Michelle Casey, MS

Deputy Director, University of Minnesota Rural Health Research Center

Phone: 612.623.8316
Fax: 612.623.8324
Email: mcasey@umn.edu

Rural Health Research Center
University of Minnesota
Division of Health Policy and Management
420 Delaware Street SE, MMC 729
Minneapolis, MN 55455


Current Projects - (1)

  • Rural Implications of Quality-Based Physician Payment Reform
    The purpose of this project is to assess existing national data about the quality of care provided by rural physicians, and to determine what additional information will be needed as CMS moves towards inclusion of all physicians in payment reforms based on quality.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Physicians, Quality

Completed Projects - (16)

  • Analysis of Critical Access Hospital Inpatient Hospitalizations and Transfers from CAHs to Other Acute and Post-Acute Care Settings Using State Inpatient Databases
    The purpose of this project is to analyze Critical Access Hospital (CAH) inpatient hospitalizations and transfers from CAHs in order to help inform the development of quality indicators for CAHs, especially quality indicators focused on the transfer process.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality, Technology
  • Analyzing the Relationship Among Critical Access Hospital Financial Status, Organizational Linkages, and Scope of Services
    This project will systematically analyze the relationships among pre- and post-conversion Critical Access Hospital (CAH) financial performance, the organizational linkages in which the hospital participates (e.g., health care systems and/or networks), and the scope of services (i.e., the number and type of services) provided.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services, Healthcare financing, Networking and collaboration
  • Assessing the Rural Relevance of Hospital Outpatient Quality Measures
    The purpose of this project is to: 1) determine the diagnoses that are most commonly treated and the procedures most commonly performed in rural hospital outpatient settings; and 2) to evaluate the rural relevance of the proposed new CMS outpatient quality measures and other potential outpatient quality measures.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality
  • Critical Access Hospital Participation in the Hospital Quality Alliance and Initial Quality Measure Results
    This project examined the participation of Critical Access Hospitals (CAHs) in public reporting of quality measures in the Centers for Medicare and Medicaid Services Hospital Compare database. It presented the initial Hospital Compare results for CAHs and comparisons with other groups of hospitals on quality measures for three conditions: acute myocardial infarction (heart attack), heart failure and pneumonia.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  • Dental Care For Rural Low Income And Minority Populations
    Research center: University of Minnesota Rural Health Research Center
    Topics: Dental health, Minority health, Poverty
  • Health Care System Response to a Growing Latino Population in Rural America
    Research center: University of Minnesota Rural Health Research Center
    Topics: Cultural competency, Hispanics, Minority health, Rural statistics and demographics
  • Hospitalizations of Rural Children for Ambulatory Care Sensitive Conditions
    This project uses state inpatient discharge data from six states, data from the Area Resource File and the AHRQ Pediatric Quality Indicators to examine Ambulatory Care Sensitive Condition admission rates for rural children.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Children, Chronic diseases and conditions
  • Impact of Hospitalists on Inpatient and Primary Care in Rural Communities
    This project will analyze primary data from a survey of rural hospitals about their use of hospitalists along with several sources of secondary data to examine why and how hospitalists are being used in rural hospitals and the impact of their use.
    Research center: Upper Midwest Rural Health Research Center
    Topic: Hospitals and clinics
  • Impact of Private Sector Quality Initiatives on Rural Providers and Patients
    The purpose of this project is to assess the impact of private sector quality reporting and quality improvement initiatives on rural providers and on the quality of care provided to rural patients.
    Research center: University of Minnesota Rural Health Research Center
    Topic: Quality
  • Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety
    The purpose of this project is to describe successful telepharmacy activities and to analyze policy issues related to the implementation of telepharmacy projects in rural hospitals. These policy issues include the potential impact of telepharmacy use on the quality of pharmaceutical services and medication safety for rural patients.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Telehealth
  • Measuring Quality in Rural Health Services: Are Hospital and Health Plan Accreditation Standards Appropriate for Rural Areas?
    Research center: University of Minnesota Rural Health Research Center
    Topic: Quality
  • Measuring Quality Performance in CAHs
    The purpose of the project is to update our previous analyses of CAH participation in Hospital Compare, analyze trends over time, and explore additional sources of quality data for CAHs.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  • Patient Assessments and Quality of Care in Rural Hospitals
    This study will 1)analyze the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care; and 2) assess whether rural patients' perspectives of hospital quality of care are related to quality measures focused on the provision of recommended care for medical conditions.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Health services, Quality
  • Quality Implications of Transferring Emergency Department Patients from Rural Hospitals
    This project will use Medicare inpatient and Emergency Department claims data to 1.) compare patients who are transferred directly from rural hospital Emergency Departments to larger hospitals with those who are admitted as inpatients to rural hospitals in terms of diagnoses, comorbidities, demographics, and the care received and 2.) analyze how the inclusion or exclusion of transferred emergency patients affects risk-adjusted mortality rates for transferring and receiving hospitals.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Emergency medical services (EMS), Quality
  • Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas
    This project will describe emergency department (ED) staffing patterns in rural hospitals; determine how the certification, training, and experience of ED physicians and other providers in different ED staffing models vary; and assess the implications of rural ED staffing for the quality of emergency care in rural areas, continuity of care, and rural EDs' role as safety net providers.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Emergency medical services (EMS), Hospitals and clinics, Quality, Workforce
  • Successful Implementation of Medication Safety Initiatives in Rural Hospitals: The Role of Pharmacists and Technology
    This project will assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, and will identify factors that facilitate successful implementation of medication safety practices in rural hospitals.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology

Publications - (65)

  • 2004 CAH Survey National Data
    University of Minnesota Rural Health Research Center
    Date: 08/2004
    As part of the monitoring efforts for the Medicare Rural Hospital Flexibility Program (Flex Program), the Flex Monitoring Team conducted a national telephone survey of 500 CAH administrators between January and April 2004. The purpose of the survey was to document the program-related experiences of CAHs over the past two years, in order to help shape public policy to improve the effectiveness of the Flex Program and CAHs. The CAH survey was developed by the Flex Monitoring Team members at the Universities of Minnesota, North Carolina, and Southern Maine and fielded by the Survey Research Center in the Division of Health Services Research and Policy at the University of Minnesota. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Access to Dental Care for Rural Low Income and Minority Populations
    University of Minnesota Rural Health Research Center
    Date: 09/2004
    Using data from the 1999 National Health Interview Survey, this study examines the relationships between rural residence, income, race/ethnicity, and access to dental care. The study confirms that rural-urban disparities in access to dental care persist, and finds significant differences by race/ethnicity and income within rural populations in utilization of dental care, affording needed dental care, and dental insurance.
  • Access to Rural Pharmacy Services in Minnesota, North Dakota, and South Dakota
    University of Minnesota Rural Health Research Center
    Date: 07/2001
    Describes the current status of rural retail pharmacies in the three states; examines the availability of pharmacy services in rural areas of the states; and analyzes regulatory and policy issues that affect the delivery of pharmacy services in rural areas. Among the findings are that pharmacy access problems in the states are not primarily due to closure of rural pharmacies in recent years; relief coverage is a major concern for many rural pharmacies; financial access to pharmacy services is a major concern in rural areas of the states; the financial viability of rural pharmacies is a key policy issue; and the addition of a Medicare prescription benefit may have a substantial negative impact on the financial status of rural pharmacies. Makes several recommendations pertaining to the capacity of colleges of pharmacy to produce an adequate supply of rural pharmacists; options for providing affordable relief coverage for rural pharmacists; financial access to prescription drug coverage for the elderly and other vulnerable populations; and the potential financial impact of a Medicare prescription benefit on rural pharmacies.
  • Ambulatory Care Sensitive Condition Hospitalizations Among Rural Children (Brief)
    Upper Midwest Rural Health Research Center
    Date: 06/2007
    Reports results from a study examining children's inpatient hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs), rural residence, poverty, health insurance, and physician supply. Admission rates for five conditions were examined: asthma, diabetes short-term complications, gastroenteritis, urinary tract infection and perforated appendix.
  • Analysis of CAH Inpatient Hospitalizations and Transfers: Implications for National Quality Measurement and Reporting
    Upper Midwest Rural Health Research Center
    Date: 12/2006
    Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Birth Volume and the Quality of Care in Rural Hospitals
    University of Minnesota Rural Health Research Center
    Date: 2014
    Evaluates obstetric care quality in low-, medium-, and high-volume areas by using hospital discharge data.
  • CAH Participation in Hospital Compare and Initial Results
    University of Minnesota Rural Health Research Center
    Date: 02/2006
    Examines the participation of Critical Access Hospitals (CAHs) in public reporting of quality measures in the Centers for Medicare and Medicaid Services Hospital Compare database. It presents the initial Hospital Compare results for CAHs and comparisons with other groups of hospitals on quality measures for three conditions: acute myocardial infarction (heart attack), heart failure and pneumonia. Although CAHs do not face the same financial incentives as Prospective Payment System hospitals to participate, the Hospital Compare initiative provides an important opportunity for CAHs to assess and improve their performance on national standards of care. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Case Studies of Regional Extension Centers Serving Rural Practices: Minnesota and North Dakota
    University of Minnesota Rural Health Research Center
    Date: 11/2013
    Focuses on the HIT Regional Extension Center serving Minnesota and North Dakota and its experiences working with rural physician practices in the two states.
  • Case Studies of Regional Extension Centers Serving Rural Practices: North Carolina
    University of Minnesota Rural Health Research Center
    Date: 11/2013
    Presents a case study focusing on the North Carolina HIT Regional Extension Center and its experience working with rural physician practices in the state.
  • Closure of Hospital Obstetric Services Disproportionately Affects Less-Populated Counties
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 04/2017
    This policy brief describes the scope of obstetric unit and hospital closures resulting in loss of obstetric services in rural U.S. counties from 2004 to 2014.
  • Comparing Rural and Urban Medicare Part D Enrollment Patterns and Prescription Drug Coverage Rates
    University of Minnesota Rural Health Research Center
    Date: 05/2013

    Examines Medicare Part D enrollment rates in rural and urban areas and the resulting impact on rural beneficiaries' overall prescription drug coverage rates.

    Key Findings:

    • Overall Medicare Part D enrollment rates increased from 55.5% in 2006, the first year of the program, to 61.4% in 2009. Annual increases were between 1 and 5 percentage points.
    • Rural Part D enrollment rates consistently lagged behind urban rates by 2 to 4 percentage points, increasing from 53.7% in 2006 to 58.6% in 2009, compared to urban rates increasing from 56.0% to 62.3%, respectively.
    • Geographic disparities in prescription coverage have greatly diminished over time: by 2009, prescription drug coverage rates topped 90% in both rural and urban areas. Rates of continuous uninsurance are approaching all-time lows of 7% in rural areas and 4% in urban areas.
    • Independent of geographic location, there is strong evidence of less-healthy beneficiaries enrolling in the Part D program, and no evidence of the Part D program crowding out private prescription drug coverage.
  • Critical Access Hospital Patient Safety Priorities and Initiatives: Results of the 2004 National CAH Survey
    University of Minnesota Rural Health Research Center
    Date: 09/2004
    Describes the patient safety results from a national phone survey of 474 CAH administrators conducted in 2004. Survey respondents were queried regarding top patient safety priorities, familiarity with the Joint Commission on Accreditation of Healthcare Organization (JCAHO) and implementation of initiatives related to the goals, factors that limit or support their ability to implement patient safety interventions, and pharmacist staffing and computer software to improve medication safety. The survey findings provide encouraging evidence of CAH interest in patient safety, but should be interpreted cautiously because of the significant number of CAHs which reported that financial resources, staff time, and technology are limiting factors in their ability to implement patient safety interventions. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2007

    Policy brief examining the second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database. A full report is also available. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.

  • Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results: Briefing Paper
    University of Minnesota Rural Health Research Center
    Date: 04/2007
    Examines the second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database for hospital quality measures. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • The Current Status of Health Information Technology Use in CAHs
    University of Minnesota Rural Health Research Center
    Date: 05/2006
    Both the public and private sectors have focused considerable attention on health information technology (HIT) as a potential means of improving the quality, safety, and efficiency of health care. The purpose of this briefing paper is to assess the current status of HIT use in Critical Access Hospitals (CAHs) nationally. This project is part of the federal Office of Rural Health Policy's initiative to implement national performance measures for the Medicare Rural Hospital Flexibility Program. It was conducted by the Flex Monitoring Team in collaboration with the Technical Assistance and Services Center (TASC) at the Rural Health Resource Center in Duluth, Minnesota. Data for the study came from a national survey of CAHs conducted in March and April 2006. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Differences in Part D Plans Offered to Rural and Urban Medicare Beneficiaries
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 07/2015

    This brief analyzes how the plan options available to rural and urban beneficiaries differ in terms of premiums, deductibles, and copayments, as well as differences in plan options within rural areas.

    Key Findings:

    • Standalone Medicare Part D prescription drug plans (PDPs) available to beneficiaries varied little in premiums, copays, deductibles, the availability of enhanced plans, and gap coverage across urban and rural areas.
    • The average deductible and average premium for available MA-PDPs varied significantly among the three geographic areas. Urban areas had the lowest costs, followed by more-densely populated and less-densely populated rural areas.
  • Do Rural Elders Have Limited Access to Medicare Hospice Services?
    University of Minnesota Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 05/2004
    Examines whether there are urban-rural differences in use of the Medicare hospice benefit before death and whether those differences suggest that there is a problem with access to hospice care for rural Medicare beneficiaries.
  • Does the Medicare Part D Decision-Making Experience Differ by Rural/Urban Location?
    University of Minnesota Rural Health Research Center
    Date: 02/2016
    Evaluates the personal experiences with choosing a Part D plan among rural residents. This study examines the geographic differences in Part D enrollees’ opinion of the plans decision-making process.
  • 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.
  • 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.
  • Health Information Technology Policy and Rural Hospitals
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009

    Health information technology (HIT) is a key component of plans to reform the health care system. HIT adoption among smaller rural providers has lagged behind larger urban providers, and the vast majority of research on HIT has focused on its adoption and impact in urban institutions. This brief summarizes the implementation status of key HIT applications in Critical Access Hospitals and other rural hospitals, and discusses policies for encouraging HIT adoption in rural hospitals.

  • Identifying Adverse Drug Events in Rural Hospitals: An Eight-State Study
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2017
    Analyzes the prevalence of Adverse Drug Events (ADEs) in rural hospitals, including both CAHs and rural PPS hospitals, related to four categories of drugs: steroids, antibiotics, opiates / narcotics, and anticoagulants in 2013 for eight states. It also examines whether or not these hospitals' ADE rates varied based on hospital characteristics.
  • Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 03/2009

    Describes successful telepharmacy activities being implemented in rural hospitals and analyzes policy issues related to the implementation of telepharmacy projects in rural hospitals.

  • Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Final Report)
    Upper Midwest Rural Health Research Center
    Date: 12/2008
    Findings from this report describe successful telepharmacy activities being implemented in rural hospitals and analyze policy issues related to the implementation of telepharmacy projects in rural hospitals.
  • Influence of Rural Residence on the Use of Preventative Health Care Services
    University of Minnesota Rural Health Research Center
    Date: 11/2000
    Study of the utilization of specific preventive healthcare services by rural women and men, and to assess the impact of rural residence, the availability of healthcare providers and technology, demographic factors, and health insurance status on the likelihood of obtaining the following preventive healthcare services: blood pressure screening, cholesterol screening, colon cancer screening, Pap smears, mammograms, flu shots, and pneumonia vaccinations.
  • 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.
  • Medical Barriers to Nursing Home Care for Rural Residents
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2017
    This policy brief describes barriers rural residents with complex medical care needs may face when seeking placement in a nursing home and identifies potential policy strategies to overcome them.
  • Medicare Costs and Utilization Among Beneficiaries in Rural Areas
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 03/2016
    This study assesses the relationship between service utilization patterns and costs for rural Medicare beneficiaries across the rural continuum. It also examines the relationships between rural beneficiaries’ service utilization and health care delivery market structure and evaluates strategies and policies to address high costs in rural areas.
  • Minimum Distance Requirements Could Harm High-Performing CAHs and Rural Communities
    North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 04/2015
    Compares the effect of location on critical access hospitals’ size, quality of care, and financial strength. Discusses implications of minimum distance requirements on critical access hospitals.
  • Nurse Staffing Levels and Quality of Care in Rural Nursing Homes
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 01/2015

    Current federal minimum staffing levels for certified nursing homes require one RN for at least eight hours per day, seven days per week, and one licensed nurse (RN or LPN) on duty the rest of the time. State minimum staffing level requirements for nursing facilities vary considerably. Consequently, nurse skill mix and nurse staffing levels per resident may vary significantly across facilities, making it important to consider these variables.

    The purpose of this study was examine the relationship between nurse staffing levels and care quality in rural nursing homes, and to assess potential differences between hospital-based and freestanding rural nursing homes.

  • The Obstetric Care Workforce in Critical Access Hospitals (CAHs) and Rural Non-CAHs
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2014

    This policy brief describes obstetric staffing patterns in rural hospitals in nine states by Critical Access Hospital (CAH) status. The purpose of this study was to examine current obstetric practice models in rural hospitals, with a goal of providing timely and useful information to rural hospitals with obstetric care units regarding the obstetric workforce and to inform policymakers involved in shaping healthcare about the context in which rural hospitals operate.

    Key Findings:

    • In the nine states we studied, almost two-thirds of the 244 rural hospitals (64.3%) had more than one type of clinician providing obstetric care. The most frequent combinations were obstetricians working with certified nurse midwives (CNMs) (17.2% of hospitals) and obstetricians working with family physicians (15.6%).
    • Critical Access Hospitals (CAHs) were significantly more likely than rural non-CAHs to have family physicians and general surgeons attending deliveries, and significantly less likely to have obstetricians attending deliveries.
    • When asked about the challenges they face staffing rural obstetric units, survey respondents most frequently cited census variability, retention and recruitment, maintenance of skills and competencies, and staffing arrangements (scheduling, taking call, unit coverage, etc.).
  • Obstetric Services and Quality among Critical Access, Rural, and Urban Hospitals in Nine States
    University of Minnesota Rural Health Research Center
    Date: 06/2013
    Compares the characteristics and quality of obstetric care in Critical Access Hospitals, other rural hospitals, and their urban counterparts.
  • Patient Assessments and Quality of Care in Rural Hospitals
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2010

    Analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care.

  • Patient Assessments and Quality of Care in Rural Hospitals (Final Report)
    Upper Midwest Rural Health Research Center
    Date: 06/2010
    Analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care. It assesses whether rural patients' perspectives of hospital quality of care are related to quality measures focused on the provision of recommended care for medical conditions.
  • Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
    Upper Midwest Rural Health Research Center
    Date: 12/2005
    To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
  • Pharmacist Staffing, Technology Use and Implementation of Medication Safety Practices in Rural Hospitals
    Upper Midwest Rural Health Research Center
    Date: 2006
    Reports the capacity of small rural hospitals to implement medication safety practices, with a focus on pharmacist staffing and the availability of technology.
  • 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.

  • Prioritizing Patient Safety Interventions in Small Rural Hospitals
    Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 12/2006
    Determines if 26 patient safety practices recommended by an expert panel as relevant to rural hospitals would be validated in terms of rural relevance and implementability by administrators and quality managers. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
  • Providing Hospice Care in Rural Areas: Challenges and Strategies to Address Them
    University of Minnesota Rural Health Research Center
    Date: 2005
    Hospices in rural settings face challenges in the provision of hospice care as a result of their location and the size of their service area population. To ascertain the challenges that hospices face in serving rural communities, researchers conducted in-depth case studies of four different models of hospice care in rural areas. The authors describe strategies used by the case study hospices and recommend policies that could increase access to hospice care for rural Medicare beneficiaries and other rural residents. National initiatives to improve end-of-life care need to consider the special challenges faced by rural hospices.
  • Quality Improvement Activities in Critical Access Hospitals: Results of the 2004 National CAH Survey
    University of Minnesota Rural Health Research Center
    Date: 09/2004
    Describes quality improvement efforts in Critical Access Hospitals (CAHs) based on a 2004 survey of 474 CAH administrators. Includes data on the use of clinical guidelines and quality measures in CAHs, and the role of Medicare Quality Improvement Organizations (QIOs). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Quality Improvement Strategies and Best Practices in Critical Access Hospitals
    University of Minnesota Rural Health Research Center
    Date: 01/2004
    Describes Critical Access Hospital (CAH) quality improvement (QI) initiatives, with examples of best practices from two CAHs that have innovative QI programs. Includes lists of changes made to staffing, training, equipment and other issues related to quality improvement.
  • 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.
  • Regulating Network Adequacy for Rural Populations: Perspectives of Five States
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 08/2017
    The purpose of this study was to examine how five geographically-diverse states with significant rural populations define "network adequacy" and the degree to which they consider rural issues when regulating networks.
  • Resources to Reduce Adverse Drug Events in Rural Hospitals
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2017
    This policy brief provides resources that could be used to decrease Adverse Drug Events (ADEs) in rural hospitals.
  • The Response of Local Health Care Systems in the Rural Midwest to a Growing Latino Population
    University of Minnesota Rural Health Research Center
    Date: 08/2003
    Reports on the case studies of rural communities in Iowa, Kansas, and Nebraska, documenting successful strategies that could be adopted by other communities facing challenges to their local rural healthcare system in meeting the needs of a growing Latino population. High rates of uninsurance for Latinos, along with language and cultural barriers to care, have contributed to difficulties accessing healthcare in these communities.
  • Rural and Urban Differences in Choice of and Satisfaction with Medicare Part D Plans
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 07/2015

    This brief examines whether rural Medicare beneficiaries are satisfied with their Medicare Part D drug plans and whether there is a difference in beneficiary satisfaction and plan selection experience by rurality.

    Key Findings:

    • Less than one in five respondents felt “extremely confident” that they had made the best plan decision. Residents in more-densely populated rural areas were significantly less likely than those in urban areas to be extremely confident.
    • Respondents in more-densely populated rural counties reported significantly lower satisfaction levels with their Part D plans than those in urban counties.
  • Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Final Report)
    Upper Midwest Rural Health Research Center
    Date: 06/2007

    The purpose of this project was to describe rural emergency department staffing nationally and to assess the potential implications of staffing for the quality of emergency care provided in rural areas. A national telephone survey of a random sample of rural hospitals with less than 100 beds was conducted in June to August 2006. The study found that the majority of rural hospitals use more than one type of staffing to cover their Emergency Department (ED), including combinations of physicians on their own medical staff, contracts with emergency physician management groups and with individual physicians, and physician assistants and nurse practitioners. The study concluded that it is important to ensure that the family physicians, internists, PAs, NPs and nurses who staff rural EDs have the expertise and technical skills needed to provide optimal ED care, and that rural ED staff may benefit from additional continuing education opportunities, particularly in terms of specialized skills to care for pediatric emergency patients and trauma patients and training in working effectively in teams. Report available upon request by contacting the Center.

  • Rural Hospital and Physician Participation in Private Sector Quality Initiatives
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2015

    Some private sector quality initiatives could potentially have a significant impact on the quality of rural health care, particularly in rural markets that are dominated by a single large insurer, as these insurers are likely to have both the resources to implement an initiative and sufficient leverage to motivate rural provider participation. This project examined private sector quality reporting and quality improvement initiatives being implemented by dominant insurers in states with significant rural populations. The policy brief profiles twelve different initiatives (half focused on physician quality improvement, half focused on hospital quality improvement).

  • 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.
  • Rural Issues Related to Comparative Effectiveness Research and Dissemination
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009

    Comparative effectiveness research, which compares the costs and benefits of different treatments for specific diseases or conditions, has the potential to improve the quality and reduce the costs of health care. This brief describes strategies for expanding clinical research in rural environments; implementing practice guidelines in rural settings; and improving access to current evidence-based information for rural health professionals and patients.

  • The Rural Obstetric Workforce in US Hospitals: Challenges and Opportunities
    University of Minnesota Rural Health Research Center
    Date: 03/2015
    Describes the healthcare and clinician types who are delivering babies in rural hospitals, such as family physicians, general surgeons, obstetricians, and midwives. Discusses the relationship between hospital birth volume and staffing models.
  • Rural Primary Care Practices and Meaningful Use of Electronic Health Records: The Role of Regional Extension Centers
    University of Minnesota Rural Health Research Center
    Date: 2014
    Examines the role Regional Extension Centers (RECs) play in assisting rural physician practices implement electronic health records (EHRs).
  • Rural Women Delivering Babies in Non-Local Hospitals: Differences by Rurality and Insurance Status
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2015

    This policy brief describes the extent to which rural pregnant women give birth in non-local hospitals, and to analyze current patterns of non-local delivery by rural women's health insurance status and residential rurality.

    Key Findings:

    • In nine geographically-diverse states with substantial rural populations, 25.4% of rural pregnant women delivered their babies in non-local hospitals in 2010 and 2012.
    • Rural women living in more densely populated rural areas were less likely to give birth in a non-local hospital (19.5%) than those in less densely populated rural areas, either next to a metropolitan area (35.9%) or not (33.7%).
    • Privately-insured rural women were more likely to give birth in non-local hospitals than rural women who were covered by Medicaid (28.6% vs. 22.5%).
    • Rural women with Medicaid coverage were more likely than privately-insured women to deliver their babies in a hospital where more than half of all births were covered by Medicaid (63.8% vs. 36.7%).
  • Rural-Urban Differences in Obstetric Care 2002-2010 and Implications for the Future
    University of Minnesota Rural Health Research Center
    Date: 01/2014
    Measures obstetric care in both rural and urban hospitals to find if trends differ from rural and urban hospital locations.
  • Rural-Urban Differences in Satisfaction with Medicare Part D: Implications for Policy
    University of Minnesota Rural Health Research Center
    Date: 01/2016
    Examines the difference in rural and urban satisfaction with Medicare Part D coverage by using data from the 2012 Medicare Current Beneficiary Survey. The research found that rural residents have lower satisfaction with their coverage.
  • 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.
  • State Variability in Access to Hospital-Based Obstetric Services in Rural US Counties
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 04/2017
    This policy brief describes state-level variations in 1) the availability of hospital-based obstetric services, and 2) the scope of obstetric unit and hospital closures resulting in the loss of obstetric services in rural U.S. counties from 2004 to 2014.
  • 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.
  • The Use of Hospitalists by Small Rural Hospitals: Results of a National Survey
    University of Minnesota Rural Health Research Center
    Date: 06/2014
    Examines reasons for using hospitalists, characteristics of hospitalist practices, and the impacts of hospitalist use in rural settings.
  • The Use of Hospitalists in Small Rural Hospitals
    Upper Midwest Rural Health Research Center
    Date: 04/2012
    This policy brief describes the results of a survey of small rural hospitals that use hospitalists, who are physicians, physician assistants or nurse practitioners who assume responsibility for patient care during inpatient hospital stays.
  • Use of the Hospice Benefit by Rural Medicare Beneficiaries
    University of Minnesota Rural Health Research Center
    Date: 08/2002
    Identifies urban-rural differences in hospice use in rural service areas.
  • Which Medicare Patients Are Transferred from Rural Emergency Departments?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2014

    Analyzes transfers of Medicare beneficiaries who received emergency care in a CAH or rural hospital and were transferred to another hospital for care.

    Key findings include the following:

    • Among Medicare beneficiaries who received same-day emergency care and inpatient care in 2010, the inpatient stay was in a different hospital for 28.4% of the Critical Access Hospital (CAH) emergency encounters, compared to 9.0% for rural non-CAHs, and 2.0% for urban hospitals.
    • The majority of transferred CAH and rural non-CAH emergency patients went to urban hospitals for inpatient care. By diagnosis, most transferred patients with intracranial injuries and cardiac-related diagnoses went to urban hospitals, while 35%-45% of patients with certain mental health diagnoses were transferred to other CAHs or rural non-CAHs.
  • Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2015
    The Centers for Medicare & Medicaid Services’ (CMS) Hospital Readmissions Reduction Program reduces Medicare payments for hospitals determined to have “excess” rates of patient readmissions for specific conditions. The purpose of this project was to assess rural-urban differences in the proportion of hospitals that received penalties under the Readmissions Reduction Program over time, and whether condition-specific hospital readmission rates differed for rural and urban hospitals.
  • 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.