Rural Health
Research Gateway

Current Research Projects

Browse all of the research projects still underway. Learn more about the research questions guiding each study, the lead researcher for each, and when the Research Center anticipates releasing completed product(s) under each project. Current projects are listed by the date they were funded by the Federal Office of Rural Healthy Policy. You can also access a list of all previously completed research projects, by date.

Projects Funded September 2022 - (32)

  • A Comparison of 2017-2019 Uncompensated Care of Rural and Urban Hospitals and a First Look at Uncompensated Care in 2020 and 2021
    North Carolina Rural Health Research and Policy Analysis Center
     This project will compare 2017-2019 uncompensated care as a percent of operating expense for rural and urban hospitals and investigate uncompensated care data for 2020 and 2021.
  • Access to and Provision of Child and Youth Behavioral Health Services in the Rural and Urban U.S.
    WWAMI Rural Health Research Center
     The need for behavioral health treatment for youth has been exacerbated by the COVID-19 pandemic. Little is known about the availability of youth behavioral health providers in rural areas. This study will investigate who provides behavioral health services to youth, how equitably the workforce is distributed, and gaps in service availability.
  • Alternative Methods for Defining Rural Hospital Service Area Market
    North Carolina Rural Health Research and Policy Analysis Center
     Options for describing the population served by a rural hospital are limited; geopolitical areas such as counties are convenient, but ZIP-based methods may be more accurate. In this project, we will consider multiple options that tradeoff ease, accuracy, ability to capture trends, and availability.
  • Assessment of the Area Deprivation Index in Rural Areas
    Rural Health Equity Research Center
     The Area Deprivation Index (ADI) was created by University of Wisconsin researchers to provide a score for neighborhoods based on their level of disadvantage. This study will characterize differences in ADI in rural vs urban areas, summarize the existing literature on ADI, and describe expert considerations for utilizing the ADI for future policy.
  • Availability and Quality of Dialysis in Rural Counties with a High Diabetes Burden
    Rural and Minority Health Research Center
     This project will examine the degree to which counties with a high population risk for end stage renal disease, defined by high diabetes prevalence, are served by dialysis providers. It will assess the accessibility and quality of services for end stage renal disease looking for disparities associated with rural residence and racial/ethnic population composition.
  • Availability of Diabetes Self-Management Education in High Need Rural Counties
    Rural and Minority Health Research Center
     This project will examine the degree to which counties with a high need for diabetes education, defined by high diabetes prevalence, have such education available. Findings will be linked to a related study that will examine the availability of dialysis for end stage renal disease, a severe outcome of poorly addressed diabetes.
  • Availability, Care Practices, and Quality of Hospice Providers Serving Rural versus Urban Communities
    WWAMI Rural Health Research Center
     This project will examine differences in availability of hospice care in rural versus urban communities as well as provider-level quality and care practices by rural-urban status of hospices. Findings will highlight potential rural-urban disparities in hospice care that can be used to inform future Medicare policy.
  • Changes in Medicare Fee-for-Services Health Care Expenditures in Rural and Urban Communities after Passage of the Affordable Care Act
    Rural and Minority Health Research Center
     This project will assess changes in Medicare per-beneficiary spending across rural and urban counties from 2007 to 2020. It will examine differences in rural versus urban per-beneficiary spending on hospital inpatient, hospital outpatient, physician, and post-acute care after the Affordable Care Act (ACA).
  • Clinical-Community Linkages in Non-Metropolitan and Metropolitan Hospitals: COVID-19 Impacts and Trends
    RUPRI Center for Rural Health Policy Analysis
     This study will examine trends in partnerships between hospitals and public health departments and other community linkages in both non-metropolitan and metropolitan hospitals with a particular focus on the impact of the COVID-19 pandemic.
  • Developing a Post-COVID Financial Distress Index
    North Carolina Rural Health Research and Policy Analysis Center
     This project will update and improve the North Carolina Rural Health Research Program's Financial Distress Index, which uses historical data about hospital financial performance, government reimbursement, organizational characteristics, and market characteristics to predict the current risk of financial distress.
  • Disparities in Family Physician Burnout Before and During the COVID-19 Pandemic
    WWAMI Rural Health Research Center
     High levels of burnout during the COVID-19 pandemic have been documented among health professionals, particularly women and persons from underrepresented groups. This study examines how burnout has changed from 2019 through 2021 among family physicians as well as variation by rural/urban geography, other sociodemographics, and practice characteristics to identify physicians most in need of interventions to foster resilience and alleviate burnout.
  • Excess Deaths Associated with COVID-19 in Rural Communities
    Maine Rural Health Research Center
     Quantifying excess deaths associated with the COVID-19 pandemic can provide a more complete measure of the total burden of the pandemic on mortality. While the National Center for Health Statistics maintains an online dashboard of U.S. excess deaths associated with the COVID-19 pandemic overall and by race/ethnicity and age, excess deaths by rurality of residence are not tabulated and we aim to fill that gap.
  • Hierarchical Condition Category (HCC) Risk Scores: Designed to Predict Future Cost and Health Care Resource Use – Do They Also Accurately Reflect Differences in Health Status between Rural and Urban Beneficiaries?
    Rural Health Equity Research Center
     This CMS Hierarchical Condition Category (CMS-HCC) risk score study will investigate differences in underlying health between rural and urban populations using recent data and analyze which factors drive observed differences.
  • Housing as a Social Determinant of Rural Health
    University of Minnesota Rural Health Research Center
     The purpose of this project is to identify rural/urban and within-rural differences in housing quality and its relationship to health and disability status, especially for individuals living in poverty. We will also identify rural-specific housing issues and innovative policy solutions to address housing challenges in order to improve rural health.
  • Low Volume Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     This analysis will compare rural low volume hospitals (LVHs) to non-LVH characteristics and estimate the financial impact of eliminating the LVH program and reverting to the original (2005) LVH classification and payment adjustment.
  • Medicare Advantage Plan Growth in Rural America: Opportunities for Beneficiaries?
    RUPRI Center for Rural Health Policy Analysis
     County Medicare Advantage enrollment data and plan characteristic data will be used to create a model accounting for the availability of plans offering benefits addressing social determinants of health. Analyses will compare rural and urban counties, and examine county characteristics to explore potential equitable opportunities for rural beneficiaries because of geography and other factors.
  • Postpartum Morbidity and Mortality and Health Care Utilization in Rural vs. Urban Communities
    University of Minnesota Rural Health Research Center
     Using 2006-2018 data from the National Health Interview Survey linked to the National Death Index through 2019, this project will examine postpartum mortality among rural and urban residents. We will also evaluate differences in health, health care utilization, and barriers to care across rural and urban communities.
  • Ransomware Attacks on Rural Hospitals
    University of Minnesota Rural Health Research Center
     The rise in hospital ransomware attacks threatens to harm patients, especially in rural areas. This project will use a novel dataset to analyze rural/urban differences in how ransomware attacks affect patients and hospitals.
  • Review of Current Research on Rural/Urban Differences in Social Determinants of Health
    Rural and Underserved Health Research Center
     Social determinants of health are social, economic, and community variables that influence health outcomes. This project will synthesize the extant literature on rural/urban differences in the social determinants of health, culminating in a comprehensive report that includes a summary of information gaps and further research needs.
  • Rural Access to Opioid Treatment Program Clinics and Certified Community Behavioral Health Clinics
    Rural and Underserved Health Research Center
     This project will identify all Certified Community Behavioral Health Clinics and Opioid Treatment Program Clinics in the U.S. and then present the number of rural and urban clinics in each state as frequency tables and map visualizations.
  • Rural Premiums, Issuer Participation, and Enrollment in Health Insurance Marketplaces: An Updated Analysis
    RUPRI Center for Rural Health Policy Analysis
     The project will describe variations in Health Insurance Marketplace plan design and availability, total and net-of-subsidy premium trends, and enrollment over time between rural and urban areas and identify associations between these factors and several key policy differences and changes, controlling for economic and demographic variation.
  • Rural-based Accountable Care Organizations Accepting Downside Risk
    RUPRI Center for Rural Health Policy Analysis
     The RUPRI Center will update its studies of rural provider participation in accountable care organizations, including differences between those who exit the program, those who remain, and those who enter. In particular, this project will address participation decisions made after a rule change in July 2019 that requires conversion to two-sided risk.
  • Rural-Urban Differences in Domestic Violence as a Contributor to Maternal Morbidity and Mortality
    University of Minnesota Rural Health Research Center
     Using 2016-2020 data from the CDC's Pregnancy Risk Assessment Monitoring System, this project will assess the prevalence of domestic violence among rural and urban residents who give birth. We will also analyze how screening and support services could be improved to support rural families that experience domestic violence, including during pregnancy and the postpartum period.
  • Rural/Urban Differences in Forgoing Health Care during the COVID-19 Pandemic
    Rural Health Equity Research Center
     Several surveys conducted during the COVID-19 pandemic showed that adults delayed or skipped healthcare services during the initial months of the COVID-19 pandemic. This study examines changes in healthcare utilization for primary and preventative care among rural and urban Medicare fee-for-service enrollees since the COVID-19 pandemic.
  • Rural/Urban Variations in Cancer Screening During the COVID-19 Pandemic
    Rural and Underserved Health Research Center
     Using the National Cancer Institute Health Information National Trends Survey, we will examine how the COVID-19 pandemic has disrupted the receipt of recommended screenings for common cancers. Findings will inform policymakers about potential widening of rural/urban disparities in the receipt of cancer preventive services and the potential need to target these services toward rural residents.
  • Socioeconomic Profiles and Market Characteristics Associated with Ambulance Deserts
    Maine Rural Health Research Center
     We will address the extent to which vulnerable, aging populations live in ambulance deserts and identify ambulance desert populations facing additional barriers to healthcare access. We will also assess the impact of hospital closures on travel distances to the nearest health care facilities.
  • Trends and Predictors of Urban-Rural and Racial/Ethnic Disparities in Hospitalizations Associated with the Top Five Cancers
    Southwest Rural Health Research Center
     This project will serve to update the Federal Office of Rural Health Policy's cancer research portfolio. Using recent nationally representative hospital discharge data, the researchers will examine trends and predictors of hospitalizations associated with the top five cancers in the U.S.: skin, lung, prostrate, breast, and colorectal.
  • Trends and Predictors of Urban-Rural and Racial/Ethnic Disparities in Hospitalizations Tied to Acute Myocardial Infarction
    Southwest Rural Health Research Center
     This project will update the Federal Office of Rural Health Policy's research portfolio on hospital-based disparities associated with acute myocardial infarctions (AMIs). Very little is known about variances in hospital-based outcomes for AMIs along the urban-rural continuum and among diverse sub-populations in the U.S.
  • Understanding Rural Health Data Challenges through Analysis of Peer-Reviewed Publication Limitations
    Rural Health Equity Research Center
     This project will quantify and characterize health data-related limitations commonly identified in published studies on rural health and ways in which researchers overcome these challenges. Findings will provide a rigorous description of rural health data challenges, which may be used by researchers, policymakers, and rural health data collectors to improve rural data and research using rural data.
  • Unmet Health and Social Needs of Rural Residents with Disability
    Maine Rural Health Research Center
     We will assess rural-urban differences in access to health care and social wellbeing for rural residents with a disability. Disability rates are often higher in rural areas and, given growing evidence of COVID-related disability, this study will provide critical information about the pre-pandemic status of unmet health and social needs among disabled persons to enable future planning.
  • Use of Z Codes by Rural and Urban Providers to Capture Data on the Social Determinants of Health Impacting Medicare Beneficiaries
    Maine Rural Health Research Center
     Using a mixed methods approach, we will examine the use of Z codes by rural and urban providers to better capture information on the social determinants of health experienced by Medicare beneficiaries across the rural continuum.
  • Work Settings, Education, and Intent to Leave Practice among Rural vs. Urban Nurses
    Rural and Underserved Health Research Center
     Using data from the 2022 National Nursing Workforce Survey, this project will describe rural/urban differences in nurses' work settings, levels of education and licensure, demographic characteristics, income, and intention to retire or leave practice. Study findings could be applied to implement policies aimed at increasing nursing school output and attracting nurses to practice in rural areas.

Projects Funded September 2021 - (21)

  • A Closer Examination of Rural Hospital Bypass
    Rural Health Equity Research Center
     This project will estimate the rural hospital bypass rate using all-payer claims data for a set of states and compare patients based on the inpatient treatments and procedures received relative to those routinely provided by rural facilities.
  • Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents: Exploring Changes in the Past 15 Years
    WWAMI Rural Health Research Center
     This project will describe the national supply of the rural and urban dental workforce and investigate whether rural adults, compared to urban adults, report lower dental care utilization, higher prevalence of dental disease or both. This study will also look at whether disparities in oral health care and supply have changed over the past 15 years.
  • Differences in Rural and Urban Hospital Cost Structures: Evidence and Implications
    RUPRI Center for Rural Health Policy Analysis
     The project will compare fixed-to-variable cost ratios in U.S. rural and urban hospitals. We hypothesize that rural hospitals will realize proportionally greater fixed costs than urban hospitals, suggesting important hospital payment system implications.
  • Disparities in Screening, Prevention, and Management of Cardiovascular Disease in Rural and Urban Primary Care
    Rural and Underserved Health Research Center
     This study will use a large national primary care registry to compare cardiovascular disease (CVD) screening, prevention, and management quality measures between rural and urban primary care practices. It will also assess for disparities by patient composition (race/ethnicity, insurance) of the practice.
  • Examining Differences in Rural and Urban Medicare FFS Beneficiaries' Emergency Department Use Pre-COVID-19 and During COVID-19
    Rural Health Equity Research Center
     This study describes and compares the differences in the utilization of emergency department (ED) services among rural and urban Medicare Fee-For-Service enrollees during 2018-2021. We will identify factors associated with differences in ED use, including shifts in volume, primary diagnoses, and admission source, before and since the COVID-19 public health emergency in rural and urban areas.
  • Federal Agencies' Recent Collaboration and Innovation in Rural Cancer Control: A Model for Practice
    Southwest Rural Health Research Center
     The investigators will conduct an examination of the multi-year effort by the National Cancer Institute to focus on rural cancer issues and its collaboration with the Federal Office of Rural Health Policy. The project will explore the key pieces of evidence that served as the impetus for the emphasis on rural America in cancer control efforts.
  • Following the Money: Do Block Grant Resources Reach Rural Communities?
    Rural Health Equity Research Center
     This project will apply a mixed methods design to describe the distribution of block grant resources from federal agencies through states to the local level in rural and non-rural communities in the United States. Findings could guide federal agencies and policy makers to develop strategies to more effectively target block grant resources to ensure that the needs of vulnerable rural populations are addressed.
  • How are Rural Health Clinics Serving Pediatric and Obstetrical Medicaid Populations?
    Maine Rural Health Research Center
     This project will examine the roles of independent and provider-based Rural Health Clinics in serving pediatric and obstetrical patients covered by state Medicaid programs.
  • Improving Racial Equity for Rural Mothers and Infants
    University of Minnesota Rural Health Research Center
     The purpose of this project is to assess differences in maternal and infant health outcomes and access to perinatal care, among urban and rural counties. We will also compare health outcomes and availability of services, including evidence-based services and supports, between rural counties that are majority Black, Indigenous, and People of Color with those that are majority white.
  • Palliative Care in the Rural U.S.
    WWAMI Rural Health Research Center
     This project will describe the availability of palliative care services in rural hospitals and community settings using data from the American Hospital Association Annual Survey, interviews with palliative care providers, and a survey of rural hospitals without palliative care services.
  • Public Health Insurance Coverage among Rural and Urban Children
    Maine Rural Health Research Center
     Medicaid and the Children's Health Insurance Program (CHIP) are important sources of health insurance coverage for rural children, yet analyses have shown a decline in overall U.S. coverage in recent years. This study will use the American Communities Survey to examine rates of Medicaid/CHIP coverage among rural versus urban children and whether these have changed over time.
  • Rural Poverty and Health: A Chartbook
    Maine Rural Health Research Center
     This chartbook will use nationally representative surveys and county-level data to provide a comprehensive overview of the health and wellbeing of rural Americans living in poverty.
  • Rural-Urban Differences in Medicaid Utilization
    North Carolina Rural Health Research and Policy Analysis Center
     Nationwide, approximately 1 in 4 rural residents are insured by Medicaid, yet we lack basic understanding of rural-urban differences in Medicaid utilization.
  • Rural-Urban Differences in Performance of Clinicians Participating in MIPS
    RUPRI Center for Rural Health Policy Analysis
     This project will use quantitative methods to compare MIPS performance and reported measures for clinicians working in rural and urban areas, overall, and by practice size; evaluate differences in spending per beneficiary, overall, and stratified by drugs and medical services for rural and urban clinicians participating in MIPS; and compare MIPS performance and spending for clinicians serving a large proportion of racial/ethnic minorities in rural and urban areas.
  • Rural-Urban Disparities in Mental Health Access and Quality in the United States
    Rural and Minority Health Research Center
     The purpose of this project is to document the recent trends of mental health care access and quality in urban and rural communities and to assess the intersectionality of residence rurality and race/ethnicity on disparities in mental health care access and quality.
  • Rural/Urban and Racial/Ethnic Inequities in Patient-Reported Health Care Access and Quality among Medicare Beneficiaries with Lung or Colorectal Cancer
    Rural and Underserved Health Research Center
     Incidence and mortality for colorectal and lung cancer are higher among rural versus urban residents, but many rural cancer patients lack accessible, high-quality care. This study will 1) Identify rural/urban inequities in Medicare cancer patient-reported health care access and quality and 2) Determine if rural racial/ethnic minority patients have worse health care access and quality than rural White patients.
  • Rural/Urban Differences in Health and Health Care Access for LGBT Adults
    University of Minnesota Rural Health Research Center
     The purpose of this project is to identify rural/urban differences in health and health care access for lesbian, gay, bisexual, and transgender (LGBT) adults. We will also identify within-rural differences among LGBT adults by race, ethnicity, age, disability status, and socio-economic status. Finally, we will identify examples of best practices supporting LGBT health and wellness in rural areas.
  • Screening, Brief Intervention and Referral to Treatment (SBIRT) Penetration in Rural vs. Urban Healthcare Settings in the U.S.
    Rural Health Equity Research Center
     This study will include an analysis of 2018/2019 Medicare, Medicaid and Commercial claims to compare the penetration of Screening, Brief Intervention and Referral to Treatment (SBIRT) and its different components in rural compared to urban healthcare settings. Within the overarching analysis, the study team will examine the type of interventions conducted within the SBIRT framework stratified by provider type, healthcare setting, and rural and urban provider ZIP codes. Findings will be analyzed within the context of county-level substance use rates, historical enactment of state SBIRT billing codes, overdoses, and alcohol poisoning-based hospital admissions contrasting trends in SBIRT administration with a proxy for community need.
  • Specialist Physicians in the Rural and Urban U.S.: Supply, Distribution, and Access
    WWAMI Rural Health Research Center
     This project will describe the geographic distribution (rural/urban, regional, and intra-rural) of specialist physicians who care for patients experiencing conditions that account for the top four leading causes of rural mortality. It will also explore how patients in rural communities that lack these specialists obtain needed care.
  • Third Party Negotiated Pricing in Rural and Urban Hospitals
    Rural and Underserved Health Research Center
     We will use third party negotiated pricing information to compare prices in urban and rural hospitals, across a variety of common services. Because there has been poor compliance with the Centers for Medicare & Medicaid Services (CMS) requirement to publish third party negotiated pricing, we will also examine if the availability of this information differs for rural and urban hospitals.
  • Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder and Medicaid Insurance Across the U.S.
    WWAMI Rural Health Research Center
     This project will analyze Medicaid claims data to compare the treatment that rural and urban patients with opioid use disorder receive, documenting the workforce providing care, the distance that patients travel to receive care, and the cost of care. Findings from this study can be used to improve policies regarding opioid use disorder treatment.

Projects Funded September 2020 - (12)

Projects Funded September 2019 - (5)

  • Examining the Potential Impact of Multiple Payment Policies on Rural Versus Urban Home Health Agencies
    WWAMI Rural Health Research Center
     This study estimates 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.
  • Methamphetamine Use, Mental Health Comorbidities, and Treatment in Rural and Urban Areas
    WWAMI Rural Health Research Center
     This study will investigate methamphetamine (meth) use in rural versus urban areas - including meth use in combination with opioids and alcohol, mental health comorbidities, and perceived need for and receipt of treatment by meth users and those with meth use disorder - to identify hotspots for targeting of prevention and treatment resources.
  • Prevalence of Opioid Prescribing, Diagnoses of Opioid Use Disorder, Treatment Patterns, and Costs Among Rural Medicare Beneficiaries
    Maine Rural Health Research Center
     Opioid use disorder (OUD) diagnoses among the aged and disabled are among the highest and fastest growing. This study uses the 2010-2017 Medicare Current Beneficiary Survey to examine opioid prescribing rates and explore risk factors associated with OUDs and associated treatment patterns and costs within rural and urban Medicare populations.
  • Rural-Urban Differences in Out-of-Pocket Prescription Drug Spending
    Maine Rural Health Research Center
     Using data from the 2014-17 Medical Expenditure Panel Survey, this study will examine rural-urban differences in out-of-pocket costs for prescription drugs. Additional analyses will examine rural-urban differences in out-of-pocket costs by type of medication and third party payer.
  • Understanding Rural Non-Emergent Emergency Department Use
    Maine Rural Health Research Center
     Research shows rural residents use emergency departments (ED) at higher rates than urban residents. Other studies suggest rural residents are more likely to visit the ED for a non-emergent reasons. This study uses the 2014-17 Medical Expenditure Panel Survey to analyze factors associated with rural versus urban residents' non-emergent use of EDs.

Projects Funded September 2018 - (1)

Projects Funded September 2017 - (1)

  • Health Care Use and Access Among Rural and Urban Elderly Medicare Beneficiaries
    Maine Rural Health Research Center
     This project will examine rural-urban differences in healthcare use and access to healthcare services among elderly Medicare enrollees using the 2011-2013 Medicare Current Beneficiary Survey. We also will identify the socioeconomic and health factors that may place rural seniors at risk for poor healthcare access.