Katy Kozhimannil, PhD, MPA

Director, University of Minnesota Rural Health Research Center

Phone: 612.626.3812
Email: kbk@umn.edu
Twitter: @katybkoz

Division of Health Policy and Management
University of Minnesota
2221 University Ave. SE, Suite 350
Minneapolis, MN 55414


Current Projects - (2)

  • Emergency Obstetrics in Communities Without Hospital-Based Maternity Care
    The purpose of this project is to describe rural hospitals that do not provide obstetric services and to survey a sample of these hospitals regarding their capacity for emergency obstetrics locally in order to inform policy to support access to high-quality maternity care for all pregnant rural residents.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Maternal health, Quality, Women
  • Making It Work: Models of Success in Rural Maternity Care
    The purpose of this project is to update information on access to obstetric services in rural counties, to identify common factors across rural communities that have maintained local hospital-based obstetric services, and to describe best practices associated with successfully supporting birth locally in rural communities.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Maternal health, Quality, Women

Completed Projects - (6)

  • Developing Rural-Relevant Strategies to Reduce Maternal Morbidity
    The purpose of this project was to distinguish and analyze predictors of maternal morbidity during childbirth hospitalization by geography and to develop recommendations to improve the safety of childbirth for rural residents. It also assessed the degree of rural focus and representation in current policy efforts to address this crisis.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Legislation and regulation, Maternal health, Quality, Women
  • Obstetric Care Practice Models and Quality in Rural Hospitals
    The project will examine current obstetric practice models in rural hospitals and assess the prospects for implementation of new policy recommendations for reducing primary cesarean rates and non-medically indicated inductions of labor in rural hospitals.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Maternal health, Quality
  • Obstetric Unit and Hospital Closures and Maternal and Infant Health in Rural Communities
    This project will examine the relationship between closure of an obstetric unit or hospital and maternity care and outcomes of childbirth in rural US counties including prenatal care, distance to delivery hospital, out-of-hospital birth, and infant health outcomes.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Children and adolescents, Health services, Hospitals and clinics, Women
  • Quality of Obstetric Care and Perinatal Safety in Rural Hospitals
    The project will use both national and state-level hospital discharge data to examine obstetric care quality and perinatal safety in rural U.S. hospitals, with an in-depth focus on rural hospitals in a nationally representative group of eight states across all four U.S. Census regions.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Maternal health, Women
  • Rural Women Giving Birth in Non-Local Hospitals: Implications for Obstetric Access and Quality
    The purpose of this project is to: 1) analyze recent data from nine geographically diverse states on delivery by rural women at non-local hospitals; 2) characterize the roles of medical vs. non-medical factors in delivery at a non-local hospital by identifying lower-risk and higher-risk women using established criteria; and 3) analyze the relationship between delivery at a non-local hospital and obstetric quality.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Hospitals and clinics, Quality, Women
  • Rural-Urban Differences in Opioid-Affected Pregnancies and Births
    This analysis aimed to combat the opioid epidemic in rural communities by describing the rates and predictors of non-medical opioid use prior to and during pregnancy and maternal diagnosis of opioid use disorder at birth, based on rural or urban maternal residence and rural or urban hospital location.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Maternal health, Substance use and treatment, Women

Publications - (49)

2020

  • Obstetric Emergencies in Rural Hospitals: Challenges and Opportunities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 09/2020
    The purpose of this policy brief is to describe the challenges rural hospitals face in providing emergency obstetric care and to highlight resources that could help rural hospitals more safely respond to obstetric emergencies.
  • Racial and Ethnic Differences in Self-Rated Health Among Rural Residents
    University of Minnesota Rural Health Research Center
    Date: 09/2020
    This study looks at racial and ethnic differences in self-rated health among rural residents as well as whether these differences can be explained by socio-demographic characteristics. Researchers used data from the 2011–2017 National Health Interview Survey to study differences in rural residents' self-rated health by race and ethnicity.
  • Characteristics of US Rural Hospitals by Obstetric Service Availability, 2017
    University of Minnesota Rural Health Research Center
    Date: 08/2020
    This study described characteristics of rural U.S. hospitals by whether they provide labor and delivery care for pregnant patients. Researchers used the 2017 American Hospital Association Annual Survey to identify rural hospitals and detail their characteristics based on whether they provide obstetric services.
  • Providing Maternity Care in a Rural Northern Iowa Community
    University of Minnesota Rural Health Research Center
    Date: 08/2020
    This case study highlights how one rural hospital in northern Iowa has successfully sustained a maternity care practice and identifies opportunities for other rural hospitals and communities seeking to ensure local access to care for pregnancy and childbirth.
  • Changes in Hospital-Based Obstetric Services in Rural US Counties, 2014-2018
    University of Minnesota Rural Health Research Center
    Date: 07/2020
    In 2014, 54% of rural U.S. counties had no hospital-based obstetric services, following a steady decrease during the previous decade. Loss of rural maternity care is tied to adverse maternal and infant health outcomes. This study shares hospital-based obstetric service losses in rural U.S. counties from 2014 to 2018.
  • Loss of Hospital-based Obstetric Services in Rural Counties in the United States, 2004-2018
    University of Minnesota Rural Health Research Center
    Date: 07/2020
    The purpose of this infographic is to show the loss of hospital-based obstetric services from 2004-2018 and how this differs by county type (micropolitan vs. noncore).
  • Nurse Practitioner Autonomy and Complexity of Care in Rural Primary Care
    University of Minnesota Rural Health Research Center
    Date: 07/2020
    The increasing number of nurse practitioners (NPs) in the rural U.S. has the potential to help alleviate primary care shortages. Using a nationwide source of claims and Electronic Health Record data from 2017, this study constructs measures of NP clinical autonomy and complexity of care.
  • Supporting the Health and Wellbeing of Middle-Aged Adults Living Alone in Rural Counties
    University of Minnesota Rural Health Research Center
    Date: 06/2020
    This report shares insights from healthcare providers in 14 rural counties with the highest rates of middle-aged adults living alone in order to inform policy and practice in how best to support the health and well-being of this demographic.
  • Rural and Urban Differences in Primary Care Pain Treatment by Clinician Type
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 04/2020
    In this brief, we compare 2017 opioid prescribing rates among physicians and nurse practitioners within primary care practices and how these differ for rural versus urban areas.

2019

  • Rural Counties with Majority Black or Indigenous Populations Suffer the Highest Rates of Premature Death in the U.S.
    University of Minnesota Rural Health Research Center
    Date: 12/2019
    Despite well-documented health disparities by rurality and race/ethnicity, research investigating racial/ethnic health differences among U.S. rural residents is limited. We used county-level data to measure and compare premature death rates in rural counties by each county's majority racial/ethnic group.
  • Rural-Urban Differences In Severe Maternal Morbidity and Mortality In the U.S., 2007-15
    University of Minnesota Rural Health Research Center
    Date: 12/2019
    In the U.S., severe maternal morbidity and mortality (SMMM) is climbing—a reality that is especially challenging for rural communities, which face declining access to obstetric services. Using data for 2007-15 from the National Inpatient Sample, we analyzed SMMM during childbirth hospitalizations among rural and urban residents.
  • Differences in Preventive Care Among Rural Residents by Race and Ethnicity
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2019
    Disparities in preventive care by rural and urban location and by race and ethnicity are well documented in the literature, but less is known about whether there are differences in healthcare use among rural residents by race and ethnicity. We address this gap by examining differences in preventive care among rural residents by race and ethnicity.
  • Severe Maternal Morbidity and Hospital Transfer Among Rural Residents
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2019
    In this brief, we compare hospital transfer rates for rural and urban residents who gave birth. We also provide descriptive information about the relationship between transfer status and severe maternal morbidity and mortality for rural residents nationally who gave birth 2008-2014.
  • Rural Focus and Representation in State Maternal Mortality Review Committees: Review of Policy and Legislation
    University of Minnesota Rural Health Research Center
    Date: 08/2019
    Between 1990 and 2013, maternal mortality nearly doubled in the U.S., and rural residents experienced decreasing access to obstetric care. To improve maternal health, many states have established maternal mortality and morbidity review committees (MMRCs). We assessed the extent of rural representation in state policy efforts related to MMRCs.
  • Dying Too Soon: County-level Disparities in Premature Death by Rurality, Race, and Ethnicity
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 03/2019
    In this brief, we examined county-level differences in premature death (years of potential life lost before age 75 per 100,000 people) by county-level racial and ethnic composition, across rural and urban counties. We also calculated whether there were rural-urban disparities in mortality within counties with similar racial and ethnic compositions.

2018

2017

2016

  • Relationship Between Hospital Policies for Labor Induction and Cesarean Delivery and Perinatal Care Quality Among Rural U.S. Hospitals
    University of Minnesota Rural Health Research Center
    Date: 11/2016
    This study focused on maternity care quality by taking a look at hospitals' policies regarding induced labor and Cesarean deliveries.
  • Why Are Obstetric Units in Rural Hospitals Closing Their Doors?
    University of Minnesota Rural Health Research Center
    Date: 08/2016
    Analyzes the reasons behind hospital- and county-level factors for rural obstetric unit closures.
  • Factors Associated with High-Risk Rural Women Giving Birth in Non-NICU Hospital Settings
    University of Minnesota Rural Health Research Center
    Date: 07/2016
    Identifies rick factors for childbirth in facilities without neonatal intensive care unit (NICU) capacities among high-risk rural women. The study found that rural women with preterm birthday and multiple gestation pregnancies were less likely to give birth in a hospital with NICU capacity if no local hospital had this capacity.
  • The Practice of Midwifery in Rural US Hospitals
    University of Minnesota Rural Health Research Center
    Date: 07/2016
    Analyzes the role of certified nurse-midwives (CNMs) in providing maternity care in rural US hospitals and to examine state-level variations on rural CNM practice. CNMs play an important role in the maternity care workforce in rural US hospitals.
  • Ensuring Access to High-Quality Maternity Care in Rural America
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    Examines the access to high-quality for rural women care during pregnancy and childbirth. Policy interventions at the local, state, and federal levels could help to address maternity care workforce shortages and improve quality of care available to the one-half million rural U.S. women who give birth each year.
  • Location of Childbirth for Rural Women: Implications for Maternal Levels of Care
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    This study looks into the rate at which rural women give birth at nonlocal hospitals. Approximately 75% of rural women gave birth at local hospitals. However, after controlling for clinical complications, rural Medicaid beneficiaries were less likely to give birth at nonlocal hospitals, implying a potential access challenge for this population.
  • Quality Measures and Sociodemographic Risk Factors: The Rural Context
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    This policy brief aims to inform discussions concerning whether or not to adjust provider quality measures for differences in patient characteristics by examining how rurality and key sociodemographic variables might affect quality-of-care outcomes.
  • State Variations in the Rural Obstetric Workforce
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    Many types of staff are necessary to successfully run an obstetrics unit. Rural hospitals face unique staffing challenges. This policy brief describes the obstetric workforce in rural hospitals by state for nine states: Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin.
  • Rural Implications of Expanded Birth Volume Threshold for Reporting Perinatal Care Measures
    University of Minnesota Rural Health Research Center
    Date: 04/2016
    In 2016 the minimum annual birth volume threshold for required reporting of the Joint Commission Perinatal Care measures by accredited hospitals decreased from 1,100 to 300 births. This study used the publicly available Join Commission Quality Check data from April 2014 to March 2015.

2015

2014

2013