Critical Access Hospitals

Completed Projects

Alphabetical list. You can also view by project completion date.

  • 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, Post-acute care, Quality
  • Analyzing Data from the Evidence-Based Telehealth Network Grant Program Grantees and Preparing Manuscripts to Further the Evidence Base for Tele-ED
    This project's main purpose was to analyze data using the revised Tele-Emergency Performance Assessment Reporting Tool gathered from Evidence-Based Tele-Emergency Network Grant Program grantees on all of their cases using telehealth in the emergency department (tele-ED) and a matched sample of non-tele-ED records to conduct comparative effectiveness analysis to help establish the evidence base for tele-ED.
    Research center: Rural Telehealth Research Center
    Topics: Critical Access Hospitals, Emergency medical services and trauma, Telehealth
  • 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, Health care financing, Health services, Networking and collaboration
  • Can a Model Predict Financial Distress Among Rural Hospitals?
    This project will extend an existing model of CAH financial distress to other types of rural hospitals. A valid model would be helpful to ORHP and state Offices of rural Health interested in predicting financial distress or closure of rural hospitals.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals, Hospitals and clinics
  • Collecting and Analyzing Data from the Evidence-Based Telehealth Network Grant Program Grantees Using the Revised Tele-Emergency Performance Assessment Report Tool
    The primary purpose of this project was to collect and analyze data using the revised Tele-Emergency Performance Assessment Reporting Tool from the six Evidence-Based Telehealth Network Grant Program grantees on all their tele-emergency department (tele-ED) cases and a matched sample of non-tele-ED cases to conduct comparative effectiveness analysis to help establish the evidence base for tele-ED.
    Research center: Rural Telehealth Research Center
    Topics: Critical Access Hospitals, Telehealth
  • Collecting and Analyzing Data on a Uniform Set of Measures from the Evidence-Based Telehealth Network Grant Program Grantees
    The primary purpose of this project will be to routinely collect and analyze data on a uniform set of measures reported by the Evidence-Based Telehealth Network Grant Program grantees to help establish the evidence base for tele-ED.
    Research center: Rural Telehealth Research Center
    Topics: Critical Access Hospitals, Telehealth
  • Community Impact Assessment
    This project will evaluate the impact of the Flex program on local communities. Activities will focus on identifying the ways in which the program could have a measurable effect, as well as the ways in which Flex program coordinators intended to affect community health. A briefing paper that integrates information on scope of services, networking, and quality will be produced. Additionally, case studies will be conducted in six CAH communities.
    Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals, Networking and collaboration, Rural Hospital Flexibility Program
  • Critical Access Hospital Access To and Use of Capital
    This project will describe the capital needs of CAHs and their experiences in accessing and using capital, based on data from an e-mail survey of State Flex Coordinators, the TASC listserve, telephone contacts with Flex Coordinators in key states, and Medicare Cost Reports.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Rural Hospital Flexibility Program
  • Critical Access Hospital Conversion Tracking
    Information regarding new CAH conversions will be gathered from Flex coordinators and CMS, and added to the CAH management information dataset that is housed at UNC. Flex coordinators will also be queried regarding topics of interest to the coordinators, the monitoring team, and the federal Office of Rural Health Policy.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Critical Access Hospitals
  • 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, Quality
  • Critical Access Hospital Readiness for CMS Value-Based Purchasing
    The purpose of this project will be to assess Critical Access Hospital readiness for participation in a Value-based Purchasing program similar to that proposed by CMS for Prospective Payment System hospitals.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Critical Access Hospitals, Health care financing, Quality
  • Developing a Financial Performance Measurement System for Critical Access Hospitals
    This project uses research and expert opinion to select dimensions and indicators of financial performance, develop appropriate bases or methods of peer comparison, investigate the relationship between quality of care and financial performance, and identify characteristics of high performing CAHs.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals, Health care financing
  • Developing a Quality Performance Measurement System for Critical Access Hospitals
    This project continues to support activities related to quality performance measurement relevant for Critical Access Hospitals. By the end of 2005, the technical expert panel had reviewed the findings of the initial field test of the small rural hospital quality measure set and made recommendations for revisions.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Quality
  • Evaluating the Financial Impact of Critical Access Hospital Conversion Over Time
    Using Medicare cost report data, this project will analyze changes in several key financial and organizational indicators that may be affected by CAH conversion, and produce annual reports describing the financial status of CAHs.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Health care financing, Rural Hospital Flexibility Program
  • Evaluation of the Medicare Rural Hospital Flexibility Program
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals, Rural Hospital Flexibility Program
  • Evaluation of the Rural Hospital Flexibility Act and the Critical Access Hospital Program
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals, Rural Hospital Flexibility Program
  • Exploring Global Budgets as a New Reimbursement Model for Low-Volume Critical Access Hospitals
    Given the complexity of the Global Budget reimbursement model, we were interested to learn if there are aspects of the model that could be applied to consolidate reimbursement across rural and frontier health care settings, particularly for CAHs with low-volume (e.g., < 5 acute patients as a daily census).
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Critical Access Hospitals, Health care financing, Hospitals and clinics
  • Financial Impact of Reimbursing CAH Swing Bed Days at the SNF PPS Rate
    This study assessed the financial impact of changing Critical Access Hospital (CAH) swing bed reimbursement from the cost-based system to the skilled nursing facility (SNF) prospective payment system (PPS).
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals, Health care financing, Long-term care, Medicare, Post-acute care
  • Financial Performance of Critical Access Hospitals, Pre- and Post-Conversion
    Making use of the financial indicators developed by project staff, the focus of this project is a longitudinal analysis of the dimensions and indicators of financial performance. Descriptive analyses are used to capture changes in all dimensions of financial performance pre- and post-conversion.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals, Health care financing, Medicare Prospective Payment System (PPS), Rural Hospital Flexibility Program
  • Identification of High-Need Rural Counties Lacking an FQHC Presence
    Federally Qualified Health Centers (FQHCs) have been key safety net providers since the program was initiated. However, many rural communities lack this resource. Expanding on the index of relative rural deprivation developed by the SCRHRC, we identified high-need rural counties that currently are not served by an FQHC or similar provider.
    Research center: Rural and Minority Health Research Center
    Topics: Critical Access Hospitals, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs)
  • Identifying Adverse Drug Events and Improving Patient Safety in Rural Hospitals
    This study identifies rates of adverse drug events (ADEs) and opportunities to improve patient safety in Critical Access Hospitals (CAHs) and nonā€CAH rural hospitals.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Hospitals and clinics, Pharmacy and prescription drugs, Quality
  • Impact of CAH Conversion on Hospital Costs and Mix of Services
    This study examined Medicare Cost Report and claims data for hospitals before and after CAH conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Critical Access Hospitals, Health care financing, Health services
  • Measuring Quality Performance in CAHs
    The purpose of the project is to update our previous analyses of Critical Access Hospital (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, Quality
  • Measuring the Community Benefits and Impact of Critical Access Hospitals
    This project will develop, test, and implement a set of community benefits and impact indicators for Critical Access Hospitals (CAHs). These indicators will assist CAHs, policymakers, and rural stakeholders to understand the impact of CAHs on their communities and local health care delivery systems.
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals
  • Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
    This project will survey Emergency Room (ER) managers in a nationally representative sample of Critical Access Hospitals (CAHs) to determine the proportion of ER encounters involving mental health pathology, types of mental health problems most commonly seen in these encounters, and resources available to CAHs to address the problems encountered.
    Research center: Maine Rural Health Research Center
    Topics: Critical Access Hospitals, Emergency medical services and trauma, Mental and behavioral health
  • National Rural Hospital Flexibility Program Review
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals, Rural Hospital Flexibility Program
  • National Rural Hospital Flexibility Program Tracking Project
    Research center: WWAMI Rural Health Research Center
    Topics: Critical Access Hospitals, Rural Hospital Flexibility Program
  • National Rural Hospital Flexibility Program Tracking Project Dissemination
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Critical Access Hospitals, Rural Hospital Flexibility Program
  • National Rural Hospital Flexibility Program Tracking Project: Analysis of CAH Quality Improvement (QI) Strategies
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Quality, Rural Hospital Flexibility Program
  • National Rural Hospital Flexibility Program Tracking Project: Analysis of Hospital Conversion and Network Development Strategies
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Networking and collaboration, Rural Hospital Flexibility Program
  • National Rural Hospital Flexibility Program Tracking Project: Analysis of Network Development Strategies and CAH Performance
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Networking and collaboration, Rural Hospital Flexibility Program
  • National Rural Hospital Flexibility Program Tracking Project: Analysis of the Financial Impact of Conversion on Critical Access Hospitals (CAHs) and the Medicare Program
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Health care financing, Rural Hospital Flexibility Program
  • National Rural Hospital Flexibility Program Tracking Project: Emergency Medical Services
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Critical Access Hospitals, Emergency medical services and trauma, Networking and collaboration, Rural Hospital Flexibility Program
  • National Rural Hospital Flexibility Program Tracking Project: Perceptions of Community Physicians
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Critical Access Hospitals, Physicians, Rural Hospital Flexibility Program
  • National Rural Hospital Flexibility Program Tracking Project: Tracking State Policy and Program Development
    Research center: Maine Rural Health Research Center
    Topics: Critical Access Hospitals, Rural Hospital Flexibility Program
  • Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention
    This project drew on a survey of patients sampled from the service areas of 25 Critical Access Hospitals (CAHs) from different regions of the country. The purpose of this project is to identify policy and programmatic issues related to bypass, specifically targeting CAHs in order to offer evidence and guidance to policymakers, CAH administrators, and planners on the location of healthcare resources, factors that affect patient actions for planning programs, and the adjustment of policies in order to retain patients locally.
    Research center: FORHP-funded Individual Grantees
    Topics: Critical Access Hospitals, Health services
  • Quality and Financial Status of Critical Access Hospitals: A Preliminary Analysis
    The purpose of this project is to continue to investigate the relationship between Critical Access Hospital financial performance and quality of care. The University of Minnesota and the University of North Carolina will jointly develop hypotheses related to the finance-quality link and statistical models suitable for testing hypotheses.
    Research centers: North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Health care financing, Quality, Rural Hospital Flexibility Program
  • Quality Improvement Organizations' Contributions to Rural Hospital Performance
    This qualitative study is designed to gather information on best-practices in Quality Improvement Organization (QIO)-rural hospital partnerships. Specifically, this study will identify successful and replicable examples in which QIOs have worked with rural and critical access hospitals to improve processes of care, implement health information technology and promote organizational safety culture.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Critical Access Hospitals, Health information technology, Hospitals and clinics, Quality
  • Quality of Obstetric Care and Perinatal Safety in Rural Hospitals
    The project will use both national and state-level hospital discharge data to examine obstetric care quality and perinatal safety in rural U.S. hospitals, with an in-depth focus on rural hospitals in a nationally representative group of eight states across all four U.S. Census regions.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Maternal health, Women
  • Quality of Surgical Care services in Critical Access Hospitals (CAHs)
    This project builds on prior work examining rural residents' bypass behavior of their local CAH to hospitals outside their community. Using recently identified inpatient surgical procedures that are commonly performed in CAHs, we will examine and compare outcomes (e.g. post-surgical complication rates, adverse events) of these procedures between CAHs and non-CAHs.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Critical Access Hospitals, Hospitals and clinics
  • Role of Intensive Care Units in Critical Access Hospitals
    This project will examine the role that intensive care units (ICUs) play in Critical Access Hospitals (CAHs). The number and geographic distribution of CAH with ICUs will be described, and types of services provided in these units discussed.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals, Health services
  • Rural Hospital Flexibility Performance Monitoring Project- Grant Years 2003-2008
    Under contract with the federal Office of Rural Health Policy, the Rural Health Research Centers at the Universities of Minnesota, North Carolina, and Southern Maine are cooperatively conducting a performance monitoring project for the Medicare Rural Hospital Flexibility Program (Flex Program). The monitoring project will assess the impact of the Flex Program on rural hospitals and communities and the role of states in achieving overall program objectives, including improving access to and the quality of health care services; improving the financial performance of Critical Access Hospitals; and engaging rural communities in health care system development.
    Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Rural Hospital Flexibility Program
  • Special Study of EMS Issues
    This study will focus on state, community, and hospital level initiatives designed to build the infrastructure to support EMS service capacity and encourage the integration of these services into the rural healthcare infrastructure in the areas of quality improvement, financing, staffing, medical control, and networking and integration.
    Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals, Emergency medical services and trauma, Networking and collaboration
  • What Does it Cost to Operate a Rural Free-Standing Emergency Department (RFED)?
    In recent months, there have been numerous media reports of rural hospital closures and the adverse effect on communities. In the face of hospital closure, one alternative for maintaining access to healthcare is a rural free-standing emergency department (RFED).
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals, Health care financing, Medicare