H. Ann Howard, BA

North Carolina Rural Health Research and Policy Analysis Center

Email: ann_howard@unc.edu

University of North Carolina - Chapel Hill
Cecil G. Sheps Center for Health Services Research
CB# 7590
Chapel Hill, NC 27599


Publications - (7)

  • The 21st Century Rural Hospital: A Chart Book
    Chartbook
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2015

    Hospitals have changed over recent decades. Hospital stays are shorter. Procedures once requiring hospitalization are now done in an outpatient setting. Hospitals have moved beyond providing mainly inpatient and emergency department care. They have become vertically integrated systems with “one-stop shopping” for all of one’s health care needs.

    The transformation of hospitals has also occurred in rural areas where the presence of a hospital with traditional inpatient and emergency department services may also ensure that other healthcare is available. Even with a cursory scan of rural hospital websites, one can see that rural hospitals offer a variety of services that range from traditional inpatient medical, surgical and obstetric care to advanced imaging, laboratory, and rehabilitation services. Outpatient primary and specialty care are available, and hospitals provide important health promotion and wellness services for the community. Hospitals vary, however, based on their resources and the needs of the populations they serve. As is often said about many things, “if you’ve seen one hospital, you’ve seen one hospital.”

    This Chart Book uses available data to present a broad profile of the 21st century rural hospital and includes such descriptors as: Where are they located? Whom do they serve? What traditional hospital services do they provide? How do they ensure outpatient services for their community? What other community benefits do they provide or enable for citizens in their area? How are they doing financially? How are they supported by federal programs?

    The pages of The 21st Century Rural Hospital: A Chart Book are each designed as a pull-out document and describe many aspects of today’s rural hospital. Each page includes charts comparing rural hospitals to each other and to urban hospitals across different dimensions such as levels of rurality, US Census region, and hospital size. Important data points are emphasized and an illustrative rural hospital is highlighted. Those who are unfamiliar with today’s rural hospital may be surprised by many data points shown here; others may use this document to research a particular data point.

  • Cesarean Section Patterns In Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2004
    Examines childbirth delivery patterns in rural hospitals and compares the cesarean section (c-section) rate in rural hospitals to that in urban hospitals. The c-section rate for rural hospitals was well above the 10-15% rate recommended by the World Health Organization, and was higher (but not statistically significant) in rural hospitals than in urban hospitals. A Findings Brief on this topic is also available.
  • Cesarean Section Rates in Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2005
    Findings Brief examining childbirth delivery patterns in rural hospitals and comparing the C-section rate in rural hospitals to that in urban hospitals using the Nationwide Inpatient Sample (NIS). Working Paper No. 80 on this topic is also available.
  • The Financial Importance of Medicare Post-Acute and Hospice Care to Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2017
    This brief describes Medicare post-acute and hospice care provided by hospitals in rural areas by characterizing the variation in the number of rural hospitals that provide PAC and hospice care, the average amount of Medicare revenue rural hospitals receive for these services, and the financial importance of PAC and hospice care to rural hospitals.
  • Rural-Urban Differences in Nursing Home and Skilled Nursing Supply
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2003
    Examines characteristics of nursing facilities and the supply of certified skilled nursing beds as the new PPS is being phased in, with particular reference to differences between urban and rural settings. Finds that rural-urban differences in the supply of long-term care beds and in the characteristics of long-term facilities are less pronounced, in general, than rural-urban differences in acute care capacity. Among the differences between urban and rural nursing facilities are: the most rural counties are the most likely to have no certified nursing homes; as counties become more rural, swing beds account for an increasing percentage of Medicare SNF discharges; and long-term care facilities in the most rural counties are more likely to be hospital based. Overall, the supply of nursing facilities does not appear to be a problem in rural areas, with the possible exception of the most rural counties.
  • Trends in Skilled Nursing and Swing-bed Use in Rural Areas, 1996-2003
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2005
    Examines trends in the delivery of skilled nursing facility (SNF) services in rural areas during a period of dramatic change in Medicare payments for both acute and post-acute care, focusing on the role of rural hospitals in providing SNF services as they respond to the new reimbursement environment. The authors examined changes in the number and types of facilities providing this level of care, and computed comparative statistics on Medicare utilization, case mix, ancillary service use and per diem costs across the three different institutional settings where inpatient skilled nursing services can be provided-freestanding SNFs, hospital-based units, and swing beds in acute care hospitals.
  • Trends over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2006
    Examines trends in the delivery of skilled nursing facility services in both hospital-based units and swing beds during a period of dramatic change in Medicare payments for post-acute care, focusing on Critical Access Hospitals (CAHs).