Current Projects
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A Closer Examination of Rural Hospital Bypass
When rural residents leave their community for care that is available in their community (hospital bypass), the local hospital’s financial condition may be adversely impacted, ultimately impairing access to care in the community. 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. More info...
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Building the Rural Evidence Base: Examining the Feasibility of Implementing Pilot Programs and Demonstrations in Rural Communities
The use of evidence-based interventions (EBIs), programs and practices that have demonstrated effectiveness at improving outcomes, is often preferred, or even required, by funders of health programs and others. This project will investigate the benefits of piloting and researching interventions in rural areas to build the rural evidence base as a step in addressing health disparities and improving health conditions in rural communities. More info...
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Considerations for the Use of Area-Level Vulnerability and Resilience Indices and Rurality in Funding Formulas
Federal funding, including through block grants, provides states with considerable flexibility in allocating funds. States therefore allocate these funds in a variety of ways and based on different factors, including recently popularized area-level measures such as the Social Vulnerability Index (SVI), and measures of population size, poverty, and rurality. The purpose of this study is to model how funding formula structures within states affect allocation amounts to counties. More info...
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Examining Post-Acute Care Utilization and Outcomes for Rural Medicare FFS and Medicare Advantage Beneficiaries
Access to post-acute services is an important component in the continuum of care and as part of value-based care payment models. The purpose of this study is to describe rural Medicare Fee-for-Service beneficiaries' and rural Medicare Advantage beneficiaries' differences in post-acute care utilization and post-discharge outcomes. More info...
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Examining Rural Population Characteristics and Access to Care: A Study of Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs)
The purpose of the Health Professional Shortage Area (HPSA) designation is to identify areas of need and prioritization of health care resources to the people in those places. HPSA designations identify a shortage of either primary medical, dental, or mental health providers within an identified geographic area, population group, or health care facility. More info...
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Exploring Rural and Urban Medicare Beneficiaries' Use of Home Health Services
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The Medicare Payment Advisory Commission (MedPAC) reported that access to home health care was adequate in 2021, with over 98% of Medicare fee-for-service beneficiaries residing in a ZIP code served by at least two HHAs. However, there is limited understanding of how well HHA service areas align geographically and to what extent rural Medicare beneficiaries use these services. More info...
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Going Beyond Hospital Closures: Estimating Rural and Urban Changes in Access to Hospital Service Lines: Rural Health Research Project
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Rural communities face challenges in accessing hospital services, which may be most pronounced when a hospital closes. However, closure of specific hospital service lines also affects access to care and is understudied. The purpose of this study is to estimate hospital service line closures over time by rurality, hospital type, and community characteristics, and estimate changes in distance to the nearest facilities after a service line closure. More info...
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Rural/Urban Differences in Forgoing Health Care during the COVID-19 Pandemic
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Several surveys conducted during the COVID-19 pandemic showed that adults delayed or skipped health care services during the initial months of the COVID-19 pandemic. To understand changes in health care utilization for rural residents versus non-rural residents during the COVID-19 pandemic, the ETSU/NORC Rural Health Research Center will analyze the use of primary and preventive care visits and elective procedures in Medicare Fee-for-Service claims prior to and during the COVID-19 pandemic. More info...
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Rural and Urban Sepsis Outcomes as a Measure of Health Care Quality: A Nationwide Comparative Analysis Using HCUP Data: Rural Health Research Project
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Sepsis is one of the costliest and most common causes of inpatient stays and contributes to approximately 350,000 deaths per year. This study explores differences in sepsis mortality rates between rural and urban hospitals, linking factors such as resource constraints and transfer delays. The study uses a retrospective cohort design, analyzing Nationwide Readmissions Database data from 2016 to 2021 to track sepsis-related hospital discharges and mortality, including postoperative sepsis and septic shock. More info...
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Screening, Brief Intervention and Referral to Treatment (SBIRT) penetration in rural vs. urban healthcare settings in the U.S.
This study will include an analysis of 2018/2019 Medicare, Medicaid and Commercial claims to compare the penetration of SBIRT and its different components (i.e., screening and brief intervention and referral to treatment) in rural compared to urban healthcare settings. Findings will elucidate practice- and system-level correlates of SBIRT adoption in rural compared to urban settings which may be useful for identifying barriers and facilitators to adoption. Furthermore, when SBIRT proficient rural healthcare settings and providers are identified, policies and procedures can be disseminated to other rural practices. More info...
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State Use of Medicaid Funding Mechanisms for Community Health Workers: Implications for Rural Populations
The purpose of this project is to describe and compare state use of two Medicaid mechanisms—Section 1115 waivers and SPAs—to support CHW services, with a focus on any implications for rural populations. By understanding how states are navigating and applying these mechanisms, it may provide insights into innovative approaches for integrating CHWs into health care in rural areas. More info...