Elizabeth Crouch, PhD

Director, Rural and Minority Health Research Center

Phone: 803.576.6055
Email: crouchel@mailbox.sc.edu

Health Services Policy and Management
University of South Carolina

Current Projects - (5)
Completed Projects - (7)
Publications - (47)

Current Projects - (5)

Availability of Diabetes Self-Management Education in High Need Rural Counties
This project will examine the degree to which counties with a high need for diabetes education, defined by high diabetes prevalence, have such education available. Findings will be linked to a related study that will examine the availability of dialysis for end stage renal disease, a severe outcome of poorly addressed diabetes.
Research center: Rural and Minority Health Research Center
Topics: Diabetes, Health services
Changes in Medicare Fee-for-Services Health Care Expenditures in Rural and Urban Communities after Passage of the Affordable Care Act
This project will assess changes in Medicare per-beneficiary spending across rural and urban counties from 2007 to 2020. It will examine differences in rural versus urban per-beneficiary spending on hospital inpatient, hospital outpatient, physician, and post-acute care after the Affordable Care Act (ACA).
Research center: Rural and Minority Health Research Center
Topics: Care management, Chronic diseases and conditions, Health disparities and health equity, Health services, Hospitals and clinics, Public health
Identifying High-Need Counties for Resource Planning
The primary aim of this project is to use data examining health care infrastructure, chronic disease prevalence, and the socioeconomic environment to create a metric for classifying rural counties based on needs and resources.
Research center: Rural and Minority Health Research Center
Topics: Chronic diseases and conditions, Diabetes, Health disparities and health equity, Healthcare access, Maternal health, Obesity, Oral health, Physicians, Poverty, Public health, Rural statistics and demographics, Social determinants of health, Uninsured and underinsured, Workforce
Rural-Urban Differences in Addressable Drivers of Staff Turnover in Skilled Nursing Facilities
The aim of the proposed study is to assess facility-level turnover rates for total nursing and registered nursing personnel across levels of rurality and by region looking at factors such as staffing ratios that can be managed by facility administrators.
Research center: Rural and Minority Health Research Center
Topics: Health services, Hospitals and clinics, Nurses and nurse practitioners, Public health, Rural Health Clinics (RHCs), Workforce
Rural-Urban Disparities in Mental Health Access and Quality in the United States
The purpose of this project is to document the recent trends of mental health care access and quality in urban and rural communities and to assess the intersectionality of residence rurality and race/ethnicity on disparities in mental health care access and quality.
Research center: Rural and Minority Health Research Center
Topics: Health disparities and health equity, Healthcare access, Mental and behavioral health

Completed Projects - (7)

Assessing Geographic Variability in Key Indicators of Water Quality and Air Quality: A Comparison of Urban vs. Rural Communities
The purpose of this project was to compare air and water quality indicators across U.S. Census tracts specifically focusing on rural vs. urban differences.
Research center: Rural and Minority Health Research Center
Topics: Environmental and agricultural health, Health disparities and health equity, Public health, Social determinants of health
Availability and Quality of Dialysis in Rural Counties with a High Diabetes Burden
This project examined the degree to which counties with a high population risk for end stage renal disease, defined by high diabetes prevalence, are served by dialysis providers. It assessed the accessibility and quality of services for end stage renal disease looking for disparities associated with rural residence and racial/ethnic population composition.
Research center: Rural and Minority Health Research Center
Topics: Diabetes, Health disparities and health equity, Health services, Public health, Quality
Examining Rural-Urban Differences in Availability of Hospital Cardiac Testing Services Between 2010-2020
This project will examine whether the availability of hospital-based cardiac testing services has changed over the past ten years in rural and urban counties and identify the characteristics of counties where service availability has changed.
Research center: Rural and Minority Health Research Center
Topics: Care management, Chronic diseases and conditions, Health disparities and health equity, Health services, Hospitals and clinics, Public health
Promotion of Rural Health Research Center Attendance at Cancer-Related Meetings
This project will promote attendance at cancer-related meetings by Rural Health Research Centers by facilitating the dissemination of information regarding important cancer meetings and handling the travel arrangements for Rural Health Research Center personnel.
Research center: Rural and Minority Health Research Center
Topics: Cancer, Minority health
Rural-Urban Differences in Adverse and Positive Childhood Experiences: Results from the National Survey of Children's Health
Using the 2016-2018 National Survey of Children's Health, the prevalence of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) exposure in all 50 states and the District of Columbia were examined and whether ACE and PCE exposure differed between rural and urban residents, by type, by count, and by racial/ethnic group.
Research center: Rural and Minority Health Research Center
Topics: American Indians and Alaska Natives, Children and adolescents, Hispanics, Minority health, Social determinants of health
Rural-Urban Differences in Child and Adolescent Mental Health pre and during the COVID-19 Pandemic
This project examined rural-urban differences in the prevalence and severity of anxiety and depression among children and adolescents before and during the COVID-19 pandemic, as well as examined rural-urban differences in access to mental health care professionals and the receipt of care from a mental health professional before and during the COVID-19 pandemic.
Research center: Rural and Minority Health Research Center
Topics: Children and adolescents, Health disparities and health equity, Health services, Mental and behavioral health, Minority health
Rural-Urban Differences in Three Domains of Access to Health Care Services
This study proposed to leverage 2018 and 2019 Behavioral Risk Factor Surveillance System data to examine rural-urban and racial/ethnic differences within rural in three domains of access to health care services (affordability, accommodation, and acceptability) that are less frequently examined in population-based surveys.
Research center: Rural and Minority Health Research Center
Topics: Health disparities and health equity, Healthcare access, Minority health

Publications - (47)

2024

Prevent or Treat: Availability of Diabetes Self-Management Education and Dialysis in High Need Rural Counties
Policy Brief
Rural and Minority Health Research Center
Date: 03/2024
In this brief, researchers assess the availability of in-county diabetes self-management education and dialysis across rural and urban counties.
Availability and Quality of Dialysis Care in Rural Versus Urban U.S. Counties
Journal Article
Rural and Minority 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.

2023

Geographic Variations in Driving Time to U.S. Mental Health Care, Digital Access to Technology, & Household Crowdedness
Journal Article
Rural and Minority Health Research Center
Date: 12/2023
This study compared travel time to mental health facilities in rural versus urban areas and potential barriers to digital devices for telemedicine access in those same rural/urban locations. In addition, the research examined private space within the home as it relates to household crowdedness.
Assessing Key Indicators of Rural Versus Urban Water Quality
Policy Brief
Rural and Minority Health Research Center
Date: 08/2023
This study presents a summary of water quality monitoring data sources and models, identifies the gaps that persist, and proposes the salient categories and types of data that should be contained in a national water quality monitoring database to accurately describe rural water quality.
Availability of Primary Care Safety Net Providers in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2023
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at the distance to the nearest primary care safety net provider.
Examining Rural-Urban Differences in the Availability of Hospital-Based Cardiac Services Between 2010-2020
Policy Brief
Rural and Minority Health Research Center
Date: 08/2023
This study examines the availability of hospital-based cardiac health care services (general cardiology, diagnostic catheterization, and interventional catheterization) and whether rural-urban differences in the availability of these health care services occurred between 2010 and 2020.
Accommodation and Acceptability of Health Care by Non-Metropolitan/Metropolitan and Race/Ethnicity Status
Policy Brief
Rural and Minority Health Research Center
Date: 07/2023
This research examined rural-urban (i.e., non-metropolitan/metropolitan) differences in accommodation and acceptability of health care by operationalizing two survey questions from the health care access optional module of the Behavioral Risk Factor Surveillance System survey.
Access to Health Services Across Rural and Urban Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 03/2023
This brief summarizes selected results from a series of reports documenting disparities in geographic access to health services for rural and urban places that have a relatively high proportion of residents from minoritized racial and ethnic groups. "Areas" were examined at the ZIP Code Tabulation Area level.
Assessing Geographic Variability in Key Indicators of Air Quality: A Rural vs. Urban Comparison of Pollution and Socio-Economic Factors
Policy Brief
Rural and Minority Health Research Center
Date: 03/2023
The purpose of this study was to examine rates of air pollution between rural and urban census tracts. In addition, urban-rural disparities in exposure to polluted air across Environmental Protection Agency-defined regions were examined.
The COVID-19 Pandemic Impact on Independent and Provider-Based Rural Health Clinics' Operations and Cancer Prevention and Screening Provision in the United States
Journal Article
Rural and Minority Health Research Center
Date: 03/2023
The provision of Rural Health Clinic (RHC) cancer prevention and screening services was examined to identify any changes pre- and peri-pandemic. The research examined overall provision of cancer prevention and screening services by RHCs and the provision of these services by independent RHCs and by provider-based RHCs .
Variations in Affordability of Health Care by Non-Metropolitan/Metropolitan and Race/Ethnicity Status Across Eight Geographically Dispersed States
Policy Brief
Rural and Minority Health Research Center
Date: 01/2023
This research examined rural-urban (i.e., non-metropolitan/metropolitan) differences in affordability inclusive of insurance coverage and cost barriers. The research also examined forgoing medical care/medication and medical debt using Behavioral Risk Factor Surveillance System survey data from the healthcare access optional module.

2022

The Impact of the COVID-19 Pandemic on Rural Health Clinics' Operations and Cancer Prevention and Control Efforts
Policy Brief
Rural and Minority Health Research Center
Date: 11/2022
This study surveyed a stratified random sample of Rural Health Clinics throughout the country to examine how the pandemic has affected their overall operations and provision of cancer prevention and control services.
Rural-Urban Differences in Child and Adolescent Mental Health Prior to and During the COVID-19 Pandemic: Results From the National Survey of Children's Health
Policy Brief
Rural and Minority Health Research Center
Date: 11/2022
This policy brief analyzes data from a large national sample of children and adolescents to examine similarities and differences between rural and urban mental health outcomes prior to and during the COVID-19 pandemic and offers considerations for policy and program development.
Rural-Urban Disparities in Quality of Inpatient Psychiatric Care
Journal Article
Rural and Minority 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.
Changes in Access to Nearest Federally Qualified Health Centers and Rural Health Clinics Among Rural ZIP Codes That Did and Did Not Experience a Hospital Closure, 2006-2018
Policy Brief
Rural and Minority Health Research Center
Date: 10/2022
This brief explores changes in geographic accessibility within rural ZIP codes throughout the U.S. to Federally Qualified Health Centers and Rural Health Clinics, between 2016 and 2018.
The Involvement of Rural Health Clinic Practitioners in Cancer Treatment Decisions and Survivorship Care
Policy Brief
Rural and Minority Health Research Center
Date: 10/2022
This study examined Rural Health Clinics' practitioner involvement in cancer treatment decisions, management of side effects, surveillance, and survivorship care.
Availability of Hospital-Based Cancer Services Before and After Rural Hospital Closure, 2008-2017
Journal Article
Rural and Minority 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.
Availability of Hospital-Based Emergency Department and Trauma Services in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 09/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas (ZCTAs) containing a high proportion of minoritized racial/ethnic residents. This report looks at the availability of hospital-based emergency department and trauma services at the ZCTA level.
Availability of Nursing Homes in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 09/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas (ZCTAs) containing a high proportion of minoritized racial/ethnic residents. This report looks at the availability of nursing homes at the ZCTA level.
Rural-Urban Differences in Child and Adolescent Access to and Receipt of Mental Health Services Prior to and During the COVID-19 Pandemic: Results From the National Survey of Children's Health
Policy Brief
Rural and Minority Health Research Center
Date: 09/2022
This policy brief analyzes data from a large, national sample of children and adolescents to examine gross inter-group similarities and differences and offer timely recommendations for alleviating the youth mental health crisis.
Availability of Pharmacies in Minoritized Racial/Ethnic Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at access to pharmacies.
Examining the Association Between Rurality and Positive Childhood Experiences Among a National Sample
Journal Article
Rural and Minority 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.
Spatial Access to Hospital-based Obstetric Units in Minoritized Racial/Ethnic Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at spatial access to hospital-based obstetric units in minoritized racial/ethnic areas.
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
Rural and Minority 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.
Rural Children With 4+ Adverse Childhood Experiences Often Lack Positive Experiences
Fact Sheet
Rural and Minority Health Research Center
Date: 07/2022
This research explored the proportion of rural children with adverse childhood experiences who lack positive childhood experience exposure.
Comparison of Cancer Treatment Services Across Hospitals
Fact Sheet
Rural and Minority Health Research Center
Date: 05/2022
This research compared the availability of comprehensive oncology, chemotherapy, and radiation therapy in Critical Access Hospitals and non-Critical Access Hospitals.
Racial/Ethnic Differences in Adverse and Positive Childhood Experiences Across Rural Communities: Results From the National Survey of Children's Health
Policy Brief
Rural and Minority Health Research Center
Date: 05/2022
This study examined whether ACE and PCE exposure varied by race/ethnicity, among rural children, finding that there were higher rates of four or more ACEs among racial/ethnic minority children.
Colorectal and Cervical Cancer Prevention in Rural Health Clinics in South Carolina
Fact Sheet
Rural and Minority Health Research Center
Date: 02/2022
This study investigated the perceptions and practices of cervical and colorectal cancer prevention in Rural Health Clinics. An online survey was administered to all Rural Health Clinics in South Carolina. Quantitative survey findings and key takeaways were reported.
Perceptions and Practices for Colorectal and Cervical Cancer Prevention and Control in Rural Health Clinics in South Carolina
Fact Sheet
Rural and Minority Health Research Center
Date: 02/2022
This study investigated the perceptions and practices for colorectal and cervical cancer prevention and control in Rural Health Clinics in South Carolina. Health practitioner interviews were used to gather qualitative data.
The Problem of the Color Line: Place, Race, and Access to Health Care in America
Journal Article
Rural and Minority Health Research Center
Date: 02/2022
Using ZIP Code Tabulation Area boundaries and associated rural-urban commuting area codes, urban and rural places with the largest share of minoritized racial and ethnic groups were identified. A StoryMap was then created to illustrate disparities experienced based on where Indigenous populations and people of color reside spatially.
Rural-Urban Differences in Adverse and Positive Childhood Experiences: Results From the National Survey of Children's Health
Policy Brief
Rural and Minority Health Research Center
Date: 01/2022
This brief examines the types and counts of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) for rural and urban children. The study reports on the differences between rural and urban ACEs and PCEs across all fifty states and the District of Columbia.

2021

Changes in Socioeconomic Mix and Health Outcomes in Rural Counties With Hospital Closures, 2005-2018
Policy Brief
Rural and Minority Health Research Center
Date: 09/2021
This brief examines the trend of hospital closures between 2005 and 2018 across definitions of rurality. Social, economic, and health structure trends at the county level across the contiguous United States were the study's focus.
Trends in Cancer Treatment Service Availability Across Critical Access Hospitals and Prospective Payment System Hospitals
Journal Article
Rural and Minority Health Research Center
Date: 08/2021
This study investigated trends in cancer services availability in urban and rural Prospective Payment System (PPS) hospitals and Critical Access Hospitals (CAHs). Compared with all PPS hospitals, CAHs offered fewer cancer treatment services and experienced a decline in service capability over time.
The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States
Journal Article
Rural and Minority Health Research Center
Date: 02/2021
This manuscript summarizes how racism and social determinants of health disproportionately affect rural racial/ethnic minorities, offers a review of the cancer disparities rural racial/ethnic minorities face, and recommends policy, research, and intervention to reduce these disparities.

2020

A National Survey of RN-to-BSN Programs: Are They Reaching Rural Students?
Journal Article
Rural and Minority 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.
Factors Associated With Perceived Job Preparedness Among RNs: Results From a National Survey
Journal Article
Rural and Minority 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.
Rural-Urban Differences in Educational Attainment Among Registered Nurses: Implications for Achieving an 80% BSN Workforce
Journal Article
Rural and Minority 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.
Travel Grant Program 2018-2019
Fact Sheet
Rural and Minority Health Research Center
Date: 01/2020
This project promoted attendance at cancer-related meetings by Rural Health Research Centers by facilitating the dissemination of information regarding important cancer meetings and handling the travel arrangements for Rural Health Research Center personnel.

2019

Geographic Disparities in Residential Proximity to Colorectal and Cervical Cancer Care Providers
Journal Article
Rural and Minority Health Research Center
Date: 11/2019
Persistent rural‐urban disparities for colorectal and cervical cancers raise concerns regarding access to treatment providers. To the authors knowledge, little is known regarding rural‐urban differences in residential proximity to cancer specialists.

2018

Rural-Urban Differences in Hospital Payer Mix in 2017
Fact Sheet
Rural and Minority Health Research Center
Date: 11/2018
This work revealed that rural hospitals heavily rely on Medicare.
Differences in Medicare Utilization and Expenditures in the Last Six Months of Life Among Patients With and Without Alzheimer's Disease and Related Disorders
Journal Article
Rural and Minority Health Research Center
Date: 10/2018
The purpose of this study was to examine differences in utilization of inpatient services and Medicare expenditures (overall and by category) in the last six months of life for patients with, versus those without, a diagnosis of Alzheimer's disease and related disorders.
The Importance of Rural Hospitals: Transfers and 30-day Readmissions Among Rural Residents and Patients Presenting at Rural Hospitals
Journal Article
Rural and Minority Health Research Center
Date: 07/2018
This study looked at reasons why transfers and readmissions occurred among Medicare patients who first came to rural hospitals.
Rural-Urban Differences in Costs of End-of-Life Care for the Last 6 Months of Life Among Patients With Breast, Lung, or Colorectal Cancer
Journal Article
Rural and Minority Health Research Center
Date: 04/2018
Our findings indicate that Medicare expenditures are lower for rural beneficiaries with each type of cancer than urban beneficiaries, even after adjusting for age, gender, race, dual eligibility, region, chronic conditions, and type of service utilization.

2017

Gender and Geographic Differences in Medicare Service Utilization During the Last Six Months of Life
Journal Article
Rural and Minority Health Research Center
Date: 11/2017
End-of-life issues are important for senior women, particularly rural women, who are more likely than their urban counterparts to live alone. The role of residence has yet to be investigated. The purpose of this study is to examine whether service utilization in the last six months of life differs across gender and rurality.
Supply-Side Differences Only Modestly Associated With Inpatient Hospitalizations Among Medicare Beneficiaries in the Last Six Months of Life
Journal Article
Rural and Minority Health Research Center
Date: 11/2017
This study examined rural and urban Medicare beneficiaries and inpatient hospitalizations during their last six months of life. The study concluded that care at the end of life is much the same for rural and urban Medicare decedents.
Differences in Medicare Service Use in the Last Six Months of Life Among Rural and Urban Dual – Eligible Beneficiaries
Report
Rural and Minority Health Research Center
Date: 08/2017
In this brief, we compare rural and urban dual-eligible beneficiaries to Medicare-only beneficiaries in their service utilization in the last six months of life. Within rural beneficiaries, we further explore differences associated with race/ethnicity.
Rural-Urban Differences in Medicare Service Use in the Last Six Months of Life
Report
Rural and Minority Health Research Center
Date: 08/2017
This brief focuses on the current status of healthcare use during the last six months of life among Medicare beneficiaries. We used data from a sample of Medicare beneficiary claims to assess whether service utilization differed between rural and urban decedents and across decedents of different race/ethnicity categories.