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 2023 - (38)

  • Access to and Use of Midwifery Care for Rural Residents
    University of Minnesota Rural Health Research Center
    Rural obstetric unit closures and health care workforce shortages limit access to care for pregnant rural residents. Our goal is to describe the midwifery workforce in rural communities and at rural hospitals that provide obstetric care, and to assess rural-urban differences in use of midwifery care at the time of childbirth.
  • Addressing Elder Abuse in Rural Areas
    University of Minnesota Rural Health Research Center
    Elder abuse, including financial, physical, and emotional abuse, as well as self-neglect, is widespread and impacts individual and population health outcomes. However, despite the fact that rural residents are older, in poorer health, and more financially vulnerable, little is known about rural/urban differences in the prevalence of and resources to address elder abuse; this project will address those gaps.
  • Barriers and Facilitators to Providing Rural Clinical Training for Health Professions Students and Residents
    WWAMI Rural Health Research Center
    Scarce rural clinical training sites are the top barrier preventing medical schools, residencies, and nurse practitioner and physician assistant education programs, among other health professional training programs, from providing rural training to their students. This study aims to describe the barriers to offering rural clinical training and the potential solutions for establishing and sustaining interdisciplinary rural clinical training.
  • Building the Rural Evidence Base: Examining the Feasibility of Implementing Pilot Programs and Demonstrations in Rural Communities
    Rural Health Equity Research Center
    Evidence-based interventions are commonly developed in populated, urban centers and then adapted for rural communities. This project will investigate the benefits of piloting and evaluating interventions in rural areas to build the rural evidence base as a step in addressing health disparities and improving health conditions in rural communities.
  • Challenges, Successes, and Sustainability of the 2019 Rural Maternity and Obstetrics Management Strategies (RMOMS) Programs
    Rural and Minority Health Research Center
    This mixed-methods study aims to understand awardees' experiences in building and maintaining cohesive networks for Rural Maternity and Obstetrics Management Strategies (RMOMS).
  • Changes in Access to Care During the Public Health Emergency: Examining Rural-Urban Disparities by Insurance Type
    Rural and Underserved Health Research Center
    Using the Behavioral Risk Factor Surveillance System data, this study will compare key access to care indicators among adult beneficiaries residing in rural and urban areas before and after the Public Health Emergency by types of health insurance. Researchers will explore state-level policy variations, such as the Affordable Care Act Medicaid expansion and COVID-19-related Medicaid coverage for uninsured adults.
  • Changes in Buprenorphine Prescribing Following the Elimination of the Drug Enforcement Administration X Waiver Requirement
    WWAMI Rural Health Research Center
    The Drug Enforcement Administration requirement for an X waiver to prescribe buprenorphine for opioid use disorder was lifted in January 2023. This study aims to describe if and how this policy change has impacted the prescribing practices of clinicians and medication treatment access for patients with opioid use disorder.
  • Comparing Across Health Indices: Differences by Rurality, Missingness, and Associations With Health Outcomes
    Rural Health Equity Research Center
    The purpose of this study is to describe and compare existing area-level indices of vulnerability by rurality and to examine associations between indices and health outcomes of interest by area-level measures of rurality.
  • Concordance Between Social Needs Screening Provision, Programming, and Partnerships in Rural PPS Hospitals
    RUPRI Center for Rural Health Policy Analysis
    This study will examine how rural Prospective Payment System (PPS) hospitals differ from urban hospitals concerning social needs screening practices and alignment between social needs screening performance and corresponding programs/strategies and/or community partnerships to address social needs.
  • Differences in Trauma Outcomes for Patients Residing in Ambulance Deserts
    Maine Rural Health Research Center
    Rural residents are 14% more likely to die after traumatic injury compared with urban residents, with distance from trauma centers and travel time likely significant contributors to this disparity. This project will use the State Emergency Department Databases and State Inpatient Database to examine differences in trauma outcomes for patients residing in ambulance deserts.
  • Disparities in Mental Health Services Access: the Intersectionality of Residence Rurality, Race, and Ethnicity
    Rural and Minority Health Research Center
    In 2021, approximately 8.6 million rural adults faced mental health challenges while millions of rural adolescents battled major depressive episodes. This study examines disparities in mental health services uptake and variation in mental health care settings across racial-ethnic and rural-urban subpopulations before and after the COVID-19 pandemic.
  • Evaluating the Impact of Inflation Reduction Act Provisions on Medicare Advantage Prescription Drug Costs
    Rural and Underserved Health Research Center
    Using Merative MarketScan data, this study will evaluate changes in the affordability of prescription drugs for urban and rural Medicare beneficiaries before and after the recent Inflation Reduction Act (IRA). The primary outcome will be an assessment of whether the IRA succeeded in reducing costs and identifying any remaining health disparities.
  • Examining Changes in Health Care Accessibility in Rural Areas: An Analysis of HPSAs and MUAs Over Time and Their Relationship With Demographic Characteristics
    Rural Health Equity Research Center
    This study focuses on Health Professional Shortage Areas and Medically Underserved Areas and analyzes health care accessibility in rural areas. It uses data from the Health Resources and Services Administration and demographic information to identify trends, spatial patterns, and demographic intersections, aiming to inform policies and interventions for improved rural healthcare access and equity.
  • Examining Post-Acute Care Utilization and Outcomes for Rural Medicare FFS and Medicare Advantage Beneficiaries
    Rural Health Equity Research Center
    This study will describe differences in post-acute care utilization and post-discharge outcomes between rural Medicare Fee-for-Service beneficiaries and rural Medicare Advantage beneficiaries overall and by region of the country, levels of rurality, and race and ethnicity.
  • Extent and Coverage of Rural PACE Services
    University of Minnesota Rural Health Research Center
    Supporting independent living and aging in place for rural residents is more important than ever. This project will provide information on the extent and coverage of rural Program of All-Inclusive Care for the Elderly (PACE) programs, along with insights into the unique challenges and opportunities faced by PACE programs operating in rural areas.
  • Geographic and Socio-Demographic Correlates of Medical Debt Among Rural Residents
    University of Minnesota Rural Health Research Center
    Medical debt is widespread and impacts financial well-being and access to care. While research suggests that medical debt is higher among rural residents compared to urban residents, more work is needed to conclusively demonstrate rural/urban differences in medical debt and within-rural risk factors for greater medical debt by geography and socio-demographic characteristics.
  • Identifying and Exploring the Settings That Nurse Practitioners and Physician Assistants Are Practicing in as Well as Trends in Specialization in These Groups
    Southwest Rural Health Research Center
    Investigators will conduct a descriptive study to assess trends in specialty and population foci of nurse practitioners (NP) and physician assistants (PA). They will also explore changes in the number of clinician types billing for procedures. Trends will be assessed by census region to inform FORHP on areas for which use of NPs and PAs can be bolstered.
  • Identifying High-Need Counties for Resource Planning
    Rural and Minority Health Research Center
    The primary aim of this project is to use data examining health care infrastructure, chronic disease prevalence, and the socioeconomic environment to create a metric for classifying rural counties based on needs and resources.
  • Impact of High Deductible Health Plans on Rural Populations
    Rural and Underserved Health Research Center
    Using data from Merative MarketScan insurance claims, this study will investigate utilization, spending, and care patterns of rural members enrolled in high deductible health plans (HDHP) compared to traditional plans. Trends in health outcomes before and after HDHP growth will be assessed to inform policy design tailored to rural residents.
  • Long-term Implications of Declining Inpatient Revenue on Bed Surge Capacity and Emergency Preparedness
    North Carolina Rural Health Research and Policy Analysis Center
    Inpatient use and key health care services offered at rural hospitals have declined over the past decade. Has the quest for efficiency in hospitals led to a dangerously low surge capacity and ability to effectively handle public health emergencies?
  • Medical and Mental Health Service Provision Amongst Rural Health Clinics
    Maine Rural Health Research Center
    This study will provide a descriptive analysis of differences in Rural Health Clinic (RHC) type, clinic size, and geographic location of RHCs providing same day medical and mental health visits, compared to RHCs that are only providing one or the other type of visits on the same day.
  • Medicare Advantage and Financial, Hospital, and Community Characteristics of Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    This project will compare financial, hospital, and community differences among rural hospitals located in areas with lower versus higher rates of Medicare Advantage penetration.
  • Medicare Disproportionate Share Hospital and Uncompensated Care Payments Since the ACA
    North Carolina Rural Health Research and Policy Analysis Center
    This project will compare disproportionate share hospital payments and uncompensated care payments to rural and urban hospitals for the years 2013-2022.
  • Mortality Risks Associated With Living in Ambulance Deserts
    Maine Rural Health Research Center
    This project will use ambulance data from the Maine Rural Health Research Center and from CDC WONDER to assess whether living in an ambulance desert is associated with higher mortality rates among rural and urban populations.
  • Non-Metropolitan/Metropolitan Differences in Barriers to Care and Utilization of Preventive Care and Wellness Visits Among Traditional Medicare and Medicare Advantage
    RUPRI Center for Rural Health Policy Analysis
    This project proposes to use the Medicare Current Beneficiaries Survey to examine differences across geography and plan type (Medicare Advantage vs. traditional) with regards to barriers to care (e.g., costs) and use of preventive services (e.g., flu shot).
  • RHCs and CAHs Participating in SSP: Characteristics of the Providers and Communities
    RUPRI Center for Rural Health Policy Analysis
    This project describes characteristics of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the Medicare Shared Savings Program (SSP), and the communities they serve. Comparisons will be made to RHCs and CAHs not participating in the SSP.
  • Risky Behaviors and Overdose Deaths Related to Illicit Drug Use
    Rural and Underserved Health Research Center
    Using the National Survey on Drug Use and Health, this study will investigate rural vs. urban variations in treatment utilization for alcohol use disorder (AUD) and, separately, drug use disorder (DUD). It will yield prevalence estimates of any treatment receipt and sources of treatment among persons with past year AUD and DUD as well as the receipt of medication therapy among those treatable with medications.
  • Risky Substance Use Among Rural and Urban Adults: An Update
    Rural and Underserved Health Research Center
    Very little research has examined rural vs. urban differences in substance misuse and treatment access nationally. Using public and nationally representative data from the National Survey on Drug Use and Health, this project will: 1) Estimate and compare alcohol use and binge drinking, and 2) Estimate and compare drug use (marijuana, other illicit drugs, and non-medical use of other drugs) between non-metropolitan and metropolitan adults.
  • Rural Nursing Home Staffing, and Resident Health, Closure, and Financial Performance
    RUPRI Center for Rural Health Policy Analysis
    There are concerns about availability and quality of care provided in nursing homes in rural areas. This project aims to evaluate staffing levels and shortages, the health status of residents, closures, and financial performance of rural nursing homes both before and during the COVID-19 pandemic.
  • Rural Obstetric Unit Closures
    University of Minnesota Rural Health Research Center
    The goal of this project is to update prior research to include the latest information on the loss of hospital-based obstetric services in rural U.S. counties. This project is important because ensuring obstetric care access and reducing maternal mortality in rural and underserved areas is a key focus of national, state, and local policies.
  • Rural-Urban Differences in Addressable Drivers of Staff Turnover in Skilled Nursing Facilities
    Rural and Minority Health Research Center
    The aim of the proposed study is to assess facility-level turnover rates for total nursing and registered nursing personnel across levels of rurality and by region looking at factors such as staffing ratios that can be managed by facility administrators.
  • Rural-Urban Differences in Medicare Advantage Plan Quality Scores
    RUPRI Center for Rural Health Policy Analysis
    This project updates previous RUPRI Center publications focused on rural-urban differences in access to, and enrollment in, Medicare Advantage plans with four- and five-star quality ratings.
  • Rural-Urban Differences in the Prevalence and Impact of Chronic Pain
    Maine Rural Health Research Center
    Limited existing evidence suggests that chronic pain may be more widespread and disabling in rural than in urban populations, and that rural residents may lack access to adequate pain treatment resources. This study will explore rural-urban differences in chronic pain prevalence, impacts, and management, and inform policies to address any identified disparities.
  • Suicide Mortality: A Comparison of Urban and Rural Rates
    Rural Health Equity Research Center
    Suicide contributes to significant mortality in the United States. This project will examine the variation in suicide rates by geography and explore its driving factors among urban and rural areas in the United States from 2018 to 2021. The research design of this study will adopt a cross-sectional, retrospective approach, using secondary data.
  • The Emerging Landscape of Rural Family Medicine Residency Training: Defining Models and Assessing Their Value
    WWAMI Rural Health Research Center
    Rural residency training options for family physicians are growing, as is the evidence for rural training in promoting rural practice choice. This study aims to use a new classification of six residency program types to describe and quantify programs and positions by type and compare relative effectiveness in producing rural physicians.
  • The Impact of Rural Surgery Training on General Surgeon Supply in Rural Communities
    WWAMI Rural Health Research Center
    A growing number of general surgery programs offer rural training that aims to address the dwindling supply of rural surgeons. This study aims to describe program models for providing rural general surgery training; quantify the availability of programs; and compare the models' effectiveness in producing rural surgeons.
  • Understanding Changes in the Rural Marriage and Family Therapist and Mental Health Counselor Workforces Under New Medicare Reimbursement Policy
    WWAMI Rural Health Research Center
    Marriage and family therapists and mental health counselors are newly eligible as of January 1, 2024, for reimbursement to provide care for Medicare enrollees. This study will describe the change in these clinicians in rural vs. urban communities and seek to understand barriers and solutions to fully realize the benefits of this new reimbursed policy for rural populations.
  • Use of Home and Community Based Services by Medicare Beneficiaries
    Maine Rural Health Research Center
    Using the Medicare Current Beneficiary Survey, we will examine rural-urban differences in the need for long term services and supports, rates of home and community-based services (HCBS) use, the use of different types of HCBS, and the impact of HCBS on subsequent use of emergent services such as hospitalizations and emergency department visits.

Projects Funded September 2022 - (24)

Projects Funded September 2021 - (15)

  • 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.
  • 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 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.
  • 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 - (9)

Projects Funded September 2019 - (4)

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.