2019 Rural Health Research Products

  • Strategic Choice in Developing Telemedicine - Observations from Three Organizations
    Report
    RUPRI Center for Rural Health Policy Analysis
    Advances in technology have made it easier to provide telemedicine services, but the actual value of telemedicine programs for health systems providing those services or for patients has not been firmly established. This paper explores organizational motivations of three large health systems for incorporating telemedicine patient care services.
  • Access and Capacity to Care for Medicare Beneficiaries in Rural Health Clinics
    Policy Brief
    University of Minnesota Rural Health Research Center
    Access to timely, high-quality healthcare is essential for health, but rural areas face particular barriers to access, including for primary care. We present findings from an online survey of RHCs describing clinic characteristics related to healthcare access for rural Medicare beneficiaries.
  • Access to Specialty Care for Medicare Beneficiaries in Rural Communities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Access to care is a challenge in many rural communities for both primary care services and specialty care services. We present findings from an online survey of Rural Health Clinics describing access issues for rural Medicare beneficiaries in seeking care from specialty care providers.
  • Impact of the Medicare Disproportionate Share Hospital Payment Cap on Urban and Rural Hospitals
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    The Medicare Disproportionate Share Hospital payment adjustment is intended to compensate hospitals serving a disproportionate number of low-income patients. This policy brief describes the number and location of urban and rural hospitals affected by a 12% payment cap established by the Medicare Modernization Act of 2003.
  • Rural-Urban Differences in Access to and Attitudes Toward Care for Medicare Beneficiaries
    Policy Brief
    University of Minnesota Rural Health Research Center
    Access to healthcare is important to health outcomes and well-being. Even among Medicare beneficiaries, access to care may differ by rural-urban location due to differences in the healthcare and socio-demographic landscape. We describe rural-urban differences in access to care for Medicare beneficiaries.
  • Partial Psychiatric Hospitalization Program Availability in Nonmetropolitan and Metropolitan Hospitals Nationally
    Policy Brief
    Rural and Underserved Health Research Center
    Partial psychiatric hospitalization programs (PPHPs) are intended to reduce or avoid inpatient stays by providing intensive psychiatric services in outpatient settings. We provide national estimates of PPHP availability among nonmetropolitan and metropolitan hospitals and describe the hospital characteristics associated with the provision of PPHPs.
  • Community Health Worker Roles and Responsibilities in Rural and Urban America
    Policy Brief
    Southwest Rural Health Research Center
    The primary aim of this study was to understand the evolving profession of community health workers (CHWs) in the U.S. Through focus groups in rural and urban regions of four states, we explored CHW roles and responsibilities, the growing professionalization of the field, and evolving interactions between CHWs and other care providers.
  • Differences in Preventive Care Among Rural Residents by Race and Ethnicity
    Policy Brief
    University of Minnesota Rural Health Research Center
    Disparities in preventive care by rural and urban location and by race and ethnicity are well documented in the literature, but less is known about whether there are differences in healthcare use among rural residents by race and ethnicity. We address this gap by examining differences in preventive care among rural residents by race and ethnicity.
  • Severe Maternal Morbidity and Hospital Transfer Among Rural Residents
    Policy Brief
    University of Minnesota Rural Health Research Center
    In this brief, we compare hospital transfer rates for rural and urban residents who gave birth. We also provide descriptive information about the relationship between transfer status and severe maternal morbidity and mortality for rural residents nationally who gave birth 2008-2014.
  • Rural Health Clinic Costs and Medicare Reimbursement
    Policy Brief
    Maine Rural Health Research Center
    We used cost report data to examine Rural Health Clinic (RHC) services costs. The findings support the National Advisory Committee on Rural Health & Human Service's conclusion that the cost-based methodology used to determine Medicare reimbursement for RHCs is outdated and RHCs subject to the reimbursement cap are paid less than their costs.
  • The Development of Telehealth Laws in the U.S. from 2008 to 2015: A Legal Landscape
    Policy Brief
    Southwest Rural Health Research Center
    This study examines the scope and evolving nature of telehealth statutes and regulations in the U.S. Our research aims to understand changes in telehealth laws over time (2008-2015), variations in legal frameworks established across the U.S., and the extent that state laws regulate the primary care delivery through the use of telehealth.
  • Prevalence and Mortality of Heart Disease and Related Conditions: Disparities Affecting the South, Rural Areas, and American Indian and Alaska Natives
    Policy Brief
    Southwest Rural Health Research Center
    This policy brief identifies trends in the prevalence of stroke, heart disease, and heart attack while also assessing trends in mortality for heart disease and related conditions across the nation. The study examined whether disease-related mortality and prevalence varied across place and time.
  • RN-to-BSN Programs: Challenges for Rural Nurse Education
    Policy Brief
    Rural and Minority Health Research Center
    To ascertain the status of rural-focused nursing education, we surveyed registered nurse to bachelor of science in nursing (RN-to-BSN) programs. Using an American Association of Colleges of Nursing mailing list, surveys were mailed to all schools with RN-to-BSN programs. This report summarizes responses from the 237 that completed surveys.
  • Rural Registered Nurses: Educational Preparation, Workplace, and Salary
    Policy Brief
    Rural and Minority Health Research Center
    Using national data from census data from the 2011-2015 American Community Survey Public Use Microdata Sample, this brief looks at the reported education levels and worksites of rural and urban registered nurses.
  • Quality Measures for Critical Access Hospital Swing Bed Patients
    Policy Brief
    University of Minnesota Rural Health Research Center
    This study identified measures to be used to assess the quality of care provided to Critical Access Hospital (CAH) swing bed patients with the goal of having these measures endorsed by the National Quality Forum and used by policymakers to help assess the value of CAH swing beds.
  • Risk Factors and Potentially Preventable Deaths in Rural Communities
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    In this study, we use variation in three risk factors – smoking, obesity, and excessive alcohol use – to identify their relative contribution to common causes of mortality.
  • Development of a Childhood Obesogenic Environment Index
    Policy Brief
    Rural and Minority Health Research Center
    The purposes of this study were to describe the development of a childhood obesogenic environment index and examine differences in obesogenic environment index values by rurality and region across the U.S.
  • Effects of the Patient Protection and Affordable Care Act on Coverage and Access to Care in Metropolitan vs. Nonmetropolitan Areas through 2016
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    The Patient Protection and Affordable Care Act as a whole led to notable increases in coverage rate and better access to care in both metropolitan and nonmetropolitan areas, and the Medicaid expansion was the key driver of coverage gains in nonmetropolitan areas.
  • Perceived Facilitators and Barriers to Rural Nursing Practice
    Policy Brief
    Rural and Minority Health Research Center
    A web-based survey was disseminated to a geographically diverse sample of nurses throughout the U.S. to assess perceived barriers and facilitators to nursing practice; job satisfaction; and self-identified challenges in nursing work environments and patient care. Of particular interest were nurses in ambulatory care practices.
  • Social Determinants of Health Among Rural Asian and Pacific Islander Populations
    Policy Brief
    Rural and Minority Health Research Center
    This policy brief is the fourth in a series of four policy briefs prepared by the Rural and Minority Health Research Center on the topic of social determinants of health. In this brief, we document current disparities within the rural Asian and Pacific Islander population.
  • Social Determinants of Health Among Rural American Indian and Alaska Native Populations
    Policy Brief
    Rural and Minority Health Research Center
    This policy brief is the third in a series of four policy briefs prepared by the Rural and Minority Health Research Center on the topic of social determinants of health. In this brief, we document current disparities within the rural American Indian and Alaska Native population.
  • Social Determinants of Health Among the Rural Hispanic Population
    Policy Brief
    Rural and Minority Health Research Center
    This policy brief is the second in a series of four policy briefs prepared by the Rural and Minority Health Research Center on the topic of social determinants of health. In this brief, we document current disparities within the rural Hispanic population. Gaps are larger for those who were born in the U.S. compared to those born outside the U.S.
  • Social Determinants of Health Among the Rural African American Population
    Policy Brief
    Rural and Minority Health Research Center
    This policy brief is the first in a series of four policy briefs prepared by the Rural and Minority Health Research Center on the topic of social determinants of health. It compares the distribution of social determinants among African American and White rural residents using information from the 2016 U.S. Census.
  • Insurer Participation in Rural Health Insurance Marketplaces: Are Some Markets Intrinsically More Competitive Than Others?
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    We examine insurer participation changes in three health insurance (Federal Employees Health Benefits Program, Medicare Advantage, and Health Insurance Marketplaces) markets over time in rural counties.
  • Measuring Access to Care in National Surveys: Implications for Rural Health
    Policy Brief
    University of Minnesota Rural Health Research Center
    This brief presents data about how access to healthcare is measured, focusing on how this applies to rural populations.
  • Unmet Need for Personal Care Assistance Among Rural and Urban Older Adults
    Policy Brief
    University of Minnesota Rural Health Research Center
    This brief presents data on rural-urban differences in unmet need for personal care among older adults with functional limitations.
  • Cost-Sharing as a Barrier to Accessing Care at FQHCs and RHCs for Rural Medicare Beneficiaries
    North Carolina Rural Health Research and Policy Analysis Center
    The purpose of this study is to investigate cost barriers to accessing care at Federally Qualified Health Centers and Rural Health Clinics for the rural Medicare population.
  • Suicidal Thoughts, Plans, and Attempts by Non-Metropolitan and Metropolitan Residence
    Policy Brief
    Rural and Underserved Health Research Center
    Suicide is among the leading causes of death in the US, and rates in non-metropolitan (rural) counties have historically exceeded those in metropolitan (urban) counties. This study examined the prevalence of suicidal thoughts, plans, and attempts by year (2010-2016) and county type (non-metropolitan, small metropolitan, and large metropolitan).
  • Identification of High-Need Rural Counties to Assist in Resource Location Planning
    Policy Brief
    Rural and Minority Health Research Center
    To identify high-need, low-resource locations, we began by identifying counties that lacked safety-net providers. For the purposes of this analysis, we identified Medicare-certified Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs) and Critical Access Hospitals (CAHs).
  • Identification of High-Need Rural Counties to Assist in Resource Location Planning for Primary Care
    Policy Brief
    Rural and Minority Health Research Center
    We examined simultaneously areas with poor health outcomes and limited access to primary care safety net settings. The combination of facility availability with health status indicators may help with identifying those areas in rural America that are in the greatest need of additional primary care resources.
  • Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    This brief describes the geographic variation of the 2019 Centers for Medicare & Medicaid Services hospital wage index by rural/urban definition, census region, Frontier and Remote Area codes and state.
  • 2019 Wage Index Differences and Selected Characteristics of Rural and Urban Hospitals
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    This brief characterizes rural/urban disparities in the 2019 Centers for Medicare & Medicaid Services hospital wage index by describing and comparing the wage indices of rural and urban hospitals by the number of beds, the amount of net patient revenue, and Medicare payment classification.
  • Characteristics of Communities Served by Rural Hospitals Predicted to be at High Risk of Financial Distress in 2019
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    This brief compares characteristics of communities served by rural hospitals predicted to be at high risk of financial distress to those served by rural hospitals predicted to not be at high risk of financial distress in 2019.
  • Geographic Variation in the 2019 Risk of Financial Distress Among Rural Hospitals
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    This brief investigates 2019 geographic variation in risk of financial distress among rural hospitals.
  • Trends in Risk of Financial Distress Among Rural Hospitals, 2015 to 2019
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    This brief investigates 2015 to 2019 trends in risk of financial distress among rural hospitals by census region and Medicare payment classification.
  • Preventive Health Service Use Among Rural Women
    Policy Brief
    Maine Rural Health Research Center
    This study used the National Health Interview Survey to examine differences in receipt of preventive health services among rural and urban women. It found that rural women are less likely to receive HPV vaccines and mammograms, even controlling for rural-urban sociodemographic and resource differences.
  • Differences in Care Processes Between Community-Entry Versus Post-acute Home Health for Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    This study describes home healthcare processes for rural Medicare beneficiaries who are admitted from the community (community-entry) versus those who are admitted following an inpatient stay (post-acute). Care processes include timely initiation of care, length of stay, and services provided (e.g., physical therapy, medical social work).
  • Primary Care Clinician Participation in the CMS Quality Payment
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Approximately 10% of primary care clinicians participate in Advanced Alternative Payment Models (A-APMs) and less than 30% of primary care clinicians participate in the Merit-Based Incentive Payment System. Metropolitan primary care clinicians are more likely to participate in A-APMs than nonmetropolitan primary care clinicians.
  • Medicare Advantage Enrollment Update 2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This annual report on Medicare Advantage (MA) enrollment shows growth in the program in nonmetropolitan and metropolitan areas. The rate of metro enrollment is higher than in nonmetro areas, but the growth rate in the nonmetropolitan population is higher. There are also significant differences in metro/nonmetro MA enrollment by plan type.
  • Facility-Based Ambulatory Care Provided to Rural Medicare Beneficiaries in 2014
    Chartbook
    North Carolina Rural Health Research and Policy Analysis Center
    This chartbook uses available Medicare claims data to describe facility-based (i.e., excludes private practitioners) ambulatory care provided to rural Medicare beneficiaries and includes claims, costs, and common diagnoses.
  • Comparing Rural and Urban Medicare Advantage Beneficiary Characteristics
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This brief reports few rural and urban differences in observed demographic characteristics among enrollees in the Medicare Advantage program. Issuers often exclude rural counties from their service areas, but we find no evidence that this is due to such demographics, suggesting that other reasons relating to population size may be more likely.
  • Dying Too Soon: County-level Disparities in Premature Death by Rurality, Race, and Ethnicity
    Policy Brief
    University of Minnesota Rural Health Research Center
    In this brief, we examined county-level differences in premature death (years of potential life lost before age 75 per 100,000 people) by county-level racial and ethnic composition, across rural and urban counties. We also calculated whether there were rural-urban disparities in mortality within counties with similar racial and ethnic compositions.
  • Do Hospital Closures Affect Patient Time in an Ambulance?
    Policy Brief
    Rural and Underserved Health Research Center
    Our study explores how a local hospital closure changes patient time in an ambulance for 9-1-1 calls. Access to emergency department services in communities, especially rural communities, persists as a priority for the Medicare program. We found when hospitals close, rural patients requiring ambulance services are disproportionately affected.
  • The Market Mechanism and Health Insurance in Rural Places: Lessons Learned from an Economics and Policy Perspective
    Report
    RUPRI Center for Rural Health Policy Analysis
    This paper focuses on unique challenges in health insurance markets facing rural people, providers, and places, identifying their origins in what economists call "market failures," defined narrowly or broadly. We conclude with observations about the current landscape of rural insurance markets and identify issues policy makers should consider.