Zachariah T. Croll, BA

Maine Rural Health Research Center

Phone: 207.228.8247
Fax: 207.228.8138

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

Publications - (8)

  • Adoption and Use of Electronic Health Records by Rural Health Clinics: Results of a National Survey
    Policy Brief
    Maine Rural Health Research Center
    Date: 09/2015

    This study reports the extent of EHR implementation and use in a randomly selected sample of 1,497 Rural Health Clinics (RHCs) surveyed in 2013. Results show that RHCs are approaching parity with other physician practices, with nearly 72 percent reporting EHR adoption and use, and 63 percent indicating use by 90 percent or more of their staff. Among RHCs without an EHR, almost 44 percent plan to implement one within the next 12 months. In general, respondents performed well on Stage 1 meaningful use measures related to clinical care and patient management but lagged on the exchange of clinical information, reporting quality measures, implementing clinical decision support rules, conducting formulary checks, transmitting lab orders, and generating patient registries. This study suggests that RHCs without an EHR have continuing technical assistance needs to support EHR adoption. RHCs with an EHR need support to fully utilize the capabilities of their systems and meet the continually evolving standards for meaningful use.

  • Are Rural Older Adults Benefiting from Increased State Spending on Medicaid Home and Community-Based Services?
    Policy Brief
    Maine Rural Health Research Center
    Date: 06/2016
    Little is known about variations in the availability or use of Medicaid Home and Community-Based Services (HCBS) within states, across rural and urban areas. This study used national claims data to examine differences in HCBS use and expenditures among rural and urban older adult Medicaid beneficiaries receiving LTSS.
  • Health Insurance CO-OPs: Product Availability and Premiums in Rural Counties
    Policy Brief
    Maine Rural Health Research Center
    Date: 10/2016
    We describe regional distribution and market prevalence of CO-OP products in rural and urban counties, and compare the number of products available in counties with and without CO-OP plans in 2014 and 2015.
  • Meaningful Use of the Electronic Health Records by Rural Health Clinics
    Maine Rural Health Research Center
    Date: 02/2014

    Identifies the rates of electronic health record (EHR) adoption among a national random sample of Rural Health Clinics (RHCs) and the extent to which RHCs that have adopted an EHR are likely to achieve Stage 1 meaningful use. Fifty-nine percent of RHCs report having an EHR and independent RHCs were more likely than hospital-based RHCs to have an EHR. Common barriers to EHR adoption by RCHs include acquisition and maintenance costs, lack of capital, and potential productivity or income loss during transition.

  • Profile of Rural Residential Care Facilities: A Chartbook
    Maine Rural Health Research Center
    Date: 05/2014

    As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF). Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents. Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs. Compared to urban facilities, the policies of rural RCFs appear less likely to support aging-in-place.

  • Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2015

    The patient-centered medical home (PCMH) model both reaffirms traditional primary care values such as continuity of care, connection with an identified personal clinician, provision of same day- and after-hours access and also prepares providers to succeed in the evolving healthcare system by focusing on accountability, continuous quality improvement, public reporting of quality data, data exchange, and patient satisfaction. However, little is known about the readiness of the over 4,000 Rural Health Clinics (RHCs) to meet the PCMH Recognition standards established by the National Council for Quality Assurance (NCQA). This policy brief reports findings from a survey of RHCs that examined their capacity to meet the NCQA PCMH requirements, and discusses the implications of the findings for efforts to support RHC capacity development.

    Key Findings:

    • Based on their performance on the “must pass” elements and related key factors, Rural Health Clinics (RHCs) are likely to have difficulties gaining National Center for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) Recognition.
    • RHCs perform best on standards related to recording demographic information and managing clinical activities, particularly for those using an electronic health record.
    • RHCs perform less well on improving access to and continuity of services, supporting patient self-management skills and shared decision-making, implementing continuous quality improvement systems, and building practice teams.
    • RHCs are likely to need substantial technical assistance targeting clinical and operational performance to gain NCQA PCMH Recognition.
  • Telemental Health in Today's Rural Health System
    Maine Rural Health Research Center
    Date: 12/2013
    Describes the organizational setting, services provided, and staff used in 53 telemental rural health programs. Also outlines the opportunities and challenges for telemental health in the rural health system.
  • Understanding the Business Case for Telemental Health in Rural Communities
    Maine Rural Health Research Center
    Date: 07/2016
    This article describes the current landscape and characteristics of rural telemental health programs and then examines their business case.