2022 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.

Community Sociodemographics and Rural Hospital Survival
Journal Article
Center for Economic Analysis of Rural Health
Date: 12/2022
This study examines whether community sociodemographic factors are associated with the survival or closure of rural hospitals at risk of financial distress between 2010 and 2019.
The Evolution of Hospital Designations and Payment in the U.S.: Implications for Rural Hospitals
Report
RUPRI Center for Rural Health Policy Analysis, RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 12/2022
Medicare hospital payment policies affecting rural hospitals play a significant role in the financial viability of rural hospitals. This report provides an overview of historic and current Medicare rural hospital payment policies and alternative payment models to understand their impact on rural hospitals and the communities they serve.
Medicaid Expansion and Access to Naloxone in Metropolitan and Nonmetropolitan Areas
Journal Article
Rural and Underserved Health Research Center
Date: 11/2022
This study evaluated the association of Medicaid expansion at the state level on the number of naloxone prescriptions dispensed and the percentage paid by Medicaid. Increasing the percentage of Medicaid-paid naloxone prescriptions improved access in metro areas.
Patterns of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 and Older, 2010-2017
Policy Brief
Maine Rural Health Research Center
Date: 11/2022
This study examines rural-urban differences in health care use among Medicare beneficiaries age 85+.
Rural-Urban Disparities in Quality of Inpatient Psychiatric Care
Journal Article
University of South Carolina Rural Health Research Center
Date: 11/2022
Using data from the Inpatient Psychiatric Facility Quality Reporting program 2015-2019, this study examined differences and changes in the quality of inpatient psychiatric care in rural and urban hospitals.
The Impact of Medicare Shared Savings Program Participation on Hospital Financial Performance: An Event-Study Analysis
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 10/2022
This study evaluated the extent to which Medicare Shared Savings Program participation affected hospital financial outcomes, including patient revenue, operating margin, different revenue source shares, and allowance and discount rate.
Small Rural Hospitals with Low-Volume Emergency Departments That May Convert to a Rural Emergency Hospital (REH)
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 10/2022
This study profiles rural hospitals eligible to convert to Rural Emergency Hospitals. The objective is to characterize rural hospitals with very low emergency department volume to inform the clinical and operational decisions that will be required to implement this new provider model.
Changes in the Supply and Rural-Urban Distribution of Social Workers in the U.S., 2014-2021
Fact Sheet
WWAMI Rural Health Research Center
Date: 10/2022
There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of social workers by rural-urban status and Census Division.
Changes in the Supply and Rural-Urban Distribution of Psychologists in the U.S., 2014-2021
Fact Sheet
WWAMI Rural Health Research Center
Date: 10/2022
There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of psychologists by rural-urban status and Census Division.
Changes in the Supply and Rural-Urban Distribution of Psychiatric Nurse Practitioners in the U.S., 2014-2021
Fact Sheet
WWAMI Rural Health Research Center
Date: 10/2022
There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of psychiatric nurse practitioners by rural-urban status and Census Division.
Changes in the Supply and Rural-Urban Distribution of Psychiatrists in the U.S., 1995-2019
Fact Sheet
WWAMI Rural Health Research Center
Date: 10/2022
There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of psychiatrists by rural-urban status and Census Division.
Changes in the Supply and Rural-Urban Distribution of Counselors in the U.S., 2014-2021
Fact Sheet
WWAMI Rural Health Research Center
Date: 10/2022
There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of counselors by rural-urban status and Census Division.
Availability of Hospital-Based Cancer Services Before and After Rural Hospital Closure, 2008-2017
Journal Article
University of South Carolina Rural Health Research Center
Date: 09/2022
Using American Hospital Association survey data from 2008 to 2017, the changes in access to cancer-related screening and treatment services were examined to determine the impact of hospital closures across hospital service areas.
Review of Rural U.S. Economic and Health Care Trends
Report
Center for Economic Analysis of Rural Health
Date: 09/2022
This report reviews recent literature and publicly available data to explore important issues at the nexus of health care and local economic vibrancy. The report also explores the economic implications associated with COVID-19, however full impacts will not be known for several years.
Predictors of Hospital Bypass for Rural Residents Seeking Common Elective Surgery
Journal Article
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 08/2022
This article used Healthcare Cost and Utilization Project State Inpatient Databases to evaluate rates and predictors for patients bypassing rural hospitals for common procedures.
Examining the Association Between Rurality and Positive Childhood Experiences Among a National Sample
Journal Article
University of South Carolina Rural Health Research Center
Date: 08/2022
Using the full National Survey of Children's Health with all 50 states and the District of Columbia, this study examined rural-urban differences in positive childhood experiences.
Health Insurance Marketplaces: Issuer Participation Trends in Non-Metropolitan Places, 2014-22
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2022
Since the 2014 implementation of Health Insurance Marketplaces (HIMs), considerable changes have been observed in the number of insurance companies offering plans across the United States. This policy brief describes changes in HIM plan issuers over the 2014-2022 period with an emphasis on variation across metropolitan and non-metropolitan places.
Update on Rural Independently Owned Pharmacy Closures in the United States, 2003-2021
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2022
Independently owned retail pharmacies in rural areas experienced a higher rate of closure than micropolitan and metropolitan areas. Closures have raised concerns about access to prescription medications as well as pharmacist-provided primary care services, which are often the sole source in rural areas for obtaining health services.
Medicare Beneficiary Access to Prescription Drugs in Rural Areas
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 08/2022
Declines in the number of retail pharmacies in rural areas have raised concerns about beneficiary access to prescription medications when their local pharmacy closes. The purpose of this policy brief is to identify the types of pharmacies used by beneficiaries in rural areas with limited or no access to local pharmacies.
Rural and Urban Pharmacy Presence – Pharmacy Deserts
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 08/2022
This policy brief continues the RUPRI Center's ongoing examination of the availability of community pharmacies and their provided services in rural areas of the U.S. The brief also provides a deeper analysis of counties with no retail pharmacies (i.e. pharmacy deserts) based on metropolitan/nonmetropolitan locations.
Higher Electronic Health Record Functionality Is Associated With Lower Operating Costs in Urban—but Not Rural—Hospitals
Journal Article
Center for Economic Analysis of Rural Health
Date: 07/2022
This study examines the relationship between electronic health record use/functionality and hospital operating costs and compares the results across rural and urban facilities.
Types of Rural and Urban Hospitals and Counties Where They Are Located
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 07/2022
The purpose of this brief is to provide a snapshot of the types of rural and urban hospitals and the counties where they are located.
Changes in Access to Community Health Services Among Rural Areas Affected and Unaffected by Hospital Closures Between 2006 and 2018: A Comparative Interrupted Time Series Study
Journal Article
University of South Carolina Rural Health Research Center
Date: 07/2022
In this article, investigators compared access to Federally Qualified Health Centers and Rural Health Clinics by those in rural areas affected versus those in rural areas unaffected by hospital closures.
County-Level Availability of Obstetric Care and Economic Implications of Hospital Closures on Obstetric Care
Policy Brief
Center for Economic Analysis of Rural Health
Date: 07/2022
This policy brief draws out demographic and economic differences between counties with obstetric care facilities and those without. It provides descriptive data on the economic changes underway in counties that lost obstetric care facilities between 2012 and 2019.
Nursing Homes in Rural America: A Chartbook
Chartbook
RUPRI Center for Rural Health Policy Analysis
Date: 07/2022
Closure of nursing homes and hospitals with swing beds in recent years has changed the availability of post-acute and long-term care services in rural areas. This study examines the availability of post-acute and long-term care services as well as characteristics of residents and nursing homes in noncore, micropolitan, and metropolitan counties.
Non-Metropolitan and Metropolitan Trends in Mental Health Treatment Availability in Community Health and Community Mental Health Centers
Policy Brief
Rural and Underserved Health Research Center
Date: 06/2022
This study shows how the supply of community mental health centers (CMHCs) and community health centers (CHCs) delivering mental health services changed from 2000 to 2019. While the supply of CHCs offering mental health services increased, the supply of CMHCs decreased.
Approaches to Serving Rural Older Adults in State Plans on Aging: A Policy Content Evaluation
Journal Article
University of Minnesota Rural Health Research Center
Date: 05/2022
In this article, we share a policy content evaluation of State Plans on Aging from all 50 U.S. states, focusing on how the states will serve older adults and including common and innovative approaches to doing so.
Social Isolation and Safety Issues Among Rural Older Adults Living Alone: Perspectives of Meals on Wheels Programs
Journal Article
University of Minnesota Rural Health Research Center
Date: 05/2022
In this article, we share results from a survey of 42 Meals on Wheels programs in rural areas across the US. Respondents highlighted challenges to meeting both social and safety needs of rural older adults living alone, as well as policy recommendations to improve the health and safety of older adults living alone in rural areas.
Community Characteristics and Financial and Operational Performance of Rural Health Clinics in the United States: A Chartbook
Chartbook
Maine Rural Health Research Center
Date: 05/2022
This chartbook provides an overview of Rural Health Clinic (RHC) characteristics and issues and will be useful to policymakers and others interested in the performance of RHCs nationally. It provides a discussion of the challenges related to collection and reporting of RHC quality data.
Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Professional Experience and Provision of Evidence-Based Care
Policy Brief
WWAMI Rural Health Research Center
Date: 05/2022
This policy brief examines the effects of emergency medical services (EMS) personnel level of experience and agency rurality on the provision of evidenced-based care. Compared with urban-serving EMS agencies, rural-serving agencies provided evidence-based care less often for stroke, hypoglycemia, and trauma but more often for seizures.
Medicare Accountable Care Organization Characteristics Associated With Participation in 2‐Sided Risk
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 05/2022
This study examined the associations of accountable care organization (ACO) characteristics with the likelihood of participation in 2-sided risk tracks in the Medicare Shared Savings Program. Small and rural ACOs were found to be less prepared to transition into 2-sided risk tracks than their urban counterparts.
The Northern Border Region: A Health-Focused Landscape Analysis
Chartbook
Maine Rural Health Research Center
Date: 04/2022
These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
Vermont: A Health-Focused Landscape Analysis
Chartbook
Maine Rural Health Research Center
Date: 04/2022
These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
New York: A Health-Focused Landscape Analysis
Chartbook
Maine Rural Health Research Center
Date: 04/2022
These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
New Hampshire: A Health-Focused Landscape Analysis
Chartbook
Maine Rural Health Research Center
Date: 04/2022
These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
Maine: A Health-Focused Landscape Analysis
Chartbook
Maine Rural Health Research Center
Date: 04/2022
These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
Rural Hospital Administrators' Beliefs About Safety, Financial Viability, and Community Need for Offering Obstetric Care
Journal Article
University of Minnesota Rural Health Research Center
Date: 03/2022
This study offers results from a national survey of a sample of 292 rural hospitals that provided obstetric services in 2021. Obstetric unit administrators shared about their experiences, the challenges they face, and the decisions that factor into providing labor and birth care for their rural communities.
Rural Hospital Profitability During the Global COVID-19 Pandemic Requires Careful Interpretation
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 03/2022
Many small rural hospitals struggle with profitability compared to their urban counterparts. The findings brief describes the pre-pandemic (2011-19) trend of rural hospital profitability and explains why possible increases in reported profitability during the pandemic (2020-21) may mask the long-term financial challenges of rural hospitals.
The Economic Effects of Rural Hospital Closures
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2022
This study updates previous research (Holmes, et al. 2006) on the economic effects of rural hospital closures by measuring the economic changes over time among U.S. rural counties that had a hospital closure from 2001-2018.
Disparities in Prenatal Immunization Rates in Rural and Urban U.S. Areas by Indicators of Access to Care
Journal Article
Southwest Rural Health Research Center
Date: 02/2022
This study evaluates variations in immunization rates among pregnant women across the urban-rural continuum. Results indicate pregnant women in rural areas more commonly rely on Medicaid to fund prenatal care but are less likely to have full or expanded access to Medicaid. This finding may contribute to immunization uptake disparities.
Estimating Mortality From Coal Workers' Pneumoconiosis Among Medicare Beneficiaries With Pneumoconiosis Using Binary Regressions for Spatially Sparse Data
Journal Article
Rural and Underserved Health Research Center
Date: 02/2022
This study estimates mortality from coal workers' pneumoconiosis and other pneumoconioses among Medicare beneficiaries using the 5% Medicare Limited Claims Data Set, 2011-2014.
Contact by Collection Agencies for Medical Debt: Rural-Urban Differences Among Older and Younger Medicare Beneficiaries
Journal Article
University of Minnesota Rural Health Research Center
Date: 02/2022
This study uses data from the 2016 Medicare Current Beneficiary Survey (n = 12,688 U.S. community-dwelling beneficiaries) to understand the impact of medical debt for rural residents. The study analyzed rural-urban differences in rates of collection agency contact for unpaid medical bills.
Quality of Home Health Agencies Serving Rural Medicare Beneficiaries
Policy Brief
WWAMI Rural Health Research Center
Date: 02/2022
This policy brief describes the quality of home health agencies (HHAs) by rural-serving status. While quality of patient care star ratings were not associated with rural-serving status, rural HHAs and urban HHAs that serve rural patients had higher patient experience star ratings than urban HHAs that do not serve rural patients.
Quality of Skilled Nursing Facilities Serving Rural Medicare Beneficiaries
Policy Brief
WWAMI Rural Health Research Center
Date: 02/2022
This policy brief describes the quality of skilled nursing facilities (SNFs) by rural-serving status. While overall star ratings and staffing star ratings were not associated with rural-serving status, rural SNFs and urban SNFs that serve rural patients had lower quality star ratings compared to urban SNFs that do not serve rural patients.
Meeting the Behavioral Health Needs of Farm Families in Times of Economic Distress
Policy Brief
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 02/2022
Economic fluctuations and periods of distress in farming cannot be eliminated, however, their impact on communities and individuals can be mitigated. Strategies for meeting the behavioral health needs of farm families by supporting community-based services, and expanding behavioral health services in rural contexts are highlighted in this work.
Serious Mental Illness and Mental Health Treatment Utilization Among Adults Residing in Non-Metropolitan and Metropolitan Counties
Policy Brief
Rural and Underserved Health Research Center
Date: 02/2022
This report estimates and compares the prevalence of mental health treatment utilization and reasons for not seeking mental health treatment among adults with serious mental illness residing in non-metropolitan and metropolitan counties nationally.
High-Performing Rural Health System
Policy Brief
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 01/2022
This document updates the RUPRI Health Panel's framework, for a high-performing rural health system, originally published in 2011. It offers a revised vision statement and updates the high-performing rural health system pillars (access, affordability, community health, and quality) and describes an underlying base of equity considerations.
An Enhanced Method for Identifying Hospital-Based Obstetric Unit Status
University of Minnesota Rural Health Research Center
Date: 01/2022
The purpose of this methodology brief is to describe an enhanced method for identifying hospital-based obstetric unit status and for identifying closures of obstetric units.
Rural Hospitals That Closed Between 2017‐20: Profitability and Liquidity in the Year Before Closure
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 01/2022
This brief examines the preclosure profitability and liquidity performance of rural hospitals that closed between 2017‐20 and compare it to the median performance of rural hospitals that remained open during the same year.