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Rural Health
Research Gateway

2020 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.

  • Decline in Inpatient Volume at Rural Hospitals
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2020
    This study examined inpatient volume in rural hospitals between 2011 and 2017. Patient population and the organizational and geographic characteristics of hospitals that were significant predictors of inpatient volume included census region, Medicare payment type, ownership type, total margin, and percent of the population in poverty.
  • Spatial Access to Vaccines for Children Providers in South Carolina: Implications for HPV Vaccination
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 12/2020
    In South Carolina, rural children ages 13 to 17 years old have lower rates of HPV vaccination initiation. To better understand potential drivers of this rural-urban disparity, this study's objective was to examine spatial access to Vaccines For Children-enrolled clinics across rural and urban areas of the state.
  • The Declining Scope of Practice of Family Physicians Is Limited to Urban Areas
    Journal Article
    Rural and Underserved Health Research Center
    Date: 11/2020
    The scope of practice for family medicine physicians has decreased in recent years. Using survey data, researchers compared family medicine physicians' scope of practice scores based on rural-urban status and other variables. Researchers found statistically significant decreases in scope of practice scores in urban settings.
  • Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 11/2020
    As increasing numbers of rural hospitals stop offering maternity care, limited information is available about local preparedness to address obstetric emergencies. This paper explores the capacity to treat obstetric emergencies encountered among rural hospitals without obstetric units.
  • Acuity Differences Among Newly Admitted Older Residents in Rural and Urban Nursing Homes
    Journal Article
    Maine Rural Health Research Center
    Date: 11/2020
    This study found newly admitted residents of rural nursing homes were more likely to have cognitive issues/problem behaviors than those in urban facilities. Yet rural facilities admitted less complex older (age 75+) residents than urban, raising questions about the rural long-term services and supports system and capacity of rural nursing homes.
  • Substance Use Among Rural and Urban Youth and Young Adults
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2020
    This study uses national data to examine rural-urban differences in the rates of substance use among youth and young adults. Findings can help inform rural-specific prevention strategies and research targeting rural communities.
  • Telehealth Use in a Rural State: A Mixed Methods Study Using Maine's All-Payer Claims Database
    Journal Article
    Rural Telehealth Research Center
    Date: 10/2020
    This study examines trends in telehealth use in Maine and identifies barriers and facilitators to its adoption. While telehealth appears to improve access to behavioral health and speech therapy services, provider shortages, lack of broadband, and restrictive Medicare and commercial coverage plans limit telehealth services use in rural areas.
  • Cervical Cancer Treatment Initiation and Survival: The Role of Residential Proximity to Cancer Care
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 10/2020
    This study looked at the role drive time to cancer care facilities played on cancer treatment initiation and survival for cervical cancer patients.
  • Medicare Advantage Enrollment Update 2019
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 10/2020
    The annual update on Medicare Advantage (MA) shows that both metropolitan and nonmetropolitan enrollment has continued to grow for more than 10 years. However, the rate of growth has been higher in nonmetropolitan counties for the past two years. Local Preferred Provider Organization plans account for nearly half of nonmetropolitan MA enrollment.
  • A National Survey of RN-to-BSN Programs: Are They Reaching Rural Students?
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 10/2020
    This study used a national survey of RN-to-BSN programs to better understand their potential role in addressing disparities in BSN-prepared nurses in rural and urban areas. The results are needed to inform policymakers and stakeholders who are responsible for addressing the status and needs of nursing education.
  • Long-Term Care Planning, Preparedness, and Response Among Rural Long-Term Care Providers
    Journal Article
    Southwest Rural Health Research Center
    Date: 09/2020
    This manuscript explores how rural long-term care providers plan, prepare, and respond to slowly or rapidly unfolding disasters (i.e., hurricanes, wildfires, and environmental spills) in three U.S. geographic areas. Data includes secondary sources and semi-constructed interviews with long-term care facilities and disaster management organizations.
  • A Comparison of Rural and Urban Specialty Hospitals
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 09/2020
    This brief describes key differences between specialty hospitals located in rural versus urban areas.
  • Telebehavioral Health Use Among Rural Medicaid Beneficiaries: Relationships With Telehealth Policies
    Journal Article
    Rural Telehealth Research Center
    Date: 09/2020
    This study assesses policy levers potentially supporting sustained use of telehealth services. Among rural Medicaid fee-for-service beneficiaries with behavioral health needs, engaging patients through informed consent within provider settings that receive facility fees may facilitate improved access to telebehavioral health services.
  • Urban Hospitals With a High Percentage of Inpatient Days for Rural Patients
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 09/2020
    The purpose of this brief is to describe characteristics of urban hospitals with a high percentage of inpatient days for rural patients and to compare how they differ from urban hospitals with lower percentages of rural inpatient days.
  • Comparing the Health Workforce Provider Mix and the Distance Travelled for Mental Health Services by Rural and Urban Medicare Beneficiaries
    Journal Article
    WWAMI Rural Health Research Center
    Date: 08/2020
    This study used 2014 administrative Medicare claims data to describe the mix of health professionals who care for rural and urban patients with mood and/or anxiety disorders. It further describes where these beneficiaries received care and the one-way distance (miles) and time (minutes) they travelled to receive it.
  • Characteristics of U.S. Rural Hospitals by Obstetric Service Availability, 2017
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 08/2020
    This study described characteristics of rural U.S. hospitals by whether they provide labor and delivery care for pregnant patients. Researchers used the 2017 American Hospital Association Annual Survey to identify rural hospitals and detail their characteristics based on whether they provide obstetric services.
  • Averted Transfers in Rural Emergency Departments Using Telemedicine: Rates and Costs Across Six Networks
    Journal Article
    Rural Telehealth Research Center
    Date: 08/2020
    In a cohort of 4,324 tele-ED cases across 26 months in 65 hospitals in 6 tele-ED networks, 20% were averted transfers, and 43% of those were then routinely discharged rather than being transferred. Averted transfers saved on average $2,673 in avoidable transport costs per patient, with 63.6% of these cost savings accruing to public insurance.
  • Nurse Practitioner Autonomy and Complexity of Care in Rural Primary Care
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 07/2020
    The increasing number of nurse practitioners (NPs) in the rural U.S. has the potential to help alleviate primary care shortages. Using a nationwide source of claims and Electronic Health Record data from 2017, this study constructs measures of NP clinical autonomy and complexity of care.
  • Changes in Hospital-Based Obstetric Services in Rural U.S. Counties, 2014-2018
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 07/2020
    In 2014, 54% of rural U.S. counties had no hospital-based obstetric services, following a steady decrease during the previous decade. Loss of rural maternity care is tied to adverse maternal and infant health outcomes. This study shares hospital-based obstetric service losses in rural U.S. counties from 2014 to 2018.
  • Mortality Among Workers Employed in the Mining Industry in the United States: A 29‐Year Analysis of the National Health Interview Survey—Linked Mortality File, 1986‐2014
    Journal Article
    Rural and Underserved Health Research Center
    Date: 07/2020
    Working in the mining industry increases the risk of chronic diseases and mortality. We investigated overall and cause‐specific mortality rates among workers employed in the mining sector in the U.S.
  • Changes in Care-Seeking After Rural Hospitals Merge
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2020
    Rural hospital mergers have increased significantly since 2010. Enhanced financial performance and improved quality are often cited as benefits, but hospital mergers can also lead to changes in the services provided by acquired hospitals. This brief estimates the use of inpatient services delivered by acquired rural hospitals following a merger.
  • Telepharmacy Rules and Statutes: A 3-Year Update for All 50 States
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
    Date: 07/2020
    This policy brief analyzed administrative rules and legislative statutes governing each state's pharmacy practice. Key features of telepharmacy regulations were investigated for comparative analysis. Twenty-one states currently authorize retail telepharmacy, but between these states the regulatory activity varies considerably.
  • Development of a National Childhood Obesogenic Environment Index in the United States: Differences by Region and Rurality
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 07/2020
    This study developed a novel childhood obesogenic environment index and highlighted important regional and rurality differences across U.S. counties.
  • The Supply and Rural-Urban Distribution of the Obstetrical Care Workforce in the U.S. - A State-Level Analysis
    Report
    WWAMI Rural Health Research Center
    Date: 06/2020
    Monitoring the supply of the obstetrical (OB) care workforce is important for identifying areas that may lack OB care access. This set of data briefs describes the supply and geographic distribution of obstetricians, advanced practice midwives, midwives (not advanced practice), and family physicians in rural versus urban counties for every state.
  • Supply and Distribution of the Primary Care Workforce in Rural America: A State-Level Analysis
    Report
    WWAMI Rural Health Research Center
    Date: 06/2020
    Maintaining an adequate supply of primary care providers in the U.S. is one of the key challenges in rural health care. This study examines the 2019 supply and geographic distribution of primary care physicians, nurse practitioners, and physician assistants across rural areas of the U.S., providing state-level data briefs.
  • The Unique Impact of COVID-19 on Older Adults in Rural Areas
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 06/2020
    Older adults in rural areas of the U.S. face unique risks related to COVID-19, which puts them at risk of not only the virus, but of not being able to meet their healthcare, social, and basic needs.
  • Expanding Access to HPV Vaccination in South Carolina Through Community Pharmacies: A Geospatial Analysis
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 06/2020
    Human papillomavirus (HPV) rates are higher in rural areas. The uptake of HPV vaccination is lower among rural populations. Pharmacies may be ideal for improving vaccination access. Does spatial access to pharmacies among adolescents and young adults in South Carolina vary by rurality and geographic access to primary care providers?
  • Supply and Distribution of the Primary Care Workforce in Rural America: 2019
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 06/2020
    Maintaining an adequate supply of primary care providers in the U.S. is one of the key challenges in rural healthcare. This study examines the 2019 supply and geographic distribution of primary care physicians, nurse practitioners, and physician assistants across rural areas of the U.S.
  • The Supply and Rural-Urban Distribution of the Obstetrical Care Workforce in the U.S.
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 06/2020
    Monitoring the supply of the obstetrical (OB) care workforce is important for identifying areas that may lack OB care access. This brief describes the supply and geographic distribution of obstetricians, advanced practice midwives, midwives (not advanced practice), and family physicians in rural versus urban counties.
  • Process of Identifying Measures and Data Elements for the HRSA School-Based Telehealth Network Grant Program
    Policy Brief
    Rural Telehealth Research Center
    Date: 06/2020
    This brief details work to identify measures and develop data elements appropriate to school-based telehealth, create an Excel-based tool, and systematically collect data from grantees in the Health Resources and Services Administration's School-Based Telehealth Network Grant Program.
  • Differences by Rurality in Satisfaction With Care Among Medicare Beneficiaries
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 05/2020
    There are stark differences between rural and urban areas in demographic characteristics, health status, and healthcare. Yet less is known about rural‐urban differences in Medicare beneficiaries' satisfaction with care. We seek to understand rural‐urban differences in satisfaction with care for Medicare beneficiaries.
  • Rural-Urban Differences in Educational Attainment Among Registered Nurses: Implications for Achieving an 80% BSN Workforce
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 05/2020
    Our primary objective was to provide updated information on rural-urban differences in educational attainment. We also examined rural-urban differences in employment type, salary, and demographics among registered nurses in different practice settings.
  • Access to Medicare Part D Plans: A Comparison of Metropolitan and Nonmetropolitan Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2020
    This policy brief updates previous reports on rural activity in the Medicare Part D program. Comparisons are made across county type, within type of Part D plan (standalone and part of Medicare Advantage plans), and between the types of plans within county classifications.
  • Rural-Urban Residence and Mortality Among Three Cohorts of U.S. Adults
    Policy Brief
    Maine Rural Health Research Center
    Date: 05/2020
    Rural residents have a shorter life expectancy than urban residents. We analyzed national linked survey and death certificate data and found risk of death was 10% higher for rural than urban residents and has increased over time. Findings suggest the overall mortality penalty in rural areas may be partly driven by social determinants of health.
  • Most Rural Hospitals Have Little Cash Going Into COVID
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2020
    This infographic uses Medicare Cost Report data to illustrate the type of rural hospitals most likely to struggle financially during the pandemic as measured by lower median days cash on hand.
  • Considerations for Defining Rural Places in Health Policies and Programs
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 05/2020
    Rural definitions in statute and policy are used to direct resources to underserved people. But changes in population behavior and census processes have led to concern about historic methods of defining rural. This paper identifies key questions, reviews rural definitions, and discusses options for reconsidering rural definitions.
  • Metropolitan/Nonmetropolitan COVID-19 Confirmed Cases and General and ICU Beds
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2020
    The spread of COVID-19 across rural areas has fueled concern about the availability of healthcare resources for dealing with the pandemic. This brief looks at a single measure of healthcare resources – hospital beds – and reports of current COVID-19 cases in a single week to assess the impact on rural facilities.
  • Factors Associated With Perceived Job Preparedness Among RNs: Results From a National Survey
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 05/2020
    This article examines perceived job preparedness by demographic and professional characteristics among practicing registered nurses who completed a national survey. Rural and male nurses felt less prepared for nursing practice and may benefit from tailored educational experiences to improve perceptions of being prepared for the workforce.
  • Estimated Reduction in CAH Profitability From Loss of Cost‐Based Reimbursement for Swing Beds
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2020
    The purpose of this study was to estimate the impact of potential loss of cost-based reimbursement for swing beds on Critical Access Hospital (CAH) profitability and to examine the characteristics of CAHs that would be most affected by such a change in reimbursement.
  • Health Care Professional Workforce Composition Before and After Rural Hospital Closure
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2020
    This policy brief examines the composition of the local healthcare workforce before and after rural hospital closure to reveal any associations with discontinuation of inpatient services in rural communities.
  • Measure and Data Element Identification for the HRSA Evidence-Based Tele-Behavioral Health Network Program and the HRSA Substance Abuse Treatment Telehealth Network Grant Program
    Policy Brief
    Rural Telehealth Research Center
    Date: 04/2020
    This brief details work to identify measures and develop data elements appropriate to tele-behavioral health, create an Excel-based tool, and collect data from grantees in the Health Resources and Services Administration's Evidence-Based Tele-Behavioral Health Network Grant Program and Substance Abuse Treatment Telehealth Network Grant Program.
  • Rural Hospital Participation in Medicare Accountable Care Organizations
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2020
    This policy brief summarizes national and regional rates of rural hospital participation in Medicare Shared Savings Program Accountable Care Organizations (ACOs) and identifies factors associated with ACO participation.
  • Rural Hospitals With Long-Term Unprofitability
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 04/2020
    The purpose of this study is to examine the characteristics of rural hospitals that had negative total margins in 2016, 2017, and 2018. We examined net patient revenue, Medicare payment classification, region, and state for 311 rural hospitals.
  • Understanding the Broader Context of Rural Hospitals and Profitability
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 04/2020
    The intent of this infographic is to quantify rural hospital profitability in the broader context of all hospitals. This infographic compares the number of rural and urban hospitals and rural and urban operating revenue and operating income.
  • 2016-18 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2020
    This study compares the 2016-18 profitability of urban Prospective Payment System (PPS) hospitals to that of rural hospitals. Rural hospitals are further divided by size of rural PPS hospitals and by the rural Medicare payment classifications.
  • Estimating the Prevalence and Spatial Clusters of Coal Workers' Pneumoconiosis Cases Using Medicare Claims Data, 2011‐2014
    Journal Article
    Rural and Underserved Health Research Center
    Date: 03/2020
    Workers in the coal mining sector are at increased risk of respiratory diseases, including coal workers' pneumoconiosis (CWP). We investigated the prevalence of CWP and its association with sociodemographic factors among Medicare beneficiaries. We found evidence of significant spatial clustering of CWP in the states and population analyzed.
  • Identifying Measures and Data Elements for the HRSA Evidence-Based Tele-Emergency Network Grant Program
    Policy Brief
    Rural Telehealth Research Center
    Date: 03/2020
    This brief details multi-project work to identify measures and develop data elements appropriate to emergency department-based telehealth, create an Excel-based tool, and systematically collect data from grantees in the Health Resources and Services Administration Evidence-Based Tele-Emergency Network Grant Program.
  • Emergency Department Telemedicine Consults Are Associated With Faster Time-to-ECG and Time-to-Fibrinolysis for Myocardial Infarction Patients
    Journal Article
    Rural Telehealth Research Center
    Date: 02/2020
    Acute myocardial infarction (AMI) is a common, deadly emergency requiring rapid diagnosis and treatment. In this rural cohort, emergency department-based telemedicine was associated with improved timeliness of electrocardiogram and fibrinolysis. This study adds to evidence that telemedicine can improve timeliness of AMI care in rural hospitals.
  • Variation in Use of Home Health Care Among Fee-for-Service Medicare Beneficiaries by Rural-Urban Status and Geographic Region: Assessing the Potential for Unmet Need
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2020
    This study describes use of home healthcare by rural-urban status and geographic region. Findings suggest geographic region drives variation more than rural-urban status. Unmet need may be highest in the most remote rural counties and rural counties within the West North Central, East North Central, Mountain, and Pacific Census Divisions.
  • Spatial Clustering Patterns and Regional Variations for Food and Physical Activity Environments Across the United States
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 01/2020
    This study examined spatial patterns of obesogenic environments for U.S. counties. We mapped the geographic dispersion of food and physical activity (PA) environments, assessed spatial clustering, and identified differences across regions and rurality categories. This study highlights geographic clustering and disparities in food and PA access.
  • Practice Predictors of Buprenorphine Prescribing by Family Physicians
    Journal Article
    Rural and Underserved Health Research Center
    Date: 01/2020
    Physicians may prescribe buprenorphine if they obtain a waiver, but relatively few family physicians do so. This paper examines the association between practice characteristics and the likelihood that a family physician will prescribe buprenorphine, based on a survey of physicians seeking board certification in family medicine.
  • Early-Career and Graduating Physicians More Likely to Prescribe Buprenorphine
    Journal Article
    Rural and Underserved Health Research Center
    Date: 01/2020
    Only a small percentage of people who need treatment for opioid use disorder receive it, including buprenorphine. This paper shows differences in rates of prescribing buprenorphine and intentions to prescribe buprenorphine between early- and mid-to-late career family physicians, based on a survey of physicians taking a certification examination.
  • Provider-to-Provider Telemedicine Improves Adherence to Sepsis Bundle Care in Community Emergency Departments
    Journal Article
    Rural Telehealth Research Center
    Date: 01/2020
    Sepsis is a life-threatening emergency, and timely "bundled" care improves survival. In this rural cohort, telemedicine in the emergency department (tele-ED) improved sepsis bundle adherence, including timely fluid resuscitation and antibiotic administration. Tele-ED may be a scalable intervention to improve sepsis emergency care in rural EDs.
  • A Bivariate Mapping Tutorial for Cancer Control Resource Allocation Decisions and Interventions
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 01/2020
    This study demonstrates how geographic information systems software, specifically ArcGIS, can be used to develop bivariate choropleth maps to inform resource allocation and public health interventions.