2015 Rural Health Research Products

  • Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    As Medicare moves to value-based payment, healthcare groups are made more accountable for patient health. But the changes have been concentrated in urban areas. Policies meant to strengthen rural health systems are complicating payment and delivery system reform in rural areas. This study examines ways to include rural areas in the changes.
  • Estimated Costs of Rural Freestanding Emergency Departments
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    A rural freestanding emergency department (RFED) is one potential model for providing emergency services in areas where hospitals have closed. The North Carolina Rural Health Research Program's Findings Brief, Estimated Costs of Rural Freestanding Emergency Departments explains the RFED concept and estimates RFED costs in three scenarios.
  • Rural Disabled Medicare Beneficiaries Spend More Out-of-Pocket Than Their Urban Counterparts
    Policy Brief
    Maine Rural Health Research Center
    Most beneficiaries seek added coverage to close the gap between the care they need and the costs covered by Medicare. This study evaluated rural-urban differences in out-of-pocket spending, supplemental coverage, and variation in spending by type of service.
  • Rural Adults Delay, Forego, and Strategize to Afford Their Pre-ACA Health Care
    Policy Brief
    Maine Rural Health Research Center
    This study provides detailed information about rural-urban differences among adults younger than age 65 in perceived affordability of health insurance coverage and services prior to implementation of the Affordable Care Act.
  • Access to Health Information Technology Training Programs at the Community College Level
    Policy Brief
    WWAMI Rural Health Research Center
    Successful implementation of health information technology (HIT) in rural areas depends on a well-trained HIT workforce, and community colleges are key in producing this workforce. This study examined HIT workforce development programs in community colleges to find their strengths and needs.
  • Implications of Rural Residence and Single Mother Status for Maternal Smoking Behaviors
    Policy Brief
    Maine Rural Health Research Center
    This study finds rural mothers are more likely than urban mothers to smoke. The authors suggest policymakers consider extending insurance for smoking cessation programs through the Affordable Care Act and Medicaid. Programs at the local, state, and national levels also could help reduce disparities in smoking-related morbidity and mortality.
  • Rural Hospital and Physician Participation in Private Sector Quality Initiatives
    Policy Brief
    University of Minnesota Rural Health Research Center
    This project examined private sector quality reporting and quality improvement initiatives being implemented by dominant insurers in states with significant rural populations. The policy brief profiles 12 initiatives, half focused on physician quality improvement and half focused on hospital quality improvement.
  • Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This brief compares cumulative enrollment totals in Health Insurance Marketplaces in metropolitan and non-metropolitan areas by state and the percentages of potential market participants enrolled. Non-metropolitan enrollment rates were higher in several states. The analysis shows how well outreach/enrollment efforts targeting rural areas work.
  • Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time?
    Policy Brief
    University of Minnesota Rural Health Research Center
    The Hospital Readmissions Reduction Program reduces Medicare payments for hospitals with excess rates of patient readmissions for certain conditions. It assesses rural/urban differences in the proportion of hospitals penalized under the program over time and whether condition-specific hospital readmission rates differ for rural/urban hospitals.
  • Post-discharge Rehabilitation Care Delivery for Rural Medicare Beneficiaries with Stroke
    Policy Brief
    Rural and Minority Health Research Center
    Provision/type of post-discharge rehab care (PDRC) received by stroke survivors by rurality and race/ethnicity are examined as are the distances between their homes and the discharge hospitals related to the type of PDRC recommended. The brief also looks at whether factors such as initial hospital admission relate to the PDRC provision/type.
  • Free Clinics in the Rural Safety Net, 2014
    Policy Brief
    Rural and Minority Health Research Center
    This brief explores two issues. First, it examines where free clinics are located and describes their availability in rural counties across all 50 states. Second, through telephone interviews with leadership at 14 of the 21 state free clinic associations, it explores the issues they face.
  • Adoption and Use of Electronic Health Records by Rural Health Clinics: Results of a National Survey
    Policy Brief
    Maine Rural Health Research Center
    This study reports the extent of electronic health record implementation and use in a randomly selected sample of 1,497 rural health clinics surveyed in 2013.
  • Assessing Rural-Urban Nurse Practitioner Supply and Distribution in 12 States Using Available Data Sources
    Policy Brief
    WWAMI Rural Health Research Center
    This study compared estimates of nurse practitioner supply in 12 states (statewide and rural vs. urban) derived from two sources: state license records and National Provider Identifier data.
  • The Intersection of Residence and Area Deprivation: The Case of Hospitalizations from Ambulatory Care Sensitive Conditions Among Children
    Policy Brief
    Rural and Minority Health Research Center
    This brief is the second in a series providing information on the role of residence and community deprivation on potentially avoidable hospitalizations among children. This brief describes the findings from a nine-state sample of children's hospitalizations and discusses the potential implications for rural health research and policy.
  • Area Deprivation is Higher Among Rural Counties - But Not All Rural Counties are Deprived
    Policy Brief
    Rural and Minority Health Research Center
    This brief is one of two on the role of residence/community deprivation on potentially avoidable hospitalizations (PAH) of children. It details development of an area deprivation index, examines area deprivation across all U.S. counties, and describes findings when applied to rates of PAH among a nine-state sample of children.
  • Prehospital Emergency Medical Services Personnel in Rural Areas: Results from a Survey in Nine States
    Report
    WWAMI Rural Health Research Center
    This study examines supply and demand for emergency response personnel, the involvement of medical directors, and the availability of medical consultation in rural and urban emergency service personnel (EMS) agencies in nine states.
  • Rural Enrollment in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This brief analyzes Health Insurance Marketplace enrollment outcomes for 2015 at rating area/county levels. Enrollment rates are reported by number of firms participating and for multiple geographic categories: population density, census region, and metropolitan status of the county. Rural/urban rates are often similar, but areas of concern exist.
  • Rural and Urban Differences in Choice of and Satisfaction with Medicare Part D Plans
    Policy Brief
    University of Minnesota Rural Health Research Center
    This brief examines whether rural Medicare beneficiaries are satisfied with their Medicare Part D drug plans and whether there is a difference in beneficiary satisfaction and plan selection experience by rurality.
  • Differences in Part D Plans Offered to Rural and Urban Medicare Beneficiaries
    Policy Brief
    University of Minnesota Rural Health Research Center
    This brief analyzes how the plan options available to rural and urban beneficiaries differ in terms of premiums, deductibles, and copayments, as well as differences in plan options within rural areas.
  • Recruitment of Non-U.S. Citizen Physicians to Rural and Underserved Areas through Conrad State 30 J-1 Visa Waiver Programs
    Report
    WWAMI Rural Health Research Center
    Conrad 30 programs allow international medical graduates (IMGs) on J-1 visas to remain in the U.S. after their residencies to provide healthcare for medically underserved populations. Information from state health department personnel was used to characterize national trends in waivers and factors related to states' successful recruitment of IMGs.
  • Care Coordination in Rural Communities Supporting the High Performance Rural Health System
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    This paper examines care coordination programs and processes that affect rural areas to discover what is happening in rural communities, how various programs and approaches are working, who benefits, and to make policy recommendations that will facilitate care coordination efforts in support of high performance rural health system development.
  • Rural Women Delivering Babies in Non-Local Hospitals: Differences by Rurality and Insurance Status
    Policy Brief
    University of Minnesota Rural Health Research Center
    This policy brief describes the extent to which rural pregnant women give birth in non-local hospitals and analyzes current patterns of non-local delivery by rural women's health insurance status and residential rurality.
  • Graduate Medical Education Financing: Sustaining Medical Education in Rural Places
    Policy Brief
    WWAMI Rural Health Research Center
    Rural Training Track (RTT) graduate medical education programs have shown success at preparing family physicians for rural practice, but financial difficulties have contributed to program closures. This policy brief reports on a survey of RTT directors and administrators across the U.S. to understand their finances.
  • Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents
    Report
    WWAMI Rural Health Research Center
    Residents of non-metropolitan counties were less likely than those in metropolitan counties to report having dental visits or teeth cleanings in the last year and more likely to report undergoing tooth extractions. These findings persisted even when controlling for demographic factors, income, insurance, and health/smoking status.
  • Characteristics of Rural Accountable Care Organizations (ACOs) - A Survey of Medicare ACOs with Rural Presence
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    In this policy brief, we present the findings of a survey of 27 rural accountable care organizations, focusing on characteristics important to their formation and operation.
  • Health Insurance Marketplaces: Early Findings on Changes in Plan Availability and Premiums in Rural Places, 2014-2015
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Analysis of national county-level Health Insurance Marketplace (HIM) plan data for 2014 and 2015 shows there is no systematic pattern to rural experiences of HIMs, although some isolated places may be at risk for weak outcomes.
  • Characteristics of Rural Communities with a Sole, Independently Owned Pharmacy
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This brief describes the populations of rural communities with single independently owned pharmacies. About 2.7 million people, more than 25% of whom live below the poverty level, live in 663 rural communities with sole independently owned pharmacies. For about 70% of these rural communities, the next closest pharmacy is more than 10 miles away.
  • A Comparison of Closed Rural Hospitals and Perceived Impact
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    This policy brief compares selected characteristics of abandoned rural hospitals and their markets to those of converted rural hospitals.
  • A Rural Taxonomy of Population and Health-Resource Characteristics
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This brief reports the newly developed taxonomy of rural places based on relevant population and health-resource characteristics and discusses how this classification tool can be utilized by policymakers and rural communities.
  • Hospital Views of Factors Affecting Telemedicine Use
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This brief expands upon previous research by examining hospital-based use of telemedicine by determining the type of use by hospitals, whether it be providing services as a hub or receiving services as a spoke, and then identifying factors from the hospitals' perspectives that affect use.
  • Variability in General Surgical Procedures in Rural and Urban U.S. Hospital Inpatient Settings
    Report
    WWAMI Rural Health Research Center
    This report addresses rural/urban differences in surgical practices in commonly performed inpatient surgical procedures that are typically handled by general surgeons. Findings indicate that rural hospitals concentrated on relatively common, low complexity procedures that can be handled by general surgeons.
  • Perspectives of Rural Hospice Directors
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Rural hospice care is under pressure by a variety of factors that are reviewed in this document. However, a central core element of rural hospice remains the strong sense of community that is embodied in the system and design of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states.
  • The 21st Century Rural Hospital: A Chart Book
    Chartbook
    North Carolina Rural Health Research and Policy Analysis Center
    This chartbook presents a broad profile of rural hospitals and includes information on location, who they serve, services they provide, how they ensure outpatient services for their communities, other community benefits they provide, and financial performance. Each page includes charts comparing rural hospitals to each other and to urban hospitals.
  • Developmental Strategies and Challenges for Rural Accountable Care Organizations
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This brief offers insights into the initial strategic decisions and challenges of four accountable care organizations (ACOs) with rural presences. These ACOs were formed as a step toward a value-driven rural delivery system. While several challenges need to be addressed, these insights can inform development of other rural ACOs.
  • Rural Provider Perceptions of the ACA: Case Studies in Four States
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    This brief summarizes the perceptions from rural providers in four states regarding the early effects of the Affordable Care Act, including changes to patient populations, financial health, and capacity for rural hospitals and rural federally qualified health centers.
  • Do Current Medicare Rural Hospital Payment Systems Align with Cost Determinants?
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    To inform policy discussions on how complex current payment models may affect rural hospitals, the North Carolina Rural Health Research Program studied differences in financial condition among rural hospitals and important determinants of differences in rural hospital costs.
  • Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace
    Policy Brief
    Maine Rural Health Research Center
    This policy brief reports findings from a survey of rural health clinics (RHC) that examined their capacity to meet the National Council for Quality Assurance patient-centered medical home requirements and discusses the implications of the findings for efforts to support RHC capacity development.
  • Surgical Services in Critical Access Hospitals, 2011
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This brief describes the types and volume of major surgical services provided in critical access hospitals across four regionally representative states in 2011.
  • Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    This brief describes the variation in emergency department use for non-emergent health conditions across rural and urban areas as well as by U.S. Census regions. Potential risk factors, including patients' socioeconomic characteristics and levels of primary care resources, are identified. Quality of care indicators are also addressed.
  • 2014: Rural Medicare Advantage Enrollment Update
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Rural Medicare Advantage (MA) and other prepaid plan enrollment in March 2014 was about 1.95 million, an increase of more than 216,000 from March 2013. Enrollment increased to 1.99 million in October 2014. Rural and urban enrollment increased despite reductions in payment and the conclusion of the MA bonus payment demonstration at 2014's end.
  • Nurse Staffing Levels and Quality of Care in Rural Nursing Homes
    Policy Brief
    University of Minnesota Rural Health Research Center
    This study's purpose was to examine the relationship between nurse staffing levels and care quality in rural nursing homes and to assess potential differences between hospital-based and freestanding rural nursing homes.