WWAMI Rural Health Research Center

Completed Projects

Alphabetical list. You can also view by project completion date.

• Access to Cancer Services for Rural Colorectal Cancer Medicare Patients: A Multi-State Study
  This study examined a comprehensive database to quantify the distance and access to four types of cancer services in a sample of rural, Medicare-insured, CRC patients, and will inform future work designed to understand discrepancies in cancer service use by the rural elderly.
  Topics: Aging, Cancer, Chronic diseases and conditions, Health services, Medicare
  
• Access to Home Care Services in the Rural United States
  This study will identify and describe the scope of home health services required to meet current and future needs in rural areas of the U.S., identify current and anticipated barriers to accessing those needs, and describe ways that may help overcome these barriers.
  Topics: Aging, Home health
  
• Access to Physician Care for the Rural Medicare Elderly
  This study described where Medicare beneficiaries in five states obtain their health care, how far they travel for that care, and the mix of physician specialties from which they obtain ambulatory care. Special attention was paid to beneficiaries who have dual Medicare-Medicaid status, who reside in poorer income areas, and who live in designated Health Professional Shortage Areas.
  Topics: Aging, Chronic diseases and conditions, Health services, Medicare, Physicians, Poverty
  
• Aging of the Rural Generalist Physician Workforce: Will Some Locations Be More Affected than Others?
  This study will identify rural locations with high proportions of generalist physicians nearing retirement age.
  Topics: Physicians, Workforce
  
• Ambulatory Care and the Rural Elderly
  Topics: Aging, Chronic diseases and conditions, Health services
  
• Are Rural Perinatal Care Systems Deregionalizing?
  Topics: Children and adolescents, Health services, Maternal health
  
• Assessing Potential Unmet Need for Home Healthcare in Rural Areas
  This study estimated potential unmet need for home healthcare in rural areas for fee-for-service Medicare beneficiaries. We compared rates of home healthcare utilization in rural areas with urban areas, accounting for acute hospital discharges and utilization of inpatient rehabilitation facilities and skilled nursing facilities.
  Topics: Health services, Home health, Hospitals and clinics, Medicare, Post-acute care
  
• Assessing Rural-Urban Nurse Practitioner Supply and Distribution in 12 States Using Available Data Sources
  This study compared estimates of nurse practitioner (NP) supply in 12 states (statewide and rural vs. urban) derived from two sources: state license records and National Provider Identifier (NPI) data.
  Topics: Nurses and nurse practitioners, Physicians, Workforce
  
• Breast, Cervical, Colorectal, and Prostate Cancer Screening in Rural America: Does Proximity to a Metropolitan Area Matter?
  The study compared cancer screening rates among various levels of rural versus urban Behavioral Risk Factor Surveillance System respondents.
  Topics: Cancer, Health promotion and disease prevention
  
• Changes in U.S. Rural Perinatal and Infant Health Care During the Last Decade
  This study examined changes in rates of adverse birth outcomes and prenatal care among rural Americans during two time periods. The study used national data from the Linked Birth Death Data Sets to assess differences in low birth weight, neonatal death, post neonatal mortality and inadequate prenatal care.
  Topics: Children and adolescents, Maternal health
  
• Chartbook of Family Practice Graduate Medical Education Programs in Rural America
  Little is known about the volume, location, and types of rural training for family physicians. This project will produce a chartbook that makes previously unreported information about family physician residency directors more fully available to medical educators and other policymakers.
  Topics: Physicians, Workforce
  
• Community College's Contributions to the Education of Allied Health Professionals in Rural Areas of the U.S.
  This study will identify rural-serving community colleges across the U.S. and their 5-year graduation trends for specific allied health professions, examine the spectrum of how rural allied health professions education currently is being allocated and delivered, and explore how community economic status and estimated regional allied health workforce demand is associated with the availability of rural community college allied health education programs.
  Topics: Allied health professionals, Workforce
  
• Current Contribution of Physicians, Advanced Practice Nurses, and Physician Assistants to the Rural Primary Care Workforce
  This two-year, multi-state study is examining the practices of rural physicians, nurse practitioners (NPs), and physician assistants (PAs) regarding their primary care visit productivity and scope of practice. Through surveys, this study will examine the contributions of physicians, NPs, and PAs by state, degree of practice rurality, practice characteristics, and primary care HPSA status in order to provide information on a range of rural primary care workforce needs.
  Topics: Nurses and nurse practitioners, Physician assistants, Physicians, Workforce
  
• Distribution and Retention of General Surgeons in Rural Areas of the U.S.
  Topics: Health services, Physicians, Workforce
  
• Diverging Populations Served by the Medicare Home Health Benefit: Comparison of Post-acute vs. Community-entry Home Health in Rural Areas
  This study examined differences between rural, fee-for-service Medicare beneficiaries who were admitted to home health from the community (community-entry) and those who were admitted to home health following an inpatient stay (post-acute) in terms of their clinical and non-clinical characteristics as well as the communities in which they live.
  Topics: Health services, Home health, Medicare, Post-acute care
  
• Do Community Health Centers Substitute for or Attract Private Rural Physicians?
  Topics: Federally Qualified Health Centers (FQHCs), Physicians
  
• Do Rural Patients with Early Stage Prostate Cancer Gain Access to All Treatment Choices?
  This research will use cancer registry data from 10 states to examine the degree to which rural residents diagnosed with early stage prostate cancer access the full range of surveillance, surgical, and radiation treatment options. Study findings will inform cancer centers, advocacy groups, rural program planners, and policymakers about services and programs needed to ensure that rural prostate cancer patients can choose from among all treatment options.
  Topics: Cancer, Chronic diseases and conditions, Health services
  
• Evaluation of Washington State Shortage Designations
  Topic: Workforce
  
• Examining the Potential Impact of Multiple Payment Policies on Rural Versus Urban Home Health Agencies
  This study estimated the impact of three recent and upcoming Medicare home health payment policies (revised rural add-on payments, new prospective payment system, and value-based purchasing demonstration) on reimbursement for home health agencies based on rural-urban status, community factors, and home health agency characteristics.
  Topics: Health services, Healthcare access, Healthcare financing, Home health, Medicare, Post-acute care
  
• Factors Associated with Rural-Residing Registered Nurses' Choices to Work in Urban Locations and Larger Rural Cities
  While larger numbers of registered nurses (RNs) are living in rural areas, research from the WWAMI RHRC shows that since 1980, a growing percentage are commuting from rural residences to work within urban and larger rural cities. This study will explore factors that may be associated with RNs' decisions to commute away from their rural areas of residence to work in less rural areas.
  Topics: Nurses and nurse practitioners, Physician assistants, Workforce
  
• Family Medicine Rural Training Track Graduates: Determinants of Rural and Urban Practice
  This project will survey physicians trained in "1-2" Rural Training Track (RTT) family medicine residencies to understand the characteristics, experiences, and attitudes that influenced their rural or urban practice choices.
  Topic: Workforce
  
• Future of Family Medicine and Implications for Primary Care Physician Supply
  This project describes recent trends in medical student interest and national match rates in primary care and family medicine, the effect of increasing proportions of female physicians on rural practice patterns, and implications of declining interest in primary care on health and the health workforce.
  Topics: Physicians, Workforce
  
• General and Specialist Surgeon Supply and Inpatient Procedural Content: A National Rural-Urban Study
  This study will examine the degree to which access to inpatient surgical care in rural areas is affected by the diminishing workforce of general surgeons. Using inpatient surgical procedure data, we will examine the availability and content of general surgical procedures in rural and urban hospitals nationally as a function of surgeon supply.
  Topic: Workforce
  
• Geographic Access to Healthcare for Rural Medicare Beneficiaries: An Update and National Look
  This objective of this study was to compare, at a national and census division level, where rural and urban Medicare beneficiaries receive ambulatory care, which types of specialists they utilize and how far beneficiaries are traveling to obtain care.
  Topics: Aging, Chronic diseases and conditions, Health services, Medicare, Workforce
  
• Health Care for the Uninsured: How Do the Uninsured Use the Rural Safety Net?
  Topic: Uninsured and underinsured
  
• Health Information Technology (HIT) Workforce Needs in Rural America
  Health care increasingly relies on effective health information technology (HIT) to capture and exchange key patient information, and requires a trained workforce to implement this technology. To understand the specific needs and constraints of rural health systems to employ an effective HIT workforce, this study will survey rural primary care clinics across the country to determine their current and projected level of HIT adoption and demand for workers with HIT skills.
  Topics: Health information technology, Workforce
  
• HIT Workforce Development in Rural-Serving Community Colleges
  This study will describe trends in the number of students completing Health Information Technology (HIT) programs in community colleges located near rural populations in the U.S.; assess the extent to which these programs have incorporated, or plan to incorporate, components of the recently released community college curriculum by the Office of the National Coordinator for HIT (ONC) into their programs; and identify factors that affect the ability of programs to reach rural student populations.
  Topics: Health information technology, Workforce
  
• Improvement in the Quality of Care for Acute Myocardial Infarction (AMI): Have Rural Hospitals Followed National Trends?
  This project will determine whether overall improvements in the quality of care for AMI among Medicare patients, as measured by adherence to guidelines, have taken place in both rural and urban hospital settings.
  Topics: Hospitals and clinics, Quality
  
• In What Types of Communities Do Rural Women Physicians Practice?
  Topics: Physicians, Women, Workforce
  
• Increasing the Supply of Providers with a Drug Enforcement Agency Waiver to Treat Opioid Addiction in Rural America – Possible Effects of Permitting Physician Assistants and Nurse Practitioners to Prescribe Buprenorphine
  This study investigated the possible effects on rural access to treatment for opioid use disorder if Drug Enforcement Administration (DEA) waivers for prescribing buprenorphine as an office-based outpatient treatment for opioid addiction are available to Physician Assistants (PAs) and Nurse Practitioners (NPs).
  Topics: Legislation and regulation, Nurses and nurse practitioners, Physician assistants, Physicians, Substance use and treatment, Workforce
  
• Influence of State Policies and Practices on J-1 Visa Waiver Physicians Service in Rural Areas
  This study will collect information from all states regarding their efforts to track IMG practice after their Conrad 30 program waiver obligations are satisfied, quantify long-term retention for states with available data, and assess how state policies shape IMG practice and long-term retention.
  Topics: International Medical Graduates (IMGs), Physicians, Workforce
  
• Is Rural Residency Training of Family Physicians an Endangered Species? An Interim Follow-up to the 1999 National BBA Study
  This study examined the proportion of rural-based family medicine residencies that have ceased operations since 2000, the residency-match experiences of the surviving programs, the proportion of U.S. medical school graduates and international medical graduates, major issues confronting these rural residencies, and likely impacts of these changes on the preparation of future family physicians for rural America.
  Topics: International Medical Graduates (IMGs), Physicians, Workforce
  
• Medicare Bonus Payments for Physician Care in Health Professional Shortage Areas
  Topics: Healthcare financing, Medicare, Physicians
  
• National Changes in Physician Supply
  This project describes the supply of allopathic and osteopathic physicians in rural and urban areas of the US. Study results will provide a current picture of rural physician supply and its variation by state and by region.
  Topics: International Medical Graduates (IMGs), Physicians, Workforce
  
• National Rural General Surgeon Project
  Topics: Health services, Physicians, Workforce
  
• National Rural Hospital Flexibility Program Tracking Project
  Topics: Critical Access Hospitals (CAHs), Rural Hospital Flexibility Program
  
• Novel Master File of Rural Family Medicine Residency Training: Program Models and Graduate Outcomes
  This study expands current work by the WWAMI RHRC to establish a comprehensive database of rural-focused family medicine residency training programs. We will use this database to (1) create a typology of rural-focused family medicine training and (2) evaluate program graduates' outcomes and the success of different program models.
  Topics: Physicians, Workforce
  
• Overcoming Barriers to Providing Rural Obstetrical Training for Physicians
  Rural communities struggle to maintain obstetrical (OB) services, due in part to scarce rural training opportunities for obstetricians and family physicians. This study described the availability, characteristics, and output of residency and fellowship programs offering rural OB training and identified solutions to support this training.
  Topics: Healthcare access, Maternal health, Physicians, Women, Workforce
  
• Perinatal Health in the Rural United States, 2005
  This study examines perinatal outcomes in rural areas across the United States in 2005.
  Topics: Children and adolescents, Women
  
• Physician Residency Rural Training Baseline Study
  Topics: Physicians, Workforce
  
• Policy Analyses of Rural Issues Related to Health Care Reform
  Health care reform provides an array of opportunities to improve health care access and quality for rural Americans. The WWAMI RHRC will support HRSA's efforts to inform this process by summarizing existing evidence characterizing the rural health care workforce and rural health care delivery and will conduct analyses exploring the potential impact on rural populations of proposed and newly- enacted health care reform legislation.
  Topic: Health services
  
• Post-acute Care Quality for Rural Medicare Beneficiaries
  This study examined rural post-acute care quality for rural Medicare beneficiaries and potential disparities in post-acute care between urban and rural providers. Publicly reported quality measures for rural skilled nursing facilities and home health agencies were compared with state and national averages as well as urban providers.
  Topics: Home health, Post-acute care
  
• Post-acute Care Trajectories for Rural Medicare Beneficiaries
  Utilization and costs of post-acute care for Medicare fee-for-service beneficiaries have grown rapidly during the last decade. This study examined post-acute care utilization for rural Medicare beneficiaries following acute hospitalization, describing use of home health and skilled nursing care and trajectories of care across settings.
  Topics: Aging, Allied health professionals, Health services, Home health, Hospitals and clinics, Medicare, Nurses and nurse practitioners, Post-acute care
  
• Practice Characteristics of Rural Nurse Practitioners in the United States
  This study will use data from HRSA's first National Sample Survey of Nurse Practitioners (NSSNP) to expand on the agency's basic descriptive analyses of rural and urban nurse practitioners (NPs).
  Topics: Nurses and nurse practitioners, Workforce
  
• Pre-hospital Emergency Medical Services Personnel in Rural and Urban Areas: Results from a Survey in Nine States
  This study uses a survey of all ground-based pre-hospital emergency medical services (EMS) agencies in nine states (AR, FL, KS, MA, MT, NM, OR, SC, WI) to examine supply and demand for emergency response personnel, the involvement of medical directors, and the availability of medical consultation, in rural and urban agencies.
  Topics: Emergency medical services (EMS) and trauma, Workforce
  
• Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Provider Experience and Provision of Evidence-based Care
  This study described the relationship between prehospital emergency medical services (EMS) providers' accumulated experience and provision of evidence-based care for rural and urban populations using newly available data on EMS agencies, personnel, and patient care.
  Topics: Allied health professionals, Emergency medical services (EMS) and trauma, Health services, Workforce
  
• Quality of Care for Acute Myocardial Infarction Patients in U.S. Rural Hospitals
  Topics: Hospitals and clinics, Quality
  
• Rural Dentistry: Availability, Practice, and Access
  Topics: Oral health, Workforce
  
• Rural Family Medicine Residency Training Survey: Follow-up to 2000 Survey
  National survey of family medicine residency training programs to quantify the amount and location of rural training. The survey also identified training that occurs in federally-qualified health centers.
  Topics: Physicians, Workforce
  
• Rural Training Track Technical Assistance Program
  This project looks into the Rural Training Track Technical Assistance (RTT-TA) Program which is a recognized model for addressing rural primary care physician shortages. The WWAMI RHRC has led the research component to investigate RTT program characteristics, graduate outcomes, and factors affecting RTT sustainability and resilience.
  Topics: Physicians, Workforce
  
• Rural-Urban Commuting Area (RUCA) Development Project: Demographic Description and Frontier Enhancement
  This project augments the initial RUCA work by producing and describing the base 1998 demography of the RUCA code areas, creating quality state maps of the RUCA codes, and making this information and the codes easily available on the Web.
  Topic: Frontier health
  
• State Rural Health Workforce Monograph
  Topics: Physicians, Workforce
  
• Supply of Physicians Waivered to Treat Opioid Addiction in Rural America: Policy Options to Remedy Critical Shortages
  This study will determine the extent to which a trained workforce exists in rural America that has received the necessary waiver to treat opioid addiction in outpatient settings with buprenorphine, a highly effective medication. It will identify areas with critical shortages and discuss policy options for expanding the supply of these qualified providers.
  Topics: Physicians, Substance use and treatment, Workforce
  
• The Current Distribution of the General Surgery Workforce in Rural America
  This project described the current national supply and distribution of general surgeons in rural vs. urban areas of the United States as well as geographic variability in the supply of general surgeons across the rural/urban and intra-rural dimensions at the regional level.
  Topics: Critical Access Hospitals (CAHs), Health services, Healthcare access, Hospitals and clinics, Physicians, Rural statistics and demographics, Workforce
  
• The Supply and Distribution of the Behavioral Health Workforce in Rural America
  Data from the National Plan and Provider Enumeration System (NPPES) file, linked to RUCA codes and population data will be used to identify behavioral health providers and describe their geographic (rural/urban, regional and intra-rural) distribution. Behavioral health professions identified in the file include psychiatrists, addiction medicine specialists, psychiatric nurse practitioners, clinical nurse specialists in mental health, clinical psychologists and licensed social workers.
  Topics: Allied health professionals, Mental and behavioral health, Workforce
  
• The Supply and Distribution of the Primary Care Health Workforce in Rural America
  This study will describe the supply and distribution of primary care providers in the rural U.S. at national, regional, and state levels using the most recent data available. Primary care health professionals include family physicians, general practitioners, general internists, pediatricians, nurse practitioners, and physician assistants.
  Topics: Nurses and nurse practitioners, Physician assistants, Physicians, Workforce
  
• The Supply and Rural-Urban Distribution of the Obstetrical Care Workforce in the U.S.
  This project will use multiple data sources to characterize the distribution of the obstetrical care workforce in the U.S., comparing health professional-to-population ratios in rural and urban areas. Health professionals examined in this study include obstetricians, family physicians, and certified nurse midwives.
  Topics: Healthcare access, Maternal health, Physicians, Workforce
  
• Trends in Health Workforce Supply in the Rural U.S.
  Rural communities in the U.S. have struggled to recruit and sustain sufficient health professionals to ensure adequate access to care. This study used multiple sources of data to describe the geographic distribution (rural/urban, regional, and intra-rural) of numerous types of health professionals.
  Topics: Allied health professionals, Healthcare access, Mental and behavioral health, Nurses and nurse practitioners, Oral health, Physician assistants, Physicians
  
• Understanding the Prescribing Practices of Rural Nurse Practitioners and Physician Assistants with a DEA Waiver to Prescribe Buprenorphine
  This study investigated the extent to which nurse practitioners and physician assistants who practice in rural areas and have a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine as an office-based outpatient treatment for opioid use disorder are providing this treatment to their patients.
  Topics: Nurses and nurse practitioners, Physician assistants, Substance use and treatment
  
• Use of Home Health Services Among High Risk Rural Medicare Patients: Patient, Service, and Community Factors Associated with Hospital Readmission
  This study will examine the 60-day post-acute care outcomes of rural Medicare patients who were discharged from hospitals and admitted to home healthcare services. Key predictors include home health services provided, type of Medicare home health reimbursement, and available community healthcare resources.
  Topics: Home health, Hospitals and clinics, Medicare, Post-acute care
  
• Use of Home Health Services Among High Risk Rural Medicare Patients: Patient, Service, and Community Factors Associated with Outcomes of Care
  This study examined outcomes of care for rural Medicare patients who were discharged from hospitals and admitted to home healthcare for post-acute services. Outcomes included emergent care use and re-hospitalization during the home health admission and community discharge.
  Topics: Health services, Home health, Medicare, Post-acute care
  
• Use of Recommended Radiation Therapy in the Rural U.S.
  This study will use cancer registry data from 10 U.S. states to examine which rural cancer patients are receiving recommended radiation therapy, and what factors influence receipt of recommended treatment. Identifying gaps in radiation therapy will inform cancer centers, rural program planners, and policy makers in rural cancer service locations and cancer support program development.
  Topics: Cancer, Chronic diseases and conditions, Health services
  
• Validation of Commuting Area Designations for the Elderly
  Topic: Aging
  
• What Are Best Practices for Providing Buprenorphine Maintenance Treatment in Rural Primary Care?
  Not all physicians with a Drug Enforcement Agency waiver to prescribe buprenorphine actually provide this treatment or fully utilize their waiver capacity. This project interviewed physicians successfully using their waivers to identify best practices for prescribing buprenorphine treatment for Opioid Use Disorder.
  Topics: Health services, Mental and behavioral health, Physicians, Substance use and treatment, Workforce
  
• What Are the Possible Impacts of Nurse Practitioners and Physician Assistants on Future Provision of Primary Care in Rural Areas?
  This study will explore how many nurse practitioners (NPs), physician assistants (PAs) and physicians will be required to meet rural health care demand resulting from expanded access to health insurance through implementation of the Affordable Care Act (ACA).
  Topics: Nurses and nurse practitioners, Physician assistants, Physicians, Workforce
  
• What Impact Will Unified GME Accreditation Have on Rural-focused Physician Residencies
  The impending unification of allopathic and osteopathic graduate medical education (GME) under a single accreditation system has uncertain implications for small and rural-focused residency programs. This study aimed to (1) quantify the rural practice outcomes of residencies in rurally-relevant specialties such as pediatrics, internal medicine, obstetrics/gynecology, emergency medicine, surgery, anesthesia, and psychiatry, and (2) interview key stakeholders to identify anticipated challenges of the accreditation merger and potential policies to strengthen vulnerable rural-focused residencies during the transition.
  Topic: Physicians
  
• What Is the Geographic Distribution of the Workforce with a DEA Waiver to Prescribe Buprenorphine?
  This project updated statistics on the supply of providers (physicians, nurse practitioners and physician assistants) with a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine and examine supply trends over time and also established baseline numbers of other eligible providers (e.g., midwives, clinical nurse specialists).
  Topics: Health services, Healthcare access, Mental and behavioral health, Nurses and nurse practitioners, Physician assistants, Physicians, Substance use and treatment, Workforce
  
• What Is the Potential of Community Paramedicine to Fill Rural Healthcare Gaps?
  Community paramedicine (CP) has been promoted as a strategy to help communities achieve the Triple Aim of improving healthcare and population health while lowering costs. This study proposes to collect descriptive information on CP programs that can be identified in the U.S., and for those programs with outcome data, compare rural with urban programs in terms of their goals, services offered, outcomes measured, and results, where available.
  Topics: Allied health professionals, Emergency medical services (EMS) and trauma
  
• What Makes Physician Assistant Programs Successful at Training Rural PAs?
  A WWAMI Rural Health Research Center study identified the physician assistant (PA) training programs that have reduced high numbers and high proportions of graduates working in rural areas. The study extended that work through a physician assistant program survey, identifying key characteristics, admission, and training strategies, and missions of successful rural programs.
  Topics: Physician assistants, Workforce
  
• What Strategies Are Nurse Practitioner Educational Programs Using to Encourage Rural Practice?
  This study will quantify and describe nurse practitioner (NP) education programs that encourage NPs to practice in rural areas, and identify data sources that could be used in future studies of the effectiveness of these programs.
  Topics: Nurses and nurse practitioners, Physician assistants, Workforce
  
• Which Physician Assistant Training Programs Produce Rural Physician Assistants? A National Study
  This study will identify the physician assistant (PA) training programs that are most successful at producing graduates who practice in rural areas. The study will focus particularly on PAs who graduated from training in the past ten years.
  Topics: Physician assistants, Workforce
  
• Which Training Programs Produce Rural Physicians? A National Health Workforce Study
  This national study is using comprehensive, longitudinal data on medical schools and residency location to determine the extent to which the nation's medical schools and residency programs vary in their production of rural physicians by specialty.
  Topics: Physicians, Workforce
  
• Who Provides Mental Health Services to Rural Medicare Beneficiaries?
  Most rural counties do not have a psychiatrist to care for the common conditions of depression or anxiety. This study describes the provider workforce that cares for rural elderly patients with depression/anxiety, including regional and rural-urban variations in mental healthcare provision.
  Topics: Health services, Medicare, Mental and behavioral health, Nurses and nurse practitioners, Physician assistants, Physicians, Substance use and treatment, Workforce
  
• Who Treats Opioid Addiction in Rural America? Quantifying the Availability of Buprenorphine Services in Rural Areas
  This study will investigate the extent to which physicians who practice in rural areas and have a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine as an office-based outpatient treatment for opioid use disorder are providing this treatment to their patients. This study will also estimate the need for office-based opioid disorder treatment in rural locations.
  Topics: Chronic diseases and conditions, Mental and behavioral health, Pharmacy and prescription drugs, Substance use and treatment