Current Projects from All Research Centers

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.

• September 2018 - (34)
• September 2017 - (25)
• April 2017 - (1)
• September 2016 - (8)
• September 2015 - (4)
• September 2014 - (4)
• September 2013 - (3)
• September 2012 - (1)
• September 2009 - (1)

Projects Funded September 2018 - (34)

• Access to Care for Rural Medicare Beneficiaries
  University of Minnesota Rural Health Research Center
  This project will examine multiple dimensions of access to care, with a focus on rural Medicare beneficiaries, including rural-urban differences in access to care, and within-rural differences in access to care by region, coverage type (traditional fee-for-service vs. supplemental Medigap coverage), and socio-demographic characteristics.
  
• Analyzing Data from the Evidence-Based Telehealth Network Grant Program Grantees and Preparing Manuscripts to Further the Evidence Base for Tele-ED
  Rural Telehealth Research Center
  This project’s main purpose is to analyze data gathered from Evidence-Based Tele-Emergency Network Grant Program grantees on all of their cases using telehealth in the emergency department (tele-ED) and a matched sample of non-tele-ED records to conduct comparative effectiveness analysis to help establish the evidence base for tele-ED.
  
• Capacity of Rural Counties to Respond to an HIV or Hepatitis C Outbreak
  Maine Rural Health Research Center
  Rural counties may be potentially vulnerable to an HIV or Hepatitis C outbreak among persons who inject drugs. Using mixed methods, we will provide an understanding of the rural areas at risk of an outbreak based on their state and county characteristics and an assessment of their public health infrastructure.
  
• Changes in Care-Seeking After Rural Hospitals Merge
  North Carolina Rural Health Research and Policy Analysis Center
  This project seeks to understand how mergers affect the inpatient care-seeking of markets served by merging hospitals.
  
• Community Health Worker Roles, Regulation and Growth in Rural America
  Southwest Rural Health Research Center
  This study looks at the role of Community Health Workers in improving access to healthcare services in rural and urban environments. Our project focuses on the growing and changing roles of these influential actors and how their responsibilities vary based on setting (hospital, clinic, community, etc.), location (rural vs. urban), and regulations.
  
• Current and Longer Term Challenges of Rural Hospitals: A Survey of Rural Hospital Executives
  North Carolina Rural Health Research and Policy Analysis Center
  This project involves surveying rural hospital executives about how they will respond to current and long-term challenges related to financial and regulatory burdens.
  
• Developing Rural-Relevant Strategies to Reduce Maternal Morbidity
  University of Minnesota Rural Health Research Center
  The purpose of this project is to distinguish and analyze predictors of maternal morbidity during childbirth hospitalization by geography and to develop recommendations to improve the safety of childbirth for rural residents. It will also assess the degree of rural focus and representation in current policy efforts to address this crisis.
  
• Disaster Planning, Preparedness, & Response for Rural Long-Term Care Providers
  Southwest Rural Health Research Center
  This project will collect and analyze data that captures how disasters affect long-term care services and patient experiences in rural areas. We will develop and pilot test long-term care provider survey, and conduct case studies of disaster-impacted, rural communities with respect to implications for long-term care services.
  
• Disparities in Preventive Care by Race and Ethnicity Among Rural Adults
  University of Minnesota Rural Health Research Center
  The purpose of this project is to identify differences in access to and use of preventive care by race and ethnicity among rural residents. Results from this project will identify racial/ethnic disparities that exist within rural communities and may guide targeted interventions to improve equity and increase access to high-quality healthcare for all rural residents.
  
• Establishing a Common Set of Measures for Tele-Behavioral Health and Tele-Substance Abuse
  Rural Telehealth Research Center
  The primary purpose of this project will be to establish data collection protocols and tools for use in a cross-grantee evaluation of the Evidence-Based Tele-Behavioral Health Network Program.
  
• Financial Impact of Reimbursing CAH Swing Bed Days at the SNF PPS Rate
  North Carolina Rural Health Research and Policy Analysis Center
  This study will assess the financial impact of changing Critical Access Hospital (CAH) swing bed reimbursement from the cost-based system to the skilled nursing facility (SNF) prospective payment system (PPS).
  
• Healthcare Use and Expenditures among Rural and Urban Medicare Beneficiaries Aged 85 and Over
  Maine Rural Health Research Center
  The proportion of U.S. residents ages 85+ is expected to grow substantially in the coming decades with the impact of this growth in rural areas likely to be pronounced. This project will use data from the Medicare Current Beneficiary Survey to examine rural-urban differences in healthcare use and expenditures among Medicare enrollees ages 85+.
  
• How Well are We Doing Meeting Healthy People 2020 Mortality Objectives at Midterm? Rural v. Urban Differences
  Southwest Rural Health Research Center
  The purpose of this project is to conduct a midterm examination of urban versus rural disparities in meeting Healthy People 2020 mortality objectives for the top 10 leading causes of death in the U.S. utilizing existing secondary databases.
  
• Impact of Capping Medicare Disproportionate Share Hospital Payments on Rural Hospitals
  RUPRI Center for Rural Health Policy Analysis
  Rural hospitals receiving Medicare prospective payment system payment and receiving disproportionate share hospital payments are subject to a 12% cap on those payments. This project will provide information on the number and location of rural hospitals subject to this cap and the fiscal impact.
  
• Launching Data Collection on a Common Set of Measures for the School-Based Telehealth Network Grant Program Evaluation
  Rural Telehealth Research Center
  The primary purpose of this project will be to launch data collection from School-Based Telehealth Network Grant Program grantees using an Excel-based data collection tool, to perform regular quality checks and data management activities, and to begin descriptive statistical analysis.
  
• Medicare Beneficiaries' Access to Preventive Services: Diabetes Self-Management Training, Medical Nutrition Therapy, and Health and Behavior Assessment and Intervention
  Rural and Underserved Health Research Center
  Medicare offers preventive services focused on self-management through several programs: Diabetes Self-Management Training, Medical Nutrition Therapy, and Health and Behavior Assessment and Intervention.
  
• Medicare Beneficiary Access to Prescription Drugs Under Part D
  RUPRI Center for Rural Health Policy Analysis
  This study will build on RUPRI Center work describing patterns of enrollment into Medicare Part D plans (including access to zero deductible plans) by using transaction files to analyze how medications are actually acquired and implications for access to local pharmacy services.
  
• Patterns of Inpatient Care-Seeking by Rural Residents
  North Carolina Rural Health Research and Policy Analysis Center
  This study seeks to gain an understanding of inpatient care-seeking behavior by rural residents to provide insight into drivers of bypass rates, the extent to which a community uses a hospital other than its local rural hospital.
  
• Post-acute Care Quality for Rural Medicare Beneficiaries
  WWAMI Rural Health Research Center
  This study will examine rural post-acute care quality for rural Medicare beneficiaries and potential disparities in post-acute care between urban and rural providers. Publicly reported quality measures for rural skilled nursing facilities and home health agencies will be compared with state and national averages as well as urban providers.
  
• Promotion of Rural Health Research Center Attendance at Cancer-Related Meetings
  Rural and Minority Health Research Center
  This project will promote attendance at cancer-related meetings by Rural Health Research Centers by facilitating the dissemination of information regarding important cancer meetings and handling the travel arrangements for Rural Health Research Center personnel.
  
• 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.
  
• Rural and Urban Differences in Access to Psychiatric Partial Hospitalization Programs
  Rural and Underserved Health Research Center
  The project will inform policymakers about the accessibility of psychiatric partial hospitalization programs, which provide moderately intensive and structured psychiatric services in outpatient settings, particularly hospital-based outpatient clinics.
  
• Rural and Urban Sources of Insurance Coverage: the Role of Public and Private Coverage over Time
  RUPRI Center for Rural Health Policy Analysis
  We will estimate the percent of rural residents obtaining insurance coverage under each of the major options available to them using multiple data sets and a methodology that accounts for multiple sources of coverage. We will compare rural and urban coverage sources and changes in coverage over time.
  
• Rural Colon and Cervical Cancer Environmental Scan
  Rural and Minority Health Research Center
  Detailed research is needed to provide a complex, textured picture of rural healthcare and the ways in which existing federally supported providers can provide adequate services across the continuum of cancer care from prevention through survivorship.
  
• Rural Versus Urban Prevalence of Intimate Partner Violence
  Southwest Rural Health Research Center
  This project will determine rural-urban disparities in the prevalence of intimate partner violence-related hospitalizations using a national representative sample of hospital admissions for the period between 2009-2014 using data from the national Healthcare Cost and Utilization Project.
  
• Serious Mental Illness and Access to Care among Rural and Urban Adults
  Rural and Underserved Health Research Center
  Very little research has examined the prevalence of serious mental illness and access to mental health treatment among rural relative to urban adults in the U.S. Using nationally representative data, this project will shed new light on the prevalence and correlates of serious mental illness and related access to mental health services.
  
• Team-Based Primary Care in Rural Communities
  University of Minnesota Rural Health Research Center
  This project will describe primary care practice structure in rural communities and quantify characteristics of primary care teams associated with high-quality care.
  
• The Association of Occupation with Mental Illnesses and Death by Suicide
  Rural and Underserved Health Research Center
  This study examines the association of occupational risk factors with mental illnesses, all-cause mortality, and suicide.
  
• The Supply and Distribution of the Primary Care Health Workforce in Rural America
  WWAMI Rural Health Research Center
  This study will describe the supply and distribution of primary care providers in the rural U.S. at national, regional, and state levels using the most recent data available. Primary care health professionals include family physicians, general practitioners, general internists, pediatricians, nurse practitioners, and physician assistants.
  
• The Supply and Rural-Urban Distribution of the Obstetrical Care Workforce in the U.S.
  WWAMI Rural Health Research Center
  This project will use multiple data sources to characterize the distribution of the obstetrical care workforce in the U.S., comparing health professional-to-population ratios in rural and urban areas. Health professionals examined in this study include obstetricians, family physicians, and certified nurse midwives.
  
• Tobacco Treatment in Rural Primary Care
  Maine Rural Health Research Center
  This study will use the National Ambulatory Medical Care Survey to compare rural and urban rates and predictors of tobacco counseling and tobacco treatment medication prescribing by primary care providers to their smoking patients.
  
• Understanding the Prescribing Practices of Rural Nurse Practitioners and Physician Assistants with a DEA Waiver to Prescribe Buprenorphine
  WWAMI Rural Health Research Center
  This study will investigate the extent to which nurse practitioners and physician assistants who practice in rural areas and have a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine as an office-based outpatient treatment for opioid use disorder are providing this treatment to their patients.
  
• Understanding Trends in Telehealth Use: An All-Payer Analysis in Maine
  Rural Telehealth Research Center
  This project's primary purpose is to use Maine's All-Payer Claims Database and key informant interviews to develop a descriptive overview of telehealth use in Maine, examining how telehealth use has changed over time (2008-2017) among rural and urban patients and providers.
  
• What Factors Influence Rural Hospitals' Participation in Accountable Care Organizations?
  RUPRI Center for Rural Health Policy Analysis
  This project examines rural hospitals' participation in Accountable Care Organizations (ACOs); identifies factors that influence ACO participation; compares whether different factors influence rural/urban hospital participation in ACOs; and analyzes factors influencing Critical Access Hospitals' participation in the Medicare Shared Savings Program.
  

Projects Funded September 2017 - (25)

• 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.
  
• 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.
  
• 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.
  
• 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/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)

• Examining the Legal Landscape in Rural America: Implications for the Healthcare Workforce, Access to Care, and Population Health
  Southwest Rural Health Research Center
  This project explores potential rural/urban differences in the prevalence of malpractice claims, clinical privilege actions, and state licensure actions among health care providers. We will also examine whether variations in nurse practitioner scope of practice laws affect rural residents differentially, especially with respect to preventive care.
  

Projects Funded September 2016 - (8)

• 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 - (4)

• 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.
  
• 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.
  

Projects Funded September 2014 - (4)

• 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 healthcare policy, policy analysis, and research. Additionally, researchers will 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.
  
• 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)

• International Medical Graduates on J-1 and H-1B Visas: Understanding Trends in their Contributions to Health Care Delivery for Rural Underserved Populations
  WWAMI Rural Health Research Center
  This study will identify trends and data needs regarding the contributions of international medical graduates' on J-1 and H-1B visas (IMGs) to rural health care delivery. A workgroup of IMG research and policy stakeholders will be established to help identify IMG supply data trends, needs, and pressing policy issues, lay the groundwork for potential areas of study, data integration and data collection, as well as strengthen the policy-relevance of our work.