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Rural Health Reform Policy Research Center Current Research Studies

Four-Year FORHP Research Center Cooperative Agreement-Funded Projects (2012-2016)

  • Examination of Trends in Rural and Urban Health: Establishing a Baseline for Health Reform
    The purpose of this project is to update and supplement the seminal Health, United States, 2001: Urban and Rural Health Chartbook. Resulting information can not only be compared to the 2001 Chartbook but provides a baseline from which to measure future change related to the Accountable Care Act implementation. Where appropriate additional charts are included wherein rural areas are subdivided by type.
    Status: Completed
  • Exploring Rural and Urban Mortality Differences
    This project examines the impact of rurality on mortality and explores the regional differences in the primary and underlying causes of death. It also explores the role of the rural public health systems in addressing social determinants of health.
    Status: Completed
  • 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.
    Status: Completed
  • Rural Hospice Surveys Regarding Family Members & Health Workforce
    This project’s two parts survey both hospice users’ family members and hospice CEOs regarding their health workforce staffing and shortages. The family member survey involves a sample of hospices from a geographically disperse group of states and the CEO survey involves a national random sample of hospice CEOs.
    Status: Completed
  • 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.
    Status: Completed
  • 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.
    Status: Completed
  • Examination of Rural and Frontier Home Health Services
    This mixed-method study is an in-depth examination of access to and utilization of home health services provided in rural and frontier areas. The study begins to explore how influential patient-centered decision-making is in determining the type of post-acute care services used by rural and frontier Medicare beneficiaries.
    Status: Completed
  • Rural End-of-Life Care: An Analysis of Rural Medicare Beneficiaries’ Healthcare Costs, Utilization, and Patient-Centered Decisions
    This research examines the costs and types of care that rural Medicare beneficiaries use during their last six months of life. In addition, to learn how patient-centered decisions are made regarding healthcare transitions at the end-of-life, interview were conducted with rural providers and families.
    Status: Completed
  • Frontier and Rural Definition Development and Dissemination Project
    This project involved completion of the development of the national Frontier and Remote (FAR) codes. The FARs were co-develop with Department of Agriculture’s Economic Research Service. The FARs were cleared through the a Federal Register notice. The new geographic taxonomy delineates frontier/remote areas in the U.S. Dissemination is through a newly developed mega geographic rural and frontier website and the ERS website.
    Status: Completed
  • Update of RUCA Taxonomy to ZIP Code Version 3 and Creation of Rural and Urban Geographic Mega Website
    This project has two main components: 1) update of ZIP code Rural-Urban Commuting Area (RUCA) taxonomy to Version 3.2; and 2) creation of a mega rural and frontier website that has three components: a) an introduction to the use of geographic methods, especially geographic taxonomies regarding healthcare (e.g., critical literature review of all U.S. rural and frontier taxonomies and comparisons of the most commonly applied taxonomies (21 pairwise comparisons with tables, maps, and text), and useful links to other websites; b) home of RUCA 3; c) home of FAR 1; and d) a section describing various ways to define service areas and other types of regions (for more information on this last described component of the website see the next project listed below). This website will emphasize the use of all of the above for healthcare policy, policy analysis, and research.
    Status: June 2016
  • Critical Review and Analysis Regarding PCSAs, HPSA Rational Service Areas, and Other: Geographic Alternatives for Creating Useful Primary Care Service Areas
    The purpose of this proposed project is to review Dartmouth’s Primary Care Service Areas (PCSAs), other Rational Service Area (RSA) methodologies, and alternative methodologies related to their strengths, weaknesses, and spatial analytic criteria regarding their ability to serve in the process of developing useful primary care service areas. The project will include normative service areas where in a primary care service area should exist (potential service area) but does not (e.g., large area/population with no providers that could support them).
    Status: August 2016
  • Utilization of Hospital Care for Rural Medicare Beneficiaries
    This project examines where rural and frontier Medicare beneficiaries access hospital care. Specifically, it explores the different types of inpatient care sought in local rural communities and at tertiary providers. Beneficiary patterns of care by condition, location type and other factors examined. The study also focuses on the bypassing behavior of rural residents when being hospitalized. Analysis sensitivity analyses are being performed regarding small travel time differences per alternative hospitals. 
    Status: June 2016
  • Exploring Global Budgets as a New Reimbursement Model for Low-Volume Critical Access Hospitals
    Given the complexity of the Global Budget reimbursement model, we are interested to learn if there are aspects of the model that can be applied to consolidate reimbursement across rural and frontier healthcare settings, particularly for CAHs with low-volume (e.g., < 5 acute patients as a daily census).
    Status: August 2016

Year 04 Projects

  • Use of Emergency Departments for Behavioral Health Related Care
    This project will study the prevalence of emergency department utilization for behavioral health diagnoses between rural and urban communities.
    Status: August 2016
  • Cost of Running a Rural Ambulance Service
    This study will address the cost of running ambulance services in rural areas by organizational structure/source of funding, the factors contributing to differences in costs, and factors contributing to differences in financial viability.
    Status: June 2016
  • Implications of Rural Ambulance Service Closures
    The purpose of this project is to examine closed ambulance services and those ambulance services adjacent to the closed units. The ambulance services adjacent to those which closed will be examined for service area, workload, and staffing for one year prior to and one year after the adjacent service closure.
    Status: June 2016
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