Rural Health
Research Gateway

Susan M. Skillman, MS

WWAMI Rural Health Research Center

Phone: 206.543.3557
Email: skillman@uw.edu

University of Washington
4311 Eleventh Ave. NE, Suite 210
Seattle, WA 98105

Current Projects - (1)

  • Comparing Utilization and Quality of Home Health Care Between Medicare Fee-for-Service and Medicare Advantage Beneficiaries by Rural-Urban Status
    This project examines differences in home health use and quality by enrollment in Medicare Fee-for-Service (FFS) versus Medicare Advantage (MA) plans. Findings will include information on rural-urban and intra-rural variation in home health care to inform policies on access, payment, and quality for Medicare FFS and MA plans.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Allied health professionals, Health disparities and health equity, Health services, Healthcare access, Healthcare financing, Home health, Medicare, Medicare Advantage (MA), Post-acute care, Quality

Completed Projects - (14)

  • Access to Home Care Services in the Rural United States
    This study will identify and describe the scope of home health services required to meet current and future needs in rural areas of the U.S., identify current and anticipated barriers to accessing those needs, and describe ways that may help overcome these barriers.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Home health
  • Assessing Rural-Urban Nurse Practitioner Supply and Distribution in 12 States Using Available Data Sources
    This study compared estimates of nurse practitioner (NP) supply in 12 states (statewide and rural vs. urban) derived from two sources: state license records and National Provider Identifier (NPI) data.
    Research center: WWAMI Rural Health Research Center
    Topics: Nurses and nurse practitioners, Physicians, Workforce
  • Community College's Contributions to the Education of Allied Health Professionals in Rural Areas of the U.S.
    This study will identify rural-serving community colleges across the U.S. and their 5-year graduation trends for specific allied health professions, examine the spectrum of how rural allied health professions education currently is being allocated and delivered, and explore how community economic status and estimated regional allied health workforce demand is associated with the availability of rural community college allied health education programs.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Workforce
  • Current Contribution of Physicians, Advanced Practice Nurses, and Physician Assistants to the Rural Primary Care Workforce
    This two-year, multi-state study is examining the practices of rural physicians, nurse practitioners (NPs), and physician assistants (PAs) regarding their primary care visit productivity and scope of practice. Through surveys, this study will examine the contributions of physicians, NPs, and PAs by state, degree of practice rurality, practice characteristics, and primary care HPSA status in order to provide information on a range of rural primary care workforce needs.
    Research center: WWAMI Rural Health Research Center
    Topics: Nurses and nurse practitioners, Physician assistants, Physicians, Workforce
  • Factors Associated with Rural-Residing Registered Nurses' Choices to Work in Urban Locations and Larger Rural Cities
    While larger numbers of registered nurses (RNs) are living in rural areas, research from the WWAMI RHRC shows that since 1980, a growing percentage are commuting from rural residences to work within urban and larger rural cities. This study will explore factors that may be associated with RNs' decisions to commute away from their rural areas of residence to work in less rural areas.
    Research center: WWAMI Rural Health Research Center
    Topics: Nurses and nurse practitioners, Physician assistants, Workforce
  • Health Information Technology (HIT) Workforce Needs in Rural America
    Health care increasingly relies on effective health information technology (HIT) to capture and exchange key patient information, and requires a trained workforce to implement this technology. To understand the specific needs and constraints of rural health systems to employ an effective HIT workforce, this study will survey rural primary care clinics across the country to determine their current and projected level of HIT adoption and demand for workers with HIT skills.
    Research center: WWAMI Rural Health Research Center
    Topics: Health information technology, Workforce
  • HIT Workforce Development in Rural-Serving Community Colleges
    This study will describe trends in the number of students completing Health Information Technology (HIT) programs in community colleges located near rural populations in the U.S.; assess the extent to which these programs have incorporated, or plan to incorporate, components of the recently released community college curriculum by the Office of the National Coordinator for HIT (ONC) into their programs; and identify factors that affect the ability of programs to reach rural student populations.
    Research center: WWAMI Rural Health Research Center
    Topics: Health information technology, Workforce
  • Long Term Trends in Characteristics of the Rural Nurse Workforce: A National Health Workforce Study
    This national study characterizes changes in the demographic, education and practice characteristics of registered nurses (RNs) in rural and urban areas from 1980 to 2004. This study provides important information for projecting future trends in rural RN supply.
    Research center: WWAMI Rural Health Research Center
    Topics: Nurses and nurse practitioners, Physician assistants, Workforce
  • Practice Characteristics of Rural Nurse Practitioners in the United States
    This study will use data from HRSA's first National Sample Survey of Nurse Practitioners (NSSNP) to expand on the agency's basic descriptive analyses of rural and urban nurse practitioners (NPs).
    Research center: WWAMI Rural Health Research Center
    Topics: Nurses and nurse practitioners, Workforce
  • The Rural/Urban Practice Location Patterns of Women Medical School Graduates
    While women are becoming an increasingly large percentage of the graduates of medical schools, they are much less likely to locate their practices in rural towns. This study involved a survey including questions about where the residents preferred to locate and how much they thought they would be practicing in the future.
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Women, Workforce
  • Use of Home Health Services Among High Risk Rural Medicare Patients: Patient, Service, and Community Factors Associated with Hospital Readmission
    This study will examine the 60-day post-acute care outcomes of rural Medicare patients who were discharged from hospitals and admitted to home healthcare services. Key predictors include home health services provided, type of Medicare home health reimbursement, and available community healthcare resources.
    Research center: WWAMI Rural Health Research Center
    Topics: Home health, Hospitals and clinics, Medicare, Post-acute care
  • Use of Home Health Services Among High Risk Rural Medicare Patients: Patient, Service, and Community Factors Associated with Outcomes of Care
    This study examined outcomes of care for rural Medicare patients who were discharged from hospitals and admitted to home healthcare for post-acute services. Outcomes included emergent care use and re-hospitalization during the home health admission and community discharge.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Home health, Medicare, Post-acute care
  • Use of Recommended Radiation Therapy in the Rural U.S.
    This study will use cancer registry data from 10 U.S. states to examine which rural cancer patients are receiving recommended radiation therapy, and what factors influence receipt of recommended treatment. Identifying gaps in radiation therapy will inform cancer centers, rural program planners, and policy makers in rural cancer service locations and cancer support program development.
    Research center: WWAMI Rural Health Research Center
    Topics: Cancer, Chronic diseases and conditions, Health services
  • What Strategies Are Nurse Practitioner Educational Programs Using to Encourage Rural Practice?
    This study will quantify and describe nurse practitioner (NP) education programs that encourage NPs to practice in rural areas, and identify data sources that could be used in future studies of the effectiveness of these programs.
    Research center: WWAMI Rural Health Research Center
    Topics: Nurses and nurse practitioners, Physician assistants, Workforce

Publications - (33)

2021

2020

2019

2018

2016

  • Community Factors and Outcomes of Home Health Care for High-Risk Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 10/2016
    Outcomes of care vary by region of the country for rural Medicare beneficiaries receiving home health services for high-risk conditions such as heart failure. Those in the East South Central and West South Central Census Divisions had lower rates of community discharge and higher rates of hospital readmission and emergency department use.
  • Conrad 30 Waivers for Physicians on J-1 Visas: State Policies, Practices, and Perspectives
    Report
    WWAMI Rural Health Research Center
    Date: 03/2016
    States rely on international medical graduates (IMGs) to fill workforce gaps in rural and urban underserved areas. This study collected quantitative and qualitative information from states to assess how state policies and practices shape IMG recruitment and practice in underserved areas.
  • Access to Rural Home Health Services: Views From the Field
    Report
    WWAMI Rural Health Research Center
    Date: 02/2016
    Access to home health care can be challenging for rural Medicare clients. Key informants for this study detailed obstacles, including financial, regulatory, workforce, and geographic issues. Rural communities will likely benefit from payment reforms that reward quality services while providing incentives to use best practices in home health care.
  • Nurse Practitioner Autonomy and Satisfaction in Rural Settings
    Journal Article
    WWAMI Rural Health Research Center
    Date: 01/2016
    Compares urban and rural primary care nurse practitioners (NPs) by practice location in urban, large rural, small rural, or isolated small rural areas by using analysis of the 2012 National Sample Survey of NPs.

2015

2014

2013

2012

2011

2009

2007

  • Changes in the Rural Registered Nurse Workforce From 1980 to 2004 (Final Report)
    WWAMI Rural Health Research Center
    Date: 10/2007
    With data from 1980-2004 National Sample Surveys of Registered Nurses, and using Rural-Urban Commuting Area definitions, this study describes changes in rural and urban registered nurse demographics, education, and employment characteristics over time.
  • Changes in the Rural Registered Nurse Workforce From 1980 to 2004 (Project Summary)
    WWAMI Rural Health Research Center
    Date: 10/2007
    Current and projected nationwide shortages of registered nurses (RNs) threaten access to and quality of care in most parts of the country. In rural areas, healthcare is frequently challenged by uneven distribution of healthcare providers, including nurses. This report shows changes in the rural RN workforce from 1980 to 2004.

2004

  • The Migration of Physicians From Sub-Saharan Africa to the United States of America: Measures of the African Brain Drain
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2004
    The objective of this paper is to describe the numbers, characteristics, and trends in the migration to the United States of physicians trained in sub-Saharan Africa.
    Methods: We used the American Medical Association 2002 Masterfile to identify and describe physicians who received their medical training in sub-Saharan Africa and are currently practicing in the USA.
    Results: More than 23% of America's 771 491 physicians received their medical training outside the USA, the majority (64%) in low-income or lower middle-income countries. A total of 5334 physicians from sub-Saharan Africa are in that group, a number that represents more than 6% of the physicians practicing in sub-Saharan Africa now. Nearly 86% of these Africans practicing in the USA originate from only three countries: Nigeria, South Africa and Ghana. Furthermore, 79% were trained at only 10 medical schools.
    Conclusions: Physician migration from poor countries to rich ones contributes to worldwide health workforce imbalances that may be detrimental to the health systems of source countries. The migration of over 5000 doctors from sub-Saharan Africa to the USA has had a significantly negative effect on the doctor-to-population ratio of Africa. The finding that the bulk of migration occurs from only a few countries and medical schools suggests policy interventions in only a few locations could be effective in stemming the brain drain.
  • The Productivity of Washington State's Obstetrician-Gynecologist Workforce: Does Gender Make a Difference?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2004
    Objective: To compare the practice productivity of female and male obstetrician-gynecologists in Washington State.
    Methods: The primary data collection tool was a practice survey that accompanied each licensed practitioner's license renewal in 1998-1999. Washington State birth certificate data were linked with the licensure data to obtain objective information regarding obstetric births.
    Results: Of the 541 obstetrician-gynecologists identified, two thirds were men and one third were women. Women were significantly younger than men (mean age 43.3 years versus 51.7 years). Ten practice variables were evaluated: total weeks worked per year, total professional hours per week, direct patient care hours per week, nondirect patient care hours per week, outpatient visits per week, inpatient visits per week, percent practicing obstetrics, number of obstetrical deliveries per year, percentage working less than 32 hours per week, and percentage working 60 or more hours per week. Of these, only 2 variables showed significant differences: inpatient visits per week (women 10.1 per week, men 12.8 per week, P <= .01) and working 60 or more hours per week (women 22.1% versus men 31.5%, P <= .05). After controlling for age, analysis of covariance and multiple logistic regression confirmed these findings and in addition showed that women worked 4.1 fewer hours per week than men (P < .01). When examining the ratio of female-to-male practice productivity in 10-year age increments from the 30-39 through the 50-59 age groups, a pattern emerged suggesting lower productivity in many variables in the women in the 40-49 age group.
    Conclusion: Only small differences in practice productivity between men and women were demonstrated in a survey of nearly all obstetrician-gynecologists in Washington State. Changing demographics and behaviors of the obstetrician-gynecologist workforce will require ongoing longitudinal studies to confirm these findings and determine whether they are generalizable to the rest of the United States.

2003

2002

  • Family Medicine Training in Rural Areas
    Journal Article
    WWAMI Rural Health Research Center
    Date: 09/2002

    Letter to the Editor: The discipline of family medicine was created in the 1970s, in part, as a way to address the chronic shortage of US rural physicians. It was predicted that the new discipline would augment the supply of rural clinicians because family physicians are much more likely than other physicians to settle in rural areas.

    There is also empirical evidence that training family physicians in rural areas increases the likelihood that residency graduates will choose to settle in rural places. However, the exact proportion of family medicine residency programs located in truly rural parts of the United States remains unknown, as does the extent to which training rural physicians is a priority of existing family medicine residency programs.

1998

  • Availability of Anesthesia Personnel in Rural Washington and Montana
    Journal Article
    WWAMI Rural Health Research Center
    Date: 03/1998
    Anesthesia has historically been an undersupplied specialty. Health personnel issues used to be dominated by the findings of the 1980 Graduate Medical Education National Advisory Committee study, which suggested that anesthesia would be a balanced specialty for the rest of the century. Recent studies, however, have demonstrated that there is an oversupply of all specialists, including anesthesiology. These studies take a "top down" view of health personnel through analysis of national statistics and exploration of subsets of the data by hospital size and rurality. This approach assumes that the databases of the American Hospital Association and the American Medical Association are accurate and do not take into account the presence of certified registered nurse anesthetists (CRNAs), who are the predominant providers of anesthesia care in the smallest and most remote hospitals in the United States. We compared the 1994 master file of the American Medical Association with our local knowledge of the practitioners in the rural areas of Washington state and found numerous small errors. These errors of one or two practitioners made no difference to the analysis of practitioner groups with more than approximately five people, but in the most rural communities the erroneous presence or absence of a single practitioner made a significant difference.