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Rural Health
Research Gateway

Current Research Projects

Browse all of the research projects still underway. Learn more about the research questions guiding each study, the lead researcher for each, and when the Research Center anticipates releasing completed product(s) under each project. Current projects are listed by the date they were funded by the Federal Office of Rural Healthy Policy. You can also access a list of all previously completed research projects, by date.

Projects Funded September 2024 - (32)

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

Projects Funded September 2023 - (38)

Projects Funded September 2022 - (14)

  • "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 the workforce is distributed, and gaps in service 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, Care Practices, and Quality of Hospice Providers Serving Rural versus Urban Communities
    WWAMI Rural Health Research Center
     This project will examine differences in availability of hospice care in rural versus urban communities as well as provider-level quality and care practices by rural-urban status of hospices. Findings will highlight potential rural-urban disparities in hospice care that can be used to inform future Medicare policy.
  • Changes in Medicare Fee-for-Services Health Care Expenditures in Rural and Urban Communities after Passage of the Affordable Care Act
    University of South Carolina Rural Health Research Center
     This project will assess changes in Medicare per-beneficiary spending across rural and urban counties from 2007 to 2020. It will examine differences in rural versus urban per-beneficiary spending on hospital inpatient, hospital outpatient, physician, and post-acute care after the Affordable Care Act (ACA).
  • Postpartum Morbidity and Mortality and Health Care Utilization in Rural vs. Urban Communities
    University of Minnesota Rural Health Research Center
     Using 2006-2018 data from the National Health Interview Survey linked to the National Death Index through 2019, this project will examine postpartum mortality among rural and urban residents. We will also evaluate differences in health, health care utilization, and barriers to care across rural and urban communities.
  • Review of Current Research on Rural/Urban Differences in Social Drivers of Health
    Rural and Underserved Health Research Center
     Social drivers 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 drivers of health, culminating in a comprehensive report that includes a summary of information gaps and further research needs.
  • Rural-based Accountable Care Organizations Accepting Downside Risk
    RUPRI Center for Rural Health Policy Analysis
     The RUPRI Center will update its studies of rural provider participation in accountable care organizations, including differences between those who exit the program, those who remain, and those who enter. In particular, this project will address participation decisions made after a rule change in July 2019 that requires conversion to two-sided risk.
  • Rural/Urban Differences in Forgoing Health Care During the COVID-19 Pandemic
    ETSU/NORC Rural Health Research Center
     Several surveys conducted during the COVID-19 pandemic showed that adults delayed or skipped healthcare services during the initial months of the COVID-19 pandemic. This study examines changes in healthcare utilization for primary and preventative care among rural and urban Medicare fee-for-service enrollees since the COVID-19 pandemic.
  • Socioeconomic Profiles and Market Characteristics Associated with Ambulance Deserts
    Maine Rural Health Research Center
     We will address the extent to which vulnerable, aging populations live in ambulance deserts and identify ambulance desert populations facing additional barriers to healthcare access. We will also assess the impact of hospital closures on travel distances to the nearest health care facilities.
  • Understanding Rural Health Data Challenges Through Analysis of Peer-Reviewed Publication Limitations
    ETSU/NORC Rural Health Research Center
     This project will quantify and characterize health data-related limitations commonly identified in published studies on rural health and ways in which researchers overcome these challenges. Findings will provide a rigorous description of rural health data challenges, which may be used by researchers, policymakers, and rural health data collectors to improve rural data and research using rural data.
  • Unmet Health and Social Needs of Rural Residents with Disability
    Maine Rural Health Research Center
     We will assess rural-urban differences in access to health care and social well-being 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 - (10)

  • A Closer Examination of Rural Hospital Bypass
    ETSU/NORC Rural Health Research Center
     This project will estimate the rural hospital bypass rate using all-payer claims data for a set of states and compare patients based on the inpatient treatments and procedures received relative to those routinely provided by rural facilities.
  • Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents: Exploring Changes in the Past 15 Years
    WWAMI Rural Health Research Center
     This project will describe the national supply of the rural and urban dental workforce and investigate whether rural adults, compared to urban adults, report lower dental care utilization, higher prevalence of dental disease or both. This study will also look at whether disparities in oral health care and supply have changed over the past 15 years.
  • 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 of the practice.
  • 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.
  • 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 well-being of rural Americans living in poverty.
  • Screening, Brief Intervention and Referral to Treatment (SBIRT) Penetration in Rural vs. Urban Healthcare Settings in the U.S.
    ETSU/NORC Rural Health Research Center
     This study will include an analysis of 2018/2019 Medicare, Medicaid and Commercial claims to compare the penetration of Screening, Brief Intervention and Referral to Treatment (SBIRT) and its different components in rural compared to urban healthcare settings. Within the overarching analysis, the study team will examine the type of interventions conducted within the SBIRT framework stratified by provider type, healthcare setting, and rural and urban provider ZIP codes. Findings will be analyzed within the context of county-level substance use rates, historical enactment of state SBIRT billing codes, overdoses, and alcohol poisoning-based hospital admissions contrasting trends in SBIRT administration with a proxy for community need.
  • Specialist Physicians in the Rural and Urban U.S.: Supply, Distribution, and Access
    WWAMI Rural Health Research Center
     This project will describe the geographic distribution (rural/urban, regional, and intra-rural) of specialist physicians who care for patients experiencing conditions that account for the top four leading causes of rural mortality. It will also explore how patients in rural communities that lack these specialists obtain needed care.
  • Third Party Negotiated Pricing in Rural and Urban Hospitals
    Rural and Underserved Health Research Center
     We will use third party negotiated pricing information to compare prices in urban and rural hospitals, across a variety of common services. Because there has been poor compliance with the Centers for Medicare & Medicaid Services (CMS) requirement to publish third party negotiated pricing, we will also examine if the availability of this information differs for rural and urban hospitals.
  • Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder and Medicaid Insurance Across the U.S.
    WWAMI Rural Health Research Center
     This project will analyze Medicaid claims data to compare the treatment that rural and urban patients with opioid use disorder receive, documenting the workforce providing care, the distance that patients travel to receive care, and the cost of care. Findings from this study can be used to improve policies regarding opioid use disorder treatment.

Projects Funded September 2020 - (5)

Projects Funded September 2019 - (2)

  • 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.
  • 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)

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.