2024 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.

Geographic Disparities in Availability of Hospital-Based Cardiac Services Across the United States
Journal Article
University of South Carolina Rural Health Research Center
Date: 12/2024
This project examined geographic disparities in the availability of essential cardiac care in counties across the United States.
Variation in Elder Abuse State Statutes by State Level of Rurality
Policy Brief
University of Minnesota Rural Health Research Center
Date: 12/2024
This policy brief examines elements of state-level elder abuse statutes' definitions and reporting requirements to investigate potential differences in these policies by state rurality that could influence one's understanding of elder abuse among rural and urban areas.
Triad Program Perspectives on Preventing and Addressing Elder Abuse in Rural Communities
Policy Brief
University of Minnesota Rural Health Research Center
Date: 11/2024
Elder abuse is a widespread issue and rural communities face unique risks to preventing, identifying, and addressing it. This brief shares results from key informant interviews with representatives of rural Triads (multi-sectoral community-based partnerships that address elder abuse) to illuminate rural-specific dimensions of this issue.
Understanding the Impact of Medical Debt in Rural Communities: Perspectives From Rural Hospital Administrators
Policy Brief
University of Minnesota Rural Health Research Center
Date: 11/2024
This policy brief presents findings from key informant interviews with nine administrators representing rural hospitals in seven states. Using content analysis of interview data, researchers share findings around hospital and community-level implications of medical debt, and policies that may help or hinder this issue.
Trends in the Health Workforce Supply in the Rural U.S.
Report
WWAMI Rural Health Research Center
Date: 10/2024
This report examines the availability of current and historical workforce data for a variety of health care professionals and provides estimates of the trends in the supply and distribution in the rural vs. urban U.S. workforce.
An Updated Model of Rural Hospital Financial Distress
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 10/2024
In fall 2024, the North Carolina Rural Health Research Program completed a study modeling financial distress among rural hospitals, "An Updated Model of Rural Hospital Financial Distress." The model updates a 2016 version, by adding recent changes in the operating environment.
News Media Coverage of Rural Hospital Closures and the Causes
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 10/2024
This study augments previous research with findings from a structured framework of attributed causes of rural hospital closures through the analysis of news media reports.
Health Care Affordability and Medical Debt: Differences by Rurality, Region, and Socio-Demographic Characteristics
Policy Brief
University of Minnesota Rural Health Research Center
Date: 09/2024
This policy brief examines rural/urban differences in rates of health care (un)affordability, as well as among rural residents by key socio-demographic characteristics.
Pediatric and Pregnancy-related Visits at Rural Health Clinics in 2018 Among Medicaid/CHIP Enrollees in 20 States
Policy Brief
Maine Rural Health Research Center
Date: 09/2024
This policy brief reports on the percentage of Medicaid-enrolled children and reproductive age women with pregnancy-related service use who visited a Rural Health Clinic in 2018 in 20 states.
Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 09/2024
This brief presents financial performance trends of hospitals who participated in Medicare's Shared Savings Program (SSP) from 2011 to 2018. Trends in six financial outcomes are compared between SSP and non-SSP hospitals over time and between rural and urban hospitals.
Profiling Social Needs Activities in Publicly Traded Medicare Advantage Organizations
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 08/2024
This article reviews how six major Medicare Advantage (MA) companies address social determinants of health (SDOH) through supplemental benefits. It analyzes public reports, highlighting MA growth, SDOH activities, and plan initiatives.
Changes in Rural Pharmacy Presence 2023
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2024
This data brief continues the RUPRI Center's series of reports exploring the availability of retail pharmacy services in rural areas of the U.S. It provides information on rural communities that have kept, lost, or gained a retail pharmacy between 2018 and 2023.
The Low-Volume Hospital Adjustment Before and During COVID-19
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2024
This brief uses current low-volume hospital adjustment qualifying criteria to compare low-volume hospitals to other rural hospitals and explores the effect of removing the adjustment before COVID-19 and during COVID.
Rural-Urban Differences in Midwifery Care During Childbirth in the U.S.
University of Minnesota Rural Health Research Center
Date: 07/2024
This infographic provides a snapshot of rural-urban differences in midwife-attended births, including changes over time as access to rural obstetric care declined and severe maternal morbidity and mortality rose across the United States.
Loss of Hospital-Based Obstetric Services in Rural Counties in the United States, 2010-2022
University of Minnesota Rural Health Research Center
Date: 07/2024
The purpose of this infographic is to show the loss of hospital-based obstetric services in rural counties from 2010 to 2022, and how this differs by rural county type (micropolitan vs. noncore).
Estimated Impacts of Multiple Payment Policies on Rural-Serving Home Health Agencies
Policy Brief
WWAMI Rural Health Research Center
Date: 07/2024
This brief examines the estimated impact of three Medicare payment policy changes on home health agency (HHA) reimbursement by rural-serving status, geographic location, and select HHA characteristics.
2018-23 Profitability of Rural Hospitals by With and Without Rural Health Clinics and Long-Term Care
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 06/2024
This study compares the 2018-23 profitability of rural hospitals for hospitals that provide and do not provide long-term care, and that operate and do not operate rural health clinics.
2018-23 Profitability of Rural and Urban Hospitals by Medicare Payment Designation
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 06/2024
This study compares profitability of three types of hospitals in both urban and rural locations: Critical Access Hospitals, Prospective Payment System-only (PPS) hospitals by number of acute beds, and PPS hospitals with special payment designations hospitals over a five-year period.
2018-23 Profitability of Rural Hospitals by Ownership and System Affiliation
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 06/2024
This study compares the 2018-23 profitability of rural hospitals based on ownership and system affiliation status. The purpose of this brief is to describe the profitability of rural hospitals over a five-year period consisting of two years before and three years after COVID-19.
Cervical Cancer Screening Rates Among Rural and Urban Females, From 2019 to 2022
Journal Article
Rural and Underserved Health Research Center
Date: 06/2024
This study examines the receipt of a Papanicolaou test in the past year among U.S. females overall and females residing in rural and urban areas in 2019, 2020, and 2022, using the Health Information National Trends Survey.
Differences in Measurement of Operating Margin: An Update
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 05/2024
This study uses recent Medicare Cost Report data to compare rural and urban hospitals using the three definitions for operating margin. Researchers assess the distribution and extent of extreme values of operating margin.
Medicare Advantage Plan Growth in Rural America: Availability of Supplemental Benefits
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2024
This policy brief compares availability of Medicare Advantage plans providing supplemental health-related benefits and special supplemental benefits for the chronically ill in metropolitan, micropolitan, and noncore counties.
Using the Updated Financial Distress Index to Describe Relative Risk of Hospital Financial Distress
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2024
Using a recent revision of the Financial Distress Index (FDI) model, this study aimed to describe the relative risk of experiencing financial distress for rural hospitals and selected urban hospitals.
Non-Urgent Use of Emergency Departments by Rural and Urban Adults
Policy Brief
Maine Rural Health Research Center
Date: 04/2024
This study provides updated information and addresses gaps in knowledge about rural non-urgent emergency department (ED) use. Understanding the rates of non-urgent ED use among rural adults and the factors associated with this use can inform policy and practice efforts to reduce inappropriate use of EDs in rural communities.
Identifying Rural Health Clinics Within the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files
Policy Brief
Maine Rural Health Research Center
Date: 03/2024
This brief describes a methodology for identifying Rural Health Clinic encounters within the Medicaid claims data using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.
COVID-19 Affected Rural and Urban Hospital Uncompensated Care
Fact Sheet
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2024
The purpose of this infographic is to illustrate the impact COVID-19 had on uncompensated care and operating margin among rural and urban hospitals.
Rural-Urban Differences in Housing Cost Burden Across the U.S.
Policy Brief
University of Minnesota Rural Health Research Center
Date: 03/2024
Housing is closely tied to health and well-being, but affordable housing is out of reach for many households. This policy brief examines the proportion of households who are housing cost burdened by rural-urban location across different U.S. geographic spaces in order to identify how housing affordability varies by location.
Nonmetropolitan Premiums, Issuer Participation, and Enrollment in Health Insurance Marketplaces in 2022
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2024
This policy brief describes differences in unsubsidized and net-of-subsidy premiums between nonmetropolitan and metropolitan counties in Health Insurance Marketplace plan design and availability in 2022.
Availability and Quality of Dialysis Care in Rural Versus Urban U.S. Counties
Journal Article
University of South Carolina Rural Health Research Center
Date: 02/2024
An examination of rural-urban differences in quality of dialysis care offered across the United States was conducted using data from Medicare certified dialysis facilities in 2020 from the Centers for Medicaid and Medicare.
Nursing Home Closures and Access to Post-Acute Care and Long-Term Care Services in Rural Areas
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 01/2024
Nursing home closures have raised concerns about access to post-acute care (PAC) and long-term care (LTC) services. In this study, researchers estimate the additional distance rural residents had to travel to access PAC and LTC services because of nursing home closures.
Suicide Rates and Risks Across U.S. Industries: A 29-Year Population-Based Survey
Journal Article
Rural and Underserved Health Research Center
Date: 01/2024
Combining 29 years of U.S. suicide data using the National Health Interview Survey (NHIS)-Mortality Linked data from 1986 through 2014, with mortality follow-up through 2015, this study estimates suicide risks across industries in the U.S. working population.
A Comparison of 2017-19 Uncompensated Care of Rural and Urban Hospitals by Net Patient Revenue, System Affiliation, and Ownership
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2024
The purpose of this study is to better understand patterns of uncompensated care. It extends a 2018 study of geographic variation in uncompensated care between rural and urban hospitals. Specifically, researchers investigate the association of uncompensated care with net patient revenue, system affiliation, and ownership.