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 2020 - (39)

  • Aging in Place in Rural America: What Does It Look Like and How Can It Be Supported?
    University of Minnesota Rural Health Research Center
     In general, people want to age in place. This project looks at the structures in place to help them do so and how those structures vary by rurality. Federal, state, and local policy implications for improving health outcomes and quality of life for rural older adults aging in place will also be identified.
  • Ambulance Deserts: Addressing Geographic Disparities in the Provision of Ambulance Services
    Maine Rural Health Research Center
     This two-year study aims to identify geographic disparities in accessing ambulance services by building a database of ambulance service locations in year one and identifying and creating maps of ambulance deserts within each of the states in year two.
  • An Insurance Profile of Rural America: A Chartbook
    RUPRI Center for Rural Health Policy Analysis
     This chartbook will describe current conditions and recent trends in rural health insurance by drawing from census data and other sources. Tables and maps, accompanied by bulleted policy takeaways, will compare rural and urban coverage sources, the degree of competition among issuers, and the share of the population who are underinsured.
  • Assessing Cancer Care Coordination in Rural Health Clinics During a Pandemic
    Rural and Minority Health Research Center
     This project will aim to understand how Rural Health Clinics perceive and implement evidence-based cancer screening and treatment and related intervention strategies before and during the COVID-19 pandemic.
  • Association of Telehealth Technology and Financial Performance in Rural Hospitals
    Rural Telehealth Evaluation Center
     American Hospital Association telehealth capability data will be merged with Centers for Medicare & Medicaid Services cost information and other databases to see if having telehealth technology is associated with improved hospital financial performance via increased revenue and profitability and access to healthcare services for rural residents.
  • Availability of Physical Health Infrastructure in Areas with a High Proportion of Historically Disadvantaged Minority Residents
    Rural and Minority Health Research Center
     This analysis will compare the likelihood that selected healthcare infrastructure elements are available within rural and urban ZIP Code Tabulation Areas that contain versus do not contain a high proportion of historically disadvantaged minority residents.
  • Characteristics of Buprenorphine Therapy Among Commercially-Insured Pregnant and Postpartum Women
    Rural Health Equity Research Center
     This project will analyze claims from a national commercial insurance database to characterize buprenorphine therapy initiation persistence and adherence among pregnant and postpartum women with opioid use disorder (OUD) and assess differences in buprenorphine OUD treatment characteristics among rural and urban pregnant/postpartum women.
  • Comparing Utilization and Quality of Home Health Care Between Medicare Fee-for-Service and Medicare Advantage Beneficiaries by Rural-Urban Status
    WWAMI Rural Health Research Center
     This project examines differences in home health use and quality by enrollment in Medicare Fee-for-Service (FFS) versus Medicare Advantage (MA) plans. Findings will include information on rural-urban and intra-rural variation in home health care to inform policies on access, payment, and quality for Medicare FFS and MA plans.
  • Comparison of Rural Hospital Closures and the Communities Served, 1990-2020
    North Carolina Rural Health Research and Policy Analysis Center
     This project will examine rural hospital closures during three decades to profile community characteristics, health status, health care services, and resources available in communities where rural hospitals have closed
  • Continuous Services in the Absence of Retail Pharmacies in Rural Communities
    RUPRI Center for Rural Health Policy Analysis
     This project will identify communities with and without pharmacies by rurality and describe the differences in population and market characteristics of communities with and without any pharmacies. Research findings regarding "pharmacy deserts" will inform alternative methods of securing services based on community characteristics.
  • Conversion of Rural Hospitals to Freestanding Emergency Centers
    North Carolina Rural Health Research and Policy Analysis Center
     This project will review the literature to establish what is known about freestanding emergency centers (FECs) and implications for a rural community. The number and types of rural hospitals that would be eligible to convert to an FEC as an alternative to closure of acute inpatient care would be estimated.
  • Current State of Remote Patient Monitoring: A Landscape Analysis
    Rural Telehealth Evaluation Center
     The use and reimbursement of remote patient monitoring (RPM) has changed drastically in the last decade. This study aims to summarize the current state of telehealth RPM services provided in the U.S. healthcare systems and summarize how telehealth RPM have been utilized in the literature, along with a case study of recent RPM reimbursement rates.
  • EB THNP/SAT TNGP, SB TNGP, and EB TNGP Measure and Data Activities
    Rural Telehealth Research Center
     The project will collect ongoing data from Evidence Based Tele-Behavioral Health Network Program and Substance Abuse Treatment Telehealth Network Grant Program participants; analyze School Based Telehealth Network Grant Program data for publications; and identify candidate data elements for a new Evidence Based Telehealth Network Grant Program.
  • Evaluating the Role of Tele-Emergency Care in Healthcare Costs and Long-Term Outcomes for Rural Medicare Beneficiaries with Sepsis
    Rural Telehealth Research Center
     Sepsis is a life-threatening emergency for which provider-to-provider telemedicine has been used to improve quality of care. The objective of this study is to measure the impact of rural tele-emergency consultation on long-term healthcare costs and outcomes, specifically through decreasing organ failure, hospital length-of-stay, and readmissions.
  • Evaluating the Rural Health Network Development Planning Grant Program
    University of Minnesota Rural Health Research Center
     This project will identify factors that facilitate and impede success of Rural Health Network Development grantees, based on discussions with grantees from the 2019 cohort and surveys of prior grantees dating back more than 10 years, as well as with technical assistance providers.
  • Evaluating the Rural HIV/AIDS Planning Grant Program
    University of Minnesota Rural Health Research Center
     The Rural HIV/AIDS Planning Grant program is administered by the Federal Office of Rural Health Policy to plan and develop healthcare networks designed to address HIV/AIDS prevention and treatment in states disproportionately impacted by the virus. This project will identify factors that facilitate and impede success of such planning efforts.
  • How Does Participation in Medicare Accountable Care Organizations Affect Rural Hospital Financial Outcomes?
    RUPRI Center for Rural Health Policy Analysis
     This project will examine the impact of Medicare Accountable Care Organizations' (ACOs') participation on rural hospitals' financial outcomes. Findings from this project will provide policy-relevant information on how ACO participation affects rural hospitals' financial bottom lines, contributing to further program design.
  • How Have the Sources of Revenue for Rural Hospitals Changed Since 2005?
    North Carolina Rural Health Research and Policy Analysis Center
     Rural hospitals have seen a steadily decreasing average acute daily census. If outpatient revenue is not expanding to fill that decrease, the decrease in patient revenue could further threaten hospital viability.
  • Inpatient Treatment Costs Associated with Substance Use Disorders
    Rural Health Equity Research Center
     The purposes of this project are to examine the costs and characteristics of inpatient stays associated with substance use disorders and to examine whether there are systematic differences in these stays and costs for persons residing in rural areas compared to urban areas.
  • Location and Characteristics of Nursing Homes in the Rural and Urban U.S.
    RUPRI Center for Rural Health Policy Analysis
     This project will examine rural and urban nursing home availability; assess the nursing home bed supply relative to the elderly population in rural and urban counties; summarize resident and nursing home characteristics; and analyze the relationship between the rural location of nursing homes and resident and nursing home characteristics.
  • Objective Program Examination and Gap Analysis of Telehealth Resource Centers
    Rural Telehealth Evaluation Center
     This project will review an inventory of existing metrics used by the Telehealth Resource Centers to summarize technical assistance (TA) activities and identify opportunities for future program development in improving TA services for expanding telehealth in the nation.
  • Opportunities for Increasing Access to Maternal Telehealth Services
    Rural Telehealth Research Center
     Rural residents face barriers to healthcare access that contribute to higher maternal morbidity and infant mortality than in urban areas. This project will use nationally representative data to identify opportunities for increasing access to maternal health services via telehealth and implementation barriers to sustaining telehealth services.
  • Out-of-Pocket Spending Among Privately Insured Rural and Urban Residents
    Maine Rural Health Research Center
     Out-of-pocket spending for healthcare services has been on the rise as deductibles and other cost-sharing requirements among the privately insured increase. This study compares rural and urban out-of-pocket healthcare spending to identify whether rural residents have been disproportionately affected by this trend.
  • Overcoming Barriers to Providing Rural Obstetrical Training for Physicians
    WWAMI Rural Health Research Center
     Rural communities struggle to maintain obstetrical (OB) services, due in part to scarce rural training opportunities for obstetricians and family physicians. This study describes the availability, characteristics, and output of residency and fellowship programs offering rural OB training and identifies solutions to support this training.
  • Rural and Urban Cancer Survivors' Follow-Up Care Experiences
    Rural and Underserved Health Research Center
     This project examines rural vs. urban differences in cancer survivors' follow-up care experiences using the 2017 Medical Expenditure Panel Survey.
  • Rural and Urban Variation in Family Physicians' Demographics and Practices
    Rural and Underserved Health Research Center
     This project will examine changes in personal demographics of family physicians comparing urban and rural areas, how these changes align with those of the populations they serve, and how rural physician practices have changed over time. This project uses American Board of Family Medicine data.
  • Rural Family Physicians' Ability to Address Patients' Social Determinants of Health Needs
    Rural and Underserved Health Research Center
     This project examines how practice-level and community-level characteristics are associated with a family physician's assessment of their practice's ability to address patients' social needs.
  • Rural Health Access: Affordability and Barriers to Care
    Maine Rural Health Research Center
     Rural-urban comparisons of healthcare access and affordability predate many policy reform efforts aimed at increasing access and decreasing costs—ongoing concerns of rural families. This study will use national health survey data to examine rural-urban differences in access to medical care, access to insurance, and affordability of care.
  • Rural Hospital Closure and Effect on Local Economies
    North Carolina Rural Health Research and Policy Analysis Center
     Several research projects have analyzed the health effects of rural hospital closures. However, highly cited evidence on the economic effects of rural hospital closures is more than a decade old. The purpose of this study is to quantify the economic impact rural hospital closures have on communities.
  • Rural-Urban Differences in Adverse and Positive Childhood Experiences: Results from the National Survey of Children's Health
    Rural and Minority Health Research Center
     Using the 2016-2018 National Survey of Children's Health, the prevalence of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) exposure in all 50 states and the District of Columbia will be examined and whether ACE and PCE exposure differs between rural and urban residents, by type, by count, and by racial/ethnic group.
  • Safe Obstetric Care Access for All Rural Residents: Minimum Standards for Clinical, Workforce, and Financial Viability of Rural Obstetric Units
    University of Minnesota Rural Health Research Center
     The goal of this project is to analyze data from rural hospitals to understand the criteria by which hospitals and communities assess their need and capacity for obstetric care access in rural counties and to describe effective ways to operationalize minimum standards for clinical safety and financial viability for rural obstetric units.
  • Summary of Telehealth Definitions: A Scoping Review
    Rural Telehealth Evaluation Center
     Telehealth services are a vital alternative to delivering health care, especially during the COVID-19 pandemic. This study provides a scope review of telehealth definitions, summarized from various sources and stakeholders.
  • Summative Examination of Licensure Portability Program
    Rural Telehealth Evaluation Center
     Licensure portability has become increasingly important to expanding telehealth services for rural populations across state lines during the COVID-19 pandemic. The proposed summative examination will provide comprehensive Licensure Portability Program review and identify future program improvements.
  • Telehealth for Chronic Disease Management in the Veterans Health Administration
    Rural Telehealth Research Center
     This project will capitalize on the aggressive adoption of telehealth within the Veterans Health Administration (VHA). The overall purpose of this jointly funded collaborative project is to better understand key factors impacting how VHA chronic disease management telehealth has reduced healthcare utilization outcomes and cost.
  • Telehealth Use Among Children in Medicaid Managed Care and Fee-for-Service Programs
    Rural Telehealth Research Center
     This project will assess differences in the use of telehealth services among rural and urban children by enrollment in state Medicaid managed care organizations and fee-for-service programs using national administrative claims datasets.
  • Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder Across the U.S.
    WWAMI Rural Health Research Center
     This study describes and compares the treatment that rural and urban patients with opioid use disorder (OUD) receive, documenting the workforce providing care, distance that patients travel to receive care, and cost of care. Findings will inform policies to ensure that rural patients with OUD have access to care from local healthcare providers.
  • Trends in Health Workforce Supply in the Rural U.S.
    WWAMI Rural Health Research Center
     Rural communities in the U.S. have struggled to recruit and sustain sufficient health professionals to ensure adequate access to care. This study uses multiple sources of data to describe the geographic distribution (rural/urban, regional, and intra-rural) of numerous types of health professionals.
  • Understanding Rural Health Clinic Services, Use, and Reimbursement
    Maine Rural Health Research Center
     This study describes the scope and intensity of services provided to Medicare beneficiaries by independent and provider-based Rural Health Clinics. It will also assess the adequacy of the Centers for Medicare & Medicaid Services' changes to the outpatient evaluation and management codes in 2021 compared to the 2021 per-visit reimbursement cap.
  • Unintentional Injury in Metropolitan and Nonmetropolitan Settings by Race or Ethnicity
    Rural and Underserved Health Research Center
     This study will describe the rates of fatal and nonfatal unintentional injury comparing metropolitan and nonmetropolitan areas, stratified by race or ethnicity. This study will use Centers for Disease Control WONDER data (2014-2018) and the 2018 National Hospital Ambulatory Medical Care Survey.

Projects Funded September 2019 - (16)

Projects Funded September 2018 - (8)

  • Current and Longer Term Challenges of Rural Hospitals: A Survey of Rural Hospital Executives
    North Carolina Rural Health Research and Policy Analysis Center
     This project involves surveying rural hospital executives about how they will respond to current and long-term challenges related to financial and regulatory burdens.
  • Healthcare Use and Expenditures Among Rural and Urban Medicare Beneficiaries Aged 85 and Over
    Maine Rural Health Research Center
     The proportion of U.S. residents ages 85+ is expected to grow substantially in the coming decades with the impact of this growth in rural areas likely to be pronounced. This project will use data from the Medicare Current Beneficiary Survey to examine rural-urban differences in healthcare use and expenditures among Medicare enrollees ages 85+.
  • Medicare Beneficiary Access to Prescription Drugs Under Part D
    RUPRI Center for Rural Health Policy Analysis
     This study will build on RUPRI Center work describing patterns of enrollment into Medicare Part D plans (including access to zero deductible plans) by using transaction files to analyze how medications are actually acquired and implications for access to local pharmacy services.
  • Post-acute Care Quality for Rural Medicare Beneficiaries
    WWAMI Rural Health Research Center
     This study will examine 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 will be compared with state and national averages as well as urban providers.
  • Psychiatric Bed Closures in Rural Hospitals: An Assessment of Trends, Impact, and Policy Strategies
    Maine Rural Health Research Center
     This study will examine trends in the closure of psychiatric beds by rural hospitals using the Substance Abuse and Mental Health Services Administration Treatment Services Locator; the American Hospital Association Annual Survey of Hospitals (2010-2017); and the Area Health Resources File.
  • Serious Mental Illness and Access to Care Among Rural and Urban Adults
    Rural and Underserved Health Research Center
     Very little research has examined the prevalence of serious mental illness and access to mental health treatment among rural relative to urban adults in the U.S. Using nationally representative data, this project will shed new light on the prevalence and correlates of serious mental illness and related access to mental health services.
  • The Association of Occupation with Mental Illnesses and Death by Suicide
    Rural and Underserved Health Research Center
     This study examines the association of occupational risk factors with mental illnesses, all-cause mortality, and suicide.
  • Tobacco Treatment in Rural Primary Care
    Maine Rural Health Research Center
     This study will use the National Ambulatory Medical Care Survey to compare rural and urban rates and predictors of tobacco counseling and tobacco treatment medication prescribing by primary care providers to their smoking patients.

Projects Funded September 2017 - (7)

  • A Chartbook of Rural Population Health
    North Carolina Rural Health Research and Policy Analysis Center
     This project creates a chartbook of population health for rural areas. This resource is designed to allow policymakers and practitioners to better understand rural-urban disparities across a wide variety of population health indicators.
  • Creating County- and Census Tract-Level Estimates of Childhood Obesity in the U.S.: A Spatial Multilevel Modeling Approach
    Rural and Minority Health Research Center
     Using the 2016 National Survey of Children's Health, spatial multilevel models will be constructed to estimate county- and Census tract-level rates of childhood obesity in the U.S. Particular emphasis will be placed on rural areas, for which direct estimates are often unavailable because of small sample sizes in population-based surveys.
  • Do Rural Breast and Colorectal Cancer Patients Present at More Advanced Disease Stages than Their Urban Counterparts?
    WWAMI Rural Health Research Center
     Access to recommended cancer screening is more difficult for rural residents than their urban counterparts. This study uses the Surveillance, Epidemiology and End Results Program (SEER) data to examine the extent to which rural residents present at more advanced disease stages for breast and colorectal cancer diagnosis than urban residents.
  • 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.
  • Post-acute Care Trajectories for Rural Medicare Beneficiaries
    WWAMI Rural Health Research Center
     Utilization and costs of post-acute care for Medicare fee-for-service beneficiaries have grown rapidly during the last decade. This study will examine 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.
  • Quality Measures for Skilled Nursing Care in Rural Swing Beds: What Works and What Doesn't?
    Southwest Rural Health Research Center
     This project will provide a systematic review of skilled nursing facility quality measures and how these measures apply to skilled nursing facility-level care provided in rural swing beds in both critical access hospitals and prospective payment system hospitals.
  • Rural Health Clinics Chartbook
    Maine Rural Health Research Center
     This project will produce a comprehensive, descriptive chartbook detailing the characteristics and status of rural health clinics (RHCs) nationally. It will also assess the use of secondary data to construct a national set of indicators for RHCs and identify gaps in our knowledge that cannot be addressed using secondary data.

Projects Funded September 2016 - (4)

Projects Funded September 2014 - (1)

  • How Do Costs for Rural Medicare Beneficiaries Using Swing Beds Compare to Those Using Skilled Nursing Facilities?
    North Carolina Rural Health Research and Policy Analysis Center
     This study will estimate and compare total Medicare expenditures for episodes of care that include post-acute stays in either swing beds or skilled nursing facilities (SNFs). Results will inform federal and state agencies, rural providers and communities as to how post-acute care in swing bed versus a SNF affects the trajectory of costs and utilization for rural Medicare beneficiaries.

Projects Funded September 2012 - (1)

  • Hospital Readmission Following Care in a Swing Bed
    North Carolina Rural Health Research and Policy Analysis Center
     This study builds on our portfolio of swing bed work by examining the rate of hospital readmission for patients who receive post-acute care in swing beds compared to skilled nursing facilities and will inform the discussion on use, cost, and benefit of swing bed care.