Rural Health
Research Gateway

Quality

Completed Projects

Listed by project completion date. You can also view these projects alphabetically.

2024

  • Availability and Quality of Dialysis in Rural Counties with a High Diabetes Burden
    This project examined the degree to which counties with a high population risk for end stage renal disease, defined by high diabetes prevalence, are served by dialysis providers. It assessed the accessibility and quality of services for end stage renal disease looking for disparities associated with rural residence and racial/ethnic population composition.
    Research center: Rural and Minority Health Research Center
    Topics: Diabetes, Health disparities and health equity, Health services, Public health, Quality
  • Rural/Urban and Racial/Ethnic Inequities in Patient-Reported Health Care Access and Quality among Medicare Beneficiaries with Lung or Colorectal Cancer
    Incidence and mortality for colorectal and lung cancer are higher among rural versus urban residents, but many rural cancer patients lack accessible, high-quality care. This study 1) Identified rural/urban inequities in Medicare cancer patient-reported health care access and quality and 2) Determined if rural racial/ethnic minority patients have worse health care access and quality than rural White patients.
    Research center: Rural and Underserved Health Research Center
    Topics: Cancer, Health disparities and health equity, Healthcare access, Maternal health, Medicare, Minority health, Quality

2023

  • Diabetes Management in Urban and Rural Areas of the U.S.
    This project used the IBM MarketScan database to examine differences in type 2 diabetes prevalence and monitoring for a commercially insured sample. It also employed definitions from the Health Effectiveness Data and Information Set guidelines for comprehensive diabetes care to determine if rural residents are more or less likely to meet recommended standards for type 2 diabetes monitoring and control.
    Research center: Rural and Underserved Health Research Center
    Topics: Care management, Chronic diseases and conditions, Diabetes, Health disparities and health equity, Health promotion and disease prevention, Health services, Healthcare access, Private health insurance, Quality
  • Rural-Urban Differences in Performance of Clinicians Participating in MIPS
    This project used quantitative methods to compare MIPS performance and reported measures for clinicians working in rural and urban areas, overall, and by practice size; evaluated differences in spending per beneficiary, overall, and stratified by drugs and medical services for rural and urban clinicians participating in MIPS; and compared MIPS performance and spending for clinicians serving a large proportion of racial/ethnic minorities in rural and urban areas.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health disparities and health equity, Healthcare financing, Physicians, Quality

2021

  • Evaluating the Rural Health Network Development Planning Grant Program
    This project identified factors that facilitate and impede success of Rural Health Network Development grantees, based on discussions with grantees from the 2019 cohort and surveys of prior grantees dating back more than 10 years, as well as with technical assistance providers.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health services, Healthcare access, Healthcare financing, Networking and collaboration, Public health, Quality
  • Hospital Readmission Following Care in a Swing Bed
    This study built on our portfolio of swing bed work by examining the rate of hospital readmission for patients who receive post-acute care in swing beds compared to skilled nursing facilities and informed the discussion on use, cost, and benefit of swing bed care.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS), Post-acute care, Quality
  • What Makes Successful Rural Accountable Care Organizations Successful?
    The U.S. Department of Health and Human Services plans to shift at least 50% of traditional Medicare spending into alternative payment models by 2018. Accountable Care Organizations (ACOs) represent a popular model in both the Medicare and Medicaid programs. This study used multiple methods to find what makes a successful ACO.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Quality

2020

  • Emergency Obstetrics in Communities Without Hospital-Based Maternity Care
    The purpose of this project was to describe rural hospitals that do not provide obstetric services and to survey a sample of these hospitals regarding their capacity for emergency obstetrics locally in order to inform policy to support access to high-quality maternity care for all pregnant rural residents.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Maternal health, Quality, Women
  • Making It Work: Models of Success in Rural Maternity Care
    The purpose of this project was to update information on access to obstetric services in rural counties, to identify common factors across rural communities that have maintained local hospital-based obstetric services, and to describe best practices associated with successfully supporting birth locally in rural communities.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Maternal health, Quality, Women
  • Team-Based Primary Care in Rural Communities
    This project will describe primary care practice structure in rural communities and quantify characteristics of primary care teams associated with high-quality care.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Allied health professionals, Healthcare access, Nurses and nurse practitioners, Physicians, Quality, Rural statistics and demographics, Workforce

2019

  • Access and Quality of Care for Rural Patients with Chronic Obstructive Pulmonary Disease
    Although rates of chronic obstructive pulmonary disease (COPD) are substantially higher in rural areas, there has been limited research on healthcare access and quality issues for individuals with COPD who live in rural communities. This project aimed to improve the accessibility and quality of care for rural COPD patients.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Cancer, Chronic diseases and conditions, Quality
  • Developing Rural-Relevant Strategies to Reduce Maternal Morbidity
    The purpose of this project was to distinguish and analyze predictors of maternal morbidity during childbirth hospitalization by geography and to develop recommendations to improve the safety of childbirth for rural residents. It also assessed the degree of rural focus and representation in current policy efforts to address this crisis.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Legislation and regulation, Maternal health, Quality, Women

2018

2017

  • After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care
    This paper describes opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from centering on inpatient hospital-based care to new models of care delivery in rural places.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Hospitals and clinics, Quality
  • Identifying Adverse Drug Events and Improving Patient Safety in Rural Hospitals
    This study identifies rates of adverse drug events (ADEs) and opportunities to improve patient safety in Critical Access Hospitals (CAHs) and non‐CAH rural hospitals.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Hospitals and clinics, Pharmacy and prescription drugs, Quality
  • Provide Guidance on Measures for the School-Based Telehealth Network Grant Program Evaluation
    The primary purpose of this project was to provide guidance on a set of measures that could be used for a cross-grantee evaluation of the School-Based Telehealth Network Grant Program.
    Research center: Rural Telehealth Research Center
    Topics: Quality, Telehealth
  • Rural Implications of Quality-Based Physician Payment Reform
    The purpose of this project is to assess existing national data about the quality of care provided by rural physicians, and to determine what additional information will be needed as CMS moves towards inclusion of all physicians in payment reforms based on quality.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Physicians, Quality

2016

  • Analyzing the Variation in the Performance of Accountable Care Organizations Serving Rural Medicare Beneficiaries
    The goals of this project are to characterize ACOs that operate in rural areas, describe the models being used to organize those ACOs, and to test relationships of those characteristics to performance measures related to financial success and quality. The study will identify potential changes in legislative and regulatory policies that could strengthen the utility of the ACO model to achieve high performing rural healthcare delivery organizations.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Healthcare financing, Legislation and regulation, Medicare, Quality
  • Quality Measures and Sociodemographic Risk Factors: The Rural Environmental Context
    For three acute care conditions/diagnoses (potential examples include diabetes, congestive heart failure, COPD), this study will (1) identify the key socio-demographic variables that may affect quality adjustment for rural populations/providers; (2) identify data sources/strategies available for the above variables; and (3) identify the quality measures (e.g. readmission rates) that should be adjusted for socio-demographic variables for rural populations/providers and estimate the potential impact of those adjustments on quality measurement.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Diabetes, Quality, Rural statistics and demographics
  • Rural Hospital Obstetric Workforce, Procedure Utilization, and Quality of Care
    This study examines the relationships between key aspects of the obstetric workforce in rural hospitals and procedure intensity and quality of maternity care in those hospitals.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Maternal health, Quality, Women, Workforce
  • Rural Population Hospice Care
    Relatively little is known about rural hospice care. The objectives of this project are to review and describe what is already known about rural hospices and to perform initial quantitative analyses on available data to describe the: number of rural hospices and their use patterns (e.g., length of stay and utilization rates), rural residents to urban hospice utilization, and rural versus urban resident hospice utilization rates. For this project, rural is be subdivided into categories such as large rural, small rural, isolated small rural, and frontier. To supplement this information, qualitative information was obtained and integrated into the findings report.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Aging, Health services, Quality

2015

  • Impact of Private Sector Quality Initiatives on Rural Providers and Patients
    The purpose of this project is to assess the impact of private sector quality reporting and quality improvement initiatives on rural providers and on the quality of care provided to rural patients.
    Research center: University of Minnesota Rural Health Research Center
    Topic: Quality
  • Perspectives of Rural Hospice Directors
    Rural hospice care, as it is currently configured, is under pressure by a variety of factors (e.g., policy and regulation, economic and financial, and organizational and structural) which 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 (i.e., typically a small non-profit arrangement) and design (i.e., a delivery system reliant on community connections and personal relationships) of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states. Fifty-three directors or key staff members were interviewed during a three-month period in 2013.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Aging, Health services, Quality, Telehealth
  • Rural Women Giving Birth in Non-Local Hospitals: Implications for Obstetric Access and Quality
    The purpose of this project is to: 1) analyze recent data from nine geographically diverse states on delivery by rural women at non-local hospitals; 2) characterize the roles of medical vs. non-medical factors in delivery at a non-local hospital by identifying lower-risk and higher-risk women using established criteria; and 3) analyze the relationship between delivery at a non-local hospital and obstetric quality.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Hospitals and clinics, Quality, Women
  • Use and Performance Variations in Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    This project describes rural usage of rural emergency departments (EDs). It will examine the conditions that are treated in these EDs and describe those that are more and less appropriate for ED use. Rural ED use is described by community characteristics including rural level. The findings provide a baseline from which to measure the future influence of the Accountable Care Act implementation on the usage of rural EDs and the appropriateness and cost efficiency of changes.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Emergency medical services (EMS) and trauma, Quality
  • Year 2 of the Sentinel Cohort of Rural Health Clinics: Testing, Evaluating and Refining a Set of Rural Health Clinic Quality Measures
    This project implements the set of core consensus quality measures identified during Year One of the Rural Health Clinic (RHC) Sentinel Cohort project among a group of approximately 130 RHCs in 13 states.
    Research center: Maine Rural Health Research Center
    Topics: Quality, Rural Health Clinics (RHCs)

2014

  • Developing a Sentinel Cohort of Rural Health Clinics for Use in Developing Relevant Quality Measures and Monitoring Program Performance
    This two year project will assemble a cohort of Rural Health Clinics (RHCs) from ten to thirteen states to participate in a sentinel quality measurement process. During the first year of the project, the cohort of RHCs will participate in the identification, development, and refinement of a discrete set RHC quality measures in conjunction with the project team and an expert panel of RHC and quality measurement experts. During the second year, the cohort will be asked to implement, report, and evaluate the measures.
    Research center: Maine Rural Health Research Center
    Topics: Quality, Rural Health Clinics (RHCs)
  • High Quality Rural Hospitals and Post-Acute Care Providers
    This project will use several large longitudinal national databases to model alternative ways of identifying high quality rural hospitals, analyze factors related to quality in rural hospitals, and examine the relationship between the quality of care provided by rural hospitals and the quality of care provided by nursing homes and home health agencies within rural communities.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Hospitals and clinics, Post-acute care, Quality
  • Observation Care Services in Rural Hospitals: Reimbursement and Quality Implications
    This project will describe the nature and scope of observation care services provided by rural hospitals and discuss policy relevant issues for Medicare beneficiaries and providers. Study findings will provide the first assessment of rural observation care services and identify policy options to minimize the potential for unintended consequences of Medicare policies related to observation care services.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Hospitals and clinics, Medicare, Quality
  • Obstetric Care Practice Models and Quality in Rural Hospitals
    The project will examine current obstetric practice models in rural hospitals and assess the prospects for implementation of new policy recommendations for reducing primary cesarean rates and non-medically indicated inductions of labor in rural hospitals.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Maternal health, Quality
  • Quality Implications of Transferring Emergency Department Patients from Rural Hospitals
    This project will use Medicare inpatient and Emergency Department claims data to 1.) compare patients who are transferred directly from rural hospital Emergency Departments to larger hospitals with those who are admitted as inpatients to rural hospitals in terms of diagnoses, comorbidities, demographics, and the care received and 2.) analyze how the inclusion or exclusion of transferred emergency patients affects risk-adjusted mortality rates for transferring and receiving hospitals.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Quality

2012

2011

  • Assessing the Rural Relevance of Hospital Outpatient Quality Measures
    The purpose of this project is to: 1) determine the diagnoses that are most commonly treated and the procedures most commonly performed in rural hospital outpatient settings; and 2) to evaluate the rural relevance of the proposed new CMS outpatient quality measures and other potential outpatient quality measures.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality

2010

  • Nursing Workforce Impact on Rural Hospital Performance Improvement in the Hospital Quality Incentive Demonstration Project
    The purpose of this project is to examine the impact of nurse staffing on hospital performance improvement in the CMS/premier Inc. Hospital Quality Incentive Demonstration project with specific interest in whether and how this relationship differs in rural hospitals as compared to urban hospitals.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality, Workforce
  • Potentially Preventable Rural Hospital Readmissions
    This project focuses on the analysis of potentially preventable rural hospital readmissions, a potential quality indicator receiving considerable attention from policymakers and payers. Using 3-M algorithm software and MedPAR inpatient claims data from 9 geographically representative states, this study will explore the relationship between readmission rates and geographic regions, categories of rural hospitals, discharge destination, clinical diagnoses and patient attributes.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality

2009

  • Critical Access Hospital Readiness for CMS Value-Based Purchasing
    The purpose of this project will be to assess Critical Access Hospital readiness for participation in a Value-based Purchasing program similar to that proposed by CMS for Prospective Payment System hospitals.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Quality
  • Developing Quality Measures and Communication Strategies for Rural Patient Transfers
    The purpose of this project is to quantify the complexity of the coordination of patient care in rural health care systems and to expand our work on developing quality measures for rural patients whose care is transferred between providers.
    Research center: Upper Midwest Rural Health Research Center
    Topic: Quality
  • Evaluation of an Outpatient Modified Paper Prescription Form
    This project will evaluate a modified paper prescription form that may be implemented in rural primary care settings cheaply and quickly with the goal of outpatient prescription error reduction.
    Research center: FORHP-funded Individual Grantees
    Topics: Pharmacy and prescription drugs, Quality
  • Health Information Technology and Quality in Rural Hospitals
    The purpose of this project is to: 1) examine the adoption of health information technology (HIT) among rural hospitals and identify hospital and market characteristics that facilitate or impede HIT diffusion; 2) measure the effect of HIT on clinical quality in rural hospitals; and 3) identify technologies that may be promoted to improve quality of care in rural areas.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Health information technology, Hospitals and clinics, Quality
  • Improvement in the Quality of Care for Acute Myocardial Infarction (AMI): Have Rural Hospitals Followed National Trends?
    This project will determine whether overall improvements in the quality of care for AMI among Medicare patients, as measured by adherence to guidelines, have taken place in both rural and urban hospital settings.
    Research center: WWAMI Rural Health Research Center
    Topics: Hospitals and clinics, Quality
  • Measuring Quality Performance in CAHs
    The purpose of the project is to update our previous analyses of Critical Access Hospital (CAH) participation in Hospital Compare, analyze trends over time, and explore additional sources of quality data for CAHs.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Quality
  • Patient Assessments and Quality of Care in Rural Hospitals
    This study will 1)analyze the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care; and 2) assess whether rural patients' perspectives of hospital quality of care are related to quality measures focused on the provision of recommended care for medical conditions.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Health services, Quality

2008

  • Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety
    The purpose of this project is to describe successful telepharmacy activities and to analyze policy issues related to the implementation of telepharmacy projects in rural hospitals. These policy issues include the potential impact of telepharmacy use on the quality of pharmaceutical services and medication safety for rural patients.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Telehealth
  • Quality and Financial Status of Critical Access Hospitals: A Preliminary Analysis
    The purpose of this project is to continue to investigate the relationship between Critical Access Hospital financial performance and quality of care. The University of Minnesota and the University of North Carolina will jointly develop hypotheses related to the finance-quality link and statistical models suitable for testing hypotheses.
    Research centers: North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Quality, Rural Hospital Flexibility Program
  • Quality Improvement Organizations' Contributions to Rural Hospital Performance
    This qualitative study is designed to gather information on best-practices in Quality Improvement Organization (QIO)-rural hospital partnerships. Specifically, this study will identify successful and replicable examples in which QIOs have worked with rural and critical access hospitals to improve processes of care, implement health information technology and promote organizational safety culture.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Critical Access Hospitals (CAHs), Health information technology, Hospitals and clinics, Quality

2007

  • Assessment of Small Rural Hospital Activities to Report Medication Errors
    This research will determine how small rural hospitals have responded to the environmental pressure to improve patient safety and quality by implementing safe medication practices and by reporting and monitoring medication errors.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality
  • Beyond Simple Ranking: Identifying and Empirically Testing Alternative Approaches for Recognizing Quality in Rural Hospitals
    The purpose of this project is to explore several alternative methods for assessing the relative quality of hospitals using data from the Hospital Quality Incentive Demonstration Project and Hospital Compare.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality
  • Pay-for-Performance and Quality Improvement in Rural Hospitals
    This project will estimate the impact on rural hospitals in the U.S. of a pay-for-performance (PFP) program similar to the CMS-sponsored Premier, Inc. Hospital Quality Incentive Demonstration; synthesize the major factors that will influence the inclusion of rural hospitals in PFP programs; and make recommendations for the design of PFP programs that will appropriately reward rural hospitals for improving quality.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Healthcare financing, Hospitals and clinics, Quality
  • Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas
    This project will describe emergency department (ED) staffing patterns in rural hospitals; determine how the certification, training, and experience of ED physicians and other providers in different ED staffing models vary; and assess the implications of rural ED staffing for the quality of emergency care in rural areas, continuity of care, and rural EDs' role as safety net providers.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Hospitals and clinics, Quality, Workforce

2006

2005

  • Analysis of 2004-2005 State Flex Grant Plans
    This project will analyze state Flex grant applications and related budget and work plan revisions focusing on state activities in the core Flex program areas of networks, quality improvement, and EMS.
    Research centers: Maine Rural Health Research Center, University of Minnesota Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Networking and collaboration, Quality, Rural Hospital Flexibility Program
  • Medicare Beneficiary Outcomes in Rural and Urban Home Health Agencies
    This study will compare the performance of rural and urban home care agencies, and identify agency characteristics that contribute to better patient care outcomes.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Home health, Medicare Prospective Payment System (PPS), Quality
  • Quality of Women's Care in Rural Health Clinics: A National Analysis
    This study will analyze the rates at which women patients receive five recommended preventive screening interventions in a national, geographically stratified random sample of Rural Health Clinics. Results of the analysis will be used to derive implications for rural health policy.
    Research center: FORHP-funded Individual Grantees
    Topics: Quality, Rural Health Clinics (RHCs), Women
  • Rural Quality Improvement Focus on Diabetes
    This project focused specifically on diabetes care management and quality improvement programming in rural areas as a way to understand the adaptability and policy implications of using chronic care coordination and other models in a rural environment.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Care management, Chronic diseases and conditions, Diabetes, Quality
  • Successful Implementation of Medication Safety Initiatives in Rural Hospitals: The Role of Pharmacists and Technology
    This project will assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, and will identify factors that facilitate successful implementation of medication safety practices in rural hospitals.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality

2004

2003

2002

2001

1999

Unknown

  • Acute and Post-Acute Care Bundled Payments and Care Coordination in Rural Environments
    The purpose of this project is to: 1) Identify opportunities and potential unintended consequences for rural providers of current proposals for implementing bundled payments for acute and post-acute care episodes; 2) Describe modifications to current bundling proposals that will address rural-specific issues; and 3) Identify quality measures related to care coordination that are relevant for rural patients whose services are reimbursed by a bundled payment.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Health services, Post-acute care, Quality