Marilyn Klug, PhD

North Dakota and NORC Rural Health Reform Policy Research Center

Phone: 701.787.0089
Email: marilyn.klug@med.und.edu

Center for Rural Health
University of North Dakota
1301 N. Columbia Road, Stop 9037
Grand Forks, ND 58202


Completed Projects - (2)

  • Effect of Type and Timeliness of Post-Acute Care on Preventable Hospital Readmissions for Rural Medicare Beneficiaries
    The purpose of this project is to: 1) determine how location of hospitals used for initial admissions by rural patients affects readmission rates; 2) assess how the use of swing beds affects rural patients' readmissions; and 3) examine the impact of the type and timeliness of post-acute care, including home health care, skilled nursing, and physician visits, on readmissions for rural patients.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Medicare
  • Potentially Preventable Rural Hospital Readmissions
    This project focuses on the analysis of potentially preventable rural hospital readmissions, a potential quality indicator receiving considerable attention from policymakers and payers. Using 3-M algorithm software and MedPAR inpatient claims data from 9 geographically representative states, this study will explore the relationship between readmission rates and geographic regions, categories of rural hospitals, discharge destination, clinical diagnoses and patient attributes.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality

Publications - (6)

  • Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 03/2012

    Explores the relationship between potentially preventable readmissions (PPRs) and (a) use of outpatient follow-up care, (b) discharge destination, (c) rural versus urban residence of the patient, and (d) time to follow-up care. These factors were examined in a large population of Medicare patients with a hospital stay for one of these prevalent diagnoses: congestive heart failure or bacterial pneumonia. Differences in readmission risk associated with outpatient visits and discharge destinations were calculated. Outpatient follow-up appears to be strongly influential in reducing PPRs, though fewer than half of the patients in the study had evidence of any kind of outpatient follow-up within 30 days. Home health care appeared to have less of an effect on reducing PPRs in rural areas relative to urban areas. Swing bed destination was associated with higher PPR risk, especially for pneumonia patients. Additional research should be done on encouragement of post-discharge follow-up care and types of outpatient interventions, access to outpatient and home health care, and use of swing beds in rural areas.

  • Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia (Final Report)
    Upper Midwest Rural Health Research Center
    Date: 03/2012
    This study explored the relationship between PPRs and a) use of outpatient follow-up care, b) discharge destination, c) rural versus urban residence of the patient, and d) time to follow-up care.
  • Exploring Rural and Urban Mortality Differences
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 03/2016
    Contains visual aids which display indicators of mortality rates by cause of death, age group, rural-urban status, region, and sex for populations 15 years of age and older cross-referenced to tables and statistical results.
  • Geographic Differences in Potentially Preventable Readmission Rates in Rural and Urban Hospitals (Final Report)
    Upper Midwest Rural Health Research Center
    Date: 11/2010
    Potentially preventable hospital readmissions (PPRs) among Medicare patients are examples of inefficiencies in the health care system. Policymakers are considering efforts to measure and publicly report preventable readmission rates and target hospitals with high rates for improvement by means of payment policy and technical assistance. To help inform the policy debate about readmissions of rural patients, this study estimated PPRs in three types of acute care hospitals: urban prospective payment system (PPS) hospitals, rural PPS hospitals and Critical Access Hospitals (CAHs).
  • Potentially Preventable Readmissions in Rural Hospitals
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 08/2009

    A hospital's potentially preventable readmission rate is a quality indicator receiving considerable attention from policymakers and payers. Using 3-M algorithm software and Medicare inpatient claims data from five states, this brief examines potentially preventable readmission rates for rural and urban hospitals, and discusses the rural implications of policy initiatives to reduce readmission rates.

  • 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.