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 2019 - (31)

  • A Current Examination of HIV and Hepatitis C in Rural Counties
    Maine Rural Health Research Center
     Using data from federal and state sources, we will produce a chartbook on county-level data on human immunodeficiency virus (HIV) prevalence and acute hepatitis C virus (HCV) incidence, examine the availability of Ryan White HIV/AIDS medical providers and other HIV and HCV treatment/testing services across the rural-urban continuum, and estimate county-level prevalence of maternal HCV infection.
  • Cancer Prevention and Control Activities in Rural Hospitals
    Rural and Minority Health Research Center
     This project aims to understand how rural hospitals perceive and implement evidence-based cancer screening and treatment and related intervention strategies.
  • Change in Service Provision at Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     The purpose of this study is to compare the services offered by rural hospitals (to urban hospitals) over time (2009-2017) and among rural hospitals of different size, region, rurality, and payment type.
  • Community Context and Rural Strategies to Support the Oldest Old
    University of Minnesota Rural Health Research Center
     This project will develop a chartbook profiling older adults (65 and older) in rural areas and assess where rural residents ages 85 and older are most likely to live, what rural counties have experienced the fastest growth of those 85 and older, and what strategies are in place or are possible for supporting this population in aging in place.
  • Continuing Data Collection on a Common Set of Measures for the School-Based TNGP Grantees
    Rural Telehealth Research Center
     The primary purpose of this project is to continue data collection from School-Based Telehealth Network Grant Program (SB TNGP) grantees to evaluate school-based telehealth using a common set of measures that will help build the evidence base and inform future policy changes and sustainability efforts.
  • Decline in Inpatient Volume at Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     The purpose of this study is to compare the decline in inpatient volume of rural hospitals to urban hospitals and among rural hospitals of different size, region, rurality, and payment type.
  • Emergency Obstetrics in Communities Without Hospital-Based Maternity Care
    University of Minnesota Rural Health Research Center
     The purpose of this project is to describe rural hospitals that do not provide obstetric services and to survey a sample of these hospitals regarding their capacity for emergency obstetrics locally in order to inform policy to support access to high-quality maternity care for all pregnant rural residents.
  • Examining the Potential Impact of Multiple Payment Policies on Rural Versus Urban Home Health Agencies
    WWAMI Rural Health Research Center
     This study estimates the impact of three recent and upcoming Medicare home health payment policies (revised rural add-on payments, new prospective payment system, and value-based purchasing demonstration) on reimbursement for home health agencies based on rural-urban status, community factors, and home health agency characteristics.
  • Financial Risk Assumption Among Rural Healthcare Providers
    RUPRI Center for Rural Health Policy Analysis
     This project will assess rural/urban providers' participation in different payment models and assumption of financial risk in the Medicare Quality Payment Program. We will conduct qualitative interviews to examine rural providers' motivations and preparedness for participating in different risk-bearing payment models.
  • How Medicare Payment Standardization Affects the Perceived "Cost" of Post-Acute Care Provided in Critical Access Hospital Swing Beds
    North Carolina Rural Health Research and Policy Analysis Center
     Medicare-allowed charges are adjusted for geographic cost differences and payments that support larger Medicare program goals. This study aims to identify the effects of the payment standardization method on the perceived "cost" of post-acute care provided in Critical Access Hospital swing beds.
  • Investigating Differences in School-Based Telehealth Implementation and Services in the School-Based TNGP Grantees
    Rural Telehealth Research Center
     The principal goal of this project is to gather contextual information from School-Based Telehealth Network Grant Program (SB TNGP) grantees regarding project design and implementation, and the practicalities of delivering telehealth services in school settings that will help explain the heterogeneity found in the data across the grantees.
  • Launching Data Collection on a Common Set of Measures for the EB THNP and SAT TNGP Grantees
    Rural Telehealth Research Center
     The primary purpose of this project is to launch data collection among Evidence-Based Tele-Behavioral Health Network Program (EB THNP) and Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) grantees on a common set of measures.
  • Living Alone: Rural-Urban Differences in Prevalence, Socio-Demographic Correlates, and Health Needs Across the Lifespan
    University of Minnesota Rural Health Research Center
     This project's purpose is to document rural-urban differences in the prevalence of living alone across different age groups, describe rural-urban differences in the socio-demographic correlates and health needs of individuals living alone, and identify rural-relevant policies and programs to support rural residents living alone across the lifespan.
  • Longitudinal Trends in Community Mental Health Center and Federally Qualified Health Center Supply in Nonmetropolitan and Metropolitan Counties
    Rural and Underserved Health Research Center
     This study will describe how the supply of community mental health centers and Federally Qualified Health Centers has changed over time in nonmetropolitan and metropolitan counties nationally.
  • Making It Work: Models of Success in Rural Maternity Care
    University of Minnesota Rural Health Research Center
     The purpose of this project is to update information on access to obstetric services in rural counties, to identify common factors across rural communities that have maintained local hospital-based obstetric services, and to describe best practices associated with successfully supporting birth locally in rural communities.
  • Planning and Pilot Testing of Evidence-Based Cancer Prevention and Control Interventions with Rural Health Clinics
    Rural and Minority Health Research Center
     This project will leverage growing collaborative efforts between the Rural and Minority Health Research Center, South Carolina Office of Rural Health, South Carolina Primary Health Care Association, and Center for Rural and Primary Healthcare to assess and improve cancer prevention and control among rural South Carolina residents.
  • Predictors and Barriers to Achieving Immunization in Rural and Urban Areas
    Southwest Rural Health Research Center
     Prenatal and timely childhood immunizations offer the optimal strategy for preventing severe morbidity and mortality due to vaccine-preventable disease. This project will evaluate possible gaps in immunization services for pregnant women and their infants in rural areas as compared to urban areas.
  • Prevalence of Opioid Prescribing, Diagnoses of Opioid Use Disorder, Treatment Patterns, and Costs Among Rural Medicare Beneficiaries
    Maine Rural Health Research Center
     Opioid use disorder (OUD) diagnoses among the aged and disabled are among the highest and fastest growing. This study uses the 2010-2017 Medicare Current Beneficiary Survey to examine opioid prescribing rates and explore risk factors associated with OUDs and associated treatment patterns and costs within rural and urban Medicare populations.
  • Risky Substance Use Among Adolescents and Adults in Nonmetropolitan and Metropolitan Counties
    Rural and Underserved Health Research Center
     Little research has examined the prevalence of risky substance use (alcohol and drugs) among nonmetropolitan adolescents and adults relative to their metropolitan counterparts. Using nationally representative data, this project will shed new light on the prevalence and correlates of risky substance use that could inform prevention strategies.
  • Rural Nursing Home Closures - Trends, Characteristics, and Impact on Access
    RUPRI Center for Rural Health Policy Analysis
     This project will build a database of nursing home closures across rural and urban areas in the U.S. and evaluate the changes in access to post-acute and/or long-term care providers. We will also describe the differences in organizational, financial, and market characteristics between open vs. closed nursing homes in rural vs. urban areas.
  • Rural Variation in Access to Naloxone for Opioid Overdose Prevention
    Rural and Underserved Health Research Center
     This project examines variability in access to naloxone-based metropolitan/nonmetropolitan dispensing counts from a representative sample of outpatient pharmacies across the U.S.
  • 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.
  • Telehealth for Heart Attack and Stroke in Rural Hospitals
    Rural Telehealth Research Center
     The primary purpose of this project is to examine telehealth for heart attack and stroke in national samples of hospitals by reviewing trends and factors in adoption of these telehealth services and implementation strategies across levels of rurality.
  • The Availability of Optional Benefits in Medicare Advantage (MA) Plans in Rural and Urban Areas and the Implications for MA Payment Policy
    RUPRI Center for Rural Health Policy Analysis
     Enrollment and landscape files containing data regarding Medicare Advantage plan activities by county will be used to describe the geographic differences in what is available to beneficiaries in benefit design and total out-of-pocket liability. Findings may reveal potential for policy actions to address equity of benefits and cost to beneficiaries.
  • The Current Distribution of the General Surgery Workforce in Rural America
    WWAMI Rural Health Research Center
     This project describes the current national supply and distribution of general surgeons in rural vs. urban areas of the United States as well as geographic variability in the supply of general surgeons across the rural/urban and intra-rural dimensions at the regional level.
  • The Geographic Expansion of Medicaid MCOs
    RUPRI Center for Rural Health Policy Analysis
     This project characterizes the counties into which Medicaid Managed Care Organizations (MCOs) expanded in 2012-18, focusing on population and provider density, sociodemographics, and health indicators. We assess the extent to which MCO geographic expansion occurred in compliance with previous network adequacy standards and evaluate how well MCOs are performing in rural areas.
  • Trends and Predictors of Human Immunodeficiency Virus (HIV) in Light of the Opioid Crisis Along the Urban-Rural Continuum
    Southwest Rural Health Research Center
     This project will explore trends in the burden of HIV and predictors of HIV-related mortality and morbidity. The study will examine how the opioid crisis has changed the nature of the burden of HIV, especially considering differential disease burdens between residents of rural areas relative to their urban counterparts.
  • Trends in Preterm Birth by Rural Status in the U.S.
    Southwest Rural Health Research Center
     This project will determine rates of preterm birth by rural versus urban residence and across census regions. The project will also examine the relationship between preterm birth and maternal characteristics, including race and ethnicity as well as pregnancy complications among women in rural versus urban residence.
  • Understanding Rural Non-Emergent Emergency Department Use
    Maine Rural Health Research Center
     Research shows rural residents use emergency departments (ED) at higher rates than urban residents. Other studies suggest rural residents are more likely to visit the ED for a non-emergent reasons. This study uses the 2014-17 Medical Expenditure Panel Survey to analyze factors associated with rural versus urban residents' non-emergent use of EDs.
  • Variations in Travel Burdens Associated with Access to Care Between Rural and Urban Residents
    Southwest Rural Health Research Center
     This project will focus on geographic access to medical and dental care, recognizing that travel time and distances can hinder individuals from obtaining necessary care. The study will explore the travel time and distances to care for specific sub-populations and in specific geographic settings, particularly urban versus rural residence and region.
  • What Is the Geographic Distribution of the Workforce with a DEA Waiver to Prescribe Buprenorphine?
    WWAMI Rural Health Research Center
     This project updates statistics on the supply of providers (physicians, nurse practitioners and physician assistants) with a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine and examine supply trends over time and also establishes baseline numbers of other eligible providers (e.g., midwives, clinical nurse specialists).

Projects Funded September 2018 - (15)

  • 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.
  • 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.
  • 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.
  • 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+.
  • 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.
  • 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.
  • 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 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.
  • 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.
  • 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 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.

Projects Funded September 2017 - (11)

  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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 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-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.
  • 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.

Projects Funded September 2016 - (5)

  • 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.
  • 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 2014 - (1)

  • 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.

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.