Health services

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

2020

2019

  • Partial Psychiatric Hospitalization Program Availability in Nonmetropolitan and Metropolitan Hospitals Nationally
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 12/2019
    Partial psychiatric hospitalization programs (PPHPs) are intended to reduce or avoid inpatient stays by providing intensive psychiatric services in outpatient settings. We provide national estimates of PPHP availability among nonmetropolitan and metropolitan hospitals and describe the hospital characteristics associated with the provision of PPHPs.
  • The Prevalence of Chronic Diseases Among Current and Ex-Miners in the United States
    Rural and Underserved Health Research Center
    Date: 12/2019
    This paper compares the prevalence and odds of chronic diseases among ex-miners and current miners, adjusting for certain variables that might influence health outcomes. The analysis found that the prevalence of chronic disease is significantly higher among ex-miners.
  • The Development of Telehealth Laws in the U.S. from 2008 to 2015: A Legal Landscape
    Policy Brief
    Southwest Rural Health Research Center
    Date: 11/2019
    This study examines the scope and evolving nature of telehealth statutes and regulations in the U.S. Our research aims to understand changes in telehealth laws over time (2008-2015), variations in legal frameworks established across the U.S., and the extent that state laws regulate the primary care delivery through the use of telehealth.
  • Hospital Closures and Short-Run Change in Ambulance Call Times
    Rural and Underserved Health Research Center
    Date: 11/2019
    Hospital closures affect the availability of emergency department services. This paper examines changes in ambulance ride times in areas with hospital closures compared to those in similar areas without hospital closures and separately analyzes changes in ambulance ride times between urban and rural areas and among Medicare-eligible patients.
  • Prescribing Practices of Nurse Practitioners and Physician Assistants Waivered to Prescribe Buprenorphine and the Barriers They Experience Prescribing Buprenorphine
    WWAMI Rural Health Research Center
    Date: 10/2019
    This study surveyed rural and urban nurse practitioners (NPs) and physician assistants (PAs) with Drug Enforcement Agency waivers to provide medication treatment for opioid use disorder by prescribing buprenorphine. Rural NPs and PAs reported facing many of the same barriers to providing buprenorphine as rural physicians have reported.
  • Declining Endoscopic Care by Family Physicians in Both Rural and Urban Areas
    Rural and Underserved Health Research Center
    Date: 07/2019
    This paper explores the decline in the percentage of family physicians providing endoscopic services overall and in urban and rural areas. This has implications on the availability of colonoscopies, endoscopies, and flexible sigmoidoscopies in areas that lack specialists who perform such services.
  • 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.
  • Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas
    Maine Rural Health Research Center
    Date: 01/2019
    Analyzing the Medicare Current Beneficiary Survey, authors from the Maine Rural Health Research Center found that compared to their urban counterparts, rural Medicare beneficiaries had higher odds of nursing home use after controlling for beneficiary characteristics and contextual factors including nursing home bed supply.

2018

2017

2016

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.
  • Rural Bypass for Elective Surgeries
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2015
    Describes the elective surgical bypass rate, the procedures most commonly bypassed by rural residents, the distribution of volume among Critical Access Hospitals (CAHs) that offer elective surgical services, and factors predictive of bypass.
  • 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.
  • Intensive Care in Critical Access Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2007
    Describes the facilities, equipment, and staffing used by Critical Access Hospitals (CAHs) for intensive care, the types of patients receiving ICU care, and the perceived impact of closing the ICU on CAH staff and the local community.
  • Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention
    FORHP-funded Individual Grantees
    Date: 2007
    Describes the results of a study to assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally.

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 (Working Paper)
    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.
  • Are Primary Care Services a Substitute or Complement for Specialty and Inpatient Services?
    WICHE Center for Rural Mental Health Research
    Date: 2005
    Analyses show primary care service use increases were associated with increases in all specialty outpatient services and inpatient services, as well as increases in inpatient/outpatient costs. Results show that health systems can implement strategies encouraging members to use more primary care services without driving up physical health costs.
  • Delivery Complications Associated With Prenatal Care Access for Medicaid-Insured Mothers in Rural and Urban Hospitals
    Rural and Minority Health Research Center
    Date: 2005
    Examined access to healthcare during pregnancy for mothers insured by Medicaid as well as the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity.
  • Does Improving Geographic Access to VA Primary Care Services Impact Patients' Patterns of Utilization and Costs?
    WICHE Center for Rural Mental Health Research
    Date: 2005
    This article examines whether the establishment of community-based outpatient clinics has affected access, use, and costs for the Department of Veterans Affairs.
  • The Effects of Rural Residence and Other Social Vulnerabilities on Subjective Measures of Unmet Need
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2005
    Are self-reports of unmet need a biased measure of access to healthcare? We examined the relationship between rural residence and perceived need for physician services and the likelihood of reporting a need for routine preventive care and/or specialty care using data from the National Survey of Children with Special Health Care Needs.
  • Explaining Black-White Differences in Receipt of Recommended Colon Cancer Treatment
    WWAMI Rural Health Research Center
    Date: 2005

    Black-white disparities exist in receipt of recommended medical care, including colorectal cancer treatment. This retrospective cohort study examines the degree to which health systems (e.g., physician, hospital) factors explain black-white disparities in colon cancer care. Black and white Medicare-insured colon cancer patients have an equal opportunity to learn about adjuvant chemotherapy from a medical oncologist but do not receive chemotherapy equally. Little disparity was explained by health systems; more was explained by illness severity, social support, and environment. Further qualitative research is needed to understand the factors that influence the lower receipt of chemotherapy by black patients.

  • More May Be Better: Evidence of a Negative Relationship Between Physician Supply and Hospitalization for Ambulatory Care Sensitive Conditions
    Rural and Minority Health Research Center
    Date: 2005
    The authors conducted an empirical test of the relationship between physician supply and hospitalization for ambulatory care sensitive conditions.
  • Providing Hospice Care in Rural Areas: Challenges and Strategies to Address Them
    University of Minnesota Rural Health Research Center
    Date: 2005

    Hospices in rural settings face challenges in the provision of hospice care as a result of their location and the size of their service area population. To ascertain the challenges that hospices face in serving rural communities, researchers conducted in-depth case studies of four different models of hospice care in rural areas. The authors describe strategies used by the case study hospices and recommend policies that could increase access to hospice care for rural Medicare beneficiaries and other rural residents. National initiatives to improve end-of-life care need to consider the special challenges faced by rural hospices.

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

1997