Rural Health
Research Gateway

Hospitals and clinics

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 Use of Midwifery Care for Rural Residents
    Rural obstetric unit closures and health care workforce shortages limit access to care for pregnant rural residents. Our goal is to describe the midwifery workforce in rural communities and at rural hospitals that provide obstetric care, and to assess rural-urban differences in use of midwifery care at the time of childbirth.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Hospitals and clinics, Maternal health, Nurses and nurse practitioners, Women, Workforce
  • Alternative Methods for Defining Rural Hospital Service Area Market
    Options for describing the population served by a rural hospital are limited; geopolitical areas such as counties are convenient, but ZIP-based methods may be more accurate. In this project, we will consider multiple options that tradeoff ease, accuracy, ability to capture trends, and availability.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare
  • 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
  • Concordance Between Social Needs Screening Provision, Programming, and Partnerships in Rural PPS Hospitals
    This study will examine how rural Prospective Payment System (PPS) hospitals differ from urban hospitals concerning social needs screening practices and alignment between social needs screening performance and corresponding programs/strategies and/or community partnerships to address social needs.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Hospitals and clinics, Medicare Prospective Payment System (PPS), Networking and collaboration, Social determinants of health
  • Developing a Post-COVID Financial Distress Index
    This project will update and improve the North Carolina Rural Health Research Program's Financial Distress Index, which uses historical data about hospital financial performance, government reimbursement, organizational characteristics, and market characteristics to predict the current risk of financial distress.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare
  • 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
  • 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
  • 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 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
  • Long-term Implications of Declining Inpatient Revenue on Bed Surge Capacity and Emergency Preparedness
    Inpatient use and key health care services offered at rural hospitals have declined over the past decade. Has the quest for efficiency in hospitals led to a dangerously low surge capacity and ability to effectively handle public health emergencies?
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare
  • Low Volume Hospitals
    This analysis will compare rural low volume hospitals (LVHs) to non-LVH characteristics and estimate the financial impact of eliminating the LVH program and reverting to the original (2005) LVH classification and payment adjustment.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare
  • Medicare Advantage and Financial, Hospital, and Community Characteristics of Rural Hospitals
    This project will compare financial, hospital, and community differences among rural hospitals located in areas with lower versus higher rates of Medicare Advantage penetration.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare, Medicare Advantage (MA)
  • 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
  • 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
  • Ransomware Attacks on Rural Hospitals
    The rise in hospital ransomware attacks threatens to harm patients, especially in rural areas. This project will use a novel dataset to analyze rural/urban differences in how ransomware attacks affect patients and hospitals.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Health information technology, Hospitals and clinics
  • 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-based Accountable Care Organizations Accepting Downside Risk
    The RUPRI Center will update its studies of rural provider participation in accountable care organizations, including differences between those who exit the program, those who remain, and those who enter. In particular, this project will address participation decisions made after a rule change in July 2019 that requires conversion to two-sided risk.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Critical Access Hospitals (CAHs), Federally Qualified Health Centers (FQHCs), Health reform, Hospitals and clinics, Legislation and regulation, Medicare
  • Rural-Urban Differences in Addressable Drivers of Staff Turnover in Skilled Nursing Facilities
    The aim of the proposed study is to assess facility-level turnover rates for total nursing and registered nursing personnel across levels of rurality and by region looking at factors such as staffing ratios that can be managed by facility administrators.
    Research center: Rural and Minority Health Research Center
    Topics: Health services, Hospitals and clinics, Nurses and nurse practitioners, Public health, Rural Health Clinics (RHCs), Workforce
  • Third Party Negotiated Pricing in Rural and Urban Hospitals
    We will use third party negotiated pricing information to compare prices in urban and rural hospitals, across a variety of common services. Because there has been poor compliance with the Centers for Medicare & Medicaid Services (CMS) requirement to publish third party negotiated pricing, we will also examine if the availability of this information differs for rural and urban hospitals.
    Research center: Rural and Underserved Health Research Center
    Topics: Critical Access Hospitals (CAHs), Federally Qualified Health Centers (FQHCs), Healthcare financing, Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS), Private health insurance
  • 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 (EMS) and trauma, Health services, Healthcare access, Hospitals and clinics