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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 2024 - (24)

  • Assessing Access to Medication Treatment for Opioid Use Disorder in Rural Communities Influenced by the Rural Communities Opioid Response Program (RCORP)
    WWAMI Rural Health Research Center
     This project will use national prescription claims data to compare access to buprenorphine treatment for opioid use disorder in rural counties with and without Rural Communities Opioid Response Program (RCORP) funding and urban counties. An accurate understanding of access to buprenorphine treatment is essential for determining the influence of RCORP funding on a critical strategy for curbing the opioid epidemic.
  • Availability and Characteristics of Outpatient and Residential Substance Use Treatment in Rural and Urban Areas
    Rural and Underserved Health Research Center
     This study will look at: 1) the availability of residential and outpatient treatment centers in rural and urban counties, including identifying counties with no facilities; and 2) characteristics of services offered (e.g., residential, outpatient), demographics of persons treated, and insurance plans accepted by rural vs urban centers.
  • Causal Effect of Nursing Home Closure on Resident Outcomes in Rural Areas
    RUPRI Center for Rural Health Policy Analysis
     We will evaluate the causal impact of nursing home closure on two key outcomes: distance to the transitioned nursing home, and resident physical and mental health outcomes. We will compare the effect of closures on outcomes for rural and urban areas using resident-level data from 2010-2019 and advanced difference-in-differences regression methods.
  • Changes in Rural Health Insurance Coverage, 2020-2023
    RUPRI Center for Rural Health Policy Analysis
     This project uses secondary data sources to characterize changes in health insurance coverage during the public health emergency (2020-2023) for rural and urban people according to demographic, employment, and geographic characteristics, and to describe how changes in federal policies impacted coverage. Researchers also assess the potential impact of maintaining more robust marketplace subsidies on rural and urban coverage rates once the "unwinding" of continuous Medicaid enrollment is complete.
  • Considerations for the Use of Area-Level Vulnerability and Resilience Indices and Rurality in Funding Formulas
    ETSU/NORC Rural Health Research Center
     The purpose of this study is to model potential funding formulas within states to understand how structural elements in formulas (i.e., inclusion of the Social Vulnerability Index, use of rural carve-outs or floor amounts, and other factors) affect county-level allocations compared to simple, population-based formulas.
  • Did Hospitals That Converted to Rural Emergency Hospital (REH) Avoid Closure?
    North Carolina Rural Health Research and Policy Analysis Center
     The goal of the Rural Emergency Hospital (REH) is to preserve access to essential services for rural residents, and to decrease the likelihood of hospital closures; some worry that the REH offers an option for otherwise financially strong hospitals to shed services. This study will investigate whether hospitals that converted to an REH in 2023 and 2024 would have likely closed in the absence of the REH designation.
  • Financial Consequences of Growth in the Number of Rural Referral Centers
    North Carolina Rural Health Research and Policy Analysis Center
     Since Centers for Medicare & Medicaid Services amended its regulations to allow hospitals in urban areas to reclassify as rural, over 400 hospitals have obtained status as a Rural Referral Center. This project will estimate the costs to hospital Medicare payment and profitability.
  • Going Beyond Hospital Closures: Estimating Rural and Urban Changes in Access to Hospital Service Lines
    ETSU/NORC Rural Health Research Center
     Rural hospital closures have been prominent in the last decade and are an important reflection of decreases in access to essential healthcare services. However, hospital closures alone may overlook other decreases to access through service line closures. This study estimates hospital service line closures over time and by rurality.
  • Identifying Characteristics Associated With Rural and Urban Medicare Beneficiaries Bypassing Local Skilled Nursing Facilities for Post-Acute Care
    WWAMI Rural Health Research Center
     This project will compare how often rural versus urban beneficiaries receive post-acute care from skilled nursing facilities (SNFs) outside of their local communities, and which patient, provider, and community characteristics are associated with bypass of local SNFs, informing policies to support SNFs in rural communities.
  • Improving Health for "Homebound" Older Adults in Rural and Urban Areas
    University of Minnesota Rural Health Research Center
     This project will describe rural-urban differences in the risk of, and characteristics associated with, being classified as "homebound." We will also identify policy and programmatic interventions to reduce the risk of becoming homebound as well as to improve outcomes for those who are homebound.
  • Mental Health Treatment Among Rural and Urban Adults at Risk for Suicide
    Rural and Underserved Health Research Center
     This study will look at rural/urban disparities in 1) the receipt and sources of mental health treatment among adults with suicidal thoughts and attempts using data from the National Survey on Drug Use and Health; and 2) mental health follow-up visits among adults with a hospital admission or emergency department visit for self-inflicted harm using data from a national insurance claims dataset.
  • Monitoring Obstetric Unit Closures and Measuring Closure Impacts to Support Rural Maternity Care Access
    University of Minnesota Rural Health Research Center
     This project will create a public health data infrastructure with annually updated information on the loss of hospital-based obstetric services, merging policy-relevant hospital and county characteristics with transportation and geographic data, and measuring trends over time in the loss of hospital-based obstetric care.
  • Neonatal Care at Rural Hospitals: Describing Access, Closures and Levels of Childbirth-Related Care
    University of Minnesota Rural Health Research Center
     This project will describe access to childbirth-related care for families living in rural and urban communities; it will document access to neonatal care and the levels of that care, describe rural counties that have lost access to neonatal care, and identify rural counties without access to either obstetric or neonatal services.
  • Oral Healthcare Utilization and Outcomes of Rural and Urban Medicaid-Insured Children in the United States
    University of South Carolina Rural Health Research Center
     Using nationally representative Medicaid claims data, this project will determine rural-urban differences in the prevalence of early childhood caries, preventative dental visits, and restorative dental visits.
  • Retention and Expansion of Hospital Services Offered by Rural Hospitals After Enrollment in 340B
    RUPRI Center for Rural Health Policy Analysis
     The 340B Federal program is designed to provide hospitals with financial stability through provision of drug discounts which may, in turn, allow hospitals to maintain or expand their service line offerings. Using a series of event study analyses over an 11-year period, this study will examine the impact of enrollment in the 340B program on discontinuing services, maintaining services, and adding new services in eligible rural hospitals.
  • Rural and Urban Medical School Programs that Demonstrate a Commitment to Producing Rural Physicians
    WWAMI Rural Health Research Center
     Studies of individual medical schools have identified characteristics associated with working in rural areas, but little is known about which organizational factors are the most significant predictors of rural practice. This project will examine characteristics of medical schools' missions and organizational commitments to promote physician practice in rural communities.
  • Rural and Urban Sepsis Outcomes as a Measure of Health Care Quality: A Nationwide Comparative Analysis Using HCUP Data
    ETSU/NORC Rural Health Research Center
     This study examines differences in sepsis prevalence, outcomes, costs, and treatment between rural and urban hospitals using the HCUP Nationwide Readmissions Database. It aims to inform policies related to access to timely, high-quality sepsis care and identify strategies to enhance healthcare outcomes across diverse hospital settings.
  • Rural Implications of Increased Medicare Beneficiary Enrollment in ACOs and MA Plans
    RUPRI Center for Rural Health Policy Analysis
     This project will leverage Centers for Medicare & Medicaid Services data showing the number of Medicare beneficiaries assigned to Accountable Care Organizations, in combination with enrollment in Medicare Advantage in rural counties, to describe implications for rural health care organizations.
  • Rural-Urban Differences in Access to and Quality of Care for People With Disabilities
    University of Minnesota Rural Health Research Center
     The purpose of this project is to identify rural-urban differences in access to and quality of health care services for people with disabilities. Results from this project will help inform policy to improve access to and quality of care for this growing population in rural areas.
  • Rural-Urban Differences in Emergency Department Utilization and Costs for Dental Conditions
    University of South Carolina Rural Health Research Center
     Emergency Department (ED) Utilization is a de facto provider for untreated dental issues. Understanding rural-urban differences in ED use for dental conditions in recent years is essential to inform federal, state, and community-level dental health initiatives such as preventive dental care, tele-dentistry infrastructure expansion, and oral hygiene practices. Ongoing national efforts addressing rural disparities in dental care should target individuals most at risk for missing preventive care and utilizing the ED for dental care.
  • Spatial Distribution of Pre-Exposure Prophylaxis (PrEP) Need and Care
    University of South Carolina Rural Health Research Center
     The incidence of HIV is disproportionately high in rural areas, but these communities often lack access to evidence-based interventions to prevent new HIV diagnoses such as PrEP. Using Medicaid claims data and the Centers for Medicare & Medicaid Services Provider file, this study will determine geographic disparities (by rurality and region) in the need for PrEP and PrEP availability and identify whether PrEP availability meets the needs across geography.
  • State Use of Medicaid Funding Mechanisms for Community Health Workers: Implications for Rural Populations
    ETSU/NORC Rural Health Research Center
     Community health workers (CHWs) serve on the frontlines of health care, with states increasingly leveraging various funding mechanisms for their services. This project will describe and compare state use of two Medicaid mechanisms—Section 1115 demonstration waivers and state plan amendments—to support CHW services, focusing on potential implications for rural populations.
  • State-Level Medicaid Bundled Payments and Rural Perinatal Care
    University of South Carolina Rural Health Research Center
     The impacts of state-level Medicaid bundled payment models will depend on many factors, such as maternity care facility structure, scope of services, and local patient bypassing behaviors during prenatal, intrapartum, and postpartum periods. For rural providers who often offer prenatal and postpartum care but not labor and delivery services, these bundled payments may impose additional financial and logistical challenges.
  • The Nursing Home and Skilled Nursing Facility Workforce in the Rural and Urban U.S.
    WWAMI Rural Health Research Center
     This project will describe the rural and urban distribution of nursing and non-nursing staff in U.S. long-term care facilities and investigate how the workforce varies by facility and community characteristics.

Projects Funded September 2023 - (34)

  • 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
    ETSU/NORC Rural Health 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 rural health disparities and improving health conditions in rural communities.
  • Challenges, Successes, and Sustainability of the 2019 Rural Maternity and Obstetrics Management Strategies (RMOMS) Programs
    University of South Carolina Rural 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.
  • Comparing Across Health Indices: Differences by Rurality, Missingness, and Associations With Health Outcomes
    ETSU/NORC Rural Health 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.
  • 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.
  • Evaluating the Variation in Rural and Urban Hospital Wages and Wage Index Pre- and Post-COVID-19 Pandemic
    North Carolina Rural Health Research and Policy Analysis Center
     The primary purpose of the wage index is to address the differences in labor costs that hospitals experience based on their geographical location.
  • Examining Post-Acute Care Utilization and Outcomes for Rural Medicare FFS and Medicare Advantage Beneficiaries
    ETSU/NORC Rural Health 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, by region of the country, and levels of rurality.
  • Examining Rural Population Characteristics and Access to Care: A Study of Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs)
    ETSU/NORC Rural Health Research Center
     This project examined Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs), analyzing geographic disparities in provider shortages across rural and urban settings. Findings highlight variations in access to primary care, mental health, and dental services, informing federal programs that allocate resources to improve health care access.
  • 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 High-Need Counties for Resource Planning
    University of South Carolina Rural 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.
  • 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 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-Urban Differences in Addressable Drivers of Staff Turnover in Skilled Nursing Facilities
    University of South Carolina Rural 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.
  • Rural/Urban Inequities in Drug and Alcohol Use Treatment
    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.
  • Suicide Mortality: A Comparison of Urban and Rural Rates
    ETSU/NORC Rural Health Research Center
     Suicide contributes to significant mortality in the United States. This project will examine the differences 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.
  • The Rural Landscape of Diabetes in the United States
    University of South Carolina Rural Health Research Center
     Rural-urban differences in diabetes and diabetes management may be attributed to socioeconomic differences and treatment available to rural residents. Using data from 2021-2023 National Health Interview Survey, this study will examine 1) rural-urban differences in diabetes and prediabetes incidence and prevalences, 2) rural-urban differences in the management, treatment, and complications associated with diabetes, and co-occurring risk factors for cardiovascular disease.
  • 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.
  • Usual Source of Primary Care for Rural Medicare Beneficiaries Before and During COVID-19
    North Carolina Rural Health Research and Policy Analysis Center
     The global pandemic was highly disruptive to existing health care use patterns, potentially affecting rural America more than urban communities. This study will describe the usual sources of primary care (USC) for rural Medicare beneficiaries before and during COVID-19 to provide insight into how COVID-19 affected USC of Medicare beneficiaries.

Projects Funded September 2022 - (13)

  • 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 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.
  • 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
    University of South Carolina Rural 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).
  • 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.
  • 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-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 Forgoing Health Care during the COVID-19 Pandemic
    ETSU/NORC Rural Health 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.
  • 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.
  • Understanding Rural Health Data Challenges through Analysis of Peer-Reviewed Publication Limitations
    ETSU/NORC Rural Health 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.
  • 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 - (8)

  • A Closer Examination of Rural Hospital Bypass
    ETSU/NORC Rural Health 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.
  • 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.
  • Screening, Brief Intervention and Referral to Treatment (SBIRT) Penetration in Rural vs. Urban Healthcare Settings in the U.S.
    ETSU/NORC Rural Health 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 - (4)

Projects Funded September 2019 - (3)

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.