Elizabeth Crouch, PhD

Co-Director, University of South Carolina Rural Health Research Center

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

Health Services Policy and Management
University of South Carolina


Current Projects - (6)

  • Environmental Influences on Child Health: A Snapshot of Children's Health in the United States
    The environment in which a child grows up strongly influences their health in childhood, adolescence, and adulthood. Using data for 2022 and 2023 from five national data sets, this project will provide a comprehensive update on rural-urban differences in child health in the U.S.
    Research center: University of South Carolina Rural Health Research Center
    Topics: Children and adolescents, Chronic diseases and conditions, Healthcare access, Obesity, Oral health, Poverty, Public health, Social determinants of health
  • Oral Healthcare Utilization and Outcomes of Rural and Urban Medicaid-Insured Children in the United States
    Using nationally representative Medicaid claims data, this project will determine rural-urban differences in the prevalence of early childhood caries, preventative dental visits, and restorative dental visits.
    Research center: University of South Carolina Rural Health Research Center
    Topics: Children and adolescents, Medicaid and CHIP, Oral health, Rural statistics and demographics
  • 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: University of South Carolina Rural Health Research Center
    Topics: Health services, Hospitals and clinics, Nurses and nurse practitioners, Public health, Rural Health Clinics (RHCs), Workforce
  • Rural-Urban Differences in Emergency Department Utilization and Costs for Dental Conditions
    Emergency Department (ED) Utilization is a de facto provider for untreated dental issues. Understanding rural-urban differences in ED use for dental conditions in recent years is essential to inform federal, state, and community-level dental health initiatives such as preventive dental care, tele-dentistry infrastructure expansion, and oral hygiene practices. Ongoing national efforts addressing rural disparities in dental care should target individuals most at risk for missing preventive care and utilizing the ED for dental care.
    Research center: University of South Carolina Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Oral health
  • Spatial Distribution of Pre-Exposure Prophylaxis (PrEP) Need and Care
    The incidence of HIV is disproportionately high in rural areas, but these communities often lack access to evidence-based interventions to prevent new HIV diagnoses such as PrEP. Using Medicaid claims data and the Centers for Medicare & Medicaid Services Provider file, this study will determine geographic disparities (by rurality and region) in the need for PrEP and PrEP availability and identify whether PrEP availability meets the needs across geography.
    Research center: University of South Carolina Rural Health Research Center
    Topic: Pharmacy and prescription drugs
  • State-Level Medicaid Bundled Payments and Rural Perinatal Care
    The impacts of state-level Medicaid bundled payment models will depend on many factors, such as maternity care facility structure, scope of services, and local patient bypassing behaviors during prenatal, intrapartum, and postpartum periods. For rural providers who often offer prenatal and postpartum care but not labor and delivery services, these bundled payments may impose additional financial and logistical challenges.
    Research center: University of South Carolina Rural Health Research Center
    Topics: Maternal health, Medicaid and CHIP

Completed Projects - (8)

  • 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: University of South Carolina Rural Health Research Center
    Topics: Environmental and agricultural health, Public health, Social determinants of health
  • Changes in Medicare Fee-for-Services Health Care Expenditures in Rural and Urban Communities after Passage of the Affordable Care Act
    This project assessed changes in Medicare per-beneficiary spending across rural and urban counties from 2007 to 2020. It examined 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: University of South Carolina Rural Health Research Center
    Topics: Care management, Chronic diseases and conditions, Health services, Hospitals and clinics, Public health
  • 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: University of South Carolina Rural Health Research Center
    Topics: Care management, Chronic diseases and conditions, Health services, Hospitals and clinics, Public health
  • Identifying High-Need Counties for Resource Planning
    The primary aim of this project was 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: University of South Carolina Rural Health Research Center
    Topics: Chronic diseases and conditions, Diabetes, Healthcare access, Maternal health, Obesity, Oral health, Physicians, Poverty, Public health, Rural statistics and demographics, Social determinants of health, Uninsured and underinsured, Workforce
  • 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: University of South Carolina Rural Health Research Center
    Topic: Cancer
  • 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: University of South Carolina Rural Health Research Center
    Topics: Children and adolescents, Health services, Mental and behavioral health
  • Rural-Urban Disparities in Mental Health Access and Quality in the United States
    The purpose of this project was to document the recent trends of mental health care access and quality in urban and rural communities.
    Research center: University of South Carolina Rural Health Research Center
    Topics: Healthcare access, Mental and behavioral health
  • The Rural Landscape of Diabetes in the United States
    Rural-urban differences in diabetes and diabetes management may be attributed to socioeconomic differences and treatment available to rural residents. Using data from 2021-2024 National Health Interview Survey, this study examined 1) rural-urban differences in diabetes and prediabetes incidence and prevalence, 2) rural-urban differences in the management, treatment, and complications associated with diabetes, and co-occurring risk factors for cardiovascular disease.
    Research center: University of South Carolina Rural Health Research Center
    Topics: Diabetes, Healthcare access, Rural statistics and demographics

Publications - (23)

2026

  • Geographic and Sociodemographic Patterns in Prevalence of Diagnosed Diabetes, U.S., 2021–2024
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 04/2026
    A comparison of National 2021-2024 data of diagnosed diabetes among rural and urban adults across multiple socioeconomic groups confirms the need for public health strategies tailored to both rural and urban communities, and within rural communities, across sociodemographic groups.
  • Identification and Characteristics of Under-Resourced and High-Need Rural Counties
    Policy Brief
    University of South Carolina Rural Health Research Center
    Date: 04/2026
    This brief provides a metric describing how publicly available county-level data on health care workforce, chronic disease prevalence, and the socioeconomic environment of rural communities can assist policymakers in identifying the highest need counties for targeted policy initiatives and public health intervention.
  • Rural-Urban Trends in the Burden of Diabetes Among U.S. Adults
    Policy Brief
    University of South Carolina Rural Health Research Center
    Date: 03/2026
    This brief provides an updated analysis of diabetes incidence, prevalence, and mortality across rural and urban counties. The National Health Interview Survey (2021, 2022, and 2023) provided diabetes incidence and prevalence data. CDC Wonder provided diabetes mortality data.
  • Medicare Fee-for-Service Health Care Expenditures Among Rural and Urban Beneficiaries During 2009-2019
    Policy Brief
    University of South Carolina Rural Health Research Center
    Date: 01/2026
    CMS Medicare Geographic Variation Public Use files, the American Community Survey, and the Area Health Resource files were the data sources for research on whether, and to what extent, rural Medicare beneficiaries used health care differently from their urban counterparts from 2009-2019.

2025

2024

2023

2022

2021

2020

  • A National Survey of RN-to-BSN Programs: Are They Reaching Rural Students?
    Journal Article
    University of South Carolina Rural 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
    University of South Carolina Rural 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
    University of South Carolina Rural 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.

2019

2018

2017