• Current Projects - (2)
• Completed Projects - (6)
• Publications - (49)

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Current Projects - (2)

• Community Context and Rural Strategies to Support the Oldest Old
  This project will develop a chartbook profiling older adults (65 and older) in rural areas and assess where rural residents ages 85 and older are most likely to live, what rural counties have experienced the fastest growth of those 85 and older, and what strategies are in place or are possible for supporting this population in aging in place.
  Research center: University of Minnesota Rural Health Research Center
  Topics: Aging, Hospice and palliative care, Long-term care, Rural statistics and demographics
  
• Living Alone: Rural-Urban Differences in Prevalence, Socio-Demographic Correlates, and Health Needs Across the Lifespan
  This project's purpose is to document rural-urban differences in the prevalence of living alone across different age groups, describe rural-urban differences in the socio-demographic correlates and health needs of individuals living alone, and identify rural-relevant policies and programs to support rural residents living alone across the lifespan.
  Research center: University of Minnesota Rural Health Research Center
  Topics: Health disparities and health equity, Social determinants of health
  

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Completed Projects - (6)

• Access to Care for Rural Medicare Beneficiaries
  This project examined multiple dimensions of access to care, with a focus on rural Medicare beneficiaries, including rural-urban differences in access to care, and within-rural differences in access to care by region, coverage type (traditional fee-for-service vs. supplemental Medigap coverage), and socio-demographic characteristics.
  Research center: University of Minnesota Rural Health Research Center
  Topics: Aging, Healthcare access, Medicare, Medicare Advantage (MA)
  
• Addressing Rural Social Isolation as a Health and Mortality Risk Factor
  This project aimed to describe rural/urban differences in the prevalence of social isolation, as well as to identify challenges and strategies related to addressing rural social isolation in order to inform policy-making.
  Research center: University of Minnesota Rural Health Research Center
  Topics: Aging, Health promotion and disease prevention
  
• Caring for Caregivers: Available Support for Unpaid Caregivers in Rural Areas
  This project describes rural-urban differences in the prevalence and intensity of informal caregiving for older adults and associated socio-demographic correlates and as well as identifies potential policy interventions to improve the quality of life and health outcomes of rural caregivers.
  Research center: University of Minnesota Rural Health Research Center
  Topics: Aging, Home health, Long-term care
  
• Disparities in Preventive Care by Race and Ethnicity Among Rural Adults
  The purpose of this project is to identify differences in access to and use of preventive care by race and ethnicity among rural residents. Results from this project will identify racial/ethnic disparities that exist within rural communities and may guide targeted interventions to improve equity and increase access to high-quality healthcare for all rural residents.
  Research center: University of Minnesota Rural Health Research Center
  Topics: Health disparities and health equity, Healthcare access, Hispanics, Minority health, Rural statistics and demographics
  
• Paving the Way: Addressing Transportation as a Social Determinant of Health for Rural Residents
  This project will use a mixed-methods design to examine ways in which transportation operates as a social determinant of health for vulnerable rural residents, and to identify exemplar transportation programs that are successfully improving health and well-being of those residents.
  Research center: University of Minnesota Rural Health Research Center
  Topics: Aging, Health services, Networking and collaboration, Transportation
  
• Skilled Nursing Facility Care for Rural Residents with Complex Care Needs
  This project will examine barriers to skilled nursing facility placement for rural residents with complex care needs, including obesity, dementia, and behavioral health problems, and explore potential implications for access to and quality of care.
  Research center: University of Minnesota Rural Health Research Center
  Topics: Health services, Hospitals and clinics, Long-term care
  

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Publications - (49)

• A National Examination of Caregiver Use of and Preferences for Support Services: Does Rurality Matter?
  University of Minnesota Rural Health Research Center
  Date: 07/2018
  The objective of this study was to assess rural-urban differences in caregiver use of and preferences for support services.
• Access and Capacity to Care for Medicare Beneficiaries in Rural Health Clinics
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 12/2019
  Access to timely, high-quality healthcare is essential for health, but rural areas face particular barriers to access, including for primary care. We present findings from an online survey of RHCs describing clinic characteristics related to healthcare access for rural Medicare beneficiaries.
• Access to Obstetric Services in Rural Counties Still Declining, with 9 Percent Losing Services, 2004-14
  University of Minnesota Rural Health Research Center
  Date: 09/2017
  Providing access to obstetric care in rural areas is a growing concern. By 2014, about 54% of rural counties in the United States did not have hospital obstetric services.
• Access to Specialty Care for Medicare Beneficiaries in Rural Communities
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 12/2019
  Access to care is a challenge in many rural communities for both primary care services and specialty care services. We present findings from an online survey of Rural Health Clinics describing access issues for rural Medicare beneficiaries in seeking care from specialty care providers.
• Addressing Commuting as a Public Health Issue: Strategies Should Differ by Rurality
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 07/2018
  This policy brief estimates the rate of solo and long (greater than 30 minutes) solo car commutes by rurality and urban adjacency and identifies differences in factors that relate to commuting behavior.
• Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States
  University of Minnesota Rural Health Research Center
  Date: 03/2018
  This study examines whether the loss of obstetric services in hospitals in rural U.S. counties led to changes in childbirth outcomes or locations.
• Barriers to Nursing Home Care for Nonelderly Rural Residents
  University of Minnesota Rural Health Research Center
  Date: 12/2017
  This study uses data from 23 semi-structured interviews with rural hospital discharge planners in five states to identify specific barriers to finding nursing home care for nonelderly rural residents. We found three primary themes—payment status, fit, and medical complexity—as well as two minor themes—caregivers and bureaucratic processes.
• Beyond Clinical Complexity: Nonmedical Barriers to Nursing Home Care for Rural Residents
  University of Minnesota Rural Health Research Center
  Date: 02/2018
  Using data from interviews with rural hospital discharge planners, we identified four themes around nonmedical barriers to rural nursing home placement with particular salience in rural areas: financial issues, transportation, nursing home availability and infrastructure, and timeliness. We also identified policy and programmatic interventions.
• Challenges Related to Pregnancy and Returning to Work after Childbirth in a Rural, Tourism-Dependent Community
  University of Minnesota Rural Health Research Center
  Date: 02/2018
  This case study highlights challenges related to pregnancy and returning to work after childbirth in a rural, tourism-dependent community in Minnesota.
• Characteristics of Counties with the Highest Proportion of the Oldest Old
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 05/2020
  The "oldest old," or individuals age 85 and older, are one of the fastest-growing segments of the U.S. population, yet little is known about where those individuals tend to live and what their communities are like. This information is important for planning how to best respond to and support this growing population.
• Closure of Hospital Obstetric Services Disproportionately Affects Less-Populated Counties
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 04/2017
  This policy brief describes the scope of obstetric unit and hospital closures resulting in loss of obstetric services in rural U.S. counties from 2004 to 2014.
• Differences in Part D Plans Offered to Rural and Urban Medicare Beneficiaries
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 07/2015
  This brief analyzes how the plan options available to rural and urban beneficiaries differ in terms of premiums, deductibles, and copayments, as well as differences in plan options within rural areas.
• Differences in Preventive Care Among Rural Residents by Race and Ethnicity
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 11/2019
  Disparities in preventive care by rural and urban location and by race and ethnicity are well documented in the literature, but less is known about whether there are differences in healthcare use among rural residents by race and ethnicity. We address this gap by examining differences in preventive care among rural residents by race and ethnicity.
• Does the Medicare Part D Decision-Making Experience Differ by Rural/Urban Location?
  University of Minnesota Rural Health Research Center
  Date: 02/2016
  Evaluates the personal experiences with choosing a Part D plan among rural residents. This study examines the geographic differences in Part D enrollees' opinion of the plans decision-making process.
• Dying Too Soon: County-level Disparities in Premature Death by Rurality, Race, and Ethnicity
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 03/2019
  In this brief, we examined county-level differences in premature death (years of potential life lost before age 75 per 100,000 people) by county-level racial and ethnic composition, across rural and urban counties. We also calculated whether there were rural-urban disparities in mortality within counties with similar racial and ethnic compositions.
• Ensuring Access to High-Quality Maternity Care in Rural America
  University of Minnesota Rural Health Research Center
  Date: 05/2016
  Examines the access to high-quality for rural women care during pregnancy and childbirth. Policy interventions at the local, state, and federal levels could help to address maternity care workforce shortages and improve quality of care available to the one-half million rural U.S. women who give birth each year.
• Gender Differences in Social Isolation and Social Support Among Rural Residents
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 08/2018
  This policy brief uses identifies gender differences in social isolation and social support among older rural residents and provides ways to reduce social isolation in rural communities.
• Key Informant Perspectives on Rural Social Isolation and Loneliness
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 10/2018
  This policy brief uses data from interviews with 22 key informants in 12 states, all of whom were experts on the issue of social isolation and/or rural health, to describe key challenges and opportunities related to rural social isolation.
• The Maternity Care Nurse Workforce in Rural U.S. Hospitals
  University of Minnesota Rural Health Research Center
  Date: 05/2017
  Findings are shared from a study examining the maternity care nursing workforce in rural hospital in the United States.
• Measuring Access to Care in National Surveys: Implications for Rural Health
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 06/2019
  This brief presents data about how access to healthcare is measured, focusing on how this applies to rural populations.
• Medical Barriers to Nursing Home Care for Rural Residents
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 05/2017
  This policy brief describes barriers rural residents with complex medical care needs may face when seeking placement in a nursing home and identifies potential policy strategies to overcome them.
• Medicare Costs and Utilization Among Beneficiaries in Rural Areas
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 03/2016
  This study assesses the relationship between service utilization patterns and costs for rural Medicare beneficiaries across the rural continuum. It also examines the relationships between rural beneficiaries' service utilization and healthcare delivery market structure and evaluates strategies and policies to address high costs in rural areas.
• Non-Medical Opioid Use Among Rural and Urban Pregnant Women, 2007-2014
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 08/2018
  This policy brief presents data on rural-urban differences in non-medical opioid use among pregnant women to inform policy, programmatic, and clinical efforts to address this crisis.
• Perspectives on Rural Caregiving Challenges and Interventions
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 08/2018
  This brief presents findings from key informant interviews describing challenges and opportunities related to supporting informal caregivers in rural areas.
• Practical Implications: Opioid-Affected Births to Rural Residents
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 09/2018
  This publication provides two physicians' reactions to research findings on rates of diagnosis of maternal opioid use disorder and infant neonatal abstinence syndrome at the time of childbirth for rural residents based on the type of hospital where the birth occurred.
• Quality Measures and Sociodemographic Risk Factors: The Rural Context
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 05/2016
  This policy brief aims to inform discussions concerning whether or not to adjust provider quality measures for differences in patient characteristics by examining how rurality and key sociodemographic variables might affect quality-of-care outcomes.
• Rates of Living Alone by Rurality and Age
  University of Minnesota Rural Health Research Center
  Date: 04/2020
  In this infographic, we identify rates of living alone for all adults and within specific age groups using two classifications of rurality.
• Regulating Network Adequacy for Rural Populations: Perspectives of Five States
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 08/2017
  The purpose of this study was to examine how five geographically-diverse states with significant rural populations define "network adequacy" and the degree to which they consider rural issues when regulating networks.
• Relationship Between Hospital Policies for Labor Induction and Cesarean Delivery and Perinatal Care Quality Among Rural U.S. Hospitals
  University of Minnesota Rural Health Research Center
  Date: 11/2016
  This study focused on maternity care quality by taking a look at hospitals' policies regarding induced labor and Cesarean deliveries.
• Resources for Caregiving in Rural Communities
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 08/2018
  This policy brief describes resources that are being used across the country to support caregivers in rural communities.
• Rural and Urban Differences in Choice of and Satisfaction with Medicare Part D Plans
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 07/2015
  This brief examines whether rural Medicare beneficiaries are satisfied with their Medicare Part D drug plans and whether there is a difference in beneficiary satisfaction and plan selection experience by rurality.
• Rural Counties with Majority Black or Indigenous Populations Suffer the Highest Rates of Premature Death in the U.S.
  University of Minnesota Rural Health Research Center
  Date: 12/2019
  Despite well-documented health disparities by rurality and race/ethnicity, research investigating racial/ethnic health differences among U.S. rural residents is limited. We used county-level data to measure and compare premature death rates in rural counties by each county's majority racial/ethnic group.
• Rural Focus and Representation in State Maternal Mortality Review Committees: Review of Policy and Legislation
  University of Minnesota Rural Health Research Center
  Date: 08/2019
  Between 1990 and 2013, maternal mortality nearly doubled in the U.S., and rural residents experienced decreasing access to obstetric care. To improve maternal health, many states have established maternal mortality and morbidity review committees (MMRCs). We assessed the extent of rural representation in state policy efforts related to MMRCs.
• Rural Hospital Employment of Physicians and Use of Cesareans and Nonindicated Labor Induction
  University of Minnesota Rural Health Research Center
  Date: 03/2017
  Findings are shared from a study that discovered the types of doctors employed at rural hospitals may make a difference in the rates of cesarean births.
• Rural Implications of Expanded Birth Volume Threshold for Reporting Perinatal Care Measures
  University of Minnesota Rural Health Research Center
  Date: 04/2016
  In 2016 the minimum annual birth volume threshold for required reporting of the Joint Commission Perinatal Care measures by accredited hospitals decreased from 1,100 to 300 births. This study used the publicly available Join Commission Quality Check data from April 2014 to March 2015.
• Rural Transportation: Challenges and Opportunities
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 11/2017
  This policy brief uses survey data from 113 key informants across all 50 states to describe challenges and opportunities related to rural transportation.
• Rural-Urban Difference in Workplace Supports and Impacts for Employed Caregivers
  University of Minnesota Rural Health Research Center
  Date: 06/2018
  This study finds that employed rural caregivers had significantly fewer workplace benefits available to them compared with urban caregivers. In particular, employed rural caregivers were less likely to have access to telecommuting, employee assistance programs, and paid leave.
• Rural-Urban Differences in Access to and Attitudes Toward Care for Medicare Beneficiaries
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 12/2019
  Access to healthcare is important to health outcomes and well-being. Even among Medicare beneficiaries, access to care may differ by rural-urban location due to differences in the healthcare and socio-demographic landscape. We describe rural-urban differences in access to care for Medicare beneficiaries.
• Rural-Urban Differences in Medicare Quality Outcomes and the Impact of Risk Adjustment
  University of Minnesota Rural Health Research Center
  Date: 09/2017
  This study examined the differences in quality of care outcomes between rural and urban Medicare beneficiaries. It concluded that rurality should be considered when discussing risk-adjustment procedures.
• Rural-Urban Differences in Medicare Quality Scores Persist After Adjusting for Sociodemographic and Environmental Characteristics
  University of Minnesota Rural Health Research Center
  Date: 09/2017
  Patient sociodemographic characteristics, such as age, race, gender, income, and education, can affect health outcomes and healthcare providers' performance on quality measures. The discussion about how to tackle these issues around quality measurement haven't included rurality, but this study examines it.
• Rural-Urban Differences in Risk Factors for Motor Vehicle Fatalities
  University of Minnesota Rural Health Research Center
  Date: 09/2018
  This study uses 2017 County Health Rankings data to run stratified regression models to estimate county-level correlates of motor vehicle fatalities (MVFs) by rural and urban location. We found that rural counties have higher rates of MVFs than urban counties (22 vs. 14 per 100,000, p<0.001).
• Rural-Urban Differences in Satisfaction with Medicare Part D: Implications for Policy
  University of Minnesota Rural Health Research Center
  Date: 01/2016
  Examines the difference in rural and urban satisfaction with Medicare Part D coverage by using data from the 2012 Medicare Current Beneficiary Survey. The research found that rural residents have lower satisfaction with their coverage.
• Rural-Urban Differences In Severe Maternal Morbidity and Mortality In the U.S., 2007-15
  University of Minnesota Rural Health Research Center
  Date: 12/2019
  In the U.S., severe maternal morbidity and mortality (SMMM) is climbing—a reality that is especially challenging for rural communities, which face declining access to obstetric services. Using data for 2007-15 from the National Inpatient Sample, we analyzed SMMM during childbirth hospitalizations among rural and urban residents.
• Severe Maternal Morbidity and Hospital Transfer Among Rural Residents
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 11/2019
  In this brief, we compare hospital transfer rates for rural and urban residents who gave birth. We also provide descriptive information about the relationship between transfer status and severe maternal morbidity and mortality for rural residents nationally who gave birth 2008-2014.
• State Variability in Access to Hospital-Based Obstetric Services in Rural U.S. Counties
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 04/2017
  This policy brief describes state-level variations in 1) the availability of hospital-based obstetric services, and 2) the scope of obstetric unit and hospital closures resulting in the loss of obstetric services in rural U.S. counties from 2004 to 2014.
• State Variations in the Rural Obstetric Workforce
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 05/2016
  Many types of staff are necessary to successfully run an obstetrics unit. Rural hospitals face unique staffing challenges. This policy brief describes the obstetric workforce in rural hospitals by state for nine states: Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin.
• Supporting the Health and Wellbeing of Middle-Aged Adults Living Alone in Rural Counties
  University of Minnesota Rural Health Research Center
  Date: 06/2020
  This report shares insights from healthcare providers in 14 rural counties with the highest rates of middle-aged adults living alone in order to inform policy and practice in how best to support the health and well-being of this demographic.
• The Practice of Midwifery in Rural US Hospitals
  University of Minnesota Rural Health Research Center
  Date: 07/2016
  Analyzes the role of certified nurse-midwives (CNMs) in providing maternity care in rural US hospitals and to examine state-level variations on rural CNM practice. CNMs play an important role in the maternity care workforce in rural US hospitals.
• Unmet Need for Personal Care Assistance Among Rural and Urban Older Adults
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 06/2019
  This brief presents data on rural-urban differences in unmet need for personal care among older adults with functional limitations.