Current Projects from All Research Centers

Projects in progress, with research still being conducted, listed by the date funded by the Federal Office of Rural Health Policy (FORHP):

Projects Funded September 2018 - (32)

Projects Funded September 2017 - (29)

  • 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.
  • Access and Quality of Care for Rural Patients with Chronic Obstructive Pulmonary Disease
    University of Minnesota Rural Health Research Center
     Although rates of chronic obstructive pulmonary disease (COPD) are substantially higher in rural areas, there has been limited research on healthcare access and quality issues for individuals with COPD who live in rural communities. This project aims to improve the accessibility and quality of care for rural COPD patients.
  • Acuity Differences among Newly Admitted Rural and Urban Nursing Home Residents
    Maine Rural Health Research Center
     This study will use nursing home assessment data to examine rural-urban differences in resident acuity upon admission; whether differences persist among newly admitted Medicare and non-Medicare residents; and whether and how nursing home, local health system, and market characteristics are associated with differences in resident acuity.
  • Ambulatory Care Provided to Rural Medicare Beneficiaries by Rural and Urban FQHCs, RHCs, and Acute Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     This project will characterize the volume, cost, and case mix of ambulatory care provided to rural Medicare beneficiaries by rural and urban federally qualified health centers (FQHCs), rural health clinics (RHCs), and acute hospitals. The study will include urban-rural and geographic comparisons of volume, cost, and case mix by provider type.
  • An Empirical Study of Health Insurance Firm Participation over Time in Rural Counties
    RUPRI Center for Rural Health Policy Analysis
     We examine changes in firm participation in multiple health insurance markets (FEHBP, MA, HIMs) over time in rural counties. We hypothesize that participation is related inversely to population density, as it becomes more difficult to spread risk, and as network formation becomes more challenging as primary and specialty care become less available.
  • 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.
  • Do Rural Communities Have a Higher Rate of Avoidable Deaths?
    North Carolina Rural Health Research and Policy Analysis Center
     Based on some estimates, roughly half of deaths are avoidable in the sense they stem from risky behavior. What is less well known is the degree to which there is a rural-urban disparity in this rate.
  • 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.
  • Identifying Obesogenic Communities in the U.S.: An Urban-Rural Comparison
    Rural and Minority Health Research Center
     In this study, we propose to create an obesogenic environment score for all U.S. counties and Census tracts, explore urban versus rural differences in obesogenic environment scores, and examine associations between obesogenic environments and childhood obesity overall and by level of rurality.
  • Lung Diseases among Coal Miners
    Rural and Underserved Health Research Center
     Coal miners are at increased risk of lung diseases. Using secondary datasets, we will assess the distribution of lung diseases across regions, identify patterns of healthcare utilization among miners relative to HRSA-funded Black Lung Clinics, and compare healthcare utilization patterns, behaviors, and comorbidities among miners and non-miners.
  • Malpractice Claims Among Rural and Urban Providers: Do State Telehealth Laws Make a Difference?
    Southwest Rural Health Research Center
     This project examines trends in state telehealth laws and whether they have affected the rural and urban malpractice environments differentially. Data from the National Practitioner Data Bank are used to determine whether changes in telehealth laws are associated with increased malpractice claims and other adverse actions against providers.
  • Mental Health Treatment Access: How Do Mental Health Treatment Use and Unmet Treatment Need Vary among Rural and Urban Adults Nationally?
    Rural and Underserved Health Research Center
     This project will estimate the prevalence and policy-modifiable correlates of unmet mental health treatment need and utilization among metropolitan, micropolitan, and other non-metropolitan adults nationally who have a mental health condition. Additionally, the study will investigate the same issues among Native Americans/American Indians.
  • Perceived Facilitators and Barriers to Rural Ambulatory Care Practice among Registered Nurses
    Rural and Minority Health Research Center
     Although a quarter of all registered nurses work in ambulatory care settings, little research has addressed the factors associated with their remaining in the profession and current job settings. The current study will survey a sample of rural and urban nurses to ascertain perceived facilitators and barriers to remaining in rural practice.
  • 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.
  • Predictors of Buprenorphine Prescribing by Family Physicians in Rural Areas Nationally
    Rural and Underserved Health Research Center
     This project will examine how physician and practice-level characteristics are associated with family physicians prescribing buprenorphine for opioid use disorder across rural and urban areas. The study will make use of a unique dataset collected among family physicians nationally in 2017.
  • 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.
  • Rates of Telemental Health Use among Rural Medicaid Enrollees: Associations with Telehealth Policy and Mental Health Access
    Rural Telehealth Research Center
     This study will examine telemental health use among rural and urban Medicaid beneficiaries with mental illness. The goals are to: 1) compare rates and patterns of telemental health; 2) assess how use rates are associated with state-level Medicaid telehealth policies; and 3) determine the extent to which telemental health provides access to care.
  • Rural Community Response to Hospital Closure
    RUPRI Center for Rural Health Policy Analysis
     The Rural Community Response to Hospital Closure project will study how rural communities adapt to local hospital closure. Within selected communities, the project will evaluate the impact of hospital closure on multiple community health-related services and characteristics.
  • 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.
  • Rural Nursing Workforce: Current Educational Characteristics and Options for Improvement
    Rural and Minority Health Research Center
     This project will examine the current distribution of nurses, subset by educational attainment, across the rural US using data from Census Public Use Microfiles. Then a survey of the approximately 750 registered nurse to bachelor of science in nursing (RN-to-BSN) educational programs across the US will identify the proportion of programs offering rural content or facilitating rural placement.
  • Rural-Urban Variation in CMS Hierarchical Condition Categories (HCC) Risk Scores
    North Carolina Rural Health Research and Policy Analysis Center
     CMS uses hierarchical condition categories (HCC) to risk-adjust Medicare beneficiaries for multiple conditions. This adjustment is used for multiple programs, but it’s unknown whether the adjustment works similarly in rural and urban areas. This project investigates the distribution of beneficiaries’ and providers’ HCC risk scores across rurality.
  • Rural/Urban Differences in Chronic Diseases and Delay of Needed Care
    Southwest Rural Health Research Center
     This project examines rural versus urban differences in the prevalence, incidence, stage, and severity of several chronic diseases, including heart disease, stroke, and selected cancers. There is a focus on delayed access to needed care and whether rural residents present later and with more advanced disease states.
  • Substance Use, Depression, and Suicide: What Are the Individual and Policy-Modifiable Correlates amongst Metropolitan and Non-metropolitan Adults?
    Rural and Underserved Health Research Center
     We will estimate the prevalence of depression and suicidal ideation and attempts amongst metropolitan and non-metropolitan adults nationally. We will also investigate how demographic, social, economic, and health (including alcohol and drug abuse) as well as healthcare access factors explain depression and suicide indicators amongst residents.
  • The Rural MACRA Experience
    RUPRI Center for Rural Health Policy Analysis
     The Rural MACRA Experience project will study rural effects of the new Medicare Quality Payment Program (QPP) implementation and operation. Rural QPP effects may include provider eligibility, program preparation and data collection challenges, data analysis bias, and differential fiscal impact.
  • The Rural/Urban Impact of Insurance Coverage Changes
    RUPRI Center for Rural Health Policy Analysis
     We will examine the impacts of changes in health insurance coverage during the last several years on use of health services and health outcomes separately for rural and urban areas. Due to differences in demand and supply level factors, we hypothesize that the effects of coverage changes differ by rural/urban status.
  • Understanding Differences in Rural and Urban Adolescent and Young Adult Substance Use
    Maine Rural Health Research Center
     Using National Survey of Drug Use and Health data, we’ll examine rural-urban adolescent/young adult substance use differences. While substance use has declined among all adolescents in recent years, it’s unclear whether the trends apply to rural adolescents/young adults who have historically higher substance use rates than their urban counterparts.
  • Who Provides Mental Health Services to Rural Medicare Beneficiaries?
    WWAMI Rural Health Research Center
     Most rural counties do not have a psychiatrist to care for the common conditions of depression or anxiety. This study will describe the provider workforce that cares for rural elderly patients with depression/anxiety, including regional and rural-urban variations in mental healthcare provision.
  • Women, Infants, and Children (WIC) 2009 Food Package Revisions on Participants in Rural Areas with Extreme Poverty Levels: Impact on Infant Breastfeeding, Infant Feeding, and Health Outcomes
    Southwest Rural Health Research Center
     This study examines the effects of the revised Women, Infants, and Children (WIC) Program food packages on breastfeeding rates among WIC participants in areas designated as rural, with high levels of extreme poverty and food deserts, and/or high rates of those who are overweight and obese.

Projects Funded April 2017 - (1)

Projects Funded September 2016 - (9)

  • Analysis of Trends in Characteristics of Rural Beneficiaries Enrolling in Medicare Advantage Plans
    RUPRI Center for Rural Health Policy Analysis
     This study will compare characteristics of rural and urban beneficiaries enrolling in Medicare Advantage (MA) plans, including their age, health status, income, and race/ethnicity. We will analyze the consequences of increasing use, promoted by policy choices, of a market-based approach in the Medicare program.
  • Assessing Potential Unmet Need for Home Healthcare in Rural Areas
    WWAMI Rural Health Research Center
     This study will estimate potential unmet need for home healthcare in rural areas for fee-for-service Medicare beneficiaries. We will compare rates of home healthcare utilization in rural areas with urban areas, accounting for acute hospital discharges and utilization of inpatient rehabilitation facilities and skilled nursing facilities.
  • Geographic Access to Healthcare for Rural Medicare Beneficiaries: An Update and National Look
    WWAMI Rural Health Research Center
     This objective of this study is to compare, at a national and census division level, where rural and urban Medicare beneficiaries receive ambulatory care, which types of specialists they utilize and how far beneficiaries are traveling to obtain care.
  • Healthcare Use and Access Among Rural & Urban Non-elderly Disabled Medicare Beneficiaries
    Maine Rural Health Research Center
     This project will explore healthcare use and barriers to healthcare access among disabled Medicare beneficiaries under 65 in rural and urban areas. The study will be based on quantitative analyses of the 2009-2013 Medicare Current Beneficiary Survey.
  • How Rural Communities Respond and Recover after a Hospital Closure
    North Carolina Rural Health Research and Policy Analysis Center
     Current rates of rural hospital closures are the highest seen in the last few decades. What can we learn from the experiences of communities experiencing hospital closures?
  • Identification of High-Need Rural Counties Lacking an FQHC Presence
    Rural and Minority Health Research Center
     Federally Qualified Health Centers (FQHCs) have been key safety net providers since the program was initiated. However, many rural communities lack this resource. Expanding on the index of relative rural deprivation developed by the SCRHRC, we will identify high-need rural counties that currently are not served by an FQHC or similar provider.
  • Impact of the Opioid Crisis on Rural Emergency Departments
    Maine Rural Health Research Center
     This study will use data from the Nationwide Emergency Department Sample and information from a panel of rural emergency care experts to assess the impact of the opioid crisis on rural emergency departments. Findings will inform policies designed to help rural healthcare systems and communities address the growing problem of opioid abuse.
  • Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Provider Experience and Provision of Evidence-based Care
    WWAMI Rural Health Research Center
     This study will describe the relationship between prehospital emergency medical services (EMS) providers’ accumulated experience and provision of evidence-based care for rural and urban populations using newly available data on EMS agencies, personnel, and patient care.
  • What Makes Successful Rural Accountable Care Organizations Successful?
    RUPRI Center for Rural Health Policy Analysis
     The U.S. Department of Health and Human Services plans to shift at least 50% of traditional Medicare spending into alternative payment models by 2018. Accountable Care Organizations (ACOs) represent a popular model in both the Medicare and Medicaid programs. This study used multiple methods to find what makes a successful ACO.

Projects Funded September 2015 - (6)

  • Cost of Running a Rural Ambulance Service
    North Dakota and NORC Rural Health Reform Policy Research Center
     This study will address the cost of running ambulance services in rural areas by organizational structure/source of funding, the factors contributing to differences in costs, and factors contributing to differences in financial viability.
  • Diverging Populations Served by the Medicare Home Health Benefit: Comparison of Post-acute vs. Community-entry Home Health in Rural Areas
    WWAMI Rural Health Research Center
     This study will examine differences between rural, fee-for-service Medicare beneficiaries who are admitted to home health from the community (community-entry) and those who are admitted to home health following an inpatient stay (post-acute) in terms of their clinical and non-clinical characteristics as well as the communities in which they live.
  • Rural Health Clinic Financial Performance and Productivity
    Maine Rural Health Research Center
     This study will use Medicare cost reports for independent and provider-based clinics to provide a detailed national picture of the financial and operational performance of RHCs and describe variations in performance related to revenue, costs, staffing, payer mix, productivity levels, and hours of operation across independent and provider-based clinics. The project will also develop measures that can be used to benchmark RHC performance over time.
  • Social Determinants of Health Among Minority Populations in Rural America
    Rural and Minority Health Research Center
     This project will compile information from the U.S. Census, the Area Health Resource File, and the Robert Wood Johnson Foundation County Rankings data set into a comprehensive summary of key social determinants of health among rural populations: demographic characteristics, economic characteristics, health facility availability, and selected health outcomes.
  • Understanding Rural-Urban Mortality Differences
    Maine Rural Health Research Center
     This study will address rural-urban mortality gaps in our understanding of rural mortality disparities using the 1985-2009 National Health Interview Survey (NHIS), linked to national death certificate data, to explore the individual-level characteristics and health behaviors of rural and urban adults and their association with mortality.
  • Use of Telehealth Services Among Rural Medicaid Enrollees: A Baseline Inventory
    Rural Telehealth Research Center
     Uses data from the Medicaid Analytic Extract (MAX) for 2011 to create a 50-state, baseline inventory of telehealth services provided to Medicaid enrollees in rural and urban settings. Provides important information on the feasibility of using MAX data to study the effects of Medicaid telehealth policies.

Projects Funded September 2014 - (5)

  • Comparisons of Rural Definitions
    North Dakota and NORC Rural Health Reform Policy Research Center
     This project will lead to the creation of a mega rural and frontier website. This website will emphasize the use of various rural definitions and datasets for health care policy, policy analysis, and research.
  • Critical Review and Analysis Regarding PCSAs, HPSA Rational Service Areas, and Other: Geographic Alternatives for Creating Useful Primary Care Service Areas
    North Dakota and NORC Rural Health Reform Policy Research Center
     The purpose of this proposed project is to review Dartmouth’s Primary Care Service Areas (PCSAs), other Rational Service Area (RSA) methodologies, and alternative methodologies related to their strengths, weaknesses, and spatial analytic criteria regarding their ability to serve in the process of developing useful primary care service areas. The project will include normative service areas where in a primary care service area should exist (potential service area) but does not (e.g., large area/population with no providers that could support them).
  • Exploring Global Budgets as a New Reimbursement Model for Low-Volume Critical Access Hospitals
    North Dakota and NORC Rural Health Reform Policy Research Center
     Given the complexity of the Global Budget reimbursement model, we are interested to learn if there are aspects of the model that can be applied to consolidate reimbursement across rural and frontier health care settings, particularly for CAHs with low-volume (e.g., < 5 acute patients as a daily census).
  • 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.
  • What Impact Will Unified GME Accreditation Have on Rural-focused Physician Residencies
    WWAMI Rural Health Research Center
     The impending unification of allopathic and osteopathic graduate medical education (GME) under a single accreditation system has uncertain implications for small and rural-focused residency programs. This proposed study aims to (1) quantify the rural practice outcomes of residencies in rurally-relevant specialties such as pediatrics, internal medicine, obstetrics/gynecology, emergency medicine, surgery, anesthesia, and psychiatry, and (2) interview key stakeholders to identify anticipated challenges of the accreditation merger and potential policies to strengthen vulnerable rural-focused residencies during the transition.

Projects Funded September 2013 - (3)

  • Rural End-of-Life Care: An Analysis of Rural Medicare Beneficiaries’ Health Care Costs, Utilization, and Patient-Centered Decisions
    North Dakota and NORC Rural Health Reform Policy Research Center
     This research examines the costs and types of care that rural Medicare beneficiaries use during their last six months of life. In addition, to learn how patient-centered decisions are made regarding health care transitions at the end-of-life, interview were conducted with rural providers and families.
  • Rural Hospice Surveys Regarding Family Members & Health Workforce
    North Dakota and NORC Rural Health Reform Policy Research Center
     This project’s two parts survey both hospice users’ family members and hospice CEOs regarding their health workforce staffing and shortages. The family member survey involves a sample of hospices from a geographically disperse group of states and the CEO survey involves a national random sample of hospice CEOs.
  • Utilization of Hospital Care for Rural Medicare Beneficiaries
    North Dakota and NORC Rural Health Reform Policy Research Center
     This project examines where rural and frontier Medicare beneficiaries access hospital care. Specifically, it explores the different types of inpatient care sought in local rural communities and at tertiary providers. Beneficiary patterns of care by condition, location type and other factors will be examined. The study will also focus on the bypassing behavior of rural residents when being hospitalized. Analysis sensitivity analyses are being performed regarding small travel time differences per alternative hospitals.

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.

Projects Funded September 2009 - (1)