North Dakota and NORC Rural Health Reform Policy Research Center

Completed Projects

Listed by project completion date. You can also view these projects alphabetically.


  • Comparisons of Rural Definitions
    This project will lead to the creation of a mega rural and frontier website. This website will emphasize the use of various rural definitions and datasets for healthcare policy, policy analysis, and research. Additionally, researchers will review Dartmouth's Primary Care Service Areas (PCSAs), other Rational Service Area (RSA) methodologies, and alternative methodologies related to their strengths, weaknesses, and spatial analytic criteria regarding their ability to serve in the process of developing useful primary care service areas.
    Topic: Frontier health
  • Cost of Running a Rural Ambulance Service
    This study will address the cost of running ambulance services in rural areas by organizational structure/source of funding, the factors contributing to differences in costs, and factors contributing to differences in financial viability.
    Topics: Emergency medical services (EMS) and trauma, Healthcare financing
  • Exploring Global Budgets as a New Reimbursement Model for Low-Volume Critical Access Hospitals
    Given the complexity of the Global Budget reimbursement model, we were interested to learn if there are aspects of the model that could be applied to consolidate reimbursement across rural and frontier health care settings, particularly for CAHs with low-volume (e.g., < 5 acute patients as a daily census).
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Hospitals and clinics
  • Rural Hospice Surveys Regarding Family Members & Health Workforce
    This project's two parts surveyed both hospice users' family members and hospice CEOs regarding their health workforce staffing and shortages. The family member survey involved a sample of hospices from a geographically disperse group of states and the CEO survey involving a national random sample of hospice CEOs.
    Topics: Hospice and palliative care, Workforce
  • Utilization of Hospital Care for Rural Medicare Beneficiaries
    This project examines where rural and frontier Medicare beneficiaries access hospital care. Specifically, it explores the different types of inpatient care sought in local rural communities and at tertiary providers. Beneficiary patterns of care by condition, location type and other factors will be examined. The study will also focus on the bypassing behavior of rural residents when being hospitalized. Analysis sensitivity analyses are being performed regarding small travel time differences per alternative hospitals.
    Topics: Frontier health, Hospitals and clinics, Medicare


  • Implications of Rural Ambulance Service Closures
    The purpose of this project was to examine closed ambulance services and those ambulance services adjacent to the closed units. The ambulance services adjacent to those which closed were examined by service area, workload, and staffing for one year prior to and one year after the adjacent service closure.
    Topics: Allied health professionals, Emergency medical services (EMS) and trauma, Frontier health, Health disparities and health equity, Health services, Workforce


  • Examination of Rural and Frontier Home Health Services
    This mixed-method study is an in-depth examination of access to and utilization of home health services provided in rural and frontier areas. The study begins to explore how influential patient-centered decision-making is in determining the type of post-acute care services used by rural and frontier Medicare beneficiaries.
    Topics: Frontier health, Home health, Post-acute care


  • Exploring Rural and Urban Mortality Differences
    This project examines the impact of rurality on mortality and explores the regional differences in the primary and underlying causes of death. It also explores the role of the rural public health systems in addressing social determinants of health.
    Topics: Public health, Social determinants of health
  • Frontier and Rural Definition Development and Dissemination Project
    The Frontier and Remote (FAR) codes are a new geographic definition that delineates frontier/remote areas in the U.S.
    Topic: Frontier health
  • Rural Population Hospice Care
    Relatively little is known about rural hospice care. The objectives of this project are to review and describe what is already known about rural hospices and to perform initial quantitative analyses on available data to describe the: number of rural hospices and their use patterns (e.g., length of stay and utilization rates), rural residents to urban hospice utilization, and rural versus urban resident hospice utilization rates. For this project, rural is be subdivided into categories such as large rural, small rural, isolated small rural, and frontier. To supplement this information, qualitative information was obtained and integrated into the findings report.
    Topics: Aging, Health services, Quality
  • Use of Emergency Departments for Behavioral Health Related Care
    This project will study the prevalence of emergency department utilization for behavioral health diagnoses between rural and urban communities.
    Topics: Emergency medical services (EMS) and trauma, Health services, Hospitals and clinics, Mental and behavioral health


  • Perspectives of Rural Hospice Directors
    Rural hospice care, as it is currently configured, is under pressure by a variety of factors (e.g., policy and regulation, economic and financial, and organizational and structural) which are reviewed in this document. However, a central core element of rural hospice remains the strong sense of community that is embodied in the system (i.e., typically a small non-profit arrangement) and design (i.e., a delivery system reliant on community connections and personal relationships) of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states. Fifty-three directors or key staff members were interviewed during a three-month period in 2013.
    Topics: Aging, Health services, Quality, Telehealth
  • Use and Performance Variations in Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    This project describes rural usage of rural emergency departments (EDs). It will examine the conditions that are treated in these EDs and describe those that are more and less appropriate for ED use. Rural ED use is described by community characteristics including rural level. The findings provide a baseline from which to measure the future influence of the Accountable Care Act implementation on the usage of rural EDs and the appropriateness and cost efficiency of changes.
    Topics: Emergency medical services (EMS) and trauma, Quality


  • Examination of Trends in Rural and Urban Health: Establishing a Baseline for Health Reform
    The purpose of this project is to update and supplement the seminal Health, United States, 2001: Urban and Rural Health Chartbook. Resulting information can not only be compared to the 2001 Chartbook but provides a baseline from which to measure future change related to the Accountable Care Act implementation. Where appropriate additional charts are included wherein rural areas are subdivided by type.
    Topics: Health disparities and health equity, Health services, Public health