Rural Health
Research Gateway

Health services

Current Projects

  • Assessing Access to Medication Treatment for Opioid Use Disorder in Rural Communities Influenced by the Rural Communities Opioid Response Program (RCORP)
    This project will use national prescription claims data to compare access to buprenorphine treatment for opioid use disorder in rural counties with and without Rural Communities Opioid Response Program (RCORP) funding and urban counties. An accurate understanding of access to buprenorphine treatment is essential for determining the influence of RCORP funding on a critical strategy for curbing the opioid epidemic.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Healthcare access, Mental and behavioral health, Pharmacy and prescription drugs, Substance use and treatment, Workforce
  • 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 services, Healthcare access, Hospice and palliative care, Medicare, Quality
  • Building the Rural Evidence Base: Examining the Feasibility of Implementing Pilot Programs and Demonstrations in Rural Communities
    Evidence-based interventions are commonly developed in populated, urban centers and then adapted for rural communities. This project will investigate the benefits of piloting and evaluating interventions in rural areas to build the rural evidence base as a step in addressing rural health disparities and improving health conditions in rural communities.
    Research center: ETSU/NORC Rural Health Research Center
    Topics: Health promotion and disease prevention, Health services
  • Causal Effect of Nursing Home Closure on Resident Outcomes in Rural Areas
    We will evaluate the causal impact of nursing home closure on two key outcomes: distance to the transitioned nursing home, and resident physical and mental health outcomes. We will compare the effect of closures on outcomes for rural and urban areas using resident-level data from 2010-2019 and advanced difference-in-differences regression methods.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Aging, Health services, Healthcare access, Long-term care, Post-acute care, Quality
  • Comparing Care-Seeking Patterns Among Rural Medicare Fee-for-Service and Medicare Advantage Beneficiaries
    This study uses national Medicare claims and encounter data to compare how often rural traditional Medicare and Medicare Advantage beneficiaries bypass their nearest hospital or primary care provider, how far they travel, and how these care-seeking patterns vary by plan type and region.
    Research center: ETSU/NORC Rural Health Research Center
    Topics: Aging, Critical Access Hospitals (CAHs), Health services, Healthcare access, Healthcare financing, Hospitals and clinics, Medicare, Medicare Advantage (MA), Quality, Rural statistics and demographics
  • Geographic Misclassification of Cancer Care Physicians and Rural Cancer Care Service Delivery Patterns
    This study will examine the potential misclassification of rural cancer care capacity by quantifying the degree to which classification by primary practice location underestimates the availability of cancer care services in rural areas when urban-based physicians regularly cross geographic boundaries to serve rural populations.
    Research center: WWAMI Rural Health Research Center
    Topics: Cancer, Health services, Healthcare access, Physicians, Rural statistics and demographics, Workforce
  • Going Beyond Hospital Closures: Estimating Rural and Urban Changes in Access to Hospital Service Lines
    Rural hospital closures have been prominent in the last decade and are an important reflection of decreases in access to essential healthcare services. However, hospital closures alone may overlook other decreases to access through service line closures. This study estimates hospital service line closures over time and by rurality.
    Research center: ETSU/NORC Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Health services, Healthcare access, Hospitals and clinics
  • Health Care Spending in Rural vs. Urban U.S. by Health Condition
    Health care spending patterns vary substantially between rural and urban areas in the U.S. This project will examine detailed health care spending patterns using insurance claim data in U.S. counties by specific health conditions across the rural-urban continuum.
    Research center: WWAMI Rural Health Research Center
    Topics: Chronic diseases and conditions, Health services, Healthcare access, Healthcare financing, Medicaid and CHIP, Medicare, Medicare Advantage (MA), Pharmacy and prescription drugs, Private health insurance, Quality
  • Health System Transformation Under Tribal Self-Governance
    Since the Indian Self-Determination and Education Assistance Act of 1975, Tribes have increasingly assumed operations of health programs from the Indian Health Service through self-determination and self-governance pathways. This project will examine Tribal health leaders' perspectives on the impacts of these pathways on access, quality, and health care delivery.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Healthcare access, Quality
  • Higher-Level Maternity Care Access in Rural Communities
    This project will build on University of Minnesota's dataset on obstetric care access, which now includes an indicator of higher-level neonatal care at U.S. hospitals. We will assess the feasibility and reliability of creating an indicator for higher-level maternal care, based on a previously published algorithm identifying maternal levels of care.
    Research center: Rural Maternal Health Data Support and Analysis Program
    Topics: Health services, Healthcare access, Hospitals and clinics, Maternal health
  • Identifying and Exploring the Settings That Nurse Practitioners and Physician Assistants Are Practicing in as Well as Trends in Specialization in These Groups
    Investigators will conduct a descriptive study to assess trends in specialty and population foci of nurse practitioners (NP) and physician assistants (PA). They will also explore changes in the number of clinician types billing for procedures. Trends will be assessed by census region to inform FORHP on areas for which use of NPs and PAs can be bolstered.
    Research center: Southwest Rural Health Research Center
    Topics: Health services, Nurses and nurse practitioners, Physician assistants
  • Monitoring Obstetric Unit Closures and Maintaining County-level Data on Hospital-based Obstetric Care 2010-2025
    This project will build on the University of Minnesota Rural Health Research Center's 2010-2024 dataset on obstetric care access. We will create updated county-level public health data infrastructure with information on hospital-based obstetric care in rural and urban counties, and on the loss of hospital-based obstetric services through 2025.
    Research center: Rural Maternal Health Data Support and Analysis Program
    Topics: Health services, Healthcare access, Hospitals and clinics, Maternal health
  • Retention and Expansion of Hospital Services Offered by Rural Hospitals After Enrollment in 340B
    The 340B Federal program is designed to provide hospitals with financial stability through provision of drug discounts which may, in turn, allow hospitals to maintain or expand their service line offerings. Using a series of event study analyses over an 11-year period, this study will examine the impact of enrollment in the 340B program on discontinuing services, maintaining services, and adding new services in eligible rural hospitals.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Critical Access Hospitals (CAHs), Health services, Hospitals and clinics, Pharmacy and prescription drugs
  • Rural Access to Infusion Services: A Geographic Analysis of Service Availability
    Infusion services are increasingly used to treat cancer and other chronic conditions, yet rural access remains poorly understood. This project will examine where rural and urban Medicare beneficiaries receive infusion services and quantify rural travel burden, including distance and travel time, across infusion types and settings.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Cancer, Health services, Healthcare access, Medicare, Transportation
  • Rural and Urban Medical School Programs that Demonstrate a Commitment to Producing Rural Physicians
    Studies of individual medical schools have identified characteristics associated with working in rural areas, but little is known about which organizational factors are the most significant predictors of rural practice. This project will examine characteristics of medical schools' missions and organizational commitments to promote physician practice in rural communities.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Healthcare access, Physicians, Workforce
  • Rural Dementia Spending and Workforce Supply
    This project will estimate the rural and urban supply of dementia care specialists in the U.S. and examine differences health care spending patterns for dementia across the rural-urban continuum using claims and facility records data.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Health services, Healthcare access, Medicaid and CHIP, Medicare, Nurses and nurse practitioners, Physicians, Workforce
  • Rural-Urban Differences in Medicare Supplemental Insurance Coverage
    This study analyzes rural-urban differences in Medicare supplemental coverage using 2015-2024 Medicare Current Beneficiary Survey data. It examines current patterns and trends in Medicare Advantage and Fee-for-Service supplemental enrollment, exploring demographic and health factors influencing coverage differences.
    Research center: Northeast Rural Health Research Center
    Topics: Aging, Health services, Healthcare access, Healthcare financing, Medicare, Medicare Advantage (MA), Rural statistics and demographics, Social determinants of health, Uninsured and underinsured
  • 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: ETSU/NORC Rural Health Research Center
    Topics: Aging, Care management, Chronic diseases and conditions, Coronavirus Disease 2019 (COVID-19), Diabetes, Health promotion and disease prevention, Health services, Medicare, Mental and behavioral health, Telehealth
  • State Use of Medicaid Funding Mechanisms for Community Health Workers: Implications for Rural Populations
    Community health workers (CHWs) serve on the front lines of health care, with states increasingly leveraging various funding mechanisms for their services. This project will describe and compare state use of two Medicaid mechanisms – Section 1115 demonstration waivers and state plan amendments – to support CHW services, focusing on potential implications for rural populations.
    Research center: ETSU/NORC Rural Health Research Center
    Topics: Allied health professionals, Health services, Healthcare financing, Medicaid and CHIP
  • The Emerging Landscape of Rural Family Medicine Residency Training: Defining Models and Assessing Their Value
    Rural residency training options for family physicians are growing, as is the evidence for rural training in promoting rural practice choice. This study aims to use a new classification of six residency program types to describe and quantify programs and positions by type and compare relative effectiveness in producing rural physicians.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Healthcare access, Physicians, Workforce
  • Using the FDI to Predict Likelihood of Specific Service Line Outcomes
    Rural hospitals face ongoing threats to service availability, including reductions in key service lines like obstetrics, behavioral health, and hospice. This study explores the potential of the Financial Distress Index (FDI) to inform planning by identifying hospitals at risk of service reductions.
    Research center: North Carolina Rural Health Research Center
    Topics: Health services, Healthcare financing, Hospitals and clinics
  • Utilization of Medicare Care Management Codes
    This study assesses the adoption of Medicare care management billing codes among rural and urban providers and the extent to which rural Medicare beneficiaries access these services. Using 2024 Medicare fee-for-service claims and provider data, this study will analyze trends in provider participation and utilization by service type, region, and rurality.
    Research center: ETSU/NORC Rural Health Research Center
    Topics: Care management, Federally Qualified Health Centers (FQHCs), Health services, Medicare, Rural Health Clinics (RHCs), Social determinants of health
  • Variation in Scope of Practice and Services Provided by Rural vs Urban Primary Care Providers
    This project will examine differences in practice patterns between rural and urban primary care providers by analyzing insurance claims data to determine variations in the density and intensity of services provided directly by primary care physicians, nurse practitioners, and physician assistants across different geographic settings.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Healthcare access, Nurses and nurse practitioners, Physician assistants, Physicians, Workforce