Health services

Research Products

Listed by publication date. You can also view these publications alphabetically.

2019

  • Measuring Access to Care in National Surveys: Implications for Rural Health
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2019
    This brief presents data about how access to healthcare is measured, focusing on how this applies to rural populations.
  • Suicidal Thoughts, Plans, and Attempts by Non-Metropolitan and Metropolitan Residence
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 05/2019
    Suicide is among the leading causes of death in the US, and rates in non-metropolitan (rural) counties have historically exceeded those in metropolitan (urban) counties. This study examined the prevalence of suicidal thoughts, plans, and attempts by year (2010-2016) and county type (non-metropolitan, small metropolitan, and large metropolitan).
  • Differences in Care Processes Between Community-Entry Versus Post-acute Home Health for Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 04/2019
    This study describes home healthcare processes for rural Medicare beneficiaries who are admitted from the community (community-entry) versus those who are admitted following an inpatient stay (post-acute). Care processes include timely initiation of care, length of stay, and services provided (e.g., physical therapy, medical social work).
  • Do Hospital Closures Affect Patient Time in an Ambulance?
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2019
    Our study explores how a local hospital closure changes patient time in an ambulance for 9-1-1 calls. Access to emergency department services in communities, especially rural communities, persists as a priority for the Medicare program. We found when hospitals close, rural patients requiring ambulance services are disproportionately affected.

2018

2017

  • ESRD Facility Characteristics by Rurality and Risk of Closure
    Report
    Rural and Minority Health Research Center
    Date: 11/2017
    This study's purpose was to profile rural end stage renal disease (ESRD) facilities, focusing on those at greatest risk for closure. We examined the characteristics of these facilities, the quality of care provided, and the distance patients in rural areas would have to travel if the facilities closed.
  • Rural Transportation: Challenges and Opportunities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2017
    This policy brief uses survey data from 113 key informants across all 50 states to describe challenges and opportunities related to rural transportation.
  • Ambulance Services for Medicare Beneficiaries: State Differences in Usage, 2012-2014
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 10/2017
    Ambulance services are at risk of scaling back or dissolving in some places. We analyzed Medicare beneficiaries' use of ambulance services across the U.S. Improved understanding of how beneficiaries, most of whom are elderly, use these services provides vital information for policymakers who set rules and regulations about access to the services.
  • Rural and Urban Utilization of the Emergency Department for Mental Health and Substance Abuse
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 06/2017
    Utilizes data from the Healthcare Cost and Utilization Project's (HCUP's) State Emergency Department Databases (SEDD) for seven states. Researchers explore, and describe in this brief, the use of the Emergency Department for mental health and substance abuse among Urban, Large Rural, Small Rural, and Isolated Small Rural residents.
  • Telepharmacy Rules and Statutes: A 50-State Survey
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2017
    This is summary analysis reviews administrative rules and legislative statutes governing the practice of telepharmacy in all 50 states. Telepharmacy is specifically authorized in 23 states and 16 states have no rules or legislation authorizing telepharmacy. Other states have pilot programs or waivers that would enable telepharmacy.

2016

  • Community Factors and Outcomes of Home Health Care for High-Risk Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 10/2016
    Outcomes of care vary by region of the country for rural Medicare beneficiaries receiving home health services for high-risk conditions such as heart failure. Those in the East South Central and West South Central Census Divisions had lower rates of community discharge and higher rates of hospital readmission and emergency department use.
  • Telemedicine Penetration and Consultation among Rural Trauma Patients in Critical Access Hospital Emergency Departments in North Dakota
    Policy Brief
    Rural Telehealth Research Center
    Date: 09/2016
    This study describes the penetration of ED-based telemedicine in North Dakota critical access hospitals and its use for rural trauma patients. Investigators showed that telemedicine subscription increased to 81 percent of rural North Dakota hospitals, and 11 percent of patients in a telemedicine-capable ED used telemedicine as part of their care.
  • Medicare Costs and Utilization Among Beneficiaries in Rural Areas
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 03/2016
    This study assesses the relationship between service utilization patterns and costs for rural Medicare beneficiaries across the rural continuum. It also examines the relationships between rural beneficiaries' service utilization and healthcare delivery market structure and evaluates strategies and policies to address high costs in rural areas.

2015

  • Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 11/2015
    As Medicare moves to value-based payment, healthcare groups are made more accountable for patient health. But the changes have been concentrated in urban areas. Policies meant to strengthen rural health systems are complicating payment and delivery system reform in rural areas. This study examines ways to include rural areas in the changes.
  • Post-discharge Rehabilitation Care Delivery for Rural Medicare Beneficiaries with Stroke
    Policy Brief
    Rural and Minority Health Research Center
    Date: 09/2015
    Provision/type of post-discharge rehab care (PDRC) received by stroke survivors by rurality and race/ethnicity are examined as are the distances between their homes and the discharge hospitals related to the type of PDRC recommended. The brief also looks at whether factors such as initial hospital admission relate to the PDRC provision/type.
  • Area Deprivation is Higher Among Rural Counties - But Not All Rural Counties are Deprived
    Policy Brief
    Rural and Minority Health Research Center
    Date: 08/2015
    This brief is one of two on the role of residence/community deprivation on potentially avoidable hospitalizations (PAH) of children. It details development of an area deprivation index, examines area deprivation across all U.S. counties, and describes findings when applied to rates of PAH among a nine-state sample of children.
  • The Intersection of Residence and Area Deprivation: The Case of Hospitalizations from Ambulatory Care Sensitive Conditions Among Children
    Policy Brief
    Rural and Minority Health Research Center
    Date: 08/2015
    This brief is the second in a series providing information on the role of residence and community deprivation on potentially avoidable hospitalizations among children. This brief describes the findings from a nine-state sample of children's hospitalizations and discusses the potential implications for rural health research and policy.
  • Prehospital Emergency Medical Services Personnel in Rural Areas: Results from a Survey in Nine States
    Report
    WWAMI Rural Health Research Center
    Date: 08/2015
    This study examines supply and demand for emergency response personnel, the involvement of medical directors, and the availability of medical consultation in rural and urban emergency service personnel (EMS) agencies in nine states.
  • Perspectives of Rural Hospice Directors
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 03/2015
    Rural hospice care is under pressure by a variety of factors that are reviewed in this document. However, a central core element of rural hospice remains the strong sense of community that is embodied in the system and design of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states.
  • Developmental Strategies and Challenges for Rural Accountable Care Organizations
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2015
    This brief offers insights into the initial strategic decisions and challenges of four accountable care organizations (ACOs) with rural presences. These ACOs were formed as a step toward a value-driven rural delivery system. While several challenges need to be addressed, these insights can inform development of other rural ACOs.
  • Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 02/2015
    This brief describes the variation in emergency department use for non-emergent health conditions across rural and urban areas as well as by U.S. Census regions. Potential risk factors, including patients' socioeconomic characteristics and levels of primary care resources, are identified. Quality of care indicators are also addressed.

2014

  • Facilitating the Formation of Accountable Care Organizations in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2014
    This brief shows characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries, one each of the four census regions. The findings can help rural providers interested in forming/participating in an ACO assess the status and potential gaps of their core structures and capabilities.
  • Integrated Care Management in Rural Communities
    Maine Rural Health Research Center
    Date: 05/2014
    This study reviews the opportunities and challenges reform initiatives under the Affordable Care Act present for rural communities. The study assesses four types of organizational models for delivering integrated care management. Each model has different strengths and drawbacks, weighing for and against implementation in rural areas.
  • Do Rural Patients with Early-Stage Prostate Cancer Gain Access to All Treatment Choices? (Final Report)
    Report
    WWAMI Rural Health Research Center
    Date: 02/2014
    This report compares rates of receipt of prostate cancer treatments and of the treatment options between early-stage prostate cancer patients living in urban and four levels of rural counties.

2013

  • Promotion and Protection of Rural Miner Health: Are the Resources in Place? (Final Report)
    West Virginia Rural Health Research Center
    Date: 06/2013
    This report shows that mining areas in the United States, compared to non-mining areas, have on average better supplies of safety net providers, hospitals, and practicing primary care physicians. However, the study results support the need to examine the availability of safety net provider types in selected geographic areas where mining is done.
  • Rural Implications of the Primary Care Incentive Payment Program
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2013
    This policy brief reports on eligibility among rural primary care providers for the Primary Care Incentive Payments established in the Patient Protection and Affordable Care Act.

2012

2011

2010

2009

2008

2007

  • Access to Cancer Services for Rural Colorectal Cancer Patients (Project Summary)
    WWAMI Rural Health Research Center
    Date: 10/2007
    This summary provides a brief overview of findings from a study to determine how far rural and urban colorectal cancer patients travel to three types of specialty cancer care services: surgery, medical oncology consultation, and radiation oncology consultation.
  • Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum
    Maine Rural Health Research Center
    Date: 10/2007
    This study examines the distribution of substance abuse treatment services across the continuum of rural and urban counties, identifying the type and intensity of services provided.
  • Rural Inpatient Psychiatric Units Improve Access to Community-Based Mental Health Services, but Medicare Payment Policy a Barrier
    Maine Rural Health Research Center
    Date: 08/2007
    This study investigates the characteristics/admission processes of inpatient psychiatric units (IPUs) in rural hospitals with less than 50 beds and the community-based services available to them when discharging patients. Reasons for developing IPUs, barriers to opening and operating a rural IPU, and factors leading some to close are also explored.
  • Why Are Fewer Hospitals in the Delivery Business?
    NORC Walsh Center for Rural Health Analysis
    Date: 04/2007
    This study examines the declining availability of hospital-based obstetric services in rural areas from the mid-1980s to the early 2000s. It looks at potential causes for this trend and explores the effects of medical malpractice reforms.
  • Exploring the Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 01/2007
    This paper reports on a series of site visits to six diverse rural communities and critical access hospitals to assess the experiences and impact of these hospitals in responding to their community's health infrastructure needs.

2006

2005

  • Trends in Skilled Nursing and Swing-bed Use in Rural Areas, 1996-2003
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2005
    This paper examines trends in the delivery of skilled nursing facility (SNF) services in rural areas during a time of dramatic change in Medicare payments for acute and post-acute care. It focuses on the role of rural hospitals in providing SNF services as they respond to the new reimbursement environment.
  • Is Large Really Beautiful? Physician Practice in Small versus Large Scale Communities
    University of Minnesota Rural Health Research Center
    Date: 09/2005
    This paper examines the effect of community size on how physicians view their practices as reported by respondents to two waves (1996-97 and 1998-99) of a national sample survey conducted as part of the Community Tracking Study. Results suggest that bigger is not necessarily better when it comes to physicians' perceptions of their practices.
  • Geographic Access to Health Care for Rural Medicare Beneficiaries
    WWAMI Rural Health Research Center
    Date: 04/2005
    This study looked at where Medicare beneficiaries from five states obtain their care, how far they travel for that care, and the mix of physician specialties from whom they obtain their ambulatory care.
  • Intensive Care In Critical Access Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2005
    This paper describes what officials at critical access hospitals mean when they report that they provide intensive care and the importance of these services to the hospital and the community it serves.
  • Scope of Services Offered by Critical Access Hospitals: Results of the 2004 National CAH Survey
    Maine Rural Health Research Center
    Date: 03/2005
    Three years of data were used to examine services offered by critical access hospitals (CAHs). The authors investigated how the services offered by CAHs have changed, the role of network affiliations in the changes, and the reasons administrators gave for reported service expansions. They also looked at how services in CAHs have changed over time.

2004

2003

  • Care Across the Continuum: Access to Health Care Services in Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2003
    This paper proposes that a continuum of care serve as the framework with which to consider rural healthcare policies, focusing on people and on places where people live rather than on the wants of providers and constituencies.
  • Grantee Sustainability in the Rural Health Outreach Grant Program
    University of Minnesota Rural Health Research Center
    Date: 12/2003
    This paper describes a study of the post-grant experiences of 99 Rural Health Outreach Grant recipients and focuses on the extent to which programs were able to maintain or expand services after their grants ended and characteristics that helped programs succeed in the post-grant period.
  • Who Receives Inpatient Charity Care in California?
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2003
    This policy analysis brief examines the results of a study regarding how California hospitals determine charity care.
  • Emergency Department Use By Medically Indigent Rural Residents
    Rural and Minority Health Research Center
    Date: 07/2003
    This report examined emergency department (ED) use, combining national data and South Carolina state data to estimate the uncompensated charges in rural EDs nationally and the ameliorating effects of rural community health centers on ED use by rural residents.
  • Access to Care among Rural Minorities: Working Age Adults
    Rural and Minority Health Research Center
    Date: 01/2003
    This report examines the prevalence of health insurance and the use of physician services in rural areas.
  • The Characteristics and Roles of Rural Health Clinics in the United States: A Chartbook
    Chartbook
    Maine Rural Health Research Center
    Date: 01/2003
    This chartbook reports on a rural health clinics (RHCs) survey. Information was collected on many topics, including their characteristics/operations; their location relative to the underservice problems/rural access needs; their safety net functions; staffing, recruitment, and financial issues; and involvement in training healthcare professionals.

2002

  • Health Services at Risk in "Vulnerable" Rural Places
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2002
    This brief discusses implications of a method to identify places in rural America at risk of being without healthcare services because they may lack a sufficient number of people to support a practice/provider, they are able to pay the full cost of care, or the population size/composition doesn't warrant the level of services currently available.
  • Impact of National Policy on Access to Health Care: The Rural Perspective
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2002
    This document discusses the current state of financial and geographic access to healthcare in the United States and federal policy.
  • Financial Incentives for Rural Hospitals to Expand the Scope of Their Services
    University of Minnesota Rural Health Research Center
    Date: 06/2002
    This paper examines the financial incentives that rural hospitals have to conduct surgery and treat more complex medical conditions. The objective is to evaluate whether rural hospitals that offer broader services are more profitable than hospitals with limited inpatient services.
  • Access to Emergency Medical Services in Rural Areas: The Supporting Role of State EMS Agencies
    University of Minnesota Rural Health Research Center
    Date: 02/2002
    This paper reports on a survey of state emergency medical services (EMS) directors about access to rural EMS; programs/initiatives by state EMS agencies to target rural/volunteer EMS providers; integration initiatives by rural EMS providers; issues in medical direction for rural EMS; and anticipated effects of the new Medicare fee schedule.

2001