Current Projects from All Research Centers

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

Projects Funded 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 - (26)

Are Rural Mothers and Infants Benefitting from Changes in National Women, Infants and Children (WIC) Policy?
Southwest Rural Health Research Center
This study explores breastfeeding practices among rural participants in the Women, Infants and Children (WIC) Program before and after a federal policy change in WIC Food Packages. National Food and Nutrition Survey data will be used to examine potential impact on breastfeeding, infant feeding practices, and food/beverage consumption.
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.
Barriers and Disparities Associated with Pneumococcal Immunization among Rural Elderly Adults
Rural and Underserved Health Research Center
Our Center will conduct analyses of national survey data and unique insurance claims data sets to identify how rurality of residence and key demographic, social, and economic characteristics serve as barriers or facilitators to vaccination against pneumococcal disease, which is relatively common although largely preventable among older Americans.
Collecting and Analyzing Data on a Uniform Set of Measures from the Evidence-Based Telehealth Network Grant Program Grantees
Rural Telehealth Research Center
The primary purpose of this project will be to routinely collect and analyze data on a uniform set of measures reported by the EB TNGP grantees to help establish the evidence base for tele-ED.
Death by a Thousand Cuts: The Cumulative Effect of Reimbursement Cuts on the Financial Distress of Rural Hospitals in 2018
North Carolina Rural Health Research and Policy Analysis Center
This project continues our work with the Financial Distress Index. The objectives of the Financial Distress Index (FDI) are to identify a group of rural hospitals facing an increased closure rate and to evaluate the potential impact drivers of the FDI model may have on the percent of hospitals at high risk of financial distress and closure.
Enrolling the Rural Uninsured: Evidence from Exceptional Rural Health Insurance Marketplaces
RUPRI Center for Rural Health Policy Analysis
The goal of this project is to explain variation in Health Insurance Marketplace (HIM) enrollment rates so that outreach strategies can be improved and public policies amended.
Exploring the Impact of Rural Hospital Closures on use of Emergency Medical Services
Rural and Underserved Health Research Center
Using a unique national database, The Enterprise Data Trust, we will explore pre- and post-closure hospital emergency department use with specific emphasis on those who used public emergency medical transportation, testing for significant changes. This study will be the first to look at the impacts of rural hospital closure at the patient level.
Financial Distress of Rural Hospitals in 2018 after Scheduled Reductions in Medicare DSH and Bad Debt Payment
North Carolina Rural Health Research and Policy Analysis Center
This study will predict the risk of financial distress of rural hospitals in 2018, after planned cuts in Medicare DSH and bad debt payments.
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.
Health Insurance Marketplaces, Medicaid, and Uncompensated Care: The Rural Impact
RUPRI Center for Rural Health Policy Analysis
This project provides an in-depth analysis of Health Insurance Marketplace (HIM) plan design, specifically measuring the availability and prevalence of high-deductible plans in rural as compared to urban areas.
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?
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.
Increasing the Supply of Providers with a Drug Enforcement Agency Waiver to Treat Opioid Addiction in Rural America – Possible Effects of Permitting Physician Assistants and Nurse Practitioners to Prescribe Buprenorphine
WWAMI Rural Health Research Center
This study will investigate the possible effects on rural access to treatment for opioid use disorder if Drug Enforcement Administration (DEA) waivers to prescribe buprenorphine as an office-based outpatient treatment for opioid addiction are available to Physician Assistants (PAs) and Nurse Practitioners (NPs).
Measuring the Quality of Swing-Bed Care in Critical Access Hospitals
University of Minnesota Rural Health Research Center
This project will identify quality measures to be used by Critical Access Hospitals to assess the quality of care provided to their swing-bed patients, and recommend appropriate uses of the measures.
Paving the Way: Addressing Transportation as a Social Determinant of Health for Rural Residents
University of Minnesota Rural Health Research Center
This project will use a mixed-methods design to examine ways in which transportation operates as a social determinant of health for vulnerable rural residents, and to identify exemplar transportation programs that are successfully improving health and well-being of those residents.
Post-Acute Care for Rural Medicare Beneficiaries
North Carolina Rural Health Research and Policy Analysis Center
This project will describe the variation in the volume, mix and financial importance of post-acute services to rural hospitals; identify hospital and community characteristics associated with variation in post-acute services provided by rural hospitals; and determine where rural Medicare beneficiaries receive post-acute services.
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.
Provide Guidance on Measures for the School-Based Telehealth Network Grant Program Evaluation
Rural Telehealth Research Center
RTRC will work cooperatively with FORHP to provide guidance on a set of measures that could be used for a cross-grantee evaluation of the SB TNGP. A secondary goal is to identify lessons learned from this effort that could be useful in designing future TNGP cooperative agreements.
Provision of Skilled Nursing in Rural America: Skilled Nursing Facilities and Swing Beds
Southwest Rural Health Research Center
This project will allow researchers and policy makers to understand the nature of swing bed and skilled nursing facility care provision in rural areas of the U.S. Our national comparison will include indicators such as service mix, length of stay, discharges, volume and census, and certifications and provider characteristics.
Rural Health Clinics Chartbook: Community Characteristics and Financial and Operational Performance
Maine Rural Health Research Center
Rural Health Clinics (RHCs) address geographic access barriers for rural Medicare and Medicaid beneficiaries and, over time, have come to be recognized for their role in serving vulnerable rural populations. This project will produce a comprehensive, descriptive chartbook detailing the characteristics and status of RHCs nationally.
Telestroke Adoption, Cost, and Quality in Hospitals in North Carolina
Rural Telehealth Research Center
Examines hospitals in North Carolina to identify all hospitals serving as a telestroke originating site and compare these structural, market, and community characteristics to hospitals that do not provide telestroke. Examines the influence of telestroke program characteristics and process measures on quality measures and costs.
The Burden of Diabetes in Rural America
Southwest Rural Health Research Center
The purpose of this project is to determine rural versus urban differences in type 2 diabetes prevalence, morbidity and mortality in the U.S. Diabetes complications, disparities and associated demographics are reported. A comparison of Mexican-American border versus non-border states is also included.
The Impact of Medicaid Expansion on Rural/Urban Variations in Access to Substance Use Treatment
Rural and Underserved Health Research Center
Research indicates that substance use treatment access is insufficient in rural areas. We will make use of our rare access to restricted use NSDUH data to offer new insights about the impact of Medicaid expansion on access to substance abuse treatment among individuals with substance abuse disorders, analyzing 13 years (2004-2016).
Variation in Scope of Practice and Medical Services Available at Family Physician Practices within Rural Areas
Rural and Underserved Health Research Center
Using data collected during recertification of family physicians by the American Board of Family Medicine, we will examine variation in the scope of practice of family physicians and services available in the primary practice site by degree of rurality and within rural categories by community-level deprivation, as well as variation by PCMH status.
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. Affordable 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 - (19)

Assessing the Impact of Medicaid Policy Changes
RUPRI Center for Rural Health Policy Analysis
Goals of this project include: 1) clearly articulating the rural considerations in Medicare reform by synthesizing information on the impact of Medicare on rural people, places, and providers; 2) assessing the impact of specific proposals to reform Medicare; and 3) analyzing the effects of market-based reform on rural populations, focusing on specific provisions of Medicare reform proposals.
Characteristics and Utilization Patterns of Rural Medicaid Recipients
South Carolina Rural Health Research Center
This study will use the Medicaid Analytic Extract file to examine the characteristics of persons enrolled in Medicaid by type of eligibility. The study will also examine overall utilization and total payments for this utilization. All estimates will be subset by rurality and region.
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.
For Amber "Waives" of Grain: The Impact of Medicaid Managed Care Waiver Programs on Care Choices in Rural America
South Carolina Rural Health Research Center
This project will use a combination of systematic review of waiver content and structured interviews with key informants to assess the potential for rural disparities in access to care for Medicaid enrollees.
Implications of Rural Ambulance Service Closures
North Dakota and NORC Rural Health Reform Policy Research Center
The purpose of this project is to examine closed ambulance services and those ambulance services adjacent to the closed units. The ambulance services adjacent to those which closed will be examined for service area, workload, and staffing for one year prior to and one year after the adjacent service closure.
Potential Impact of ESRD Payment Reform on Rural Dialysis Patients
South Carolina Rural Health Research Center
This study will estimate the potential implications of rural dialysis facility loss for rural patients. Specifically, we will identify low-volume dialysis facilities in rural areas, profile the patients they serve, and estimate the additional travel burden that these patients would experience if facilities close.
Rural Demography and Aging: The LTSS Imperative in Rural America
Maine Rural Health Research Center
The proposed project aims to create a current, broad-ranging, detailed profile of health care/LTSS needs and use patterns among rural and urban older adults through a literature review and analysis of data sets including the American Community Survey, the Area Health Resource File, and the Medicare Current Beneficiary Survey.
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.
Rural Residents' Early Experience with the Affordable Care Act & Health Insurance Marketplaces
Maine Rural Health Research Center
Using the Health Reform Monitoring Survey (HRMS), this project will produce two briefs examining rural-urban comparisons in insurance status, open enrollment knowledge and perceptions, and perceived affordability of coverage available through the Health Insurance Marketplaces.
Social Determinants of Health Among Minority Populations in Rural America
South Carolina Rural 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.
State Policy Issues That May Impact HIMs’ Success in Rural Places: A Regional Analysis
RUPRI Center for Rural Health Policy Analysis
Goals of this project include gathering detailed data and providing analysis and policy recommendations on issues relating to network adequacy and service areas for HIMs, with additional investigation of other state-level policy variables (such as the Medicaid expansion decision) which may have a confounding or moderating effect on the relationship between network adequacy and enrollees’ choices and premiums.
The Financial and Community Experience of Sole Community Hospitals in Comparison to Other Rural Hospitals
North Carolina Rural Health Research and Policy Analysis Center
This research will investigate the financial and community experience of SCHs in comparison with other rural hospitals. The availability of alternative facilities, and the socioeconomic and demographic characteristics of SCH service areas will be compared to other rural hospital service areas.
The Supply and Distribution of the Behavioral Health Workforce in Rural America
WWAMI Rural Health Research Center
Data from the National Plan and Provider Enumeration System (NPPES) file, linked to RUCA codes and population data will be used to identify behavioral health providers and describe their geographic (rural/urban, regional and intra-rural) distribution. Behavioral health professions identified in the file include psychiatrists, addiction medicine specialists, psychiatric nurse practitioners, clinical nurse specialists in mental health, clinical psychologists and licensed social workers.
Understanding Rural-Urban Mortality Differences
Maine Rural Health Research Center
This study will address rural-urban mortality gaps in our understanding of rural mortality disparities using the 1985-2009 National Health Interview Survey (NHIS), linked to national death certificate data, to explore the individual-level characteristics and health behaviors of rural and urban adults and their association with mortality.
Use of Emergency Departments for Behavioral Health Related Care
North Dakota and NORC Rural Health Reform Policy Research Center
This project will study the prevalence of emergency department utilization for behavioral health diagnoses between rural and urban communities.
Use of Home Health Services among High Risk Rural Medicare Patients: Patient, Service, and Community Factors Associated with Outcomes of Care
WWAMI Rural Health Research Center
This study will examine outcomes of care for rural Medicare patients who were discharged from hospitals and admitted to home health care for post-acute services. Outcomes will include emergent care use and re-hospitalization during the home health admission and community discharge.
Use of Telehealth Services Among Rural Medicaid Enrollees: A Baseline Inventory
Rural Telehealth Research Center
Uses data from the Medicaid Analytic Extract (MAX) for 2011 to create a 50-state, baseline inventory of telehealth services provided to Medicaid enrollees in rural and urban settings. Provides important information on the feasibility of using MAX data to study the effects of Medicaid telehealth policies.
What Constitutes An Adequate Provider Network For Rural Health Populations?
University of Minnesota Rural Health Research Center
The purpose of this study is to develop norms/standards for provider network adequacy for rural populations (which may vary across different rural environments) that will be useful to consumers, providers, and policymakers in the decisions they face with respect to health plan choices, participation, and policies.
Who Treats Opioid Addiction in Rural America? Quantifying the Availability of Buprenorphine Services in Rural Areas.
WWAMI Rural Health Research Center
This study will investigate the extent to which physicians 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. This study will also estimate the need for office-based opioid disorder treatment in rural locations.

Projects Funded September 2014 - (11)

Comparisons of Rural Definitions
North Dakota and NORC Rural Health Reform Policy Research Center
This project will lead to the creation of a mega rural and frontier website. This website will emphasize the use of various rural definitions and datasets for health care policy, policy analysis, and research.
Critical Review and Analysis Regarding PCSAs, HPSA Rational Service Areas, and Other: Geographic Alternatives for Creating Useful Primary Care Service Areas
North Dakota and NORC Rural Health Reform Policy Research Center
The purpose of this proposed project is to review Dartmouth’s Primary Care Service Areas (PCSAs), other Rational Service Area (RSA) methodologies, and alternative methodologies related to their strengths, weaknesses, and spatial analytic criteria regarding their ability to serve in the process of developing useful primary care service areas. The project will include normative service areas where in a primary care service area should exist (potential service area) but does not (e.g., large area/population with no providers that could support them).
Disparities in Access to Oral Health Care Among Rural Children: Current Status and Models for Innovation
South Carolina Rural Health Research Center
The ACA contains key provisions on addressing oral health disparities among vulnerable populations. This project will provide baseline information on trends in rural health and describe the experiences of four states taking innovative approaches to implementation of key ACA oral health provisions.
Do Rural Health Clinics (RHCs) Provide Services that Lower Rates of Preventable Hospitalizations?
RUPRI Center for Rural Health Policy Analysis
This project uses 3 years of individual-level Medicare claims data to analyze the relationship between receiving care at a Rural Health Clinic (RHC) and the likelihood of potentially preventable hospitalization and/or potentially preventable emergency department (ED) visits. The project will explore this relationship among both fee-for-service Medicare enrollees and Medicare-Medicaid dual eligibles.
Examination of Rural and Frontier Home Health Services
North Dakota and NORC Rural Health Reform Policy Research Center
This mixed-method study is an in-depth examination of access to and utilization of home health services provided in rural and frontier areas. The study begins to explore how influential patient-centered decision-making is in determining the type of post-acute care services used by rural and frontier Medicare beneficiaries.
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.
Rural Implications of Quality-Based Physician Payment Reform
University of Minnesota Rural Health Research Center
The purpose of this project is to assess existing national data about the quality of care provided by rural physicians, and to determine what additional information will be needed as CMS moves towards inclusion of all physicians in payment reforms based on quality.
Rural-Urban Differences in Medicare Service Use and Expenditures in the Last Six Months of Life
South Carolina Rural Health Research Center
Patterns of end-of-life care are known to vary by rurality and by minority status, and the availability of facilities such as hospice also vary with rurality. This study will examine the relationship between level of service use during the last six months of life and facility availability in county of residence (hospital, SNF, IRF, home health, hospice), as well as minority status of the beneficiary and whether the beneficiary is also eligible for Medicaid (“dual eligible”).
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.
What Makes Physician Assistant Programs Successful at Training Rural PAs?
WWAMI Rural Health Research Center
A current WWAMI RHRC study has identified the physician assistant (PA ) training programs that have reduced high numbers and high proportions of graduates working in rural areas. The proposed study will extend that work through a physician assistant program survey, identifying key characteristics, admission, and training strategies, and missions of successful rural programs.

Projects Funded September 2013 - (4)

Integrated Organizational Relationships and Rural Health Providers
University of Minnesota Rural Health Research Center
The project will assess the types of integrated organizational relationships that include participation by rural health providers, to understand their potential relationship to new organizational initiatives stimulated by health care reform.
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 - (3)

Eligibility Transitions under the Affordable Care Act: Policy Considerations for Ensuring Coverage Continuity Among Rural Residents
Maine Rural Health Research Center
This study will assess rural versus urban income volatility, the potential effects on states' efforts to ensure continuous health insurance coverage to individuals enrolled in Medicaid expansions or Exchange plans under the Affordable Care Act, and develop policy recommendations to address any observed differences.
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.
Transitions of Care Among Rural Medicare Beneficiaries: The Care Continuum
South Carolina Rural Health Research Center
Because they are often hospitalized outside their home community, rural Medicare beneficiaries may experience a different sequence of services after discharge than do urban beneficiaries. This study will follow beneficiaries across the continuum of post-hospital care to determine if rural beneficiaries, particularly minority beneficiaries, are more likely to experience care disruption and adverse outcomes, such as re-hospitalization.

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.