Gary Hart, PhD

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

Phone: 701.777.3848
Fax: 701.777.6779
Email: gary.hart@med.und.edu

Center for Rural Health
University of North Dakota
School of Medicine and Health Sciences
1301 N. Columbia Road, Stop 9037
Suite E231 (Office #252)
Grand Forks, ND 58202


Current Projects - (5)

  • Comparisons of Rural Definitions
    This project will lead to the creation of a mega rural and frontier website. This website will emphasize the use of various rural definitions and datasets for health care policy, policy analysis, and research.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topic: Frontier health
  • Critical Review and Analysis Regarding PCSAs, HPSA Rational Service Areas, and Other: Geographic Alternatives for Creating Useful Primary Care Service Areas
    The purpose of this proposed project is to review Dartmouth’s Primary Care Service Areas (PCSAs), other Rational Service Area (RSA) methodologies, and alternative methodologies related to their strengths, weaknesses, and spatial analytic criteria regarding their ability to serve in the process of developing useful primary care service areas. The project will include normative service areas where in a primary care service area should exist (potential service area) but does not (e.g., large area/population with no providers that could support them).
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Physicians, Workforce
  • 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 Hospice Surveys Regarding Family Members & Health Workforce
    This project’s two parts survey both hospice users’ family members and hospice CEOs regarding their health workforce staffing and shortages. The family member survey involves a sample of hospices from a geographically disperse group of states and the CEO survey involves a national random sample of hospice CEOs.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Hospice and palliative care, Workforce
  • Utilization of Hospital Care for Rural Medicare Beneficiaries
    This project examines where rural and frontier Medicare beneficiaries access hospital care. Specifically, it explores the different types of inpatient care sought in local rural communities and at tertiary providers. Beneficiary patterns of care by condition, location type and other factors will be examined. The study will also focus on the bypassing behavior of rural residents when being hospitalized. Analysis sensitivity analyses are being performed regarding small travel time differences per alternative hospitals.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Frontier health, Hospitals and clinics, Medicare

Completed Projects - (18)

  • Access to Physician Care for the Rural Medicare Elderly
    This study described where Medicare beneficiaries in five states obtain their health care, how far they travel for that care, and the mix of physician specialties from which they obtain ambulatory care. Special attention was paid to beneficiaries who have dual Medicare-Medicaid status, who reside in poorer income areas, and who live in designated Health Professional Shortage Areas.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Chronic diseases and conditions, Health services, Medicare, Physicians, Poverty
  • Ambulatory Care and the Rural Elderly
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Chronic diseases and conditions, Health services
  • Chartbook of Family Practice Graduate Medical Education Programs in Rural America
    Little is known about the volume, location, and types of rural training for family physicians. This project will produce a chartbook that makes previously unreported information about family physician residency directors more fully available to medical educators and other policymakers.
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
  • Evaluation of Washington State Shortage Designations
    Research center: WWAMI Rural Health Research Center
    Topic: Workforce
  • Examination of Trends in Rural and Urban Health: Establishing a Baseline for Health Reform
    The purpose of this project is to update and supplement the seminal Health, United States, 2001: Urban and Rural Health Chartbook. Resulting information can not only be compared to the 2001 Chartbook but provides a baseline from which to measure future change related to the Accountable Care Act implementation. Where appropriate additional charts are included wherein rural areas are subdivided by type.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Health disparities, Health policy, Health services, Public health
  • Frontier and Rural Definition Development and Dissemination Project
    The Frontier and Remote (FAR) codes are a new geographic definition that delineates frontier/remote areas in the U.S.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topic: Frontier health
  • Medicare Bonus Payments for Physician Care in Health Professional Shortage Areas
    Research center: WWAMI Rural Health Research Center
    Topics: Healthcare financing, Medicare, Physicians
  • National Rural General Surgeon Project
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Physicians, Workforce
  • National Rural Hospital Flexibility Program Tracking Project
    Research center: WWAMI Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  • National Study of Rural-Urban Differences in Use of Home Oxygen for Chronic Obstructive Lung Disease: Are Rural Medicare Beneficiaries Disadvantaged?
    To understand disparities in care among rural and urban Medicare beneficiaries, data from Medicare's Durable Medical Equipment (DME) files were used to assess rural/urban variation in the home use of supplemental oxygen.
    Research center: WWAMI Rural Health Research Center
    Topics: Chronic diseases and conditions, Medicare
  • 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
  • Rural Health Center Expansion and Recruitment Survey
    This collaborative project between WWAMI and the South Carolina Rural Health Research Centers examined and described the current staffing needs of rural health centers (HC), ascertained the staffing, recruitment, and retention issues that HC CEOs regard as most critical; distinguished how issues differ between CEOs contemplating development of expansion sites versus those who are not; and described how these findings correlate with the literature and current national supply projections for the categories of health professions needed by the HCs.
    Research centers: South Carolina Rural Health Research Center, WWAMI Rural Health Research Center
    Topics: Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Workforce
  • Rural Population Hospice Care
    Relatively little is known about rural hospice care. The objectives of this project are to review and describe what is already known about rural hospices and to perform initial quantitative analyses on available data to describe the: number of rural hospices and their use patterns (e.g., length of stay and utilization rates), rural residents to urban hospice utilization, and rural versus urban resident hospice utilization rates. For this project, rural is be subdivided into categories such as large rural, small rural, isolated small rural, and frontier. To supplement this information, qualitative information was obtained and integrated into the findings report.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Aging, Health services, Quality
  • Rural-Urban Commuting Area (RUCA) Development Project: Demographic Description and Frontier Enhancement
    This project augments the initial RUCA work by producing and describing the base 1998 demography of the RUCA code areas, creating quality state maps of the RUCA codes, and making this information and the codes easily available on the Web.
    Research center: WWAMI Rural Health Research Center
    Topics: Defining rural, Frontier health
  • State Rural Health Workforce Monograph
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
  • The Rural/Urban Practice Location Patterns of Women Medical School Graduates
    While women are becoming an increasingly large percentage of the graduates of medical schools, they are much less likely to locate their practices in rural towns. This study involved a survey including questions about where the residents preferred to locate and how much they thought they would be practicing in the future.
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Women, Workforce
  • Use and Performance Variations in Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    This project describes rural usage of rural emergency departments (EDs). It will examine the conditions that are treated in these EDs and describe those that are more and less appropriate for ED use. Rural ED use is described by community characteristics including rural level. The findings provide a baseline from which to measure the future influence of the Accountable Care Act implementation on the usage of rural EDs and the appropriateness and cost efficiency of changes.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Emergency medical services (EMS), Quality
  • Validation of Commuting Area Designations for the Elderly
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Defining rural

Publications - (51)

  • 2005 Physician Supply and Distribution in Rural Areas of the United States (Full Report)
    WWAMI Rural Health Research Center
    Date: 11/2007
    This study describes the 2005 supply and distribution of physicians (including osteopathic physicians and international medical graduates) with particular emphasis on generalists in rural areas. Results indicate variability in the rural-urban distribution of physicians, with generalist physicians playing prominent roles in rural areas.
  • 2005 Physician Supply and Distribution in Rural Areas of the United States (Project Summary)
    WWAMI Rural Health Research Center
    Date: 11/2007
    This study describes the 2005 supply and distribution of physicians (including osteopathic physicians and international medical graduates) with particular emphasis on generalists in rural areas. Results indicate variability in the rural-urban distribution of physicians, with generalist physicians playing prominent roles in rural areas.
  • Access to Cancer Services for Rural Colorectal Cancer Patients
    WWAMI Rural Health Research Center
    Date: 2008
    Includes findings from a study to determine how far rural and urban colorectal cancer (CRC) patients travel to three types of specialty cancer care services-surgery, medical oncology consultation, and radiation oncology consultation.
  • Access to Maternity Care in Rural Washington: Its Effect on Neonatal Outcomes and Resource Use
    Upper Midwest Rural Health Research Center
    Date: 01/1997
    Compares birth outcomes for areas with poor health care access to those with adequate health care access in rural Washington state.
  • Access to Specialty Health Care for Rural American Indians in Two States
    WWAMI Rural Health Research Center
    Date: 06/2008
    Examines access to specialty services among rural Indian populations in Montana and New Mexico, based on a survey sent to primary care providers addressing access to specialty physicians, perceived barriers to access, and access to nonphysician clinical services.
  • An Analysis of Medicare's Incentive Payment Program for Physicians in Health Professional Shortage Areas
    WWAMI Rural Health Research Center
    Date: 03/2004
    The Medicare Incentive Payment program provides a 10 percent bonus payment to physicians who treat patients in Health Professional Shortage Areas (HPSAs). Results show that physicians eligible for the bonus payments often did not claim them, and physicians who likely did not work in approved HPSA sites, claimed the bonus payments and received them.
  • The Changing Geography of Americans Graduating from Foreign Medical Schools
    WWAMI Rural Health Research Center
    Date: 02/2006
    Reports the results of a study of U.S.-born international medical graduates, analyzing changes in their numbers and countries of training from the 1960s and before until the early 2000s.
  • Characterizing the General Surgery Workforce in Rural America
    WWAMI Rural Health Research Center
    Date: 05/2004
    General surgeons form a crucial component of the medical workforce in rural areas of the United States. Analysis of the data suggests that the general surgical workforce has not kept pace with the rising population, and that the number of general surgeons in most rural areas of the U.S. will decline further. Report available by contacting the Center.
  • The Contribution of Nurse Practitioners and Physician Assistants to Generalist Care in Underserved Areas of Washington State
    WWAMI Rural Health Research Center
    Date: 08/2003
    Uses productivity data from the non-physician clinician (NPC) and physician populations in Washington State to assess the contribution to generalist care made by NPCs, giving special attention to the role of NPCs in rural and underserved areas and the role of women NPCs in the female provider population. Overall, generalist NPCs make up 23.4 percent of the generalist provider population and perform about 21 percent of the generalist outpatient visits in Washington State. NPC contribution is higher in rural areas of the state and a bit lower in urban areas. In rural areas, female physicians provided only 49.3 percent of the visits by female providers; female NPCs provided the remaining 50.3 percent. In urban areas, female physicians provided about 63.5 percent; female NPCs provided 46.5 percent. NPCs made similar contributions to total care in rural HPSAs compared to rural non-shortage areas, though physician assistants appear to contribute somewhat more care in HPSAs with severe shortages of providers. The results suggest that accurate and meaningful estimates of available generalist care must take into account the contribution of NPCs.
  • Dimensions of Retention: A National Study of the Locational Histories of Physician Assistants
    WWAMI Rural Health Research Center
    Date: 1999
    This study describes the locational histories of a representative national sample of physician assistants and considers the implications of observed locational behavior for recruitment and retention of physician assistants in rural practice.
  • The Distribution of Rural Female Generalist Physicians in the United States
    WWAMI Rural Health Research Center
    Date: 2000
    Female physicians are underrepresented in rural areas. What impact might the increasing proportion of women in medicine have on the rural physician shortage? To begin addressing this question, we present data describing the geographic distribution of female physicians in the United States.
  • Do International Medical Graduates (IMGs) "Fill the Gap" in Rural Primary Care in the United States? A National Study
    WWAMI Rural Health Research Center
    Date: 2009
    Compares the practice locations of international medical graduates (IMGs) and U.S. medical graduates (USMGs) in primary care specialties.
  • Educating Generalist Physicians for Rural Practice: How Are We Doing?
    WWAMI Rural Health Research Center
    Date: 2000
    About 20 percent of Americans live in rural areas, 9 percent of physicians practice there. Physicians consistently settle in metropolitan, suburban, and other nonrural areas. This report summarizes the successes/failures of medical education and government initiatives intended to prepare and place more generalist physicians in rural practice.
  • Emergency Department Use by the Rural Elderly
    WWAMI Rural Health Research Center
    Date: 2000
    This study uses Medicare data to compare emergency department (ED) use by rural and urban elderly beneficiaries. Given the similarity of diagnostic conditions associated with ED visits, rural EDs must be capable of dealing with the same range of emergency conditions as urban EDs.
  • Family Medicine Residency Training in Rural Areas: How Much is Taking Place, and Is It Enough to Prepare a Future Generation of Rural Family Physicians?
    WWAMI Rural Health Research Center
    Date: 03/2002
    Determines how much rural family practice training is taking place in the United States. The report concludes that to the extent that there is a link between the place of training and future practice, the lack of rural training contributes to the shortage of rural physicians.
  • The Flight of Physicians From West Africa: Views of African Physicians and Implications for Policy
    WWAMI Rural Health Research Center
    Date: 2005
    West African-trained physicians have been migrating from the sub-continent to rich countries, primarily the US and the UK, since medical education began in Nigeria and Ghana in the 1960s. In 2003, we visited six medical schools in West Africa to investigate the magnitude, causes, and consequences of the migration.
  • Gender-Related Factors in the Recruitment of Generalist Physicians to the Rural Northwest
    WWAMI Rural Health Research Center
    Date: 02/2001
    Examines differences in the factors female and male generalist physicians considered influential in their rural practice location choice and identifies the practice arrangements that attracted female generalist physicians to rural areas. Findings include: women were more likely than men to have been influenced in practice choice by issues related to spouse/personal partner, flexible scheduling, family leave, and availability of childcare; women were more highly influenced by the interpersonal aspects of recruitment; and men and women were equally likely to consider community factors, practice content, practice partner compatibility, and financial issues. Findings indicate that rural communities and practices recruiting physicians should place high priority on practice scheduling, spouse/partner, and interpersonal issues in the recruiting process if they want to achieve a gender-balanced physician workforce. Report available by contacting the Center.
  • Geographic Access to Health Care for Rural Medicare Beneficiaries
    WWAMI Rural Health Research Center
    Date: 04/2005
    This study looked at where Medicare beneficiaries of five states obtain their care, how far they travel for that care, and the mix of physician specialties from whom they obtain their ambulatory care. Findings from this study suggest that rural residents do not rely on urban areas for the majority of their care. Those living in small and isolated rural areas have decreased geographic access to healthcare providers, particularly specialists, and rely heavily on generalists for the majority of their care. Additionally, results of the study suggest that these individuals have few visits overall and must travel longer distances to access certain types of care. These findings have policy implications for geographic reimbursement differentials, telehealth networks, and graduate medical education. Report available upon request by contacting the Center.
  • Health Center Expansion and Recruitment Survey 2004: Results by Health and Human Services Regions and Health Center Geography
    WWAMI Rural Health Research Center
    Date: 03/2007
    Reports findings from the national study of health centers staffing, recruitment and retention. Provides information by HHS region, urban and rural geography, and national overall estimates. Includes 118 graphs of selected survey results.
  • How Many Physicians Can a Rural Community Support? A Practice Income Potential Model for Washington State
    WWAMI Rural Health Research Center
    Date: 04/2001
    Addresses the ability of smaller and underserved rural communities to financially support needed physicians. Reports on an experimental simulation model that projects potential practice income for primary care physicians in rural communities of Washington State. Finds that the distribution of physicians follows predicted economic potential. Surprisingly, the types of rural communities most likely to have fewer physicians are not small isolated towns, but larger communities with above average population growth, closer proximity to metro areas and somewhat lower average family incomes. Towns in HPSAs were predominantly constrained by demand deficits. To overcome demand barriers, continuous subsidies such as enhanced Medicare payments for certified Rural Health Clinics or 10 percent Medicare supplemental payments for care provided in a HPSA could be offered. Signing-bonus approaches may help overcome initial reluctance to practice in rural areas where demand is sufficient to support long-term retention.
  • Improving the Quality of Outpatient Care for Older Patients with Diabetes: Lessons from a Comparison of Rural and Urban Communities
    WWAMI Rural Health Research Center
    Date: 08/2001
    Compares the quality of diabetic care received by patients in rural and urban communities in Washington State. Concludes that large rural towns may provide the best conditions for high-quality care-growing communities that serve as regional referral centers and have an adequate, but not excessive, supply of generalist and specialist physicians.
  • Metropolitan, Urban and Rural Commuting Areas: Toward a Better Depiction of the U.S. Settlement System
    WWAMI Rural Health Research Center
    Date: 1999
    Analyzes 1990 census-defined urbanized areas and tract-to-tract commuter flows. Results include a modest shift of population from metropolitan to nonmetropolitan, as well as a significant reduction in the areal size of metropolitan areas, disaggregation of many areas, and frequent reconfiguration to a more realistic settlement form.
  • Modeling the Mental Health Workforce in Washington State: Using State Licensing Data to Examine Provider Supply in Rural and Urban Areas
    WWAMI Rural Health Research Center
    Date: 2006
    Identifies mental health shortage areas using existing licensing and survey data. Found that notable shortages of mental health providers existed throughout the state, especially in rural areas. Urban areas had 3x the psychiatrist FTEs per 100,000 and more than 1.5x the nonpsychiatrist mental health provider FTEs per 100,000 as rural areas.
  • National Estimates of Physician Assistant Productivity
    WWAMI Rural Health Research Center
    Date: 2001
    Analysis of productivity data from a nationally representative sample of physician assistants (PAs) showed that PAs performed 61.4 outpatient visits per week compared with 74.2 visits performed by physicians. However, productivity of PAs varies strongly across practice specialty and location.
  • The National Health Service Corps: Rural Physician Service and Retention
    WWAMI Rural Health Research Center
    Date: 07/1997
    The National Health Service Corps (NHSC) scholarship program is the most ambitious program in the US designed to supply physicians to underserved areas, in addition the NHSC promotes long-term retention of physicians in the areas to which they were initially assigned. This study explores some of the issues involved in retention in rural areas.
  • A National Study of Lifetime Asthma Prevalence and Trends in Metro and Non-Metro Counties, 2000-2003 (Full Report)
    WWAMI Rural Health Research Center
    Date: 01/2007
    Reports the findings of a study of the prevalence of and recent trends in asthma among adults residing in metropolitan and non-metropolitan counties in the United States. In 2003, the adjusted prevalence of lifetime asthma diagnosis was 12.0 percent for metropolitan counties and 11.0 percent for non-metropolitan counties (p < 0.001). Prevalence of lifetime asthma diagnosis trended upwards across the rural-urban spectrum between 2000 and 2003, and states with the highest 2003 prevalence and the greatest increase in prevalence among non-metropolitan residents were concentrated in the West Census region (e.g., Arizona, California, Oregon and Washington). Asthma prevalence in non-metropolitan counties was highest for those aged 18 to 34 (15.9%), the unemployed (13.5%), American Indians (12.7%) and women (12.4%).
  • A National Study of Obesity Prevalence and Trends by Type of Rural County
    WWAMI Rural Health Research Center
    Date: 2005
    Analyzes data from the Behavioral Risk Factor Surveillance System for 1994-1996 and 2000-2001 to estimate the recent trends in obesity among U.S. adults residing in rural locations. In 2000-2001 the prevalence of obesity was 23.0% for rural adults and 20.5% for urban, representing increases of 4.8% and 5.5%, respectively, since 1994-1996.
  • Obesity Prevalence In Rural Counties: A National Study
    WWAMI Rural Health Research Center
    Date: 01/2004
    Using a telephone survey of adults aged 18 and older residing in states participating in the Behavioral Risk Factor Surveillance System in 1994-96 and 2000-2001, researchers found that the prevalence of obesity was 23 percent for rural adults and 20.5 percent for urban adults.
  • Pathways to Rural Practice: A Chartbook of Family Medicine Residency Training Locations and Characteristics
    WWAMI Rural Health Research Center
    Date: 08/2005
    Discusses characteristics and geographic locations of family medicine residency programs' rural locations, types of rural family medicine training by location, and rural mission of family medicine residencies.
  • Perinatal and Infant Health Among Rural and Urban American Indians/Alaska Natives
    WWAMI Rural Health Research Center
    Date: 09/2002
    Provides a national profile of rural and urban American Indian/Alaska Native (AI/AN) maternal and infant health.
  • 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 And Trends In Smoking: A National Rural Study
    WWAMI Rural Health Research Center
    Date: 2006
    Using data from the Behavioral Risk Factor Surveillance System, the prevalence of smoking between 1994-1996 and 2000-2001 did not change substantially for the United States as a whole. The prevalence of smoking for rural residents decreased by more than 2 percent in six states. However, it increased by 2 percent or more in ten states.
  • Problem Drinking: Rural and Urban Trends in America, 1995/1997 to 2003
    WWAMI Rural Health Research Center
    Date: 03/2006
    Assesses the prevalence of, and recent trends in, alcohol use among adults 18 years and older in rural areas of the United States. The paper finds that heavy drinking was highest and increasing in urban areas, but that binge drinking was greater in rural areas. It recommends tailoring interventions specifically to meet the needs of rural residents.
  • The Production of Rural Female Generalists by U.S. Medical Schools
    WWAMI Rural Health Research Center
    Date: 05/1999
    Compares the production of rural female generalists among medical schools. Data from the 1996 AMA Physician Masterfile for the 1988-96 graduate cohort were analyzed to compare the production of rural female generalists by medical school. Outcome measures included total number and percentage of rural female generalist graduates of each school.
  • Quality of Care for Acute Myocardial Infarction: Are the Gaps Between Rural and Urban Hospitals Closing?
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 03/2010

    Many simple, evidence-based guidelines that improve acute myocardial infarction outcomes are inadequately implemented in both rural and urban hospitals. Overall, there has been improvement in acute myocardial infarction quality measures, and persistent rural-urban disparities in only a few. Particularly in small and remote small rural locations, developing strategies to increase use of beneficial discharge medications is important.

  • Quality of Care for Myocardial Infarction in Rural and Urban Hospitals
    WWAMI Rural Health Research Center
    Date: 2010
    In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted.
  • Results of the 2004 Health Center Expansion and Recruitment Survey for Health Centers: Analyses for Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI States)
    WWAMI Rural Health Research Center
    Date: 11/2006
    Presents a subset of the findings from the larger national study of Federally Qualified Health Center (FQHC) staffing needs of FQHCs located in Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) overall and by urban and rural geography.
  • Rural and Urban Physicians: Does the Content of Their Medicare Practices Differ?
    WWAMI Rural Health Research Center
    Date: 1999
    Rural and urban areas have significant differences in the availability of medical technology, medical practice structures and patient populations. This study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physicians practicing in rural and urban areas.
  • Rural Definitions for Health Policy and Research
    WWAMI Rural Health Research Center
    Date: 07/2005
    Defining "rural" for health policy and research purposes requires researchers and policy analysts to specify which aspects of rurality are most relevant to the topic at hand and then select an appropriate definition. Rural and urban taxonomies often do not discuss important demographic, cultural, and economic differences across rural places-differences that have major implications for policy and research. Factors such as geographic scale and region also must be considered. Several useful rural taxonomies are discussed and compared in this article. Careful attention to the definition of "rural" is required for effectively targeting policy and research aimed at improving the health of rural Americans.
  • Rural Dental Practice: A Tale of Four States (Full Report)
    WWAMI Rural Health Research Center
    Date: 03/2006
    Reports the findings of a study investigating rural dentist issues, such as demography, training, practice characteristics, staff, and job satisfaction, in Alabama, California, Maine, and Missouri. Generally, dentists and their work patterns were similar across the four states. Dentist practices varied dramatically across states regarding staffing patterns. Vacancy rates for dental hygienists varied greatly from state to state, ranging from 35 percent to 6 percent, while dental assistant vacancy rates varied from 12 percent to 4 percent. Dentist Medicaid participation and volume differed widely across the states. The majority of dentists in the four states were satisfied with their professional life, but the percentage who felt they were too busy or not busy enough varied widely among the states.
  • Rural Research Focus: Rural Physician Shortages
    WWAMI Rural Health Research Center
    Date: 05/2002
    Discusses a model for understanding how many physicians a rural community can support, based on research at the WWAMI Rural Health Research Center.
  • Shortages of Medical Personnel At Community Health Centers: Implications for Planned Expansion
    WWAMI Rural Health Research Center
    Date: 2006
    Examines the status of workforce shortages that may limit Community Health Center (CHC) expansion by surveying all 846 federally-funded US CHCs that directly provide clinical services and are within the 50 states and the District of Columbia.
  • State of the Health Workforce in Rural America: Profiles and Comparisons
    WWAMI Rural Health Research Center
    Date: 01/2003

    Overview of rural healthcare workforce issues. National and state-by-state data on the healthcare workforce, with rural-urban comparisons and interstate comparisons. Also includes data on rural healthcare facilities. To request a copy, call (206) 685-0402 or email: rowe@u.washington.edu

  • Trends in Perinatal and Infant Health Disparities Between Rural American Indians and Alaska Natives and Rural Whites
    WWAMI Rural Health Research Center
    Date: 04/2009
    Examines perinatal care, birth outcomes, and infant health between rural American Indian and Alaska Native (AIAN) persons and rural Whites over time. Despite significant decreases in inadequate prenatal care and postneonatal death among American Indians and Alaska Natives, additional measures are needed to close health gaps for this group.
  • Trends in Professional Advice to Lose Weight Among Obese Adults, 1994-2000
    WWAMI Rural Health Research Center
    Date: 2005
    The authors studied whether rising obesity prevalence in the U.S. was accompanied by an increasing trend in professional advice to lose weight among obese adults, and found that disparities in professional advice to lose weight associated with income and educational attainment increased from 1994 to 2000. They concluded that there is a need for mechanisms that allow health care professionals to devote sufficient attention to weight control and to link with evidence-based weight loss interventions, especially those that target groups most at risk for obesity
  • The U.S. Rural Physician Workforce: Analysis of Medical School Graduates from 1988-1997 (Final Report)
    WWAMI Rural Health Research Center
    Date: 10/2008
    Despite continued federal and state efforts to increase the number of physicians in rural areas, disparities between the supply of rural and urban physicians persist. This paper describes the training of the rural physician workforce in the United States and examines the variations in medical school and residency production of rural physicians.
  • Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 02/2015

    The purpose of this brief is to describe the geographic variation in the use of EDs for non- emergent health conditions across rural and urban areas as well as by U.S. Census Regions. Potential risk factors including patients’ socioeconomic characteristics, geographic location and level of primary care resources are identified. Quality of care indicators, limited to wait times and the length of the visit for rural and urban EDs, are also addressed.

  • The Washington State Nurse Anesthetist Workforce: A Case Study
    WWAMI Rural Health Research Center
    Date: 02/2007
    The purpose of this study was to describe the Washington State Certified Registered Nurse Anesthetist (CRNA) workforce and analyze selected dimensions of their clinical practice.
  • Who is Caring for the Underserved? A Comparison of Primary Care Physicians and Nonphysician Clinicians in California and Washington
    WWAMI Rural Health Research Center
    Date: 07/2003
    Compares the geographic distribution and patient populations of physician and nonphysician primary care clinicians. Includes the proportion of clinicians within each discipline practicing in rural areas, Health Professional Shortage Areas (HPSAs), and areas with vulnerable populations.
  • WWAMI Physician Workforce 2005
    WWAMI Rural Health Research Center
    Date: 05/2005
    Data on physician supply, demand, and need in the WWAMI region have not been routinely collected or reported. This report responds to a request by the University of Washington School of Medicine (UWSOM) Primary Care Steering Committee to examine the current supply and distribution of physicians in the WWAMI region. These data can help inform and guide the UWSOM in the production of physicians for the WWAMI region. The analysis utilizes the 2005 AMA Masterfile to determine the population-based supply of physicians at the state and county level, analyzed by the discipline of physician, and whether they had graduated from, or trained at the University of Washington, which is the only medical school for the five-state WWAMI region. The emphasis on primary care is important as over one-third of the WWAMI population lives in rural areas and tends to be medically underserved, relying on primary care physicians for the majority of their medical needs.
  • Wyoming Physicians Are Significant Providers of Safety Net Care
    WWAMI Rural Health Research Center
    Date: 11/2006
    Describes the contributions of family and general practice physicians from Wyoming to the health care safety net.