Rural Health
Research Gateway

Yvonne Jonk, PhD

Deputy Director, Maine Rural Health Research Center

Phone: 207.228.8038
Fax: 207.228.8138
Email: yvonne.jonk@maine.edu
X: @MERuralHealth

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

Current Projects - (9)

  • Differences in Trauma Outcomes for Patients Residing in Ambulance Deserts
    Rural residents are 14% more likely to die after traumatic injury compared with urban residents, with distance from trauma centers and travel time likely significant contributors to this disparity. This project will use the State Emergency Department Databases and State Inpatient Database to examine differences in trauma outcomes for patients residing in ambulance deserts.
    Research center: Maine Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Healthcare access, Hospitals and clinics
  • Health Care Use and Access Among Rural and Urban Elderly Medicare Beneficiaries
    This project will examine rural-urban differences in healthcare use and access to healthcare services among elderly Medicare enrollees using the 2011-2013 Medicare Current Beneficiary Survey. We also will identify the socioeconomic and health factors that may place rural seniors at risk for poor healthcare access.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Medicare
  • Medical and Mental Health Service Provision Amongst Rural Health Clinics
    This study will provide a descriptive analysis of differences in Rural Health Clinic (RHC) type, clinic size, and geographic location of RHCs providing same day medical and mental health visits, compared to RHCs that are only providing one or the other type of visits on the same day.
    Research center: Maine Rural Health Research Center
    Topics: Health services, Mental and behavioral health, Rural Health Clinics (RHCs)
  • Mortality Risks Associated With Living in Ambulance Deserts
    This project will use ambulance data from the Maine Rural Health Research Center and from CDC WONDER to assess whether living in an ambulance desert is associated with higher mortality rates among rural and urban populations.
    Research center: Maine Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Healthcare access
  • Prevalence of Opioid Prescribing, Diagnoses of Opioid Use Disorder, Treatment Patterns, and Costs Among Rural Medicare Beneficiaries
    Opioid use disorder (OUD) diagnoses among the aged and disabled are among the highest and fastest growing. This study uses the 2010-2017 Medicare Current Beneficiary Survey to examine opioid prescribing rates and explore risk factors associated with OUDs and associated treatment patterns and costs within rural and urban Medicare populations.
    Research center: Maine Rural Health Research Center
    Topics: Medicare, Pharmacy and prescription drugs, Substance use and treatment
  • Socioeconomic Profiles and Market Characteristics Associated with Ambulance Deserts
    We will address the extent to which vulnerable, aging populations live in ambulance deserts and identify ambulance desert populations facing additional barriers to healthcare access. We will also assess the impact of hospital closures on travel distances to the nearest health care facilities.
    Research center: Maine Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Healthcare access, Rural statistics and demographics, Social determinants of health, Transportation
  • Understanding Rural Non-Emergent Emergency Department Use
    Research shows rural residents use emergency departments (ED) at higher rates than urban residents. Other studies suggest rural residents are more likely to visit the ED for a non-emergent reasons. This study uses the 2014-17 Medical Expenditure Panel Survey to analyze factors associated with rural versus urban residents' non-emergent use of EDs.
    Research center: Maine Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Health services, Healthcare access, Hospitals and clinics
  • Use of Home and Community Based Services by Medicare Beneficiaries
    Using the Medicare Current Beneficiary Survey, we will examine rural-urban differences in the need for long term services and supports, rates of home and community-based services (HCBS) use, the use of different types of HCBS, and the impact of HCBS on subsequent use of emergent services such as hospitalizations and emergency department visits.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Health services, Home health, Long-term care, Medicare
  • Use of Z Codes by Rural and Urban Providers to Capture Data on the Social Determinants of Health Impacting Medicare Beneficiaries
    Using a mixed methods approach, we will examine the use of Z codes by rural and urban providers to better capture information on the social determinants of health experienced by Medicare beneficiaries across the rural continuum.
    Research center: Maine Rural Health Research Center
    Topics: Health services, Medicare, Physicians, Social determinants of health

Completed Projects - (6)

  • Acuity Differences Among Newly Admitted Rural and Urban Nursing Home Residents
    This study used nursing home assessment data to examine rural-urban differences in resident acuity upon admission; whether differences persisted among newly admitted Medicare and non-Medicare residents; and whether and how nursing home, local health system, and market characteristics were associated with differences in resident acuity.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Long-term care
  • Ambulance Deserts: Addressing Geographic Disparities in the Provision of Ambulance Services
    This two-year study aimed to identify geographic disparities in accessing ambulance services by building a database of ambulance service locations in year one and identifying and creating maps of ambulance deserts within each of the states in year two.
    Research center: Maine Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Healthcare access, Rural statistics and demographics, Transportation
  • Are Part D Plans Meeting the Needs of Rural Medicare Beneficiaries?
    The purpose of this project is to assess whether the Medicare Part D prescription drug plans available in rural counties are sufficient to meet the needs of rural Medicare beneficiaries.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
  • Cost of Running a Rural Ambulance Service
    This study will address the cost of running ambulance services in rural areas by organizational structure/source of funding, the factors contributing to differences in costs, and factors contributing to differences in financial viability.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Emergency medical services (EMS) and trauma, Healthcare financing
  • Healthcare Use and Expenditures Among Rural and Urban Medicare Beneficiaries Aged 85 and Over
    The proportion of U.S. residents ages 85+ is expected to grow substantially in the coming decades with the impact of this growth in rural areas likely to be pronounced. This project used data from the Medicare Current Beneficiary Survey to examine rural-urban differences in healthcare use and expenditures among Medicare enrollees ages 85+.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Healthcare access, Long-term care, Medicare
  • Understanding Trends in Telehealth Use: An All-Payer Analysis in Maine
    This project's primary purpose was to use Maine's All-Payer Claims Database and key informant interviews to develop a descriptive overview of telehealth use in Maine, examining how telehealth use had changed over time (2008-2017) among rural and urban patients and providers.
    Research center: Rural Telehealth Research Center
    Topics: Medicare, Private health insurance, Telehealth

Publications - (18)

2024

2023

  • A Consensus Panel Approach to Estimating the Start-Up and Annual Service Costs for Rural Ambulance Agencies
    Policy Brief
    Maine Rural Health Research Center
    Date: 08/2023
    This brief fills the information void on the costs of running rural ambulance services and establishes a minimum access standard for ambulances servicing a 25-minute travel time radius from the ambulance station, enabling policymakers and community stakeholders to develop strategic plans for the financing and provision of ambulance services.
  • Ambulance Deserts: Geographic Disparities in the Provision of Ambulance Services
    Chartbook
    Maine Rural Health Research Center
    Date: 05/2023
    Access to timely ambulance service is an essential part of the emergency medical system. Yet ambulance access varies widely with significant gaps across the country. This research identifies places and people that are more than 25 minutes from an ambulance station, also called an ambulance desert.
  • Rural-Urban Differences in Workers' Access to Paid Sick Leave
    Journal Article
    Maine Rural Health Research Center
    Date: 02/2023
    The authors analyzed the prevalence of paid sick leave (PSL) among rural versus urban workers and found that rural workers had lower access to PSL than urban workers, even after adjusting for worker and employment characteristics, especially those who were Hispanic, lacked employer-sponsored insurance, and reported poorer health status.

2022

  • Patterns of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 and Older, 2010-2017
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2022
    This study examines rural-urban differences in health care use among Medicare beneficiaries age 85+.
  • Community Characteristics and Financial and Operational Performance of Rural Health Clinics in the United States: A Chartbook
    Chartbook
    Maine Rural Health Research Center
    Date: 05/2022
    This chartbook provides an overview of Rural Health Clinic (RHC) characteristics and issues and will be useful to policymakers and others interested in the performance of RHCs nationally. It provides a discussion of the challenges related to collection and reporting of RHC quality data.
  • Maine: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • New Hampshire: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • New York: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • The Northern Border Region: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • Vermont: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.

2020

  • Acuity Differences Among Newly Admitted Older Residents in Rural and Urban Nursing Homes
    Journal Article
    Maine Rural Health Research Center
    Date: 11/2020
    This study found newly admitted residents of rural nursing homes were more likely to have cognitive issues/problem behaviors than those in urban facilities. Yet rural facilities admitted less complex older (age 75+) residents than urban, raising questions about the rural long-term services and supports system and capacity of rural nursing homes.
  • Telehealth Use in a Rural State: A Mixed Methods Study Using Maine's All-Payer Claims Database
    Journal Article
    Rural Telehealth Research Center
    Date: 10/2020
    This study examines trends in telehealth use in Maine and identifies barriers and facilitators to its adoption. While telehealth appears to improve access to behavioral health and speech therapy services, provider shortages, lack of broadband, and restrictive Medicare and commercial coverage plans limit telehealth services use in rural areas.
  • Telebehavioral Health Use Among Rural Medicaid Beneficiaries: Relationships With Telehealth Policies
    Journal Article
    Rural Telehealth Research Center
    Date: 09/2020
    This study assesses policy levers potentially supporting sustained use of telehealth services. Among rural Medicaid fee-for-service beneficiaries with behavioral health needs, engaging patients through informed consent within provider settings that receive facility fees may facilitate improved access to telebehavioral health services.

2015

2014

2013