University of Minnesota Rural Health Research Center

Research Products & Journal Articles

Browse the full list of research publications from this Rural Health Research Center.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.






  • 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.
  • Racial and Ethnic Differences in Self-Rated Health Among Rural Residents
    Journal Article
    Date: 09/2020
    This study looks at racial and ethnic differences in self-rated health among rural residents as well as whether these differences can be explained by socio-demographic characteristics. Researchers used data from the 2011–2017 National Health Interview Survey to study differences in rural residents' self-rated health by race and ethnicity.
  • 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
    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. Rural/urban inequities, combined with within-rural inequities in health, healthcare, and financial resources cause particular challenges.
  • 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.









  • 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.


  • 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.


  • 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.




  • The Current Status of Health Information Technology Use in CAHs
    Date: 05/2006
    The purpose of this briefing paper is to assess the current status of health information technology use in critical access hospitals nationally.
  • A Review of State Flex Program Plans, 2004-2005
    Date: 03/2006
    This paper examines the objectives and project activities proposed by states in their Medicare Rural Hospital Flexibility Program (Flex Program) grant applications for Fiscal Year 2004 to strengthen the rural healthcare infrastructure in their states. It highlights recent trends in state Flex Program planning, development, and implementation.
  • CAH Participation in Hospital Compare and Initial Results
    Date: 02/2006
    This paper examines the participation of critical access hospitals (CAHs) in public reporting of quality measures in the Centers for Medicare and Medicaid Services Hospital Compare database. It presents the initial results for CAHs and comparisons with other hospital groups on quality measures for various conditions.


  • 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.
  • The Availability and Use of Capital by Critical Access Hospitals
    Date: 03/2005
    This paper examines the experiences of critical access hospitals (CAHs) in meeting their capital needs. It focuses on their efforts to obtain capital, the capital sources tapped through these efforts and how CAHs have used the capital they have been able to obtain over the last few years and assesses their current capital needs.
  • 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.



  • 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.
  • The Response of Local Health Care Systems in the Rural Midwest to a Growing Latino Population
    Date: 08/2003
    This paper reports on the case studies of rural communities in Iowa, Kansas, and Nebraska, documenting successful strategies that could be adopted by other communities facing challenges to their rural healthcare system in meeting the needs of a growing Latino population.
  • 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.