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

2025

2010-2023 County-Level Hospital-Based Obstetric Care Status
Date: 10/2025
This data resource is a county-level dataset containing the county FIPS code, state, and an indicator of whether each US county had hospital-based obstetrics care in each year, 2010-2023. It is available for download as an XLS file.
An Enhanced Method for Identifying Hospital-Based Obstetric Unit Status, Version 2 with Addendum
Date: 10/2025
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. Version two of the methodology was used to identify obstetric care access in the 2010-2023 data resource.
Reasons for Experiencing Delayed or Forgone Health Care Among Rural American Indian/Alaska Native and Rural Non-Hispanic White Individuals, 2022
Policy Brief
Date: 09/2025
The purpose of this policy brief is to show reported reasons for experiencing delayed or forgone health care and how this differs between rural American Indian/Alaska Native (AI/AN) and rural non-Hispanic white people as well as by Indian Health Service care access among rural AI/AN people.
Rural/Urban Differences in Health, Health Care Use, and Barriers to Care for Postpartum and Parenting Women, 2006-2018
Policy Brief
Date: 08/2025
The goal of this analysis was to describe rural/urban differences in health, health care utilization, and barriers to care for reproductive-age females, with specific focus on those who are parents of young children (ages 1-4) and those who are postpartum (gave birth in the last year).
2010-2022 County-Level Hospital-Based Obstetric Care Status
Date: 07/2025
This data resource is a county-level dataset containing the county FIPS code, state, and an indicator of whether each United States county had hospital-based obstetrics care in each year, 2010-2022. It is available for download as an XLS file.
Geographic and Demographic Correlates of Living in Manufactured Homes: Implications for Health
Policy Brief
Date: 07/2025
This brief examines rates of living in manufactured homes by rural and urban location, as well as rates among rural residents by region and socio-demographic characteristics. It also examines differences in crowded housing, housing quality, and housing cost burden by manufactured vs. more permanent housing structures.
Preventing Medical Debt Among Rural Residents: Example Programs From Hospitals in Minnesota and Montana
Date: 06/2025
This case series highlights efforts by rural hospitals to prevent medical debt for their patients. These may serve as examples to others considering ways to address health care affordability in their rural communities.
Resources for Measuring Rurality in Research on Maternity Care
Date: 01/2025
The primary objective of this brief is to explore the complexities inherent in defining rurality in maternal health research. In addition, this brief aims to provide insights into how different measures of rurality influence research outcomes, with the goal of informing best practices in maternal health research.
Rural-Urban Differences in PACE Organization and Enrollee Characteristics
Policy Brief
Date: 01/2025
The Program of All-Inclusive Care for the Elderly (PACE) operates in most states and many rural areas. This brief addresses how PACE enrollee characteristics vary between rural and urban areas.

2024

Midwifery Care at Rural Hospitals in Montana and California
Date: 12/2024
These case studies describe how two hospitals that serve rural U.S. communities incorporate midwifery care into their services.
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.
Information for Rural Stakeholders About Access to Maternity and Obstetric Care: A Community-Relevant Synthesis of Research
Date: 09/2024
This document aims to inform rural stakeholders about challenges related to access to and quality of hospital-based childbirth care in rural U.S. communities.
States and Rural Communities With and Without the Program of All-Inclusive Care for the Elderly (PACE)
Policy Brief
Date: 09/2024
The purpose of this policy brief is to measure sociodemographic differences in areas with and without a Program of All-Inclusive Care for the Elderly (PACE) organization headquarters among rural communities and by state-level PACE availability and headquarters location.
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.
Risk Factors for Poor Health Among U.S. Older Adults in Rural and Urban Areas: Injury, Food Insecurity, and Lack of Social and Emotional Support
Policy Brief
Date: 06/2024
This policy brief examines three risk factors for poor health outcomes among older adults: injury, food insecurity, and lack of social and emotional support by rural-urban residence.
Understanding the Rise of Ransomware Attacks on Rural Hospitals
Policy Brief
Date: 06/2024
This policy brief presents findings from a novel database of hospital ransomware attacks, focusing on the frequency and characteristics of ransomware attacks on rural hospitals.
Housing for Rural Residents Recovering from Substance Use Disorders
Date: 05/2024
The purpose of this case series is to highlight organizations providing housing for individuals in recovery from substance use disorders in rural communities. These may serve as examples to others considering this work.
Rural/Urban Differences in Housing Quality and Adequacy: Findings From the American Housing Survey, 2019
Policy Brief
Date: 05/2024
In this policy brief, researchers identify rural/urban differences in various measures of housing quality using a nationally representative survey.
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.
Differences in Residential Stability by Rural/Urban Location and Socio-Demographic Characteristics
Policy Brief
Date: 08/2023
This policy brief identifies rural/urban differences in residential stability and examines rural/urban differences in regional, socio-demographic, and health characteristics associated with living in the same home for more than 20 years.
Eight Postpartum Support Programs in Rural Communities Across the United States
Date: 08/2023
This case study series highlights locally focused organizations working to improve postpartum health for rural residents across the United States. Interviews were conducted with eight unique organizations working in their local rural communities to support postpartum health.
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.
State Differences in Recommended Components of Care Received During Postpartum Visits for Rural and Urban Residents, 2016-2019
Policy Brief
Date: 07/2023
The purpose of this policy brief is to measure state-level differences in the receipt of recommended postpartum care components among rural and urban residents in the United States who gave birth from 2016 to 2019.
Two National-Level Organizations Supporting Rural Postpartum Health Across the United States
Date: 07/2023
The purpose of this case study series is to highlight national-level organizations working in innovative ways to improve postpartum health for rural residents across the United States. These may serve as examples to others considering this work.
Distribution of Direct Care Workforce COVID-19 Funding Between Rural and Urban Counties in Minnesota and Illinois
Policy Brief
Date: 05/2023
The purpose of this policy brief is to examine trends in the distribution of federal Coronavirus Aid, Relief, and Economic Securities Act of 2020 (CARES Act) funding designed to support the direct care workforce between rural and urban counties in Minnesota and Illinois.
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

Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas (policy brief)
Policy Brief
Date: 11/2022
The policy brief examines disparities in the supply of home health aides and nursing assistants in rural areas compared to urban areas. Researchers estimate the ratio of home health aides and nursing assistants relative to the population of adults (age 65+) across rural and urban areas in the U.S.
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.
Evaluating the Rural HIV/AIDS Planning Program
Policy Brief
Date: 01/2022
The purpose of this policy brief is to understand the overall experiences of the first grantee cohort (2020-21) of the Rural HIV/AIDS Planning Program. We pay particular attention to any barriers to or facilitators of successful grant implementation, and the sustainability of programs and acquisition of future funding.

2021

Barriers to Aging in Place in Rural Communities: Perspectives From State Offices of Rural Health
Policy Brief
Date: 11/2021
This policy brief presents findings from an online survey of State Offices of Rural Health describing barriers for older adults in successfully aging in place in rural communities, and recommendations for how to improve the ability to safely age in place in rural areas of their states.
Rural Health Network Development Planning Grants: Geographic Location and Change Over Time
Policy Brief
Date: 11/2021
The purpose of this policy brief is to examine the geographic distribution of Rural Health Network Development Planning Grant recipients across the United States.
Examples of Statewide Age-Friendly Initiatives
Policy Brief
Date: 10/2021
The purpose of these policy briefs is to identify the extent of statewide programs to support aging in place or age-friendly environments and, within those, to identify the extent to which such programs have an explicit rural focus. The "Examples" document provides an overview of the initiatives identified in the "Environmental Scan."
Statewide Age-Friendly Initiatives: An Environmental Scan
Policy Brief
Date: 10/2021
The purpose of these policy briefs is to identify the extent of statewide programs to support aging in place or age-friendly environments and, within those, to identify the extent to which such programs have an explicit rural focus. The "Examples" document provides an overview of the initiatives identified in the "Environmental Scan."
Successes and Challenges to Network Sustainability: Perspectives of 2019-2020 Rural Health Network Development Planning Grantees
Policy Brief
Date: 10/2021
The purpose of this brief is to examine the successes and challenges to network sustainability, as well as barriers to and facilitators of success among the 2019-2020 cohort grantees in the Rural Health Network Development Planning Grant Program.
State and Regional Differences in Access to Hospital-Based Obstetric Services for Rural Residents, 2018
Policy Brief
Date: 08/2021
This policy brief measures state and regional differences in the availability of hospital-based obstetric services among rural hospitals in the U.S. in 2018.
"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.
Preferences for Long-Term Care Arrangements Among Rural and Urban Older Adults
Policy Brief
Date: 05/2021
This study describes care preferences by rural and urban location and by demographic characteristics among rural residents.
Success Among Rural Health Network Development Planning Grant Awardees: Barriers and Facilitators
Policy Brief
Date: 05/2021
The purpose of this policy brief is to examine the barriers to and facilitators of success for grantees implementing the Rural Health Network Development Planning Grant and meeting their individual goals for the grant period.
Trends in Network Focus Areas Among Network Development Planning Grantees, 2003-2020
Policy Brief
Date: 05/2021
The purpose of this policy brief is to examine the trends over time in network focus areas among grantees awarded the Rural Health Network Development Planning Grant from 2003-2020.
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.
Rural and Urban Hospital Characteristics by Obstetric Service Provision Status, 2010-2018
Policy Brief
Date: 04/2021
The purpose of this policy brief is to illustrate the differences between urban and rural hospitals that provide obstetric services by their size, capacity, location, and community characteristics, as well as to compare these factors between rural hospitals with obstetric services and those that recently closed their obstetric units.
Barriers to Health Care Access for Rural Medicare Beneficiaries: Recommendations From Rural Health Clinics
Policy Brief
Date: 01/2021
This brief presents findings from an online survey of Rural Health Clinics describing barriers for Medicare patients in accessing healthcare services and recommendations for how to improve access to care for Medicare beneficiaries in rural areas.

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.
Obstetric Emergencies in Rural Hospitals: Challenges and Opportunities
Policy Brief
Date: 09/2020
The purpose of this policy brief is to describe the challenges rural hospitals face in providing emergency obstetric care and to highlight resources that could help rural hospitals more safely respond to obstetric emergencies.
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.
Providing Maternity Care in a Rural Northern Iowa Community
Date: 08/2020
This case study highlights how one rural hospital in northern Iowa has successfully sustained a maternity care practice and identifies opportunities for other rural hospitals and communities seeking to ensure local access to care for pregnancy and childbirth.
Rural-Urban Differences Among Older Adults
Chartbook
Date: 08/2020
This chartbook presents the characteristics of older adults in rural counties, as well as rural-urban differences among older adults, across four domains: demographics, socioeconomic characteristics, healthcare access and use, and health characteristics.
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.
Characteristics of Counties With the Highest Proportion of the Oldest Old
Policy Brief
Date: 05/2020
The "oldest old," or individuals age 85 and older, are one of the fastest-growing segments of the U.S. population, yet little is known about where those individuals tend to live and what their communities are like. This information is important for planning how to best respond to and support this growing population.
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.
Rural and Urban Differences in Primary Care Pain Treatment by Clinician Type
Policy Brief
Date: 04/2020
In this brief, we compare 2017 opioid prescribing rates among physicians and nurse practitioners within primary care practices and how these differ for rural versus urban areas.

2019

Access and Capacity to Care for Medicare Beneficiaries in Rural Health Clinics
Policy Brief
Date: 12/2019
Access to timely, high-quality healthcare is essential for health, but rural areas face particular barriers to access, including for primary care. We present findings from an online survey of RHCs describing clinic characteristics related to healthcare access for rural Medicare beneficiaries.
Access to Specialty Care for Medicare Beneficiaries in Rural Communities
Policy Brief
Date: 12/2019
Access to care is a challenge in many rural communities for both primary care services and specialty care services. We present findings from an online survey of Rural Health Clinics describing access issues for rural Medicare beneficiaries in seeking care from specialty care providers.
Rural-Urban Differences in Access to and Attitudes Toward Care for Medicare Beneficiaries
Policy Brief
Date: 12/2019
Access to healthcare is important to health outcomes and well-being. Even among Medicare beneficiaries, access to care may differ by rural-urban location due to differences in the healthcare and socio-demographic landscape. We describe rural-urban differences in access to care for Medicare beneficiaries.
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.
Severe Maternal Morbidity and Hospital Transfer Among Rural Residents
Policy Brief
Date: 11/2019
In this brief, we compare hospital transfer rates for rural and urban residents who gave birth. We also provide descriptive information about the relationship between transfer status and severe maternal morbidity and mortality for rural residents nationally who gave birth 2008-2014.
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.
Measuring Access to Care in National Surveys: Implications for Rural Health
Policy Brief
Date: 06/2019
This brief presents data about how access to healthcare is measured, focusing on how this applies to rural populations.
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

Key Informant Perspectives on Rural Social Isolation and Loneliness
Policy Brief
Date: 10/2018
This policy brief uses data from interviews with 22 key informants in 12 states, all of whom were experts on the issue of social isolation and/or rural health, to describe key challenges and opportunities related to rural social isolation.
Practical Implications: Opioid-Affected Births to Rural Residents
Policy Brief
Date: 09/2018
This publication provides two physicians' reactions to research findings on rates of diagnosis of maternal opioid use disorder and infant neonatal abstinence syndrome at the time of childbirth for rural residents based on the type of hospital where the birth occurred.
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).
Non-Medical Opioid Use Among Rural and Urban Pregnant Women, 2007-2014
Policy Brief
Date: 08/2018
This policy brief presents data on rural-urban differences in non-medical opioid use among pregnant women to inform policy, programmatic, and clinical efforts to address this crisis.
Perspectives on Rural Caregiving Challenges and Interventions
Policy Brief
Date: 08/2018
This brief presents findings from key informant interviews describing challenges and opportunities related to supporting informal caregivers in rural areas.
Resources for Caregiving in Rural Communities
Policy Brief
Date: 08/2018
This policy brief describes resources that are being used across the country to support caregivers in rural communities.
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.
Addressing Commuting as a Public Health Issue: Strategies Should Differ by Rurality
Policy Brief
Date: 07/2018
This policy brief estimates the rate of solo and long (greater than 30 minutes) solo car commutes by rurality and urban adjacency and identifies differences in factors that relate to commuting behavior.
Availability of Respiratory Care Services in Critical Access and Rural Hospitals
Policy Brief
Date: 06/2018
This policy brief describes the availability of respiratory care services and respiratory therapists in Critical Access Hospitals (CAHs) and in rural and urban Prospective Payment System (PPS) hospitals.
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.
Critical Access Hospital Swing-Bed Quality Measures: Findings From Key Informant Interviews
Policy Brief
Date: 04/2018
This study examines how Critical Access Hospitals (CAHs) are currently assessing the quality of care provided to their swing-bed patients.
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.
Challenges Related to Pregnancy and Returning to Work After Childbirth in a Rural, Tourism-Dependent Community
Date: 02/2018
This case study highlights challenges related to pregnancy and returning to work after childbirth in a rural, tourism-dependent community in Minnesota.

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.
Rural Transportation: Challenges and Opportunities
Policy Brief
Date: 11/2017
This policy brief uses survey data from 113 key informants across all 50 states to describe challenges and opportunities related to rural transportation.
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.
Regulating Network Adequacy for Rural Populations: Perspectives of Five States
Policy Brief
Date: 08/2017
The purpose of this study was to examine how five geographically-diverse states with significant rural populations define "network adequacy" and the degree to which they consider rural issues when regulating networks.
Identifying Adverse Drug Events in Rural Hospitals: An Eight-State Study
Policy Brief
Date: 05/2017
Analyzes the prevalence of Adverse Drug Events (ADEs) in rural hospitals, including both CAHs and rural PPS hospitals, related to four categories of drugs: steroids, antibiotics, opiates / narcotics, and anticoagulants in 2013 for eight states. It also examines whether or not these hospitals' ADE rates varied based on hospital characteristics.
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.
Medical Barriers to Nursing Home Care for Rural Residents
Policy Brief
Date: 05/2017
This policy brief describes barriers rural residents with complex medical care needs may face when seeking placement in a nursing home and identifies potential policy strategies to overcome them.
Resources to Reduce Adverse Drug Events in Rural Hospitals
Policy Brief
Date: 05/2017
This policy brief provides resources that could be used to decrease Adverse Drug Events (ADEs) in rural hospitals.
Closure of Hospital Obstetric Services Disproportionately Affects Less-Populated Counties
Policy Brief
Date: 04/2017
This policy brief describes the scope of obstetric unit and hospital closures resulting in loss of obstetric services in rural U.S. counties from 2004 to 2014.
State Variability in Access to Hospital-Based Obstetric Services in Rural U.S. Counties
Policy Brief
Date: 04/2017
This policy brief describes state-level variations in 1) the availability of hospital-based obstetric services, and 2) the scope of obstetric unit and hospital closures resulting in the loss of obstetric services in rural U.S. counties from 2004 to 2014.
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.
Rural-Urban Differences in Insurer Participation for Marketplace-Based Coverage
Policy Brief
Date: 08/2016
This policy brief examines the differences between rural and urban counties in terms of the number and composition of insurers in Federally-Facilitated Marketplaces.
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

Rural Hospital and Physician Participation in Private Sector Quality Initiatives
Policy Brief
Date: 10/2015
This project examined private sector quality reporting and quality improvement initiatives being implemented by dominant insurers in states with significant rural populations. The policy brief profiles 12 initiatives, half focused on physician quality improvement and half focused on hospital quality improvement.
Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time?
Policy Brief
Date: 10/2015
The Hospital Readmissions Reduction Program reduces Medicare payments for hospitals with excess rates of patient readmissions for certain conditions. It assesses rural/urban differences in the proportion of hospitals penalized under the program over time and whether condition-specific hospital readmission rates differ for rural/urban hospitals.
Differences in Part D Plans Offered to Rural and Urban Medicare Beneficiaries
Policy Brief
Date: 07/2015
This brief analyzes how the plan options available to rural and urban beneficiaries differ in terms of premiums, deductibles, and copayments, as well as differences in plan options within rural areas.
Rural and Urban Differences in Choice of and Satisfaction With Medicare Part D Plans
Policy Brief
Date: 07/2015
This brief examines whether rural Medicare beneficiaries are satisfied with their Medicare Part D drug plans and whether there is a difference in beneficiary satisfaction and plan selection experience by rurality.
Rural Women Delivering Babies in Non-Local Hospitals: Differences by Rurality and Insurance Status
Policy Brief
Date: 06/2015
This policy brief describes the extent to which rural pregnant women give birth in non-local hospitals and analyzes current patterns of non-local delivery by rural women's health insurance status and residential rurality.
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.
Nurse Staffing Levels and Quality of Care in Rural Nursing Homes
Policy Brief
Date: 01/2015
This study's purpose was to examine the relationship between nurse staffing levels and care quality in rural nursing homes and to assess potential differences between hospital-based and freestanding rural nursing homes.

2014

The Obstetric Care Workforce in Critical Access Hospitals (CAHs) and Rural Non-CAHs
Policy Brief
Date: 11/2014
This brief details rural hospital obstetric staffing patterns in nine states by critical access hospital status. The purpose was to examine obstetric practice models in rural hospitals, providing information to rural hospitals with obstetric care units regarding workforce and informing policymakers about the context in which the hospitals operate.
Successful Health Insurance Outreach, Education, and Enrollment Strategies for Rural Hospitals
Policy Brief
Date: 11/2014
This brief offers best practices for hospitals to use in health insurance outreach/enrollment based on interviews with administrators, staff, and community reps at 11 rural hospitals. It also discusses certified application counselors and the importance of collaborative community partnerships in conducting insurance enrollment outreach/education.
Does Rurality Affect Observation Care Services Use in CAHs for Medicare Beneficiaries?
Policy Brief
Date: 10/2014
This brief describes the use of observation services across levels of rurality by Medicare beneficiaries in critical access hospitals, the demographics and health status of patients receiving these services, and the characteristics of their observation stays.
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.
Which Medicare Patients Are Transferred From Rural Emergency Departments?
Policy Brief
Date: 06/2014
A brief from the University of Minnesota Rural Health Research Center analyzes transfers of Medicare beneficiaries who received emergency care in a critical access hospitals or rural hospitals and were transferred to other hospitals for care.
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).

2013

Case Studies of Regional Extension Centers Serving Rural Practices: Minnesota and North Dakota
Date: 11/2013
This case study focuses on the HIT Regional Extension Center serving Minnesota and North Dakota and its experiences working with rural physician practices in the two states.
Case Studies of Regional Extension Centers Serving Rural Practices: North Carolina
Date: 11/2013
This case study focuses on the North Carolina HIT Regional Extension Center and its experience working with rural physician practices in the state.
Obstetric Services and Quality Among Critical Access, Rural, and Urban Hospitals in Nine States
Date: 06/2013
This policy brief compares the characteristics and quality of obstetric care in critical access hospitals, other rural hospitals, and their urban counterparts.
Comparing Rural and Urban Medicare Part D Enrollment Patterns and Prescription Drug Coverage Rates
Date: 05/2013
This study examines Medicare Part D enrollment rates in rural and urban areas and the resulting impact on rural beneficiaries' overall prescription drug coverage rates.

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

Is Large Really Beautiful? Physician Practice in Small Versus Large Scale Communities
Date: 09/2005
This paper examines the effect of community size on how physicians view their practices as reported by respondents to two waves (1996-97 and 1998-99) of a national sample survey conducted as part of the Community Tracking Study. Results suggest that bigger is not necessarily better when it comes to physicians' perceptions of their practices.
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

Sustaining Community Health Services Over Time: Models From the Rural Health Outreach Grant Program
Date: 11/2004
This paper discusses post-grant sustainability of services provided by recipients of Rural Health Outreach Grant Program projects.
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.
Measuring Rural Hospital Quality
Date: 04/2004
This paper seeks to identify rural hospital quality measures that reflect quality in all hospitals and are sensitive to the rural hospital context.
The Financial Benefits of Critical Access Hospital Conversion for FY 1999 and FY 2000 Converters
Date: 01/2004
This paper discusses the impact of conversion to critical access hospital (CAH) status on the financial condition of rural hospitals one and two years after conversion. CAHs pre- and post-conversion revenues are compared, and CAH revenues are compared to small rural hospitals that did not convert to cost-based Medicare reimbursement.
Quality Improvement Strategies and Best Practices in Critical Access Hospitals
Date: 01/2004
This paper describes critical access hospital (CAH) quality improvement (QI) initiatives, with examples of best practices from two CAHs that have innovative QI programs. It includes lists of changes made to staffing, training, equipment, and other issues related to QI.

2003

Grantee Sustainability in the Rural Health Outreach Grant Program
Date: 12/2003
This paper describes a study of the post-grant experiences of 99 Rural Health Outreach Grant recipients and 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.
Are There Geographic Disparities in Out-of-Pocket Spending by Medicare Beneficiaries?
Date: 10/2003
This paper describes a study comparing out-of-pocket spending among rural and urban Medicare recipients. It includes data on differences based on supplemental insurance coverage.
Rural Health Networks: Evolving Organizational Forms and Functions
Date: 06/2003
This report discusses results of a survey of rural health networks. It includes information about the location, membership, relationships, governance, management, process, and products of rural health networks.
Environmental Context of Patient Safety and Medical Errors
Date: 03/2003
This paper explores the environmental context of patient safety/medical errors with specific interest in rural areas. It reviews patient safety/medical error literature, identifies features of rural healthcare organizations and their environment relating to patient safety issues/medical errors, and discusses error reduction/prevention strategies.
Rural Hospitals: New Millennium and New Challenges
Date: 02/2003
This report discusses the changes in rural hospitals that took place in the decade of the 1990s and discusses some of the challenges that face rural hospitals in 2003. It includes discussion of rural hospitals' organizational structures, health service provision, payment/reimbursement, and financial performance.
The Financial Effects of Critical Access Hospital Conversion
Date: 01/2003
This paper describes how the first wave of conversions to critical access hospital status affected rural hospitals' financial performances and organizational structures.
Rate of Return on Capital Investments at Small Rural Hospitals
Date: 01/2003
This paper examines whether the aging of rural facilities is due to a lower rate of return on capital investment at these hospitals. This paper also investigates whether membership in a hospital system improves access to capital and results in the updating of buildings and equipment.

2002

Implementing Quality Assessment and Performance Improvement Systems in Rural Health Clinics: Clinic and State Agency Responses
Date: 08/2002
This paper assesses the potential of a diverse set of rural health clinics (RHCs) to comply with the quality assessment and performance improvement program (QAPI) requirements and the capacity of state agencies to provide RHCs with technical assistance in their QAPI implementation.
Use of the Hospice Benefit by Rural Medicare Beneficiaries
Date: 08/2002
This publication identifies urban-rural differences in hospice use in rural service areas.
Rural Hospital Access to Capital: Issues and Recommendations
Date: 07/2002
This paper identifies programs that have assisted/could assist rural hospitals in meeting capital needs; assesses whether rural hospital borrowers have difficulty in meeting capital needs under existing grant, loan, and mortgage insurance programs; and discusses potential options for improving access to capital for rural hospitals.
Financial Incentives for Rural Hospitals to Expand the Scope of Their Services
Date: 06/2002
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 limited inpatient services.
Understanding Rural Hospital Bypass Behavior
Date: 06/2002
This study provides a descriptive analysis of rural hospital bypass behavior. It focuses on the extent to which patients admitted from rural areas are bypassing local facilities and whether there are changes in bypass patterns over time.
Access to Emergency Medical Services in Rural Areas: The Supporting Role of State EMS Agencies
Date: 02/2002
This paper reports on a survey of state emergency medical services (EMS) directors about access to rural EMS; programs/initiatives by state EMS agencies to target rural/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.

2001

Medicare Minus Choice: How HMO Withdrawals Affect Rural Beneficiaries
Date: 10/2001
This report assesses the impact of Medicare HMO withdrawals and service reductions on rural Medicare beneficiaries.
Rural Hospitals' Ability to Finance Inpatient, Skilled Nursing, and Home Health Care
Date: 10/2001
This study surveys 448 rural hospitals to see how they are restructuring in light of the Balanced Budget Act of 1997.
Access to Rural Pharmacy Services in Minnesota, North Dakota, and South Dakota
Date: 07/2001
This paper describes the 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.
Rural Government Role in Medicaid Managed Care: The Development of County-Based Purchasing in Minnesota
Date: 01/2001
This paper describes the development and implementation in Minnesota of a model for rural county government participation in Medicaid-managed care initiatives.

2000

Influence of Rural Residence on the Use of Preventative Health Care Services
Date: 11/2000
This paper details a study of the utilization of specific preventive healthcare services by rural women and men to assess the impact of rural residence, the availability of healthcare providers and technology, demographic factors, and health insurance status on the likelihood of obtaining several preventive healthcare services.
Financial Viability of Rural Hospitals in a Post-BBA Environment
Date: 10/2000
This paper evaluates the financial viability of rural hospitals under the Balanced Budget Act of 1997 and the Balanced Budget Refinement Act of 1999 Medicare payment policies. It estimates the number of hospitals that will become critical access hospitals and the number of beds at each hospital.
Why Do Rural Primary-Care Physicians Sell Their Practices?
Date: 06/2000
This study evaluates why rural primary care physicians sell their practices. It examines the factors that led independent physicians to sell their practices to either non-local buyers, local hospitals, or local physicians.
Strategic Choices of Rural Health Networks: Implications for Goals and Performance Measurement
Date: 01/2000
The purpose of this study is to obtain a greater understanding of rural health networks by classifying them according to their functions and purposes. Examples of performance measures that might be used for the different network types are given.