Rural Health
Research Gateway

Healthcare access

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 (CAHs), 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, 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
  • Barriers and Facilitators to Providing Rural Clinical Training for Health Professions Students and Residents
    Scarce rural clinical training sites are the top barrier preventing medical schools, residencies, and nurse practitioner and physician assistant education programs, among other health professional training programs, from providing rural training to their students. This study aims to describe the barriers to offering rural clinical training and the potential solutions for establishing and sustaining interdisciplinary rural clinical training.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Healthcare access, Nurses and nurse practitioners, Physician assistants, Physicians, Workforce
  • Challenges, Successes, and Sustainability of the 2019 Rural Maternity and Obstetrics Management Strategies (RMOMS) Programs
    This mixed-methods study aims to understand awardees' experiences in building and maintaining cohesive networks for Rural Maternity and Obstetrics Management Strategies (RMOMS).
    Research center: Rural and Minority Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Maternal health, Minority health, Networking and collaboration, Telehealth, Women
  • Changes in Access to Care During the Public Health Emergency: Examining Rural-Urban Disparities by Insurance Type
    Using the Behavioral Risk Factor Surveillance System data, this study will compare key access to care indicators among adult beneficiaries residing in rural and urban areas before and after the Public Health Emergency by types of health insurance. Researchers will explore state-level policy variations, such as the Affordable Care Act Medicaid expansion and COVID-19-related Medicaid coverage for uninsured adults.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Healthcare financing, Medicaid and CHIP, Uninsured and underinsured
  • Changes in Buprenorphine Prescribing Following the Elimination of the Drug Enforcement Administration X Waiver Requirement
    The Drug Enforcement Administration requirement for an X waiver to prescribe buprenorphine for opioid use disorder was lifted in January 2023. This study aims to describe if and how this policy change has impacted the prescribing practices of clinicians and medication treatment access for patients with opioid use disorder.
    Research center: WWAMI Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Legislation and regulation, Mental and behavioral health, Nurses and nurse practitioners, Physician assistants, Physicians, Substance use and treatment, Workforce
  • Characteristics of Buprenorphine Therapy Among Commercially-Insured Pregnant and Postpartum Women
    This project will analyze claims from a national commercial insurance database to characterize buprenorphine therapy initiation persistence and adherence among pregnant and postpartum women with opioid use disorder (OUD) and assess differences in buprenorphine OUD treatment characteristics among rural and urban pregnant/postpartum women.
    Research center: Rural Health Equity Research Center
    Topics: Health disparities and health equity, Healthcare access, Maternal health, Substance use and treatment
  • Comparing Across Health Indices: Differences by Rurality, Missingness, and Associations With Health Outcomes
    The purpose of this study is to describe and compare existing area-level indices of vulnerability by rurality and to examine associations between indices and health outcomes of interest by area-level measures of rurality.
    Research center: Rural Health Equity Research Center
    Topics: Health disparities and health equity, Healthcare access, Poverty, Rural statistics and demographics, Social determinants of health, Uninsured and underinsured
  • 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
  • Differences in Trauma Outcomes for Patients Residing in Ambulance Deserts
    Rural residents are 14% more likely to die after traumatic injury compared with urban residents, with distance from trauma centers and travel time likely significant contributors to this disparity. This project will use the State Emergency Department Databases and State Inpatient Database to examine differences in trauma outcomes for patients residing in ambulance deserts.
    Research center: Maine Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Healthcare access, Hospitals and clinics
  • Disparities in Mental Health Services Access: the Intersectionality of Residence Rurality, Race, and Ethnicity
    In 2021, approximately 8.6 million rural adults faced mental health challenges while millions of rural adolescents battled major depressive episodes. This study examines disparities in mental health services uptake and variation in mental health care settings across racial-ethnic and rural-urban subpopulations before and after the COVID-19 pandemic.
    Research center: Rural and Minority Health Research Center
    Topics: Children and adolescents, Coronavirus Disease 2019 (COVID-19), Health services, Healthcare access, Mental and behavioral health
  • Examining Changes in Health Care Accessibility in Rural Areas: An Analysis of HPSAs and MUAs Over Time and Their Relationship With Demographic Characteristics
    This study focuses on Health Professional Shortage Areas and Medically Underserved Areas and analyzes health care accessibility in rural areas. It uses data from the Health Resources and Services Administration and demographic information to identify trends, spatial patterns, and demographic intersections, aiming to inform policies and interventions for improved rural healthcare access and equity.
    Research center: Rural Health Equity Research Center
    Topics: Health disparities and health equity, Healthcare access, Mental and behavioral health, Oral health, Workforce
  • Examining Differences in Rural and Urban Medicare FFS Beneficiaries' Emergency Department Use Pre-COVID-19 and During COVID-19
    This study describes and compares the differences in the utilization of emergency department (ED) services among rural and urban Medicare Fee-For-Service enrollees during 2018-2021. We will identify factors associated with differences in ED use, including shifts in volume, primary diagnoses, and admission source, before and since the COVID-19 public health emergency in rural and urban areas.
    Research center: Rural Health Equity Research Center
    Topics: Coronavirus Disease 2019 (COVID-19), Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Health disparities and health equity, Healthcare access, Hospitals and clinics, Medicare, Social determinants of health
  • Examining Post-Acute Care Utilization and Outcomes for Rural Medicare FFS and Medicare Advantage Beneficiaries
    This study will describe differences in post-acute care utilization and post-discharge outcomes between rural Medicare Fee-for-Service beneficiaries and rural Medicare Advantage beneficiaries overall and by region of the country, levels of rurality, and race and ethnicity.
    Research center: Rural Health Equity Research Center
    Topics: Care management, Critical Access Hospitals (CAHs), Healthcare access, Home health, Medicare, Medicare Advantage (MA), Post-acute care
  • 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
  • Extent and Coverage of Rural PACE Services
    Supporting independent living and aging in place for rural residents is more important than ever. This project will provide information on the extent and coverage of rural Program of All-Inclusive Care for the Elderly (PACE) programs, along with insights into the unique challenges and opportunities faced by PACE programs operating in rural areas.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Disabilities, Health disparities and health equity, Healthcare access, Home health, Social determinants of health
  • Geographic and Socio-Demographic Correlates of Medical Debt Among Rural Residents
    Medical debt is widespread and impacts financial well-being and access to care. While research suggests that medical debt is higher among rural residents compared to urban residents, more work is needed to conclusively demonstrate rural/urban differences in medical debt and within-rural risk factors for greater medical debt by geography and socio-demographic characteristics.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Poverty, Public health, Rural statistics and demographics, Social determinants of health
  • 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)
  • Identifying High-Need Counties for Resource Planning
    The primary aim of this project is to use data examining health care infrastructure, chronic disease prevalence, and the socioeconomic environment to create a metric for classifying rural counties based on needs and resources.
    Research center: Rural and Minority Health Research Center
    Topics: Chronic diseases and conditions, Diabetes, Health disparities and health equity, Healthcare access, Maternal health, Obesity, Oral health, Physicians, Poverty, Public health, Rural statistics and demographics, Social determinants of health, Uninsured and underinsured, Workforce
  • Impact of High Deductible Health Plans on Rural Populations
    Using data from Merative MarketScan insurance claims, this study will investigate utilization, spending, and care patterns of rural members enrolled in high deductible health plans (HDHP) compared to traditional plans. Trends in health outcomes before and after HDHP growth will be assessed to inform policy design tailored to rural residents.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Healthcare financing, Private health insurance, Rural statistics and demographics
  • Mortality Risks Associated With Living in Ambulance Deserts
    This project will use ambulance data from the Maine Rural Health Research Center and from CDC WONDER to assess whether living in an ambulance desert is associated with higher mortality rates among rural and urban populations.
    Research center: Maine Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Healthcare access
  • Non-Metropolitan/Metropolitan Differences in Barriers to Care and Utilization of Preventive Care and Wellness Visits Among Traditional Medicare and Medicare Advantage
    This project proposes to use the Medicare Current Beneficiaries Survey to examine differences across geography and plan type (Medicare Advantage vs. traditional) with regards to barriers to care (e.g., costs) and use of preventive services (e.g., flu shot).
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Healthcare access, Medicare Advantage (MA)
  • Out-of-Pocket Spending Among Privately Insured Rural and Urban Residents
    Out-of-pocket spending for healthcare services has been on the rise as deductibles and other cost-sharing requirements among the privately insured increase. This study compares rural and urban out-of-pocket healthcare spending to identify whether rural residents have been disproportionately affected by this trend.
    Research center: Maine Rural Health Research Center
    Topics: Healthcare access, Healthcare financing, Private health insurance, Public health, Uninsured and underinsured
  • 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
  • Postpartum Morbidity and Mortality and Health Care Utilization in Rural vs. Urban Communities
    Using 2006-2018 data from the National Health Interview Survey linked to the National Death Index through 2019, this project will examine postpartum mortality among rural and urban residents. We will also evaluate differences in health, health care utilization, and barriers to care across rural and urban communities.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Maternal health, Medicaid and CHIP, Mental and behavioral health, Private health insurance, Social determinants of health, Uninsured and underinsured, Women
  • Psychiatric Bed Closures in Rural Hospitals: An Assessment of Trends, Impact, and Policy Strategies
    This study will examine trends in the closure of psychiatric beds by rural hospitals using the Substance Abuse and Mental Health Services Administration Treatment Services Locator; the American Hospital Association Annual Survey of Hospitals (2010-2017); and the Area Health Resources File.
    Research center: Maine Rural Health Research Center
    Topics: Healthcare access, Hospitals and clinics, Mental and behavioral health
  • Review of Current Research on Rural/Urban Differences in Social Determinants of Health
    Social determinants of health are social, economic, and community variables that influence health outcomes. This project will synthesize the extant literature on rural/urban differences in the social determinants of health, culminating in a comprehensive report that includes a summary of information gaps and further research needs.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Poverty, Quality, Social determinants of health, Uninsured and underinsured
  • Risky Behaviors and Overdose Deaths Related to Illicit Drug Use
    Using the National Survey on Drug Use and Health, this study will investigate rural vs. urban variations in treatment utilization for alcohol use disorder (AUD) and, separately, drug use disorder (DUD). It will yield prevalence estimates of any treatment receipt and sources of treatment among persons with past year AUD and DUD as well as the receipt of medication therapy among those treatable with medications.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Mental and behavioral health, Substance use and treatment
  • 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 Obstetric Unit Closures
    The goal of this project is to update prior research to include the latest information on the loss of hospital-based obstetric services in rural U.S. counties. This project is important because ensuring obstetric care access and reducing maternal mortality in rural and underserved areas is a key focus of national, state, and local policies.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Healthcare access, Hospitals and clinics, Maternal health, Women, Workforce
  • 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 Analysis of Persistent Health Professional Shortage Areas
    The study will describe rural-urban differences in persistent Health Professional Shortage Area designations for primary care, mental health, and dental care between 2010 and 2020, including those located in persistent poverty and majority minority counties.
    Research center: Rural Health Equity Research Center
    Topics: Healthcare access, Mental and behavioral health, Oral health, Workforce
  • Rural-Urban Disparities in Mental Health Access and Quality in the United States
    The purpose of this project is to document the recent trends of mental health care access and quality in urban and rural communities and to assess the intersectionality of residence rurality and race/ethnicity on disparities in mental health care access and quality.
    Research center: Rural and Minority Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Mental and behavioral health
  • 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
  • Socioeconomic Profiles and Market Characteristics Associated with Ambulance Deserts
    We will address the extent to which vulnerable, aging populations live in ambulance deserts and identify ambulance desert populations facing additional barriers to healthcare access. We will also assess the impact of hospital closures on travel distances to the nearest health care facilities.
    Research center: Maine Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Healthcare access, Rural statistics and demographics, Social determinants of health, Transportation
  • 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
  • Suicide Mortality: A Comparison of Urban and Rural Rates
    Suicide contributes to significant mortality in the United States. This project will examine the variation in suicide rates by geography and explore its driving factors among urban and rural areas in the United States from 2018 to 2021. The research design of this study will adopt a cross-sectional, retrospective approach, using secondary data.
    Research center: Rural Health Equity Research Center
    Topics: Health disparities and health equity, Healthcare access, Mental and behavioral health, Public health, Rural statistics and demographics, Social determinants of health, Uninsured and underinsured
  • The Impact of Rural Surgery Training on General Surgeon Supply in Rural Communities
    A growing number of general surgery programs offer rural training that aims to address the dwindling supply of rural surgeons. This study aims to describe program models for providing rural general surgery training; quantify the availability of programs; and compare the models' effectiveness in producing rural surgeons.
    Research center: WWAMI Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Physicians, 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
  • Trends in Health Workforce Supply in the Rural U.S.
    Rural communities in the U.S. have struggled to recruit and sustain sufficient health professionals to ensure adequate access to care. This study uses multiple sources of data to describe the geographic distribution (rural/urban, regional, and intra-rural) of numerous types of health professionals.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Healthcare access, Mental and behavioral health, Nurses and nurse practitioners, Oral health, Physician assistants, Physicians
  • Unmet Health and Social Needs of Rural Residents with Disability
    We will assess rural-urban differences in access to health care and social wellbeing for rural residents with a disability. Disability rates are often higher in rural areas and, given growing evidence of COVID-related disability, this study will provide critical information about the pre-pandemic status of unmet health and social needs among disabled persons to enable future planning.
    Research center: Maine Rural Health Research Center
    Topics: Coronavirus Disease 2019 (COVID-19), Disabilities, Health disparities and health equity, Healthcare access
  • Updating and Exploring the Burden of Potentially Avoidable Emergency Department Visits in Rural U.S. Communities
    This project will update the Federal Office of Rural Health Policy's research portfolio on potentially avoidable emergency department (ED) visits among rural residents across the U.S., particularly as they relate to ambulatory care sensitive conditions (ACSCs). Data on ACSC-related ED visits will be drawn from the State Emergency Department Databases, and findings will be stratified by census region, patient's place along the urban-rural continuum, and by race/ethnicity.
    Research center: Southwest Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Healthcare access, Medicaid and CHIP, Uninsured and underinsured