Health services

Current Projects

  • A Closer Examination of Rural Hospital Bypass
    This project will estimate the rural hospital bypass rate using all-payer claims data for a set of states and compare patients based on the inpatient treatments and procedures received relative to those routinely provided by rural facilities.
    Research center: Rural Health Equity Research Center
    Topics: Critical Access Hospitals, Health reform, Health services, Healthcare access, Hospitals and clinics, Medicaid and CHIP, Medicare, Medicare Advantage (MA), Minority health, Private health insurance, Uninsured and underinsured
  • Access to and Provision of Child and Youth Behavioral Health Services in the Rural and Urban U.S.
    The need for behavioral health treatment for youth has been exacerbated by the COVID-19 pandemic. Little is known about the availability of youth behavioral health providers in rural areas. This study will investigate who provides behavioral health services to youth, how equitably the workforce is distributed, and gaps in service availability.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Children and adolescents, Health disparities and health equity, Health services, Healthcare access, Mental and behavioral health, Nurses and nurse practitioners, Pharmacy and prescription drugs, Physician assistants, Physicians, Substance use and treatment, Workforce
  • Availability and Quality of Dialysis in Rural Counties with a High Diabetes Burden
    This project will examine the degree to which counties with a high population risk for end stage renal disease, defined by high diabetes prevalence, are served by dialysis providers. It will assess the accessibility and quality of services for end stage renal disease looking for disparities associated with rural residence and racial/ethnic population composition.
    Research center: Rural and Minority Health Research Center
    Topics: Diabetes, Health disparities and health equity, Health services, Public health, Quality
  • Availability of Diabetes Self-Management Education in High Need Rural Counties
    This project will examine the degree to which counties with a high need for diabetes education, defined by high diabetes prevalence, have such education available. Findings will be linked to a related study that will examine the availability of dialysis for end stage renal disease, a severe outcome of poorly addressed diabetes.
    Research center: Rural and Minority Health Research Center
    Topics: Diabetes, Health services
  • Availability, Care Practices, and Quality of Hospice Providers Serving Rural versus Urban Communities
    This project will examine differences in availability of hospice care in rural versus urban communities as well as provider-level quality and care practices by rural-urban status of hospices. Findings will highlight potential rural-urban disparities in hospice care that can be used to inform future Medicare policy.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Coronavirus Disease 2019 (COVID-19), Health disparities and health equity, Health services, Healthcare access, Hospice and palliative care, Medicare, Quality
  • Changes in Medicare Fee-for-Services Health Care Expenditures in Rural and Urban Communities after Passage of the Affordable Care Act
    This project will assess changes in Medicare per-beneficiary spending across rural and urban counties from 2007 to 2020. It will examine differences in rural versus urban per-beneficiary spending on hospital inpatient, hospital outpatient, physician, and post-acute care after the Affordable Care Act (ACA).
    Research center: Rural and Minority Health Research Center
    Topics: Care management, Chronic diseases and conditions, Health disparities and health equity, Health services, Hospitals and clinics, Public health
  • Clinical-Community Linkages in Non-Metropolitan and Metropolitan Hospitals: COVID-19 Impacts and Trends
    This study will examine trends in partnerships between hospitals and public health departments and other community linkages in both non-metropolitan and metropolitan hospitals with a particular focus on the impact of the COVID-19 pandemic.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Coronavirus Disease 2019 (COVID-19), Critical Access Hospitals, Health services, Hospitals and clinics, Networking and collaboration, Public health, Social determinants of health
  • 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
  • Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents: Exploring Changes in the Past 15 Years
    This project will describe the national supply of the rural and urban dental workforce and investigate whether rural adults, compared to urban adults, report lower dental care utilization, higher prevalence of dental disease or both. This study will also look at whether disparities in oral health care and supply have changed over the past 15 years.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Health disparities and health equity, Health services, Healthcare access, Oral health, Workforce
  • Disparities in Screening, Prevention, and Management of Cardiovascular Disease in Rural and Urban Primary Care
    This study will use a large national primary care registry to compare cardiovascular disease (CVD) screening, prevention, and management quality measures between rural and urban primary care practices. It will also assess for disparities by patient composition (race/ethnicity, insurance) of the practice.
    Research center: Rural and Underserved Health Research Center
    Topics: Care management, Chronic diseases and conditions, Health disparities and health equity, Health promotion and disease prevention, Health services, Minority health, Physicians, Quality
  • Examining Rural-Urban Differences in Availability of Hospital Cardiac Testing Services Between 2010-2020
    This project will examine whether the availability of hospital-based cardiac testing services has changed over the past ten years in rural and urban counties and identify the characteristics of counties where service availability has changed.
    Research center: Rural and Minority Health Research Center
    Topics: Care management, Chronic diseases and conditions, Health disparities and health equity, Health services, Hospitals and clinics, Public health
  • Examining the Burden of Public Stigma Associated with Mental Illness in the Rural U.S.
    This project will quantitatively examine the burden of public stigma associated with mental illness in rural versus nonrural communities using a nationally representative panel-based survey. Findings will inform strategies aimed at reducing stigma and improving the lives of those experiencing mental illness in rural communities.
    Research center: Rural Health Equity Research Center
    Topics: Health services, Mental and behavioral health
  • Examining the Potential Impact of Multiple Payment Policies on Rural Versus Urban Home Health Agencies
    This study estimates the impact of three recent and upcoming Medicare home health payment policies (revised rural add-on payments, new prospective payment system, and value-based purchasing demonstration) on reimbursement for home health agencies based on rural-urban status, community factors, and home health agency characteristics.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Healthcare access, Healthcare financing, Home health, Medicare, Post-acute care
  • Following the Money: Do Block Grant Resources Reach Rural Communities?
    This project will apply a mixed methods design to describe the distribution of block grant resources from federal agencies through states to the local level in rural and non-rural communities in the United States. Findings could guide federal agencies and policy makers to develop strategies to more effectively target block grant resources to ensure that the needs of vulnerable rural populations are addressed.
    Research center: Rural Health Equity Research Center
    Topics: Health services, Healthcare financing, Public health, Rural statistics and demographics
  • Hierarchical Condition Category (HCC) Risk Scores: Designed to Predict Future Cost and Health Care Resource Use – Do They Also Accurately Reflect Differences in Health Status between Rural and Urban Beneficiaries?
    This CMS Hierarchical Condition Category (CMS-HCC) risk score study will investigate differences in underlying health between rural and urban populations using recent data and analyze which factors drive observed differences.
    Research center: Rural Health Equity Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Medicaid and CHIP, Medicare, Medicare Advantage (MA)
  • How are Rural Health Clinics Serving Pediatric and Obstetrical Medicaid Populations?
    This project will examine the roles of independent and provider-based Rural Health Clinics in serving pediatric and obstetrical patients covered by state Medicaid programs.
    Research center: Maine Rural Health Research Center
    Topics: Children and adolescents, Health services, Healthcare financing, Maternal health, Medicaid and CHIP, Rural Health Clinics (RHCs), Women
  • How Does Participation in Medicare Accountable Care Organizations Affect Rural Hospital Financial Outcomes?
    This project will examine the impact of Medicare Accountable Care Organizations' (ACOs') participation on rural hospitals' financial outcomes. Findings from this project will provide policy-relevant information on how ACO participation affects rural hospitals' financial bottom lines, contributing to further program design.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Care management, Health reform, Health services, Hospitals and clinics, Medicare
  • Palliative Care in the Rural U.S.
    This project will describe the availability of palliative care services in rural hospitals and community settings using data from the American Hospital Association Annual Survey, interviews with palliative care providers, and a survey of rural hospitals without palliative care services.
    Research center: WWAMI Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospice and palliative care, Hospitals and clinics
  • Rural Access to Opioid Treatment Program Clinics and Certified Community Behavioral Health Clinics
    This project will identify all Certified Community Behavioral Health Clinics and Opioid Treatment Program Clinics in the U.S. and then present the number of rural and urban clinics in each state as frequency tables and map visualizations.
    Research center: Rural and Underserved Health Research Center
    Topics: Health services, Healthcare access, Mental and behavioral health, Substance use and treatment
  • Rural and Urban Cancer Survivors' Follow-Up Care Experiences
    This project examines rural vs. urban differences in cancer survivors' follow-up care experiences using the 2017 Medical Expenditure Panel Survey.
    Research center: Rural and Underserved Health Research Center
    Topics: Cancer, Care management, Health disparities and health equity, Health services, Healthcare access, Physicians, Post-acute care, Quality
  • Rural Poverty and Health: A Chartbook
    This chartbook will use nationally representative surveys and county-level data to provide a comprehensive overview of the health and wellbeing of rural Americans living in poverty.
    Research center: Maine Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Poverty, Rural statistics and demographics
  • Rural/Urban Differences in Forgoing Health Care during the COVID-19 Pandemic
    Several surveys conducted during the COVID-19 pandemic showed that adults delayed or skipped healthcare services during the initial months of the COVID-19 pandemic. This study examines changes in healthcare utilization for primary and preventative care among rural and urban Medicare fee-for-service enrollees since the COVID-19 pandemic.
    Research center: Rural Health Equity Research Center
    Topics: Aging, Care management, Chronic diseases and conditions, Coronavirus Disease 2019 (COVID-19), Diabetes, Health disparities and health equity, Health promotion and disease prevention, Health services, Medicare, Mental and behavioral health, Minority health, Telehealth
  • Rural/Urban Variations in Cancer Screening During the COVID-19 Pandemic
    Using the National Cancer Institute Health Information National Trends Survey, we will examine how the COVID-19 pandemic has disrupted the receipt of recommended screenings for common cancers. Findings will inform policymakers about potential widening of rural/urban disparities in the receipt of cancer preventive services and the potential need to target these services toward rural residents.
    Research center: Rural and Underserved Health Research Center
    Topics: Cancer, Coronavirus Disease 2019 (COVID-19), Health disparities and health equity, Health promotion and disease prevention, Health services, Healthcare access
  • Specialist Physicians in the Rural and Urban U.S.: Supply, Distribution, and Access
    This project will describe the geographic distribution (rural/urban, regional, and intra-rural) of specialist physicians who care for patients experiencing conditions that account for the top four leading causes of rural mortality. It will also explore how patients in rural communities that lack these specialists obtain needed care.
    Research center: WWAMI Rural Health Research Center
    Topics: Cancer, Care management, Chronic diseases and conditions, Frontier health, Health disparities and health equity, Health services, Healthcare access, Physicians, Social determinants of health, Telehealth, Workforce
  • The Direct Care Workforce in Rural Areas
    In this study, we will measure the supply of long-term care services and supports (LTSS) direct care workers relative to older adult populations in rural and urban areas and measure employer and industry turnover among LTSS direct care workers. We will also explore how compensation levels – including wages and employer-based health insurance – are related to and predict worker turnover in the LTSS direct care workforce in rural and urban areas.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Allied health professionals, Health services, Home health, Long-term care, Post-acute care, Poverty, Rural statistics and demographics, Social determinants of health, Workforce
  • Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder Across the U.S.
    This study describes and compares the treatment that rural and urban patients with opioid use disorder (OUD) receive, documenting the workforce providing care, distance that patients travel to receive care, and cost of care. Findings will inform policies to ensure that rural patients with OUD have access to care from local healthcare providers.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Healthcare access, Healthcare financing, Mental and behavioral health, Nurses and nurse practitioners, Pharmacy and prescription drugs, Physician assistants, Physicians, Substance use and treatment, Telehealth
  • Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder and Medicaid Insurance Across the U.S.
    This project will analyze Medicaid claims data to compare the treatment that rural and urban patients with opioid use disorder receive, documenting the workforce providing care, the distance that patients travel to receive care, and the cost of care. Findings from this study can be used to improve policies regarding opioid use disorder treatment.
    Research center: WWAMI Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Healthcare financing, Legislation and regulation, Medicaid and CHIP, Mental and behavioral health, Nurses and nurse practitioners, Pharmacy and prescription drugs, Physician assistants, Physicians, Substance use and treatment, Telehealth, Workforce
  • Understanding Rural Health Clinic Services, Use, and Reimbursement
    This study describes the scope and intensity of services provided to Medicare beneficiaries by independent and provider-based Rural Health Clinics. It will also assess the adequacy of the Centers for Medicare & Medicaid Services' changes to the outpatient evaluation and management codes in 2021 compared to the 2021 per-visit reimbursement cap.
    Research center: Maine Rural Health Research Center
    Topics: Health services, Healthcare financing, Hospitals and clinics, Medicare, Rural Health Clinics (RHCs)
  • 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 and trauma, Health services, Healthcare access, Hospitals and clinics
  • 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