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.

• September 2023 - (40)
• September 2022 - (22)
• September 2021 - (15)
• September 2020 - (9)
• September 2019 - (3)
• September 2018 - (1)
• September 2017 - (1)

Projects Funded September 2023 - (40)

• 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.
  
• 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 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.
  
• 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 - (22)

• "Older, Sicker, Poorer": A Scoping Review of the Literature That Contributes to This Narrative on Rural Americans
  Southwest Rural Health Research Center
  The investigators will conduct a scoping review of peer-reviewed literature to explore the contributive evidence that rural Americans are older, sicker, and poorer. The project will provide historical and context-setting perspectives on the factors that have led to this description and the extent to which it still holds true. The project will also identify literature gaps to inform future research.
  
• 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.
  
• Assessing the Clinical and Financial Impact of Community Health Workers in Rural America
  Southwest Rural Health Research Center
  This scoping review project will assess how often the existing literature has examined community health workers (CHW) in rural America and what the literature suggests about the clinical and financial impact that CHWs have in rural communities.
  
• 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).
  
• 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.
  
• 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.
  
• 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.
  
• 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
  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.
  
• 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 - (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)

• 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.
  
• 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.
  
• 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.
  
• Racial and Ethnic Disparities Shouldered by Rural Americans: Evidence from the Peer-Reviewed and Grey Literature on the Five Leading Causes of Death
  Southwest Rural Health Research Center
  A systematic review of peer-reviewed and grey literature will explore the role of racial and ethnic disparities in the five leading causes of death. The project will provide historical and context setting perspectives on the contributors to the five leading causes of death, particularly as they involve the intersection of rurality and non-majority demographic identities.
  
• 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.
  
• Updating and Exploring the Burden of Potentially Avoidable Emergency Department Visits in Rural U.S. Communities
  Southwest Rural Health Research Center
  This project will update the Federal Office of Rural Health Policy's research portfolio on potentially avoidable emergency department (ED) visits among rural residents across the U.S., particularly as they relate to ambulatory care sensitive conditions (ACSCs). Data on ACSC-related ED visits will be drawn from the State Emergency Department Databases, and findings will be stratified by census region, patient's place along the urban-rural continuum, and by race/ethnicity.
  

Projects Funded September 2019 - (3)

• 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.
  

Projects Funded September 2018 - (1)

• 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.
  

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.