John A. Gale, MS

Maine Rural Health Research Center

Phone: 207.228.8246
Fax: 207.228.8138
Email: john.gale@maine.edu

University of Southern Maine
PO Box 9300
34 Bedford Street
Portland, ME 04104-9300


Current Projects - (2)

  • Rural Health Clinic Financial Performance and Productivity
    This study will use Medicare cost reports for independent and provider-based clinics to provide a detailed national picture of the financial and operational performance of RHCs and describe variations in performance related to revenue, costs, staffing, payer mix, productivity levels, and hours of operation across independent and provider-based clinics. The project will also develop measures that can be used to benchmark RHC performance over time.
    Research center: Maine Rural Health Research Center
    Topics: Medicare, Rural Health Clinics (RHCs)
  • Rural Health Clinics Chartbook: Community Characteristics and Financial and Operational Performance
    Rural Health Clinics (RHCs) address geographic access barriers for rural Medicare and Medicaid beneficiaries and, over time, have come to be recognized for their role in serving vulnerable rural populations. This project will produce a comprehensive, descriptive chartbook detailing the characteristics and status of RHCs nationally.
    Research center: Maine Rural Health Research Center
    Topic: Rural Health Clinics (RHCs)

Completed Projects - (15)

  • Adolescent Alcohol Use in Rural Areas: What Are the Issues?
    This study will use the National Survey on Drug Use and Health (NSDUH) to examine the effect of developmental, individual, and environmental factors on adolescent alcohol use across the urban-rural continuum.
    Research center: Maine Rural Health Research Center
    Topic: Substance abuse
  • Analysis of 2004-2005 State Flex Grant Plans
    This project will analyze state Flex grant applications and related budget and work plan revisions focusing on state activities in the core Flex program areas of networks, quality improvement, and EMS.
    Research centers: Maine Rural Health Research Center, University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Networking and collaboration, Quality
  • Availability, Characteristics, and Role of Detoxification Services in Rural Areas
    This project will produce a comprehensive description of the distribution and characteristics of detoxification (detox) services across rural areas including a discussion of access issues, the role of detox services within local systems of care, barriers to the delivery of detox services by rural providers, and policy and regulatory incentives needed to encourage the development of rural detox services. Products will include a working paper and related journal articles addressing these topics.
    Research center: Maine Rural Health Research Center
    Topic: Substance abuse
  • Catastrophic Consequences: The Rise of Opioid Abuse in Rural Communities
    This project will analyze national data on the prevalence of opioids in rural and urban settings as well as describe state and local efforts to promote prevention and access to treatment.
    Research center: Maine Rural Health Research Center
    Topic: Substance abuse
  • Developing a Sentinel Cohort of Rural Health Clinics for Use in Developing Relevant Quality Measures and Monitoring Program Performance
    This two year project will assemble a cohort of Rural Health Clinics (RHCs) from ten to thirteen states to participate in a sentinel quality measurement process. During the first year of the project, the cohort of RHCs will participate in the identification, development, and refinement of a discrete set RHC quality measures in conjunction with the project team and an expert panel of RHC and quality measurement experts. During the second year, the cohort will be asked to implement, report, and evaluate the measures.
    Research center: Maine Rural Health Research Center
    Topics: Quality, Rural Health Clinics (RHCs)
  • Development of State Flex Program Logic Models and Related Toolkit
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  • Measuring the Community Benefits and Impact of Critical Access Hospitals
    This project will develop, test, and implement a set of community benefits and impact indicators for Critical Access Hospitals (CAHs). These indicators will assist CAHs, policymakers, and rural stakeholders to understand the impact of CAHs on their communities and local health care delivery systems.
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  • National Study of Rural Health Clinics
    Research center: Maine Rural Health Research Center
    Topics: Health services, Rural Health Clinics (RHCs)
  • National Study of Substance Abuse Prevalence and Treatment Services in Rural Areas
    This project will research the prevalence of the abuse of legal and illegal substances across rural populations and geographic areas, including the extent to which rural individuals are receiving treatment for their substance abuse and barriers to the receipt of treatment.
    Research center: Maine Rural Health Research Center
    Topics: Health disparities, Health services, Rural statistics and demographics, Substance abuse
  • Provision of Specialty Mental Health Services by Rural Health Clinics
    This project will document the extent to which Rural Health Clinics (RHCs) are employing mental health staff nationally, understand why more RHCs are not employing specialty mental health staff, and analyze the barriers to and opportunities for the delivery of mental health services by RHCs. The results will identify opportunities and interventions to encourage RHCs to offer this important service.
    Research center: Maine Rural Health Research Center
    Topics: Health services, Mental health, Rural Health Clinics (RHCs), Substance abuse
  • Rural E-Mental Health: Models That Enhance Access, Service Delivery, and Integration of Care
    E-mental health programs have been developed in rural areas as a promising approach to address the chronic challenges of low availability of mental health clinicians, long travel distances, and stigma surrounding mental health care. The literature has established the technical feasibility of these programs and interest remains strong in developing and implementing them more broadly. However, we lack a clear understanding of the viability of current rural e-mental health programs - both the business case for starting and sustaining them and the clinical case for what services and functions may be provided _ and what impact they have had. The current rural health environment is changing significantly and it is important to understand where and how e-mental health programs have been established and sustained, what impact they have had, and what value they may add to other initiatives. To address this gap we will conduct interviews with between 24-30 current rural e-mental health programs.
    Research center: Maine Rural Health Research Center
    Topics: Mental health, Telehealth
  • Safety Net Activities of Independent Rural Health Clinics
    This national study will investigate and describe the safety net role of independent Rural Health Clinics (RHC). It will further examine the market effect of Federally Qualified Health Centers (FQHC) on the safety net role of independent RHCs at the county level.
    Research center: Maine Rural Health Research Center
    Topics: Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs)
  • Special Study of EMS Issues
    This study will focus on state, community, and hospital level initiatives designed to build the infrastructure to support EMS service capacity and encourage the integration of these services into the rural healthcare infrastructure in the areas of quality improvement, financing, staffing, medical control, and networking and integration.
    Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Networking and collaboration
  • Transformation of Rural Health Clinics: Are They Ready to Serve as Patient-Centered Medical Homes?
    Rural Health Clinics (RHCs) face pressure to transform their practices by becoming patient-centered medical homes (PCMHs). This study will document the readiness of RHCs to serve as PCMHs and provide information to assist policymakers in developing technical assistance and other policy resources to support RHCs in doing so.
    Research center: Maine Rural Health Research Center
    Topics: Health policy, Rural Health Clinics (RHCs)
  • Using Program Logic Models to Monitor the Performance of State Flex Programs
    This project will use a program logic model approach to track state program activities and develop tools that allow states to systematically monitor and manage their accomplishments in the context of Flex Program goals.
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program

Publications - (39)

  • Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences? (Policy Brief)
    Maine Rural Health Research Center
    Date: 03/2012
    After controlling for a broad range of key risk and protective factors, it is clear that an unexplained rural effect persists with rural adolescents still exhibiting higher alcohol use than their urban counterparts
  • Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences? (Working Paper)
    Maine Rural Health Research Center
    Date: 03/2012
    Rural adolescent alcohol use is a complex social problem. Using data from the 2008-2009 National Survey of Drug Use and Health, this study by the Maine Rural Health Research Center examines alcohol use among rural and urban adolescents between the ages of 12 and 17. After controlling for a broad range of key risk and protective factors, it is clear that an unexplained rural effect persists with rural adolescents still exhibiting higher alcohol use than their urban counterparts. Our findings suggest that rural adolescents who start drinking at an earlier age are more likely to engage in problem drinking behavior as they get older, leading to a need for interventions that target pre-teens and younger adolescents. Moreover, we found urban-rural differences in specific protective factors, which may be the most promising for evidence-based, rural-specific prevention strategies targeting parents, schools, and churches.
  • Adoption and Use of Electronic Health Records by Rural Health Clinics: Results of a National Survey
    Policy Brief
    Maine Rural Health Research Center
    Date: 09/2015

    This study reports the extent of EHR implementation and use in a randomly selected sample of 1,497 Rural Health Clinics (RHCs) surveyed in 2013. Results show that RHCs are approaching parity with other physician practices, with nearly 72 percent reporting EHR adoption and use, and 63 percent indicating use by 90 percent or more of their staff. Among RHCs without an EHR, almost 44 percent plan to implement one within the next 12 months. In general, respondents performed well on Stage 1 meaningful use measures related to clinical care and patient management but lagged on the exchange of clinical information, reporting quality measures, implementing clinical decision support rules, conducting formulary checks, transmitting lab orders, and generating patient registries. This study suggests that RHCs without an EHR have continuing technical assistance needs to support EHR adoption. RHCs with an EHR need support to fully utilize the capabilities of their systems and meet the continually evolving standards for meaningful use.

  • Are Rural Health Clinics Part of the Rural Safety Net? (Policy Brief)
    Maine Rural Health Research Center
    Date: 09/2010
    Key Findings: 86% of independent RHCs offer free care, sliding fee scales, or both; 97% were currently accepting new Medicaid/SCHIP patients; RHCs' patient mix has a higher proportion of Medicaid/SCHIP patients in counties not served by a federally funded Community Health Center (CHC). Lacking the grant funds and federal technical assistance provided to CHCs to build service capacity, few RHCs have had the resources to expand their scope of services. The Affordable Care Act has made it clear that partnering with CHCs is an option for RHCs that find themselves serving safety net populations. More study is needed laying out the details of such arrangements, the reimbursement and governance implications, and the relative advantages and disadvantages from the perspectives of the CHC, the RHC, the physician, and especially, the patient.
  • Availability, Characteristics, and Role of Detoxification Services in Rural Areas
    Maine Rural Health Research Center
    Date: 12/2009
    Few detox providers (n=235) serve rural America; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve patients across a 100 mile radius, making travel distances a barrier to outpatient care. Referral options to substance abuse treatment are limited, especially in isolated rural areas. Analyses are based on a 2008 survey of rural detox facilities conducted by the Maine Rural Health Research Center.
  • The Characteristics and Roles of Rural Health Clinics in the United States: A Chartbook
    Maine Rural Health Research Center
    Date: 01/2003
    Reports on the results of a national survey of Rural Health Clinics (RHCs). Information was collected on a wide range of topics of concern to RHCs including: 1) the characteristics and operations of the clinics; 2) their location relative to the underservice problems and access needs of rural areas; 3) safety net functions of RHCs; 4) staffing, recruitment and financial issues; and 5) involvement in the training of health care professionals. Among the findings: most RHCs continue to serve rural, underserved communities; RHCs are filling a valuable safety net role by serving Medicaid, uninsured, and low-income patients and providing free and reduced cost care; recruitment and retention is a problem for RHCs, and some RHCs face continued financial challenges despite cost-based reimbursement. RHCs continue to be an important source of primary care and safety net services in rural communities. Legislative efforts to address concerns about the program have included the refinement of the shortage area criteria used by the RHC program (Balanced Budget Act of 1997) and the implementation of a Medicaid prospective payment system (Benefits Improvement and Protection Act of 2000). Additional research is needed to understand the impact of these changes on the RHCs and the residents of rural communities served by them.
  • The Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 02/2007
    Discusses the findings of a project to understand the community involvement and impact of Critical Access Hospitals (CAHs) and the Medicare Rural Hospital Flexibility Program (Flex Program). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Comparative Performance Data for Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Date: 2004
    Discusses the potential use of comparative performance data for critical access hospitals (CPD-CAH) to facilitate performance and quality improvement. Covers potential benefits and drawbacks of CPD-CH and identifies issues in the development and implementation of CPD-CAH.
  • Creating Program Logic Models: A Toolkit for State Flex Programs
    Maine Rural Health Research Center
    Date: 04/2006
    Provide states with a tool for planning, managing, reporting on, and assessing their Flex Program goals, activities, and accomplishments; assistance in identifying and defining measurable outcomes; information linking state-level Flex Program strategies to specific and measurable outcomes; and a consistent program-reporting framework to convey results to both internal and external stakeholders. The Program Logic Model (PLM) Toolkit is organized according to the steps in the PLM development process and guides the user through each section. Included in the Toolkit is an overview of PLMs, their component parts, and the application of the PLM framework to the planning, implementation, and evaluation of the Flex Program. The bulk of the Toolkit provides a step-by-step approach to developing a Program Logic Model. The final section of the Toolkit lists resources for additional information on PLMs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum
    Maine Rural Health Research Center
    Date: 10/2007
    Considering recent growth in substance abuse among rural populations and the documented scarcity of rural health resources, this study examines the distribution of substance abuse treatment services across the continuum of rural and urban counties, identifying the type and intensity of services provided. Using the 2004 National Survey of Substance Abuse Treatment Services linked to the 2003 Rural-Urban Continuum Codes, we found few substance abuse treatment facilities operating outside of urban and rural adjacent areas and limited availability of intensive services across rural areas. This situation is particularly striking for opioid treatment programs, which are nearly absent in rural areas. The narrow range of services available in rural areas may preclude an individualized treatment approach and long-term follow-up recommended by professional organizations and other experts. The greater proportion of rural-based facilities accepting public payers and providing discounted care may reflect higher rates of uninsurance and underinsurance.
  • Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum (Research & Policy Brief No. 35B)
    Maine Rural Health Research Center
    Date: 02/2008
    This Research & Policy Brief highlights findings from a recent study examining the distribution of substance abuse treatment facilities in rural and urban counties and identifying the type and intensity of services provided. Key findings include:
    • Access to substance abuse treatment is limited in rural areas by fewer treatment beds.
    • Less populated rural areas contain a small proportion of facilities offering a range of core services and varying levels of outpatient and intensive services.
    • Opioid treatment programs are nearly absent in rural areas.
  • Emergency Medical Services (EMS) Activities Funded by the Medicare Rural Hospital Flexibility Program
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2006
    Describes the EMS related activities that the 45 states receiving funding from the Medicare Rural Hospital Flexibility (Flex) Program proposed to conduct in fiscal year 2004-2005. Since the first full year of funding, the number and range of EMS improvement activities proposed has increased substantially states' proposals contained 239 documented EMS improvement activities. Of these, 40% focused on the Integration of Health Services attribute, 13% on Human Resource challenges, and 13% on Education Systems. Continued support of activities begun prior to 2004 was common. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Encouraging Rural Health Clinics to Provide Mental Health Services
    Maine Rural Health Research Center
    Date: 05/2010
    This study examined changes in the delivery of mental health services by Rural Health Clinics (RHCs), their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services. Key Findings:
    • Approximately 6% of independent and 2% of provider-based RHCs offer mental health services.
    • 38% of study RHCs reported their mental health services were not profitable but continued to provide them in response to community and patient needs.
    • An important factor in the development of RHC mental health services is the presence of a local champion who spearheads the development effort.
  • Exploring the Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 01/2007
    Reports on a series of site visits to six diverse rural communities and Critical Access Hospitals (CAHs) to assess the experiences and impact of these hospitals in responding to their community's health infrastructure needs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Few and Far Away: Detoxification Services in Rural Areas (Research & Policy Brief)
    Maine Rural Health Research Center
    Date: 12/2009
    Based on Working Paper #41: Availability, Characteristics, and Role of Detoxification Services in Rural Areas. Findings: Few rural detox providers exist; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve a 100 mile radius. Travel distances are a barrier to outpatient detox models. Referral options to substance abuse treatment are limited, especially in isolated rural areas.
  • Health Information Exchange: A Strategy for Improving Access for Rural Veterans in the Maine Flex Rural Veterans Health Access Program
    Maine Rural Health Research Center
    Date: 05/2016
    This paper reports on the design and implementation of a first-in-the-nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers.
  • Integrating Primary Care and Mental Health: Current Practices in Rural Community Health Centers
    Maine Rural Health Research Center
    Date: 10/2006
    Provides information on models for integrating mental health services in rural community health centers, viability of linkages between primary care and mental health providers, resources available, reimbursement, treatment philosophy, diversification, referral and enhancement. Available for purchase.
  • Meaningful Use of the Electronic Health Records by Rural Health Clinics
    Maine Rural Health Research Center
    Date: 02/2014

    Identifies the rates of electronic health record (EHR) adoption among a national random sample of Rural Health Clinics (RHCs) and the extent to which RHCs that have adopted an EHR are likely to achieve Stage 1 meaningful use. Fifty-nine percent of RHCs report having an EHR and independent RHCs were more likely than hospital-based RHCs to have an EHR. Common barriers to EHR adoption by RCHs include acquisition and maintenance costs, lack of capital, and potential productivity or income loss during transition.

  • Medicaid Managed Behavioral Health in Rural Areas
    Maine Rural Health Research Center
    Date: 01/2001
    Study of which states have implemented Medicaid managed behavioral health (MMBH) programs in rural areas. Describes these programs in terms of Medicaid populations served, program design, and implementation model. Describe the experience of programs regarding access to and coordination of services.
  • Medicaid Managed Behavioral Health Programs in Rural Areas (Research and Policy Brief)
    Maine Rural Health Research Center
    Date: 08/2001
    Study of which states have implemented Medicaid managed behavioral health (MMBH) programs in rural areas. Describes these programs in terms of Medicaid populations served, program design, and implementation model. Describe the experience of programs regarding access to and coordination of services.
  • Mental Health Care in Rural Communities: the Once and Future Role of Primary Care
    Maine Rural Health Research Center
    Date: 2006
    Discusses issues related to the delivery of mental health services in the United States. Addresses how these issues complicate the delivery of services in rural areas. Offers an argument for integrating primary care and mental health in rural areas.
  • Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
    Maine Rural Health Research Center
    Date: 09/2005
    Investigates the extent and types of cases that present with mental health problems in Critical Access Hospitals (CAHs) emergency rooms (ERs), as well as the resources available to ER staff for addressing such problems and what actually happens to such patients. Emergency department managers in a random sample of 422 CAHs in 44 states completed a telephone survey (response rate = 84.7%) responding to questions about prevalence of mental health problems in their ER and what options they had for responding to such problems. On average, CAHs had 99 emergency room visits per week. Of these visits, 9.4% were mental health related. CAH ERs play a significant role in providing mental health services to rural residents. Although nearly 20% of mental health encounters result in transfers to other facilities, over 40% of mental health problems are addressed on-site through treatment or referrals. Nearly half (43%) of CAH ER managers reported having no access to local mental health providers of any kind.
  • Monitoring the Community Benefits of CAHs: A Review of the Data (Briefing Paper)
    Maine Rural Health Research Center
    Date: 03/2010
    There is a growing national interest in the benefits provided by nonprofit and public hospitals to their communities in exchange for the tax benefits or public funding that they receive.
  • Monitoring the Community Benefits of Critical Access Hospitals: A Review of the Data
    Policy Brief
    Maine Rural Health Research Center
    Date: 03/2010

    This brief examines the community benefit activities of Critical Access Hospitals (CAHs) using data from the Flex Monitoring Team's (FMT) pilot test of a set of community benefit data collection tools and performance indicators, the Internal Review Service's (IRS) 2006 Hospital Compliance Study, and the 2007 FMT CAH survey.

  • Pilot Testing a Rural Health Clinic Quality Measurement Reporting System
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2016
    More than 4,000 Rural Health Clinics (RHCs) serve the primary care needs of rural communities. Unfortunately, the Rural Health Clinic Program is plagued by a lack of data participating clinics. This reports on the results with a focus on assessing the feasibility and utility of the reporting system and quality measures for the participating RHCs.
  • The Provision of Mental Health Services by Rural Health Clinics
    Maine Rural Health Research Center
    Date: 05/2010
    The number of Rural Health Clinics (RHCs) providing specialty mental health services remains limited. This study examined changes in the delivery of mental health services by RHCs, their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services. Approximately 6% of independent and 2% of provider-based RHCs offer mental health services by doctoral-level psychologists and/or clinical social workers. Models used to provide mental health services include contracted and/or employed clinicians housed in the same facility as primary care providers. A key element in the development of mental health services is the presence of an internal champion (typically clinicians or senior administrators) who identify the need for and undertake implementation of services, help overcome internal barriers, and direct resources to the development of services.
  • Quality and Performance Improvement Grant Activities Under the Flex Program
    Maine Rural Health Research Center
    Date: 08/2006
    Describes quality and performance improvement activities proposed by states during the 2005 grant year under the Medicare Rural Health Flexibility Program (Flex Program). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • A Review of State Flex Program Plans, 2004-2005
    Maine Rural Health Research Center, University of Minnesota Rural Health Research Center
    Date: 03/2006
    Examines the objectives and project activities proposed by states in their Medicare Rural Hospital Flexibility Program (Flex Program) grant applications for Fiscal Year 2004 to strengthen the rural healthcare infrastructure in their states. Highlights recent trends in State Flex Program planning, development, and implementation. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Rural and Frontier Mental and Behavioral Health Care: Barriers, Effective Policy Strategies, Best Practices
    Maine Rural Health Research Center
    Date: 2006
    Discusses barriers to mental and behavioral health service delivery in rural America. Includes model programs and model policy strategies for rural mental and behavioral healthcare delivery. Also discusses the roles that telehealth and that the State Offices of Rural Health should play in service delivery.
  • Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2015

    The patient-centered medical home (PCMH) model both reaffirms traditional primary care values such as continuity of care, connection with an identified personal clinician, provision of same day- and after-hours access and also prepares providers to succeed in the evolving healthcare system by focusing on accountability, continuous quality improvement, public reporting of quality data, data exchange, and patient satisfaction. However, little is known about the readiness of the over 4,000 Rural Health Clinics (RHCs) to meet the PCMH Recognition standards established by the National Council for Quality Assurance (NCQA). This policy brief reports findings from a survey of RHCs that examined their capacity to meet the NCQA PCMH requirements, and discusses the implications of the findings for efforts to support RHC capacity development.

    Key Findings:

    • Based on their performance on the “must pass” elements and related key factors, Rural Health Clinics (RHCs) are likely to have difficulties gaining National Center for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) Recognition.
    • RHCs perform best on standards related to recording demographic information and managing clinical activities, particularly for those using an electronic health record.
    • RHCs perform less well on improving access to and continuity of services, supporting patient self-management skills and shared decision-making, implementing continuous quality improvement systems, and building practice teams.
    • RHCs are likely to need substantial technical assistance targeting clinical and operational performance to gain NCQA PCMH Recognition.
  • Rural Opioid Abuse Prevention and Treatment Strategies: The Experience in Four States
    Policy Brief
    Maine Rural Health Research Center
    Date: 04/2017
    Little is known about what states with large rural populations are doing to combat opioid use disorders (OUD) in rural communities. This qualitative study identified rural challenges to the provision of OUD prevention, treatment, and recovery services and explored promising strategies to tackle the opioid crisis in rural communities.
  • Rural Opioid Abuse: Prevalence and User Characteristics
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2016
    Opioid abuse is the fastest growing substance abuse problem in the nation and the primary cause of unintentional drug overdose deaths. This study examined the rural-urban prevalence of non-medical use of pain relievers and heroin in the past year and the socio-economic characteristics associated with their use and other risky behavior.
  • Rural Vets: Their Barriers, Problems, Needs
    Maine Rural Health Research Center
    Date: 05/2013
    Evolving population trends--the aging of rural veterans, the growing number of female veterans and rates of homelessness among veterans--place significant demands on VA and rural delivery systems. Coordination among healthcare providers is essential to increasing the availability of services and expanding veteran outreach programs.
  • Safety Net Activities of Independent Rural Health Clinics
    Maine Rural Health Research Center
    Date: 09/2010
    Rural Health Clinics (RHCs) are an important part of the rural health care infrastructure, providing a wide range of primary care services to the rural residents of 45 states. Since RHCs are located in underserved rural areas and serve vulnerable populations, many consider them safety net providers. In this paper we explore whether and to what extent independent RHCs are serving a safety net role, or have the capacity to serve that role.
  • The State Flex Program at 10 Years: Strengthening Critical Access Hospitals and Rural Communities
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 04/2007
    To understand the priorities and accomplishments of state Flex Grant Programs, members of the Flex Monitoring Team asked Flex Coordinators to identify and discuss their states' three most successful initiatives in the past two years. Interviews were conducted during February 2007 with Flex Coordinators and State Office of Rural Health staff (SORH) in all 45 states. The listed publication is a policy brief; the full report will be available in the fall of 2007. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 10/2007
    Explores activities funded by the Medicare Rural Hospital Flexibility Program (Flex Program) to strengthen the rural health care infrastructure and discusses which activities were considered most successful by State Flex Coordinators. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Telemental Health in Today's Rural Health System
    Maine Rural Health Research Center
    Date: 12/2013
    Describes the organizational setting, services provided, and staff used in 53 telemental rural health programs. Also outlines the opportunities and challenges for telemental health in the rural health system.
  • Understanding the Business Case for Telemental Health in Rural Communities
    Maine Rural Health Research Center
    Date: 07/2016
    This article describes the current landscape and characteristics of rural telemental health programs and then examines their business case.
  • Use of Critical Access Hospital Emergency Rooms by Patients With Mental Health Symptoms
    Maine Rural Health Research Center
    Date: 2007
    Describes the results of a study investigating the use of critical access hospital (CAH) emergency rooms by patients with mental health problems to understand the role these facilities play in rural mental health needs and the challenges they face.