2014 Research Publications

Browse the full list of research publications from the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

  • Rural-Urban Differences in Continuity of Care Among Medicare Beneficiaries
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2014
    In response to the ACA and other reforms in the healthcare market, new care models are being tested and implemented. To addresses concerns that healthcare in rural areas may be more fractured and thus a difficult place for the models to succeed, we measured continuity of care using detailed data on a sample of Medicare beneficiaries from 2000-2009.
  • Best Practices for Health Insurance Marketplace Outreach and Enrollment in Rural Areas
    Fact Sheet
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2014
    Research suggests enrollment rates for those in rural areas was less than urban areas during the first Health Insurance Marketplace enrollment period. Interviews of navigators, health centers, and others in rural counties with high enrollment rates were conducted to uncover best practices for marketing, outreach/education, in-reach, and enrollment.
  • The Obstetric Care Workforce in Critical Access Hospitals (CAHs) and Rural Non-CAHs
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2014
    This brief details rural hospital obstetric staffing patterns in nine states by critical access hospital status. The purpose was to examine obstetric practice models in rural hospitals, providing information to rural hospitals with obstetric care units regarding workforce and informing policymakers about the context in which the hospitals operate.
  • Successful Health Insurance Outreach, Education, and Enrollment Strategies for Rural Hospitals
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2014
    This brief offers best practices for hospitals to use in health insurance outreach/enrollment based on interviews with administrators, staff, and community reps at 11 rural hospitals. It also discusses certified application counselors and the importance of collaborative community partnerships in conducting insurance enrollment outreach/education.
  • Characteristics, Utilization Patterns, and Expenditures of Rural Dual Eligible Medicare Beneficiaries
    Policy Brief
    Rural and Minority Health Research Center
    Date: 11/2014
    This study analyzes the rural-urban differences regarding dual eligible beneficiaries and their races, regions of residence, patterns of utilizing health services, and Medicare expenditures.
  • Intensity of Service Provision for Medicare Beneficiaries Utilizing Home Health Services: A Closer Look at Cerebrovascular Disease, Diabetes, and Joint Replacement
    Report
    Rural and Minority Health Research Center
    Date: 11/2014
    This report details the impact of home health services provided to the rural elderly receiving Medicare by the number of visits, the use of rehabilitation specialists, and the median payment per each claim.
  • Rural-Urban Disparities in Heart Disease
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 10/2014
    The Department of Health and Human Services' report Health, United States, 2001: With Urban and Rural Health Chartbook illustrated trends and highlighted priorities in urban/rural health. The Rural Health Reform Policy Research Center replicated the analyses using the most recent data available. This brief highlights key heart disease findings.
  • The 2014 Update of the Rural-Urban Chartbook
    Chartbook
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 10/2014
    This chartbook includes trends and disparities in urban/rural health. Reports on population characteristics include age, race and ethnicity, and poverty; risk factors such as smoking, alcohol use, and obesity; mortality data; health status measures such as adolescent births and total tooth loss; healthcare access/use; and mental health measures.
  • Rural Border Health Chartbook II
    Chartbook
    Rural and Minority Health Research Center
    Date: 10/2014
    This chartbook presents an analysis of border counties, urban and rural, by comparing them to other counties within the four border states and to rural and urban counties in the rest of the county. It details county-level rates and statistics for socio-demographic factors, the physical environment, access to care, and health outcomes.
  • Does Rurality Affect Observation Care Services Use in CAHs for Medicare Beneficiaries?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2014
    This brief describes the use of observation services across levels of rurality by Medicare beneficiaries in critical access hospitals, the demographics and health status of patients receiving these services, and the characteristics of their observation stays.
  • Observation Care Services for Medicare Beneficiaries in Rural Hospitals: Policy Issues and Stakeholder Perspectives
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2014
    This brief describes the findings of a qualitative study aimed at gaining a greater understanding of the rural policy context surrounding the use of observation care services by Medicare beneficiaries from 2010 to 2013.
  • Differences in Case-Mix between Rural and Urban Recipients of Home Health Care
    Report
    Rural and Minority Health Research Center
    Date: 10/2014
    This report provides a description of the health status and service needs of rural and urban Medicare home health patients based on professional assessments of their conditions at the start of care.
  • Geographic Variation in Plan Uptake in the Federally Facilitated Marketplace
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2014
    This brief combines the data on plan selection in the federally facilitated marketplaces with estimates of those likely to qualify for the marketplace to calculate the percentage of potential eligible individuals who chose a health insurance plan (the uptake rate). It contains a heat map showing the variation in uptake rates across the country.
  • Rural Implications of the Blueprints for State-Based Health Insurance Marketplaces
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2014
    This report presents various states' approaches to the Health Insurance Marketplace, including service and rating areas, network adequacy requirements, rural consumer outreach, rural representation on the marketplace governing board, certification and oversight of Qualified Health Plans, and design of the Small Business Health Options Program.
  • Geographic Variation in Premiums in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2014
    This policy brief analyzes the 2014 premiums of health insurance plans available in the new marketplaces created by the Affordable Care Act.
  • Rural Hospital Mergers and Acquisitions: Who Is Being Acquired and What Happens Afterward?
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2014
    A brief from the North Carolina Rural Health Research and Policy Analysis Center examines the implications of mergers and acquisitions for small rural hospitals. The brief addresses the characteristics of rural hospitals that merged and the changes in hospital financial performance, staffing, or services following a merger.
  • Health Information Technology Workforce Needs of Rural Primary Care Practices
    WWAMI Rural Health Research Center
    Date: 07/2014
    Assesses electronic health records and heath information technology workforce resources that are needed by rural primary care practices to manage the increasing patient populations.
  • Facilitating the Formation of Accountable Care Organizations in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2014
    This brief shows characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries, one each of the four census regions. The findings can help rural providers interested in forming/participating in an ACO assess the status and potential gaps of their core structures and capabilities.
  • How Does Medicaid Expansion Affect Insurance Coverage of Rural Populations?
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2014
    This brief examines how states' decisions on Medicaid expansion are impacting rural areas in the United States. Population estimates, current state expansion status, and state-level insurance estimates were used to answer two main questions—how is expansion affecting rural populations and how would it differ if every state were to expand Medicaid.
  • The Effect of Medicare Payment Policy Changes on Rural Primary Care Practice Revenue
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2014
    This policy brief describes the impact of recent Medicare payment updates to the Geographic Practice Cost Indices portion of the Medicare Physician Fee Schedule on rural primary care providers' practice revenue from Medicare.
  • The Use of Hospitalists by Small Rural Hospitals: Results of a National Survey
    University of Minnesota Rural Health Research Center
    Date: 06/2014
    Examines reasons for using hospitalists, characteristics of hospitalist practices, and the impacts of hospitalist use in rural settings.
  • Home Health Care Agency Availability in Rural Counties
    Report
    Rural and Minority Health Research Center
    Date: 06/2014
    This report looks at home healthcare, including availability and service quality, in the United States and in rural counties. Findings include that counties at risk for limited service availability were almost all rural. Of the 34 counties lacking home health agencies, 30 were rural. Of the 120 counties served by single agencies, 118 were rural.
  • Update: Independently Owned Pharmacy Closures in Rural America
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2014
    This brief examines the closure of independently owned rural pharmacies in the United States from 2003 to 2013 and its effects on rural Americans' access to medications and other pharmacy services. This report is an update to past publications from RUPRI.
  • The Contribution of Physicians, Physician Assistants, and Nurse Practitioners Toward Rural Primary Care: Findings from a 13-state Survey
    WWAMI Rural Health Research Center
    Date: 06/2014
    Evaluates a questionnaire that measures weekly outpatient visits and services provided in a rural setting.
  • Which Medicare Patients Are Transferred from Rural Emergency Departments?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2014
    A brief from the University of Minnesota Rural Health Research Center analyzes transfers of Medicare beneficiaries who received emergency care in a critical access hospitals or rural hospitals and were transferred to other hospitals for care.
  • Support for Rural Recruitment and Practice Among U.S. Nurse Practitioner Education Programs
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 05/2014
    This brief details nurse practitioner (NP) education programs across the United States to identify those actively promoting NP practice in rural areas. It also describes the use of education methods that may promote rural practice and identifies barriers to recruiting rural students and providing rural NP clinical training.
  • Safety Net Clinics Serving the Elderly in Rural Areas: Rural Health Clinic Patients Compared to Federally Qualified Health Center Patients
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2014
    This brief, the third and final in a series on rural health centers (RHC), uses data from 2009 Medicare outpatient provider claims to look at clinic locations, number of beneficiaries served, and number of/cost per claim for each type of rural safety net clinic, as well as beneficiaries' ages, health problems, and distance traveled for care.
  • A Guide to Understanding the Variation in Premiums in Rural Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2014
    This brief provides a framework for assessing variations in the premiums of plans offered in the Health Insurance Marketplaces across geography.
  • Profile of Rural Residential Care Facilities: A Chartbook
    Chartbook
    Maine Rural Health Research Center
    Date: 05/2014
    This chartbook offers information on part of the rural long-term services and supports (LTSS) continuum—the residential care facility (RCF). Survey results identify national/regional differences between rural and urban RCFs, focusing on facilities, resident and service characteristics of RCFs, and the ability to meet the LTSS needs of residents.
  • Implications of Rurality and Psychiatric Status for Diabetic Preventive Care Use Among Adults with Diabetes
    Policy Brief
    Maine Rural Health Research Center
    Date: 05/2014
    This brief examines patterns of diabetic preventive care use among adults with diabetes to determine whether these patterns vary according to respondents' rural/urban residence or the presence/absence of a mental health diagnosis.
  • High Deductible Health Insurance Plans in Rural Areas
    Maine Rural Health Research Center
    Date: 05/2014
    Using the 2007-2010 National Health Interview Survey, this study examines rural residents' enrollment in high deductible health plans and the implications for evolving Affordable Care Act Health Insurance Marketplaces.
  • Integrated Care Management in Rural Communities
    Maine Rural Health Research Center
    Date: 05/2014
    This study reviews the opportunities and challenges reform initiatives under the Affordable Care Act present for rural communities. The study assesses four types of organizational models for delivering integrated care management. Each model has different strengths and drawbacks, weighing for and against implementation in rural areas.
  • From Health Care Volume to Health Care Value - Success Strategies for Rural Health Care Providers
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2014
    Examines strategies that rural healthcare providers can use to improve healthcare quality for patients.
  • Extent of Telehealth Use in Rural and Urban Hospitals
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2014
    This brief provides discussion with statistics on the use of telehealth in rural hospitals and the opportunities telehealth can bring to supporting healthcare in rural communities.
  • Medicare Accountable Care Organizations: Program Eligibility, Beneficiary Assignment, and Quality Measures
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2014
    This brief discusses Medicare Shared Savings Program eligibility, participation requirements, and quality measures relative to accountable care organization formation.
  • Health Insurance Coverage of Low-Income Rural Children Increases and is More Continuous Following CHIP Implementation
    Policy Brief
    Maine Rural Health Research Center
    Date: 03/2014
    This study found that following the Children's Health Insurance Program's (CHIP) implementation, health insurance coverage and continuity increased among low-income children, particularly for those living in rural areas. By CHIP's maturity, coverage for rural children improved so much that their uninsured rate dropped below that of urban children.
  • The Uninsured: An Analysis by Age, Income, and Geography
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2014
    This brief analyzes the rural/urban uninsured populations by age. Furthermore, we discuss the potential for age differences between rural and urban uninsured populations to drive Health Insurance Marketplace premiums upward, an effect which may be mitigated or compounded by various other factors.
  • Do Rural Patients with Early-Stage Prostate Cancer Gain Access to All Treatment Choices? (Final Report)
    Report
    WWAMI Rural Health Research Center
    Date: 02/2014
    This report compares rates of receipt of prostate cancer treatments and of the treatment options between early-stage prostate cancer patients living in urban and four levels of rural counties.
  • Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where?
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2014
    This brief examines health conditions of patients discharged from rural prospective payment system (PPS) hospitals and critical access hospitals (CAHs) to swing beds and skilled nursing facilities (SNFs).
  • Meaningful Use of the Electronic Health Records by Rural Health Clinics
    Maine Rural Health Research Center
    Date: 02/2014
    This paper identifies the rates of electronic health record adoption among a random national sample of rural health clinics (RHCs) and the extent to which RHCs that have adopted an EHR are likely to achieve Stage 1 meaningful use.
  • Rural-Urban Differences in Obstetric Care 2002-2010 and Implications for the Future
    University of Minnesota Rural Health Research Center
    Date: 01/2014
    Measures obstetric care in both rural and urban hospitals to find if trends differ from rural and urban hospital locations.
  • 2012 Rural Medicare Advantage Quality Ratings and Bonus Payments
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2014
    This brief analyzes differences in rural Medicare Advantage (MA) quality ratings and payments and suggests reasons why quality ratings vary by geography. Overall, the quality rating of MA plans in rural areas is lower than in urban areas, a result of the availability of, and enrollment in, different types of MA plans.
  • Birth Volume and the Quality of Care in Rural Hospitals
    University of Minnesota Rural Health Research Center
    Date: 2014
    Evaluates obstetric care quality in low-, medium-, and high-volume areas by using hospital discharge data.
  • Rural Primary Care Practices and Meaningful Use of Electronic Health Records: The Role of Regional Extension Centers
    University of Minnesota Rural Health Research Center
    Date: 2014
    Examines the role Regional Extension Centers (RECs) play in assisting rural physician practices implement electronic health records (EHRs).
  • Trends in Hospital Network Participation and System Affiliation, 2007-2012
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 2014
    Network participation and system affiliation are two ways for hospitals to build and/or access necessary capacities to engage in the transformation to an integrated, patient-centered, pay-for-value care delivery model. This brief tracks trends in network participation and system affiliation among U.S. general community hospitals from 2007 to 2012.