Alana Knudson, PhD

Deputy Director, North Dakota and NORC Rural Health Reform Policy Research Center

Phone: 301.634.9326
Email: knudson-alana@norc.org

NORC Walsh Center for Rural Health Analysis


Current Projects - (2)

  • Exploring Global Budgets as a New Reimbursement Model for Low-Volume Critical Access Hospitals
    Given the complexity of the Global Budget reimbursement model, we are interested to learn if there are aspects of the model that can be applied to consolidate reimbursement across rural and frontier health care settings, particularly for CAHs with low-volume (e.g., < 5 acute patients as a daily census).
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Healthcare financing, Hospitals and clinics
  • Rural End-of-Life Care: An Analysis of Rural Medicare Beneficiaries’ Health Care Costs, Utilization, and Patient-Centered Decisions
    This research examines the costs and types of care that rural Medicare beneficiaries use during their last six months of life. In addition, to learn how patient-centered decisions are made regarding health care transitions at the end-of-life, interview were conducted with rural providers and families.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Aging, Long term care, Medicare

Completed Projects - (5)

  • Examination of Rural and Frontier Home Health Services
    This mixed-method study is an in-depth examination of access to and utilization of home health services provided in rural and frontier areas. The study begins to explore how influential patient-centered decision-making is in determining the type of post-acute care services used by rural and frontier Medicare beneficiaries.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Frontier health, Home health
  • Exploring Rural and Urban Mortality Differences
    This project examines the impact of rurality on mortality and explores the regional differences in the primary and underlying causes of death. It also explores the role of the rural public health systems in addressing social determinants of health.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topic: Public health
  • Hospitalizations of Rural Children for Ambulatory Care Sensitive Conditions
    This project uses state inpatient discharge data from six states, data from the Area Resource File and the AHRQ Pediatric Quality Indicators to examine Ambulatory Care Sensitive Condition admission rates for rural children.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Children, Chronic diseases and conditions
  • Impact of Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural American Indian Elders
    This project examined the types of health insurance coverage of rural Native American elders ages 55 and older, and examine how different types of health insurance coverage and lack of health insurance coverage impact access to health care services among Native American elders by geographic location (rural frontier, rural non-frontier and urban).
    Research center: Upper Midwest Rural Health Research Center
    Topics: Aging, American Indians and Alaska Natives, Frontier health, Health insurance and the uninsured, Minority health, Rural statistics and demographics
  • Perspectives of Rural Hospice Directors
    Rural hospice care, as it is currently configured, is under pressure by a variety of factors (e.g., policy and regulation, economic and financial, and organizational and structural) which are reviewed in this document. However, a central core element of rural hospice remains the strong sense of community that is embodied in the system (i.e., typically a small non-profit arrangement) and design (i.e., a delivery system reliant on community connections and personal relationships) of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states. Fifty-three directors or key staff members were interviewed during a three-month period in 2013.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Aging, Health policy, Health services, Quality, Telehealth

Publications - (11)

  • The 2014 Update of the Rural-Urban Chartbook
    Chartbook
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 10/2014

    Includes current trends and disparities in urban and rural health. Reports on population characteristics including age, race and ethnicity, and poverty; health-related behaviors and risk factors including smoking, alcohol consumption, obesity, and physical inactivity; mortality data; other health status measures including adolescent births, limitation of activity, and total tooth loss; healthcare access and use; and mental health measures. Individual data tables are available in an Excel file.

  • Ambulatory Care Sensitive Condition Hospitalizations Among Rural Children (Brief)
    Upper Midwest Rural Health Research Center
    Date: 06/2007
    Reports results from a study examining children's inpatient hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs), rural residence, poverty, health insurance, and physician supply. Admission rates for five conditions were examined: asthma, diabetes short-term complications, gastroenteritis, urinary tract infection and perforated appendix.
  • Chronic Disease in American Indian/Alaska Native Elders
    Upper Midwest Rural Health Research Center
    Date: 2005
    Describes the prevalence of chronic diseases among Native American elders.
  • Exploring Rural and Urban Mortality Differences
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 03/2016
    Contains visual aids which display indicators of mortality rates by cause of death, age group, rural-urban status, region, and sex for populations 15 years of age and older cross-referenced to tables and statistical results.
  • Geographic Differences in Potentially Preventable Readmission Rates in Rural and Urban Hospitals (Final Report)
    Upper Midwest Rural Health Research Center
    Date: 11/2010
    Potentially preventable hospital readmissions (PPRs) among Medicare patients are examples of inefficiencies in the health care system. Policymakers are considering efforts to measure and publicly report preventable readmission rates and target hospitals with high rates for improvement by means of payment policy and technical assistance. To help inform the policy debate about readmissions of rural patients, this study estimated PPRs in three types of acute care hospitals: urban prospective payment system (PPS) hospitals, rural PPS hospitals and Critical Access Hospitals (CAHs).
  • Home is Where the Heart Is: Insights on the Coordination and Delivery of Home Health Services in Rural America
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 08/2017
    Access to home health in rural areas is an important public policy concern, particularly with the growing number of older adults residing in rural America. This qualitative study seeks to better understand how home health services are provided in rural areas, and identifies facilitators and barriers to providing care.
  • The Impact of Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural Native American Elders
    Upper Midwest Rural Health Research Center
    Date: 10/2007
    Examines health insurance coverage and access to healthcare among American Indian and Alaska Native elders (Native elders) -- defined as 55 years or older. Young elders, 55 to 64 years of age, are most likely to be uninsured with one-third reporting having no insurance, while 15% of older elders, 65 years of age and over, report they are uninsured. Uninsured Native elders are about twice as likely as insured Native elders to indicate they have no regular provider. In addition, one out of 10 Native elders report they were not able to get care when they needed it during the preceding 12 months. Reasons cited for not getting healthcare when it was needed included long waiting times, transportation problems, and cost. The authors conclude it is essential to develop policies that address the financial, geographical, and cultural aspects that negatively impact access to culturally appropriate healthcare. Full report available on request by contacting the Center.
  • Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Final Report)
    Upper Midwest Rural Health Research Center
    Date: 12/2008
    Findings from this report describe successful telepharmacy activities being implemented in rural hospitals and analyze policy issues related to the implementation of telepharmacy projects in rural hospitals.
  • Perspectives of Rural Hospice Directors
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 03/2015

    Rural hospice care, as it is currently configured, is under pressure by a variety of factors (e.g., policy and regulation, economic and financial, and organizational and structural) which are reviewed in this document. However, a central core element of rural hospice remains the strong sense of community that is embodied in the system (i.e., typically a small non-profit arrangement) and design (i.e., a delivery system reliant on community connections and personal relationships) of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states. Fifty-three directors or key staff members were interviewed during a three-month period in 2013.

  • Prevalence of Chronic Disease Among American Indian and Alaska Native Elders
    Upper Midwest Rural Health Research Center
    Date: 10/2005
    Examines chronic disease prevalence and functional limitations among American Indian/Alaska Natives by rurality, gender, age, health care access, and health behaviors. Includes policy recommendations.
  • Rural-Urban Disparities in Heart Disease
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 10/2014

    In 2001, the U.S. Department of Health and Human Services HHS) released its 25th report on the health of the nation titled Health, United States, 2001: With Urban and Rural Health Chartbook. The chartbook, compiled by the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC), illustrated trends and highlighted various priorities in urban and rural health. The Rural Health Reform Policy Research Center (RHRPRC) replicated the analyses conducted in 2001 using the most recent data available (2006-2011). This brief highlights key findings around heart disease.