75% of rural women gave birth at local hospitals. However, after controlling for clinical complications, rural Medicaid beneficiaries were less likely to give birth at nonlocal hospitals, implying a potential access challenge for this population.
Rural Implications of Expanded Birth Volume Threshold for Reporting Perinatal Care Measures
Journal Article
Date: 04/2016
In 2016 the minimum annual birth volume threshold for required reporting of the Joint Commission Perinatal Care measures by accredited hospitals decreased from 1,100 to 300 births. This study used the publicly available Join Commission Quality Check data from April 2014 to March 2015.
Does the Medicare Part D Decision-Making Experience Differ by Rural/Urban Location?
Journal Article
Date: 02/2016
Evaluates the personal experiences with choosing a Part D plan among rural residents. This study examines the geographic differences in Part D enrollees' opinion of the plans decision-making process.
Rural-Urban Differences in Satisfaction With Medicare Part D: Implications for Policy
Journal Article
Date: 01/2016
Examines the difference in rural and urban satisfaction with Medicare Part D coverage by using data from the 2012 Medicare Current Beneficiary Survey. The research found that rural residents have lower satisfaction with their coverage.

2015

Minimum Distance Requirements Could Harm High-Performing CAHs and Rural Communities
Journal Article
Date: 04/2015
Compares the effect of location on critical access hospitals' size, quality of care, and financial strength. Discusses implications of minimum distance requirements on critical access hospitals.
The Rural Obstetric Workforce in U.S. Hospitals: Challenges and Opportunities
Journal Article
Date: 03/2015
Describes the healthcare and clinician types who are delivering babies in rural hospitals, such as family physicians, general surgeons, obstetricians, and midwives. Discusses the relationship between hospital birth volume and staffing models.

2014

The Use of Hospitalists by Small Rural Hospitals: Results of a National Survey
Journal Article
Date: 06/2014
Examines reasons for using hospitalists, characteristics of hospitalist practices, and the impacts of hospitalist use in rural settings.
Rural-Urban Differences in Obstetric Care 2002-2010 and Implications for the Future
Journal Article
Date: 01/2014
Measures obstetric care in both rural and urban hospitals to find if trends differ from rural and urban hospital locations.
Birth Volume and the Quality of Care in Rural Hospitals
Journal Article
Date: 2014
Evaluates obstetric care quality in low-, medium-, and high-volume areas by using hospital discharge data.
Rural Primary Care Practices and Meaningful Use of Electronic Health Records: The Role of Regional Extension Centers
Journal Article
Date: 2014
Examines the role Regional Extension Centers (RECs) play in assisting rural physician practices implement electronic health records (EHRs).

2011

Meaningful Use of Health Information Technology by Rural Hospitals
Journal Article
Date: 01/2011
This study examines the current status of meaningful use of health information technology in Critical Access Hospitals (CAHs) and other rural and urban U.S. hospitals, and it discusses the potential role of Medicare payment incentives and disincentives in encouraging CAHs and other rural hospitals to achieve meaningful use.

2010

Current Practices and State Regulations Regarding Telepharmacy in Rural Hospitals
Journal Article
Date: 07/2010
Telepharmacy practices in rural hospitals in several states were examined, and relevant policies and state laws and regulations were analyzed, along with issues to be addressed as the use of telepharmacy expands.
The Effect of Health Information Technology on Quality in U.S. Hospitals
Journal Article
Date: 04/2010
This study examines changes in quality of care following adoption of electronic health records among a national sample of U.S. hospitals from 2004 to 2007. The use of computerized physician order entry and electronic health records resulted in significant improvements in two quality measures; larger effects in academic than nonacademic hospitals.

2009

Implementing Patient Safety Initiatives in Rural Hospitals
Journal Article
Date: 09/2009
This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for patient safety initiatives in eight small Tennessee rural hospitals using a multi-organizational collaborative model. The demonstration identified and facilitated implementation of three patient safety interventions.

2008

Rural Emergency Department Staffing and Participation in Emergency Certification and Training Programs
Journal Article
Date: 06/2008
This paper describes how rural hospitals nationally are staffing their emergency departments (EDs) and explores the participation of rural ED physicians and other healthcare professionals in selected certification and training programs that teach skills needed to provide high quality emergency care.

2005

Providing Hospice Care in Rural Areas: Challenges and Strategies to Address Them
Journal Article
Date: 2005

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.

2004

Do Rural Elders Have Limited Access to Medicare Hospice Services?
Journal Article
Date: 05/2004
Examines whether there are urban-rural differences in use of the Medicare hospice benefit before death and whether those differences suggest that there is a problem with access to hospice care for rural Medicare beneficiaries.