Search |
| Title | Description | Status | Funder | |
|---|---|---|---|---|
 Understanding Changes in the Rural Marriage and Family Therapist and Mental Health Counselor Workforces Under New Medicare Reimbursement Policy |
Marriage and family therapists (MFTs) and mental health counselors (MHCs) are newly eligible as of... Understanding Changes in the Rural Marriage and Family Therapist and Mental Health Counselor Workforces Under New Medicare Reimbursement Policy Marriage and family therapists (MFTs) and mental health counselors (MHCs) are newly eligible as of January 1, 2024, for reimbursement from the Centers for Medicare & Medicaid Services under the Consolidated Appropriations Act of 2023 to provide care for Medicare enrollees. To qualify, MFTs and MHCs must be licensed or certified by the state where they provide services, have at least two years of supervised clinical experience, and meet other federal requirements including having a National Provider Identifier (NPI). This change could help address both rural and urban behavioral health work shortages. Past WWAMI Rural Health Research Center research found that nearly one-fifth (18.4%) of rural counties had no counselors with an NPI compared to 4.6% of urban counties. This study will investigate the quarterly change in the MFT and MHC workforces with an NPI (and thus eligible for Medicare reimbursement) during the 12 months prior to this legislative change and the 9 months following it (through September 2024). We will also seek to understand barriers and solutions to fully realize the potential benefits of the new policy for rural populations. Study questions are as follows:
Contacts |
In Progress | HRSA | 2024-08-27" |
| The Emerging Landscape of Rural Family Medicine Residency Training: Defining Models and Assessing Their Value |
Compared with rural background, rural residency training is an even stronger predictor of which... The Emerging Landscape of Rural Family Medicine Residency Training: Defining Models and Assessing Their Value Compared with rural background, rural residency training is an even stronger predictor of which family physicians choose rural practice. Meanwhile, there is growing awareness of the value of rural training and recent legislation seeking to expand rural training positions. Important differences in rural training include where the residency is located (rural or urban), how much rural training residents receive, and whether all or a subset of a program’s residents receive rural training. Experts from the RTT Collaborative and the WWAMI Rural Health Research Center have developed a typology of rural training. It defines rural training as being located in a place that is rural according to at least two federal definitions and delineates six program types:
This study will use this new typology to describe and quantify programs and positions according to model type and compare the models’ relative effectiveness in producing rural physicians.
Contact |
In Progress | HRSA | 2024-08-27" |
| The Impact of Rural Surgery Training on General Surgeon Supply in Rural Communities |
Rural surgeons provide access to surgical care and serve a critical role in supporting primary care... The Impact of Rural Surgery Training on General Surgeon Supply in Rural Communities Rural surgeons provide access to surgical care and serve a critical role in supporting primary care physicians and hospitals in the communities they treat. For decades, workforce analyses have suggested a crisis in access to surgical care in rural populations, with fewer and older surgeons working in rural areas. A growing number of general surgery residencies are addressing these concerns by developing dedicated rotations and training tracks aimed at exposing trainees to rural surgery. In 2015, the WWAMI Rural Health Research Center identified nine general surgery programs that had a mission to produce rural physicians and required at least two months of rural training for some or all of their residents. A 2020 study found that 39 surgery programs had self-identified as having a rural track in the FREIDA™ residency database. And according to the RTT Collaborative, as of July 1, 2023, there were 5 accredited rural general surgery programs out of 362 programs with 17 active rural post-graduate year 1 positions, where a rural program is defined as having its primary hospital in a rural location according to two federal definitions, and residents spend more than 50% of their total time training in a rural place. Four of these programs were rurally located and one was a Rural Track Program (a designation of the Accreditation Council on Graduate Medical Education, ACGME), representing just 1% (17 of 1670) of all first-year positions offered in the General Surgery specialty in 2023 through the National Resident Matching Program. These varied reports illustrate that, depending on the criteria, the number of programs providing rural general surgery training varies widely. Existing surgery program designs and strategies that residencies use to produce rural surgeons have not been well described, nor have their outcomes, including reducing the shortages of surgeons in rural areas. This study seeks to establish baseline knowledge on rural surgery training by answering these questions:
Contact |
In Progress | 2024-08-27" | |
| Barriers and Facilitators to Providing Rural Clinical Training for Health Professions Students and Residents |
Competition for scarce rural clinical training sites is the top barrier preventing nurse... Barriers and Facilitators to Providing Rural Clinical Training for Health Professions Students and Residents Competition for scarce rural clinical training sites is the top barrier preventing nurse practitioner (NP) and physician assistant (PA) education programs from providing rural training to their students. Medical schools and residencies also struggle to find and develop preceptors and teaching sites. Meanwhile, the demand for rural training is increasing as the number of health professions schools and students expands, including those with a rural orientation. Other barriers to rural clinical training include funding for internships, student difficulties traveling to rural sites and affording living expenses, lack of rural housing for students, and lack of available and willing rural preceptors. Anecdotally, educators also report that health system consolidation increasingly means that the decision to precept is made at a distant corporate site rather than locally, as rural facilities merge into larger health systems. Community-based sites for clinical training hold potential, but smaller and more rural sites may lack the resources and capacity to accept students and provide effective training. Factors that are important for enabling health professions education in rural communities include adequate patient volumes and demographic characteristics to support learning about a variety of patients and conditions, funding to attract and develop faculty clinical preceptors, broadband internet access, and availability of student housing. The COVID-19 pandemic resulted in the adoption of distance learning modalities for clinical education that have the potential to support more rural training, but virtual learning strategies cannot substitute for all in-person learning. This combination of challenges and necessary ingredients for successful rural clinical training calls for new models to encourage collaboration between and across disciplines, particularly models that support interprofessional training. This study seeks to understand trends in teaching among family physicians as well as barriers and facilitators to rural training collaborations by answering these questions:
Contact |
In Progress | HRSA | 2024-08-27" |
| Changes in Buprenorphine Prescribing Following the Elimination of the Drug Enforcement Administration X Waiver Requirement |
The opioid epidemic continues to ravage the United States. Though buprenorphine is an effective... Changes in Buprenorphine Prescribing Following the Elimination of the Drug Enforcement Administration X Waiver Requirement The opioid epidemic continues to ravage the United States. Though buprenorphine is an effective medication treatment for opioid use disorder, access to treatment remains challenging, especially for rural patients. Until January 2023, clinicians who wanted to provide buprenorphine were required to obtain a waiver from the Drug Enforcement Administration (DEA). In 2020, the percentage of rural counties without any waivered clinician to prescribe buprenorphine was 36.9%, more than twice the rate in urban counties (15.3%). The removal of the waiver requirement may impact some clinicians’ decisions on whether to add buprenorphine to their practices. Prior research has shown that nearly one in five rural physicians (19.0%) with a DEA waiver to prescribe buprenorphine who reported they were not using their waiver cited concerns of DEA intrusion as a barrier. The requirement to register rather than have a waiver (with a specific patient limit) may mitigate these concerns. Many clinicians will also still be required to take a one-time 8-hour approved training. All prescribers will be required to register with the DEA and check a box to confirm they have met the training requirement or are exempt based on their prior training in addiction medicine. The historically low rate of prescribing buprenorphine and the uncertain impacts of waiver policy change call for continued tracking of the availability of these services for rural patients to identify where treatment gaps exist. This study aims to examine changes in prescribing over time to determine if lifting the requirement has resulted in increased access to buprenorphine by answering the following questions:
Contact |
In Progress | HRSA | 2024-08-27" |
| Disparities in Family Physician Burnout Before and During the COVID-19 Pandemic |
Burnout is commonly understood to manifest as emotional exhaustion, depersonalization, and feelings... Disparities in Family Physician Burnout Before and During the COVID-19 Pandemic Burnout is commonly understood to manifest as emotional exhaustion, depersonalization, and feelings of reduced accomplishment. Studies of physicians have found that burnout can lead to premature exit from the profession as well as severe emotional and physical health consequences, including suicide. Burnout not only has negative consequences for health care professionals but also can result in lower quality of patient care, of particular concern during the COVID-19 pandemic when demand for health professionals has outstripped supply in many areas. High levels of burnout during the COVID-19 pandemic have been documented among health professionals, particularly women and persons from underrepresented groups. This study will examine how burnout has changed from 2019 through 2021 among family physicians as well as how these patterns vary by rural/urban geography, other sociodemographics, and practice characteristics to identify physicians most in need of education and practice interventions to foster resilience and alleviate burnout. Using data from the American Board of Family Medicine, this study examines the following questions:
Davis Patterson, PhD |
In Progress | HRSA | 2022-11-09" |
| Availability, Care Practices, and Quality of Hospice Providers Serving Rural versus Urban Communities |
The Medicare hospice benefit pays for essential services in patient homes and in facilities (e.g.,... Availability, Care Practices, and Quality of Hospice Providers Serving Rural versus Urban Communities The Medicare hospice benefit pays for essential services in patient homes and in facilities (e.g., inpatient hospice and hospitals) to address management of terminal illnesses and related conditions. Overall utilization of hospice has increased over time, but a smaller percentage of rural decedents receive hospice care compared to urban decedents, and disparities in utilization increase as rurality increases. No recent studies have examined variation in hospice availability in rural versus urban communities and during the COVID-19 pandemic. Differences in hospice quality and care practices of providers serving rural versus urban beneficiaries have also not been well studied. To address these gaps in knowledge and provide updated information on rural hospice care, this project will use publicly available, provider-level data on hospice from 2018-2022, including Medicare Compare-Hospice and the Post-Acute Care and Hospice Provider Utilization and Payment Public Use Files, to address the following research questions:
This project will provide a comprehensive picture of hospice availability and provider-level quality and care provision in rural versus urban communities. Findings on potential disparities in care can be used to inform Medicare policy to help ensure rural beneficiaries have access to high-quality hospice services. Contact Tracy Mroz, PhD |
In Progress | HRSA | 2022-11-09" |
| Access to and Provision of Child and Youth Behavioral Health Services in the Rural and Urban U.S. |
Rural counties have a lower per capita supply of behavioral health providers, including... Access to and Provision of Child and Youth Behavioral Health Services in the Rural and Urban U.S. Rural counties have a lower per capita supply of behavioral health providers, including psychologists, psychiatrists, and psychiatric nurse practitioners (NPs), than urban counties. About 10% of all U.S. children and adolescents live in a county with no child psychiatrists or with inadequate broadband to access telepsychiatry. This percentage jumps to half (51.1%) in rural counties. Medicaid data from 2013-2014 show that rural youth are more than twice as likely to be prescribed a new psychotropic medication by a primary care nurse practitioner than by a psychiatrist. As the child and adolescent psychiatrist workforces age (44.2% are 55 years of age or older), understanding the geographic distribution of the behavioral health workforce and services they provide to children and adolescents, particularly in rural areas, is vital to ensure adequate and equitable access to care. To address these gaps in knowledge we will answer the following research questions:
Contact Holly Andrilla, MS |
In Progress | HRSA | 2022-11-09" |
| Palliative Care in the Rural U.S. |
Palliative care aims to increase comfort and quality of life for patients with serious illness... Palliative Care in the Rural U.S. Palliative care aims to increase comfort and quality of life for patients with serious illness while reducing healthcare costs. As the U.S. population ages, demand for palliative care services is growing. Resources to meet growing demand for palliative care remain insufficient, particularly in rural areas. Only 17 percent of rural hospitals with 50 beds or more have palliative care programs. No comprehensive national information exists on the prevalence of palliative care services in smaller rural hospitals, and innovative rural models for providing this care in low resource environments have not been fully described. This study seeks to describe the availability of palliative in rural versus urban hospitals and document emerging palliative care solutions for rural communities. This study will describe the availability of palliative care services in rural hospitals and community settings using data from the American Hospital Association (AHA), interviews with palliative care providers from small rural hospitals that provide palliative care services, and a survey of rural hospitals without palliative care services. Study findings can help inform policy initiatives to ensure that rural populations have access to palliative care. Contact Davis Patterson, PhD
|
Complete | HRSA | 2022-02-24" |
| Specialist Physicians in the Rural and Urban U.S.: Supply, Distribution, and Access |
A shortage of physicians in rural areas has been reported for decades, but trends in the geographic... Specialist Physicians in the Rural and Urban U.S.: Supply, Distribution, and Access A shortage of physicians in rural areas has been reported for decades, but trends in the geographic variability in specialist physician supply and distribution and types of communities suffering shortages of specialty have not been well documented. A recent WWAMI RHRC study of Medicare beneficiaries found that residents of remote rural places had median one-way travel times that exceeded 30 minutes to obtain care for conditions including heart disease and cancer. Rural Health Clinics have reported lack of access to specialists as their most common difficulty in making timely referrals. This study will describe changes over time in the supply and distribution of specialist that provide care for conditions that account for the leading four causes of rural mortality: heart disease (cardiology), cancer (oncology and various surgical subspecialties), chronic lower respiratory disease (pulmonology), and stroke (neurology). We will also interview rural health system leaders in remote communities to understand how rural patients with these conditions access appropriate specialty care. Tracking trends in local physician supply and alternatives will help to inform the development of realistic policy solutions to address disparities in accessing specialty care. Contact Davis Patterson, PhD |
In Progress | HRSA | 2022-02-24" |
| Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents: Exploring Changes in the Past 15 Years |
Previous WWAMI RHRC research found that rural adults see dental providers less frequently and have... Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents: Exploring Changes in the Past 15 Years Previous WWAMI RHRC research found that rural adults see dental providers less frequently and have higher odds of permanent tooth loss than adults in urban areas. Rural adults also have higher rates of dental caries. Lower dentists-to-population supply contribute to these oral health outcomes. Compared to the population’s distribution, dentists are significantly underrepresented within rural counties, especially in smaller and more isolated locations. This national study will revisit the issue of dental supply and updates data that is more than a decade old on whether adults in rural locations report lower dental care utilization, a higher prevalence of dental disease or both compared to those in urban locations after accounting for demographic, socioeconomic and other factors. We will also explore disparities by socioeconomic status and racial/ethnic background to investigate and document differences at a time when systemic racial disparities have been exposed in the health care system. Contact C. Holly A. Andrilla, MS |
In Progress | HRSA | 2022-02-24" |
| Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder and Medicaid Insurance Across the U.S. |
Opioid use disorder (OUD) and opioid-related overdose deaths are on the rise in rural areas. Rural... Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder and Medicaid Insurance Across the U.S. Opioid use disorder (OUD) and opioid-related overdose deaths are on the rise in rural areas. Rural communities face unique challenges in accessing treatment for OUD. Buprenorphine is an effective medication treatment for opioid use disorder (MOUD). A major benefit of buprenorphine over other currently available MOUDs, such as methadone, is that it can be provided in office-based settings rather than in certified opioid treatment programs, which are less available in rural places. Since 2016, the number of rural clinicians who are waivered by the DEA to be able to prescribe buprenorphine has doubled. Yet, many rural patients are not able to access care. Medicaid covers about a quarter of rural adults, yet little is known about the care provided to rural patients covered by Medicaid insurance for OUD. This study will use Medicaid claims data to 1) describe the workforce that is caring for rural (including micropolitan adjacent, micropolitan non-adjacent and small and remote rural counties) versus urban populations with OUD covered by Medicaid insurance, treatments received, (including medications (e.g. buprenorphine, naltrexone) and cognitive therapy) and retention in treatment (duration); (2) explore regional differences in care for urban and rural patients with Medicaid insurance; (3) compare care received by patients living in counties with and without a waivered clinician; (4) compare the distance and time that patients from micropolitan adjacent, micropolitan non-adjacent and small and remote rural counties travel for OUD care compared to urban patients; and (5) compare the cost of treatment for patients with OUD from rural and urban areas. Analyses will also compare NP prescribing practices in states that require NP supervision by physicians with those that allow NPs to prescribe autonomously. Our analysis will also provide helpful insights about where and from whom low-income rural patients with OUD receive care (such as psychosocial support) in the absence of a comprehensive OUD treatment workforce in their local communities. Contact C. Holly A. Andrilla, MS |
In Progress | HRSA | 2022-02-24" |
| Methamphetamine Use, Mental Health Comorbidities, and Treatment in Rural and Urban Areas |
Methamphetamine (meth) use has been on the rise in rural and urban areas of the U.S., but more so... Methamphetamine Use, Mental Health Comorbidities, and Treatment in Rural and Urban Areas Methamphetamine (meth) use has been on the rise in rural and urban areas of the U.S., but more so in rural areas. Meth use is also unevenly distributed across U.S. regions, with more in the West, but pockets of growing meth use are emerging in other regions as well. Alarm is growing about meth use as a serious public health problem, particularly because there are no proven treatments for meth addiction. National trend data are available on meth use, but information at the subnational level has been lacking to inform regional and local policy. This study aims to identify hotspots and trends in rural versus urban meth use, including analyses within sub-rural geographies and U.S. regions to allow better targeting of resources for prevention and treatment. We will also examine meth use in combination with other substances (opioids and alcohol), mental health comorbidities, and perceived need for and receipt of treatment by people who use meth and those with meth use disorder. We will use 2016-2018 data from the National Survey on Drug Use and Health (NSDUH) to characterize meth use, treatment, and association with other mental health comorbidities. Contact |
In Progress | HRSA | 2021-07-16" |
 How Can We Support Rural-Centric Residency Programs as Unified ACGME Accreditation Approaches in 2020? |
The Accreditation Council for Graduate Medical Education (ACGME) will be the single accrediting... How Can We Support Rural-Centric Residency Programs as Unified ACGME Accreditation Approaches in 2020? The Accreditation Council for Graduate Medical Education (ACGME) will be the single accrediting body for all osteopathic and allopathic residencies beginning in 2020. All small and rural residencies face vulnerabilities in achieving and maintaining accreditation, but osteopathic residencies may now be particularly challenged. Through a review of ACGME applications, interviews, and a survey of programs, this study seeks to identify challenges as well as resources and solutions that can support rural and small residency programs in primary care and several other specialties critical to rural communities. This study was conducted by the Collaborative for Rural Primary care Research, Education, and Practice (Rural PREP), a HRSA-funded project of the University of Washington, Ohio University, and the University of North Dakota. For more information, contact Davis Patterson, PhD |
In Progress | HRSA | 2021-06-24" |
| Recruitment to Rural Residency Programs: Match Rates and Best Practices |
This study explores the history of National Residency Matching Program (NRMP) match rates for... Recruitment to Rural Residency Programs: Match Rates and Best Practices This study explores the history of National Residency Matching Program (NRMP) match rates for rurally located family medicine residency programs over the past 25 years (1995-2020) in an effort to examine the widely held perception that low match rates equate to unfavorable program outcomes and to identify successful recruitment strategies for rural programs and for recruitment to rural practice generally. This study was conducted by the Collaborative for Rural Primary care Research, Education, and Practice (Rural PREP), a HRSA-funded project of the University of Washington, Ohio University, and the University of North Dakota. For more information contact Randall Longenecker, MD |
Complete | HRSA | 2021-05-24" |
| Routes to Rural Readiness: Enhancing Recruitment and Retention of Nurse Practitioners in Rural Primary Care Through Residencies |
This study examined the purpose and characteristics of rural NP residencies (postgraduate programs)... Routes to Rural Readiness: Enhancing Recruitment and Retention of Nurse Practitioners in Rural Primary Care Through Residencies This study examined the purpose and characteristics of rural NP residencies (postgraduate programs) that aim to promote the successful recruitment, transition, and retention of NPs in rural primary care practice. We compiled a list of rural NP residencies and verified the location of each clinic as rural if it met any of several federal definitions of rurality. We interviewed grant and project administrators, residency program directors, clinic personnel, and former and current NP residents. Of 20 rural NP residencies identified, we interviewed 12 program directors or managers. All but 1 program was 12 months long. Three-quarters had federal funding. Each slowly increased residents’ patient load and included didactic content and specialty rotations. We identified 2 different program models and 3 administrative models. Some NPs’ intentionally chose rural practice, while others opted for a rural residency when unable to secure employment in an urban location. Most programs were new and not yet able to report on residents’ subsequent employment locations. It is premature to conclude definitively that rural NP residencies facilitate and promote NP connectedness to, and investment in, rural communities based on our investigation. Nonetheless, these programs are an option to encourage the recruitment and retention of NPs in rural practice, with further study needed to determine their long-term contribution to rural primary care practice. For a list of rurally oriented NP programs, visit the RTT Collaborative: https://rttcollaborative.net/rural-programs/ Kaplan L, Pollack SW, Skillman SM, Patterson DG. Is being there enough? Postgraduate nurse practitioner residencies in rural primary care. J Rural Health. Preprint posted online November 28, 2022. https://doi.org/10.1111/jrh.12729 Read the full article https://doi.org/10.1111/jrh.12729 For more information contact Louise Kaplan, PhD, ARNP, FNP-BC, FAANP, FAAN |
Complete | HRSA | 2021-05-24" |
| The Impact of Telepsychiatry Services on the Training of Rural Primary Care Teams in Integrated Behavioral Healthcare |
There is a shortage of rural primary care personnel with expertise in team care for patients with... The Impact of Telepsychiatry Services on the Training of Rural Primary Care Teams in Integrated Behavioral Healthcare There is a shortage of rural primary care personnel with expertise in team care for patients with common mental disorders. Building the workforce for this population is a national priority. In this study we investigated the feasibility of regular systematic case reviews through telepsychiatric consultation, within collaborative care for depression, as a continuous training and workforce development strategy in rural clinics. Weekly systematic case reviews using telepsychiatric consultation served both as a model for patient care and as a training and workforce development strategy in rural primary care sites delivering collaborative care. These are important benefits to consider in implementing the collaborative care model of behavioral health integration. This study was conducted by the Collaborative for Rural Primary care Research, Education, and Practice (Rural PREP), a HRSA-funded project of the University of Washington, Ohio University, and the University of North Dakota. For more information contact: Ian Bennett, MD |
Complete | HRSA | 2021-05-24" |
| Measuring the Commitment of Health Professions Schools to Rural Primary Care |
Despite some medical schools’ stated intentions to produce rural or primary care physicians,... Measuring the Commitment of Health Professions Schools to Rural Primary Care Despite some medical schools’ stated intentions to produce rural or primary care physicians, these health professionals remain in short supply. This study describes the rurally oriented organizational and educational factors of U.S. medical schools. The research team conducted a search of publicly available data and compiled information on rurally relevant characteristics of all 182 allopathic and osteopathic medical schools operating in the 50 states and the District of Columbia in 2016 and updated in 2019 (see article below). Few medical schools (8.2%) expressed an explicit commitment to producing rural physicians in public mission statements. However, most (64.8%) provided rural clinical experiences and many demonstrated their commitment in other ways. Only 39 (21.4%) did so through a formal rural program. A forthcoming companion paper will report on data from the American Medical Association to examine which U.S. medical schools produce high proportions of rural primary care physicians and the factors that predict that output. This study was conducted by the Collaborative for Rural Primary care Research, Education, and Practice (Rural PREP), a HRSA-funded project of the University of Washington, Ohio University, and the University of North Dakota. For more information contact: Randall Longenecker MD |
In Progress | HRSA | 2021-05-24" |
| Routes to Rural Readiness: Enhancing Clinical Training Experiences for Nurse Practitioner Practice in Rural Primary Care |
Advanced practice registered nurses (APRNs) provide vital care in rural and safety-net settings.... Routes to Rural Readiness: Enhancing Clinical Training Experiences for Nurse Practitioner Practice in Rural Primary Care Advanced practice registered nurses (APRNs) provide vital care in rural and safety-net settings. This study identifies, describes, and compares the approaches of rural-oriented NP education programs to facilitate the NP transition from education to practice in rural settings. Preparing NP students effectively during their education may be key to their success in rural practice. In addition, because research regarding effective strategies for recruiting and retaining rural or safety-net providers often focuses on physicians or combinations of health care professionals, we also conducted a scoping review using MEDLINE and CINAHL to identify effective strategies and research gaps specific to recruiting and retaining APRNs in rural and safety-net settings. We found 13 articles published between 1990 and 2019. Educational experiences and loan repayment obligations influenced APRNs to seek employment in both types of settings. Rural connectedness or satisfaction with the community, having a mentor and supportive work environment, and salary and benefits influenced retention in rural practice. Post-graduate NP residency and an NP-physician team-based care model influenced retention in safety-net settings. We found a limited quantity of evidence for strategies that encourage a strong rural and safety-net APRN workforce, indicating need for additional research. This study was conducted by the Collaborative for Rural Primary care Research, Education, and Practice (Rural PREP), a HRSA-funded project of the University of Washington, Ohio University, and the University of North Dakota. For more information contact: Louise Kaplan, PhD, ARNP, FNP-BC, FAANP, FAAN |
Complete | HRSA | 2021-05-24" |
| How Can We Strengthen Rural Opportunities in K-16 Education to Promote Primary Care Health Careers? |
Health career pathway programs can promote and prepare rural students in grades kindergarten... How Can We Strengthen Rural Opportunities in K-16 Education to Promote Primary Care Health Careers? Health career pathway programs can promote and prepare rural students in grades kindergarten through college (K–16) for health careers, but little is known about the prevalence and characteristics of these programs in the U.S. This mixed-methods study provides a baseline description of health career pathway programs for rural K–16 students through a scoping review, survey, and semi-structured interviews with program directors. Among 165 programs responding to the survey, motivational or health career awareness (95.1%), health care exposure (92.0%), and mentorship (70.2%) were the most commonly used strategies. About one-third of programs (34.6%) had discontinued at least one strategy in the past three years, often due to loss of funding or a change in priorities. While reported outcomes suggested positive program effects, evaluations lacked rigor to draw definitive conclusions about program success. This study serves to generate hypotheses for further studies examining characteristics of student participants, program strategies and activities, and outcome measurement for health career pathway programs. This study was conducted by the Collaborative for Rural Primary care Research, Education, and Practice (Rural PREP), a HRSA-funded project of the University of Washington, Ohio University, and the University of North Dakota. Contact: |
Complete | HRSA | 2021-05-24" |
| Are Family Physicians Trained in Small Rural Residencies of Comparable Quality to Family Physicians Overall? |
Because residency location is a strong determinant of eventual practice location, residency... Are Family Physicians Trained in Small Rural Residencies of Comparable Quality to Family Physicians Overall? Because residency location is a strong determinant of eventual practice location, residency training in rural communities is critical for meeting rural workforce needs. Yet the quality of training and medical care provided by graduates of small rural family medicine residency programs is sometimes questioned. Using data from the American Board of Family Medicine, this study seeks to demonstrate the value of rural training by examining how graduates of small rural family medicine programs compare with other family medicine residency graduates on ratings of competence and medical knowledge, current scope of practice, and output to rural practice. This study was conducted by the Collaborative for Rural Primary care Research, Education, and Practice (Rural PREP), a HRSA-funded project of the University of Washington, Ohio University, and the University of North Dakota. For more information contact: Davis Patterson, PhD |
Complete | HRSA | 2021-05-24" |
| Routes to Rural Readiness: Enhancing Rural Clinical Training Experiences for Physician Assistants |
Rural provider shortages in primary care can be alleviated by encouraging and supporting physician... Routes to Rural Readiness: Enhancing Rural Clinical Training Experiences for Physician Assistants Rural provider shortages in primary care can be alleviated by encouraging and supporting physician assistants (PAs) to practice in rural areas. This study will survey and interview PA program directors to describe the approaches of rurally oriented PA programs as well as the availability and varying models of rural clinical training in the most successful programs. This study was conducted by the Collaborative for Rural Primary care Research, Education, and Practice (Rural PREP), a HRSA-funded project of the University of Washington, Ohio University, and the University of North Dakota. For more information contact: Eric Larson, PhD |
Complete | HRSA | 2021-05-24" |
| Targeted Medical School Admissions: A Strategic Process for Meeting Our Social Mission |
Increased medical school class sizes and new medical schools have not addressed the workforce... Targeted Medical School Admissions: A Strategic Process for Meeting Our Social Mission Increased medical school class sizes and new medical schools have not addressed the workforce issues in rural communities. This study examined the admissions policies of U.S. allopathic and osteopathic medical schools that target applicants likely to enter rural practice. We surveyed Deans of Admissions about their schools’ targeted admissions strategies aimed at recruitment and selection of students likely to practice rurally. To gain deeper insight into the admissions policies, we conducted interviews with key medical schools. 133 of 185 (71.8%) U.S. medical schools responded to our survey. Most respondents (69.2%) reported a targeted process to recruit and select students likely to practice in a rural setting, indicating widespread awareness of workforce challenges. This study demonstrated varying approaches to and allocation of resources towards admissions targeting, especially the application and interviewing processes, with the more resource-intensive efforts occurring less commonly. Interviews with personnel from 10 schools identified key themes pertaining to motivations for targeted admissions strategies, needed resources, challenges to success, and recommendations for schools contemplating admissions changes. This study was conducted by the Collaborative for Rural Primary care Research, Education, and Practice (Rural PREP), a HRSA-funded project of the University of Washington, Ohio University, and the University of North Dakota. Contact: |
Complete | HRSA | 2021-04-27" |
| The Current Distribution of the General Surgery Workforce in Rural America |
The United States is in a long-standing and worsening shortage of general surgeons. While the... The Current Distribution of the General Surgery Workforce in Rural America The United States is in a long-standing and worsening shortage of general surgeons. While the number of physicians (including the number of general surgeons) has increased over the past fifteen years, the supply of general surgeons per 100,000 population has decreased. The effect of this shortage is felt strongly in rural areas of the nation, where the shortages are likely to be far more pronounced than those in urban areas, and where residents are less likely to have local alternatives when in need of surgical services. General surgeons contribute substantially to the financial viability of rural hospitals and provide essential backup to rural primary care physicians especially in the areas of emergency surgery and obstetrical, gynecological, and orthopedic procedures. Rural populations clearly bear a disproportionate share of the burden of poor local access to surgical services and the concomitant higher risk of poor outcome or death. This project describes the supply and geographic distribution of general surgeons across rural/urban, intra-rural area types and regions using the American Medical Association (AMA) Physician Masterfile data and Claritas population data to calculate general surgeon/population ratios. Contact |
Complete | HRSA | 2021-03-16" |
| Examining the Potential Impact of Multiple Payment Policies on Rural versus Urban Home Health Agencies |
Home health agencies are navigating several new and upcoming Medicare payment policy changes. These... Examining the Potential Impact of Multiple Payment Policies on Rural versus Urban Home Health Agencies Home health agencies are navigating several new and upcoming Medicare payment policy changes. These changes include 1) revised targeting and beginning of phase out of rural add-on payments which became effective in 2019; 2) the Patient-Driven Groupings Model (PDGM), a new prospective payment system scheduled to be implemented in 2020; and 3) the Home Health Value-Based Purchasing (HHVBP) demonstration. All Medicare-certified home health agencies (~12,000) serving fee-for-service beneficiaries will be impacted by the PDGM. The revised rural add-on payments impact all home health agencies that serve rural beneficiaries. About 2,000 home health agencies are currently participating in the HHVBP demonstration, of which 13% are rurally located. The cumulative impact of these policies on home health agencies has not been explored. The proposed study will estimate the cumulative impact on home health agencies, comparing home health agencies operating under one, two, or all three policies. We hypothesize there will be differential impacts based on rural-urban status, community factors, and home health agency characteristics. We will estimate and report impacts by rural-urban status, community factors, and home health agency characteristics. We will compare the cumulative impacts with the separate impacts of the three individual payment policy changes. We will then identify rural counties where access to and/or quality of home health care may be most impacted by the cumulative payment policy changes. Contact |
Complete | HRSA | 2021-03-16" |
| What is the Geographic Distribution of the Workforce with a DEA Waiver to Prescribe Buprenorphine? |
This study found that the number of clinicians with a Drug Enforcement Agency (DEA) waiver to... What is the Geographic Distribution of the Workforce with a DEA Waiver to Prescribe Buprenorphine? This study found that the number of clinicians with a Drug Enforcement Agency (DEA) waiver to provide medication treatment for opioid use disorder (MOUD) more than doubled from December 2017 to July 2020, from 37,869 to 98,344. The availability of DEA-waivered clinicians has increased across all geographic categories. Nearly two thirds of all rural counties (63.1%) had at least one clinician with a DEA waiver but more than half of small and remote rural counties had none. There were also significant differences in access by US Census Division. The study found that the substantial expansion in the number and types of providers who can prescribe buprenorphine, combined with the increased number of patients waivered clinicians can treat at one time, offers significant, but not fully realized, potential to curtail the OUD epidemic in rural communities. Contact |
Complete | HRSA | 2021-03-16" |
| Overcoming Barriers to Providing Rural Obstetrical Training for Physicians |
Rural communities face diminishing availability of obstetrical (OB) services. Nearly a third of... Overcoming Barriers to Providing Rural Obstetrical Training for Physicians Rural communities face diminishing availability of obstetrical (OB) services. Nearly a third of rural counties in 2019 had no OB clinicians. Family physicians are the most common health professional providing rural OB care, but more than half of rural counties had no family physicians who delivered babies in 2019, and this number is declining. Delivery by family physicians is associated with lower rates of caesarian section births, indicating that this workforce is important not only to increase rural access to OB care, but also to improve quality and reduce costs. Meanwhile, the U.S. is experiencing a national shortage of obstetricians and gynecologists (OB-GYNs), again more acutely in rural areas. How widespread rural OB training is and how expansion of this training can best be supported are not well understood. This study seeks to describe the availability, characteristics, and output of rural OB training programs, including family medicine residencies and OB fellowships. We identify barriers, facilitators, and solutions to support rural OB training. Study findings can help policymakers and rural health professional educators develop new initiatives to help ensure the availability of a robust rural OB workforce. Lead researcherHealthcare access Maternal Health Women |
Complete | HRSA | 2020-10-23" |
| Trends in Health Workforce Supply in the Rural U.S. |
This study describes the supply and distribution of selected health professionals in the rural U.S.... Trends in Health Workforce Supply in the Rural U.S. This study describes the supply and distribution of selected health professionals in the rural U.S. nationally, and within Census Divisions, providing a nuanced description of the variability in supply and geographic distribution. We also examine historic variation, overall and per capita, in rural/urban, regional, and intra-rural supply using several data sources, such as the Area Health Resource File (AHRF), the National Plan and Provider Enumeration System (NPPES), and Urban Influence Codes (UICs). Depending on data availability, health professionals to be analyzed include primary care physicians, nurse practitioners, physician assistants, dentists, behavioral health providers (including psychiatrists, psychologists, psychiatric nurse practitioners, social workers, and counselors), obstetric providers (including obstetricians, advanced practice midwives, and midwives) and specialist physicians (overall and individual specialties not listed previously, including general surgeons). Tracking the trends in the rural workforce will allow for the development of solutions to address access disparities. We also identify gaps in data availability by profession and time period as a spur to promoting improved data collection and reporting on the rural health workforce. Lead researcherbehavioral health Healthcare access Nurse and nurse practitioners physician assistants workforce |
In Progress | HRSA | 2020-10-23" |
| Comparing Utilization and Quality of Home Health Care Between Medicare Fee-for-Service and Medicare Advantage Beneficiaries by Rural-Urban Status |
This study uses new Medicare Advantage (MA) encounter data from the Centers for Medicare &... Comparing Utilization and Quality of Home Health Care Between Medicare Fee-for-Service and Medicare Advantage Beneficiaries by Rural-Urban Status This study uses new Medicare Advantage (MA) encounter data from the Centers for Medicare & Medicaid Services (CMS) combined with Medicare Fee-for-Service (FFS) data and publicly available data on home health agencies. We examine differences in home health care use, including services within home health episodes, and receipt of care from high-quality home health agencies, comparing beneficiaries enrolled in MA versus FFS by rural-urban status and geographic region. Analyses also examine intra-rural variation and differences by MA plan type. Results have important policy implications as MA enrollment grows and MA plans explore greater flexibility in offering home-based services than the FFS program. In addition, incentives for serving rural FFS beneficiaries will decrease and sunset in three years, and a new FFS home health payment system started in CY2020. Understanding baseline differences in home health care between MA and FFS beneficiaries across the rural-urban continuum will help inform future policy initiatives for both programs from the perspective of rural beneficiaries and providers, a key component of CMS’s rural health strategy. Lead researcheraging allied health professionals health disparities and health equity health services Healthcare access healthcare financing Home health Medicare medicare advantage Post-acute Care |
In Progress | HRSA | 2020-10-23" |
| Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder Across the U.S. |
This study uses health care claims data to (1) describe the workforce that is caring for rural... Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder Across the U.S. This study uses health care claims data to (1) describe the workforce that is caring for rural (including large rural, small rural and isolated small rural) versus urban populations with OUD, treatments received, (including medication and cognitive therapy) and retention in treatment (duration); (2) explore regional differences in care for urban and rural patients; (3) compare the care received by patients living in counties with and without Drug Enforcement Agency (DEA)-waivered providers; (4) compare the distance and time that patients from large, small and isolated small rural places travel for opioid use disorder (OUD) care compared to urban patients and (5) compare the cost of treatment for patients with OUD from rural and urban areas. Analyses will also compare nurse practitioner (NP) prescribing practices in states that require NP supervision by physicians with those that allow NPs to prescribe autonomously. Findings from this study can be used to improve national and state policies regarding the DEA waiver to prescribe buprenorphine and scope of practice, which could improve access for rural and other disadvantaged populations. Our analysis will also provide helpful insights about where and from whom rural patients with OUD receive care (such as psychosocial support) in the absence of a comprehensive OUD treatment workforce in their local communities. Lead researcherbehavioral health Health Services Healthcare access healthcare financing Mental health Nurse and nurse practitioners physician assistants Substance use and treatment telehealth |
In Progress | HRSA | 2020-10-23" |
| Impact of COVID-19 on Cancer-Related Health Behaviors in Rural Cancer Patients and Rural Cancer Survivors |
The COVID-19 global pandemic has had an unprecedented impact on the lives of almost every resident... Impact of COVID-19 on Cancer-Related Health Behaviors in Rural Cancer Patients and Rural Cancer Survivors The COVID-19 global pandemic has had an unprecedented impact on the lives of almost every resident of the United States. The subsequent public health mitigation strategies, including social distancing measures, are effectively reducing transmission of the COVID-19 virus, but may have negative impact on behaviors important for cancer patients and cancer survivors (e.g., adhering to cancer treatment or cancer surveillance, physical activity, healthy diet, or alcohol consumption). Because rural cancer patients and rural cancer survivors already have significant barriers to accessing cancer care and engaging in healthy behaviors, the impact of COVID-19 social distancing measures may be even more pronounced in these settings. The purpose of this study is to conduct a cross-sectional survey of 800 (400 rural, 400 non-rural) cancer patients and cancer survivors in Washington state to measure non-adherence to cancer care and explore the degree to which COVID-19 social distancing measures are associated with non-adherence to cancer care and unhealthy cancer-related health behaviors for rural and non-rural participants. The results of this study will be critical in helping understand the potentially negative health impact of COVID-19 for rural cancer patients (a particularly vulnerable group) and provide guidance to public health professionals and policy makers to develop strategies to reduce the negative health impact. Lead researcher |
In Progress | National Cancer Institute | 2020-09-05" |
| The Supply and Rural-Urban Distribution of the Obstetrical Care Workforce in the U.S. |
Monitoring the rural and urban supply and distribution of clinicians who provide obstetrical (OB)... The Supply and Rural-Urban Distribution of the Obstetrical Care Workforce in the U.S. Monitoring the rural and urban supply and distribution of clinicians who provide obstetrical (OB) services is important for identifying areas that may lack access to OB care and identifying solutions. This brief describes the supply and geographic distribution of four types of OB care clinicians – obstetricians, advanced practice midwives, midwives (not advanced practice), and family physicians – using data from the 2019 National Plan and Provider Enumeration System and the American Board of Family Medicine. We provide estimates of each clinician type per 100,000 women of child-bearing age (15 through 49 years), describing supply and distribution for rural versus urban counties and among rural counties, micropolitan versus non-core counties. Our findings reveal that significant disparities exist between rural and urban areas in the supply of clinicians who provide OB services. Lead Researcher: Davis Patterson PhD |
Complete | HRSA | 2018-10-17" |
| The Supply and Distribution of the Primary Care Health Workforce in Rural America |
Chronic and sometimes severe shortages of primary care providers in rural areas of the U.S. have... The Supply and Distribution of the Primary Care Health Workforce in Rural America Chronic and sometimes severe shortages of primary care providers in rural areas of the U.S. have challenged rural communities for decades. Primary care shortages especially threaten health and healthcare in rural communities in part because rural populations depend on primary care providers in ways that urban populations do not. Rural primary care providers deliver a wider range of medical services than their urban counterparts, coordinate care that must be obtained in other locations, and have an essential role in connecting patients to specialty services that are unavailable locally. The geographic maldistribution of primary care providers across rural areas creates particularly acute shortages in some regions and some types of rural areas, while other rural areas are relatively well supplied. This study examines the 2019 supply and geographic distribution of primary care physicians, nurse practitioners, and physician assistants across rural areas of the U.S. We used 2019 primary care provider data from National Plan and Provider Enumeration System linked to county-level Urban Influence Codes and 2019 Claritas population data to calculate provider-to-population ratios for each provider type in all U.S. non-metropolitan counties. We compared supply between metropolitan, micropolitan, and non-core counties for each provider types. Findings are presented in a series of national maps, tables, and charts. (Individual state-level analyses are also available.) Nationally, the provider-to-population ratio of family physicians is slightly higher in rural than urban areas, but the overall per capita supply of primary care providers remains substantially lower in rural areas than urban areas. About 5% of rural counties, mostly non-core counties, have no family physicians. Maldistribution of primary care providers continues to exacerbate primary care provider shortages in some rural areas, especially in more remote non-core counties. Lead Researcher: Eric H. Larson, PhD |
Complete | HRSA | 2018-10-17" |
| Understanding the Prescribing Practices of Rural Nurse Practitioners and Physician Assistants with a DEA Waiver to Prescribe Buprenorphine |
The United States is in the midst of a severe and tragic opioid abuse epidemic. In 2015 more than 2... Understanding the Prescribing Practices of Rural Nurse Practitioners and Physician Assistants with a DEA Waiver to Prescribe Buprenorphine The United States is in the midst of a severe and tragic opioid abuse epidemic. In 2015 more than 2 million Americans suffered from pain reliever disorder and more than half a million were using heroin. In 2016, an estimated 42,249 Americans died of an opioid drug overdose. Data suggest that rural areas are disproportionately impacted. Both death rates and non-medical use of prescription drugs have been rising more rapidly in rural than urban areas. The most effective treatment options for opioid use disorder (OUD) include buprenorphine-naloxone, a medication differing from methadone in that office-based physicians, nurse practitioners (NPs) and physician assistants (PAs) with a Drug Enforcement Administration (DEA) waiver can prescribe it. Several recent WWAMI RHRC studies have found a paucity of physicians located in rural areas who have a DEA waiver to prescribe buprenorphine as an office-based outpatient treatment for OUD and a relatively low percentage of physicians with a waiver who are prescribing, as well as described the barriers physicians report in providing this service. More than half of rural US counties (and 44% of all counties) lack even a single waivered provider. Additionally, the presence of a provider who has obtained a DEA waiver in a county does not necessarily mean that buprenorphine treatment is available there. In a recent national survey of rural physicians with a DEA waiver, more than half (53%) of physicians with the initial 30-patient waiver reported they were not treating any patients. No study has looked at the prescribing patterns of NPs and PAs in rural America who obtained a DEA waiver as allowed under the Comprehensive Addiction and Recovery Act. Other treatment options such as Opioid Treatment Centers are available in urban areas but are not readily available in rural locations. This study will extend our past work, describing the availability of office-based outpatient treatment for OUD in rural areas by surveying all rural NPs and PAs with a DEA waiver to prescribe buprenorphine. The survey will seek to quantify the number of rural NPs and PAs currently providing treatment, the number of patients being treated, and factors that facilitate or discourage these providers from offering treatment. |
Complete | HRSA | 2018-10-17" |
| Post-acute Care Quality for Rural Medicare Beneficiaries |
Over one-third of Medicare beneficiaries are discharged to post-acute care following inpatient... Post-acute Care Quality for Rural Medicare Beneficiaries Over one-third of Medicare beneficiaries are discharged to post-acute care following inpatient hospitalization, with initial post-acute care services provided by skilled nursing facilities and home health agencies about 80% of the time. Post-acute care is also a key driver of geographic variation in Medicare spending. Due to wide geographic variation in utilization, costs, and quality of post-acute care for Medicare beneficiaries, CMS is implementing value-based purchasing programs for skilled nursing facilities and home health agencies to incentivize high quality, efficient care. The skilled nursing facility value-based purchasing program started in 2017 and includes all Medicare-certified skilled nursing facilities across the country. The home health value-based purchasing demonstration started in 2016 and includes all Medicare-certified home health agencies in nine states. A nationwide home health value-based purchasing program is slated to launch by 2022. Both value-based purchasing programs include rural providers. Yet little is known about quality of care specifically among rural post-acute care providers and with respect to urban providers. Since rural post-acute care providers face unique challenges in delivering care and rural post-acute patients are often sicker and at higher risk for poor outcomes, rural providers may be at greater risk for penalties under value-based purchasing programs. Rural post-acute care providers that have Medicare payments substantially decreased for poor performance may not have the resources necessary to implement quality improvement initiatives to avoid further penalties. While high-quality care must remain a key goal for all providers, reductions in payments may disproportionately impact some rural providers, which in turn may exacerbate disparities for rural beneficiaries. Lead Researcher: Tracy Mroz, PhD |
Complete | HRSA | 2018-10-17" |
| What Are Best Practices for Providing Buprenorphine Maintenance Treatment in Rural Primary Care? |
Not all physicians with a Drug Enforcement Agency waiver to prescribe buprenorphine actually... What are Best Practices for Providing Buprenorphine Maintenance Treatment in Rural Primary Care? Not all physicians with a Drug Enforcement Agency waiver to prescribe buprenorphine actually provide this treatment or fully utilize their waiver capacity. This project will interview physicians successfully using their waivers to identify best practices for prescribing buprenorphine treatment for Opioid Use Disorder. |
Complete | HRSA | 2018-04-20" |
| Do Rural Breast and Colorectal Cancer Patients Present at More Advanced Disease Stages than their Urban Counterparts? |
This project used the Surveillance, Epidemiology and End Results Program (SEER) data set to examine... Do Rural Breast and Colorectal Cancer Patients Present at More Advanced Disease Stages than their Urban Counterparts? This project used the Surveillance, Epidemiology and End Results Program (SEER) data set to examine the extent to which rural residents present at more advanced disease stages for breast and colorectal cancer diagnosis when compared to urban residents. We found:
|
Complete | HRSA | 2018-04-20" |
| Who Provides Mental Health Services to Rural Medicare Beneficiaries? |
This study described the provider workforce that cares for rural elderly patients with... Who Provides Mental Health Services to Rural Medicare Beneficiaries? This study described the provider workforce that cares for rural elderly patients with depression/anxiety. It also described regional and rural-urban variation in mental health care provision. |
Complete | HRSA | 2018-04-20" |
| Post-Acute Care Trajectories for Rural Medicare Beneficiaries |
This study examined post-acute care utilization for rural Medicare beneficiaries following acute... Post-acute Care Trajectories for Rural Medicare Beneficiaries This study examined post-acute care utilization for rural Medicare beneficiaries following acute hospitalization. Post-acute care services help patients transition from hospitalization in acute care facilities to their homes. Post-acute care services include skilled nursing, rehabilitation, and medical social work services designed to help patients maximize their functional abilities and return safely to community living. Skilled nursing facilities and home health agencies provide the vast majority of post-acute care services to Medicare beneficiaries. Yet, post-acute care services for rural Medicare beneficiaries specifically have not been well documented, despite the unique challenges of providing post-acute care in rural communities and possible limitations accessing these services. Even less is known about whether rural Medicare beneficiaries with planned discharges to post-acute care providers actually receive those services. This project uses Medicare administrative data to describe the most common types of care trajectories among rural beneficiaries following discharge from acute hospitalization and compares planned versus actual discharges to skilled nursing facilities and home health agencies following acute hospitalization. |
Complete | HRSA | 2018-04-20" |
| Increasing the Supply of Providers with a Drug Enforcement Agency Waiver to Treat Opioid Addiction in Rural America – Possible Effects of Permitting Physician Assistants and Nurse Practitioners to Prescribe Buprenorphine |
This study will investigate the possible effects on rural access to treatment for opioid use... Increasing the Supply of Providers with a Drug Enforcement Agency Waiver to Treat Opioid Addiction in Rural America – Possible Effects of Permitting Physician Assistants and Nurse Practitioners to Prescribe Buprenorphine This study will investigate the possible effects on rural access to treatment for opioid use disorder if Drug Enforcement Administration (DEA) waivers to prescribe buprenorphine as an office-based outpatient treatment for opioid addiction were available to Physician Assistants (PAs) and Nurse Practitioners (NPs). Better understanding of the potential additional workforce available to treat the devastating opioid use epidemic will allow policy makers to make informed decisions on expanding waiver eligibility. |
Complete | HRSA | 2018-02-03" |
| Geographic Access to Health Care for Rural Medicare Beneficiaries: An Update and National Look |
Rural residents generally use fewer medical services, travel farther for care and often have more... Geographic Access to Health Care for Rural Medicare Beneficiaries: An Update and National Look Rural residents generally use fewer medical services, travel farther for care and often have more problems accessing medical and surgical specialists than their urban counterparts. These issues can be particularly problematic for older rural Medicare beneficiaries who need specialist services or for whom long travel distances may pose challenges. The objective of this study was to compare, at a national and Census Division level, where rural and urban Medicare beneficiaries receive ambulatory care, which types of specialists they utilize and how far beneficiaries are traveling to obtain care. In addition to rural/urban comparisons, intra-rural variation in utilization and travel distance will be evaluated and compared. |
Complete | HRSA | 2018-02-03" |
| Assessing Potential Unmet Need for Home Health Care in Rural Areas |
This study will estimate potential unmet need for home health care in rural areas for... Assessing Potential Unmet Need for Home Health Care in Rural Areas This study will estimate potential unmet need for home health care in rural areas for fee-for-service Medicare beneficiaries. We will compare rates of home health care utilization in rural areas with urban areas, accounting for acute hospital discharges and utilization of inpatient rehabilitation facilities and skilled nursing facilities. We will examine intra-rural variation in transition from hospital to different post-acute care providers and quantity of home health care services by diagnostic group. Findings from this study will help inform policies addressing access to and reimbursement of rural home health care and adequacy of home health care workforce supply. |
Complete | HRSA | 2018-02-03" |
| Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Provider Experience and Provision of Evidence-based Care |
This study will describe the relationship between prehospital emergency medical services (EMS)... Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Provider Experience and Provision of Evidence-based Care This study will describe the relationship between prehospital emergency medical services (EMS) providers’ accumulated experience and provision of evidence-based care for rural and urban populations using newly available data on EMS agencies, workforce, and patient care. Results will inform policies for ensuring that rural populations have timely and appropriate access to high-quality prehospital emergency care. |
Complete | HRSA | 2018-02-03" |
| Rural Physician Residencies under Unified Accreditation |
The impending unification in 2020 of allopathic and osteopathic graduate medical education (GME)... What Impact Will Unified GME Accreditation Have on Rural-focused Physician Residencies? The impending unification in 2020 of allopathic and osteopathic graduate medical education (GME) under a single accreditation system has uncertain implications for small and rural-focused residency programs. This study quantified the availability of rural-centric residency training (required rural training of at least 8 weeks) in the rurally-relevant specialties of pediatrics, internal medicine, obstetrics/gynecology, emergency medicine, surgery, anesthesia, and psychiatry. Findings include the distribution of rural vs. urban training locations and rural-specific content of rural-centric residency programs. |
Complete | HRSA | 2015-11-30" |
| Rural Home Health Services for High Risk Patients |
This study will examine outcomes of care for rural Medicare patients who were discharged from... Use of Home Health Services among High Risk Rural Medicare Patients: Patient, Service, and Community Factors Associated with Outcomes of Care This study will examine outcomes of care for rural Medicare patients who were discharged from hospitals and admitted to home health care for post-acute services. Outcomes will include emergent care use and re-hospitalization during the home health admission and community discharge. Key predictors include type of rural community (large, small, isolated small), geographic region, types and amounts of home health services provided, home health agency workforce characteristics, and available community health care resources. |
Complete | HRSA | 2015-11-30" |
| Rural Behavioral Health Workforce |
Data from the National Plan and Provider Enumeration System (NPPES) file, linked to RUCA codes and... Supply and Distribution of the Behavioral Health Workforce in Rural America Data from the National Plan and Provider Enumeration System (NPPES) file, linked to RUCA codes and population data, will be used to identify behavioral health providers and describe their geographic (rural/urban, regional and intra-rural) distribution. Behavioral health professions identified in the file include psychiatrists, addiction medicine specialists, psychiatric nurse practitioners, clinical nurse specialists in mental health, clinical psychologists and licensed social workers. |
Complete | 2015-11-30" | |
| Programs Producing Rural PAs: Part 2 |
This study builds on a previous WWAMI RHRC study that identified the physician assistant (PA)... What Makes Physician Assistant Programs Successful at Training Rural PAs? This study builds on a previous WWAMI RHRC study that identified the physician assistant (PA) training programs that have produced high numbers and high proportions of graduates working in rural areas. This study will extend that work through a physician assistant program survey, identifying key characteristics, admission and training strategies, and missions of successful rural programs. |
Complete | 2015-11-30" | |
| Post-acute vs. Community-entry Home Health in Rural Areas |
Medicare beneficiaries may be admitted to home health following an inpatient stay (post-acute) or... Diverging Populations Served by the Medicare Home Health Benefit: Comparison of Post-acute vs. Community-entry Home Health in Rural Areas Medicare beneficiaries may be admitted to home health following an inpatient stay (post-acute) or directly from the community (community-entry). An analysis of Medicare data for rural, fee-for-service Medicare beneficiaries who utilized home health from 2011 to 2013 found significant differences in care processes between community-entry and post-acute home health. Compared to post-acute home health episodes, community-entry home health episodes on average were longer; less likely to include physical, occupational, and speech therapy visits; more likely to include medical social work visits; and less likely to be initiated on the physician-ordered start date or within two days of referral. Results suggest community-entry and post-acute home health are serving different needs for rural Medicare beneficiaries, which provides preliminary support for distinguishing between the two types of episodes in payment policy reform. |
Complete | HRSA | 2015-11-30" |
| Community Paramedicine Evidence |
Community paramedicine (CP) has been promoted as a strategy to help communities achieve the Triple... What Is the Potential of Community Paramedicine to Fill Rural Healthcare Gaps? Community paramedicine (CP) has been promoted as a strategy to help communities achieve the Triple Aim of improving healthcare and population health while lowering costs. This study is collecting descriptive information on CP programs that can be identified in the U.S., and for those programs with outcome data, comparing rural with urban programs in terms of their goals, services offered, outcomes measured, and results. |
Complete | 2015-11-30" | |
| Availability of Buprenorphine Services in Rural Areas |
This study will investigate the extent to which physicians who practice in rural areas and have a... Who Treats Opioid Addiction in Rural America? Quantifying the Availability of Buprenorphine Services in Rural Areas This study will investigate the extent to which physicians who practice in rural areas and have a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine as an office-based outpatient treatment for opioid use disorder are providing this treatment to their patients. This study will also estimate the need for office-based opioid disorder treatment in rural locations. |
Complete | 2015-11-30" | |
| Rural Physician Assistants |
Background: In the 1970s, graduates of physician assistant (PA) programs practiced largely in... National Rural Physician Assistant Content of Care Study Background: In the 1970s, graduates of physician assistant (PA) programs practiced largely in primary care settings serving rural and other underserved populations. By the 1990s, PAs were practicing in a much wider variety of settings in many medical specialties. Aim: To describe the demography, practice arrangements and content of practice of a nationally representative sample of PAs collected in the 1990s. Methods: A stratified random sample of PAs was surveyed in 1993-1994. The demography, practice characteristics and content of PA practice were analyzed across practice location and medical specialty. Results: Of all the living PAs ever trained, 95% were active in the health care delivery system at the time of the survey. Eighty-seven percent of those trained were practicing as PAs, nearly all of whom were practicing full time. Rural PAs were more likely to be white and male than their urban counterparts and had lower levels of education prior to entering PA training. Generalist PAs performed many more outpatient visits than specialist PAs, and fewer inpatient visits. In urban areas, PAs were making a large contribution to surgical care. About three-fourths of the rural PAs were generalists. Conclusions: The broader scope of practice of generalist PAs, especially those serving rural populations, points to the need to ensure that training programs, especially those emphasizing generalist care for rural and underserved populations, provide sufficient breadth in medical training to meet those needs. Funded by HRSA’s ORHP. |
Complete | 2015-10-02" | |
| Unhealthy Lifestyles of Rural/Urban Minorities: Obesity |
Background: Obesity is on the rise in the United States and has been implicated in serious chronic... Unhealthy Lifestyle Behaviors Among Minority Group Members: A National Rural and Urban Study of Obesity Background: Obesity is on the rise in the United States and has been implicated in serious chronic health problems. Obesity is very costly in terms of medical spending and lost productivity. Aim: To estimate the prevalence of and recent trends in obesity among U.S. adults residing in rural and urban locations. Methods: A telephone survey of adults aged 18 years and older residing in states participating in the Behavioral Risk Factor Surveillance System (BRFSS) in 1994-1996 and 2000-2001. The main outcome measure for the study was obesity, defined as a body mass index of 30 or greater, based on self-report. Results: In 2000-2001, the prevalence of obesity was 23.0% for rural adults and 20.5% for their urban counterparts, increases of 4.8% and 5.5%, respectively, since 1994-1996. The highest obesity prevalence occurred in rural counties of Mississippi, Texas and Louisiana. Only Rhode Island and Colorado had rural counties that met the HealthyPeople 2010 goal of a maximum of 15% obese for adults. Conclusions: Despite recent attention to the prevalence of obesity, obesity rates continue to rise across the United States and differentially affect inhabitants of rural and urban areas. Funded by HRSA’s ORHP. |
Complete | 2015-09-25" | |
| Unhealthy Lifestyles of Rural/Urban Minorities: Cigarettes |
Background: Cigarette smoking is the leading preventable cause of death in the United States. Aim:... Unhealthy Lifestyle Behaviors Among Minority Group Members: A National Rural and Urban Study of Cigarette Smoking Background: Cigarette smoking is the leading preventable cause of death in the United States. Aim: To estimate the prevalence of and recent trends in smoking among adults residing in three types of rural locations. Methods: Telephone survey of adults aged 18 years or older who participated in the Behavioral Risk Factor Surveillance System in 1994-1996 and 2000-2001. Results: The prevalence of smoking changed little from the mid-1990s; it was 22.0% in urban areas, 24.9% in rural adjacent areas, 24.0% in large rural non-adjacent areas, and 24.9% in small rural non-adjacent areas. For rural locations combined, its prevalence was not below the 12% goal of HealthyPeople 2010 for any state. Its prevalence was ≥ 28% for rural residents of Kentucky, Ohio and Indiana. Since the mid-1990s, the prevalence of smoking for rural respondents decreased by more than 2% in California, Connecticut, Maryland, North Carolina, Tennessee, and Utah. However, it increased by 2% or more in Alabama, Delaware, Georgia, Massachusetts, Michigan, Mississippi, New Hampshire, Oklahoma, South Carolina, and Texas. Conclusions: Smoking remains a refractory public health problem. Better ways to curb smoking in rural America are needed. Funded by HRSA’s ORHP. |
Complete | 2015-09-25" | |
| Unhealthy Lifestyles of Rural/Urban Minorities: Alcohol Use |
Aim: To estimate the prevalence of and recent trends in alcohol use among U.S. adults in rural... Unhealthy Lifestyle Behaviors Among Minority Group Members: A National Rural and Urban Study of Alcohol Use Aim: To estimate the prevalence of and recent trends in alcohol use among U.S. adults in rural areas. Methods: A telephone survey of adults aged 18 years or older residing in states participating in the Behavioral Risk Factor Surveillance System (BRFSS), in the years 1995/1997 and 1999/2001. Results: Urban counties led rural counties for moderate and heavy drinking in 1999/2001, and also saw the largest increases in heavy drinking between 1995/1997 and 1999/2001. Binge drinking was nearly as high in remote rural counties with a large town as in urban counties, and increased the most for remote rural counties with a large town. Urban whites were more likely than any other racial/ethnic group to report moderate or heavy drinking, while American Indians in remote rural counties with a large town were the most likely to report binge drinking. Significant increases in heavy and binge drinking were highest for rural residents in the Northeast and Midwest and lowest in the South Census region. Conclusions: Heavy drinking was highest and increased the most in urban counties; however, binge drinking increased the most in remote rural counties with a large town, and heavy and binge drinking increased for rural counties of all types. Funded by HRSA’s ORHP. |
Complete | 2015-09-25" | |
| Trends in Rural Perinatal Care of American Indians |
While there have been dramatic improvements in AI/AN maternal and child health since these measures... National Trends in the Perinatal and Infant Health Care of Rural and Urban American Indians (AIs) and Alaska Natives (ANs) While there have been dramatic improvements in AI/AN maternal and child health since these measures were first recorded in the mid-1950s, significant disparities persist between AI/AN and non-AI/AN populations in the United States. This study (1) examined trends in prenatal care use, low-birthweight rate, and the neonatal and postneonatal mortality rates in rural and urban AI/AN populations nationally between 1985 and 1997, and compared these trends in the white populations during the same time period; (2) examined trends in causes of death for rural and urban AI/AN populations nationally between 1985 and 1997, and compared these trends to the white population during the same time period; and (3) analyzed trends in our study measures for AI/AN and white populations by Census region, division, and Indian Health Service (IHS) Service Areas. The study used the National Linked Birth Death Data Set at three points in time: 1985-1987, 1989-1991, and 1995-1997, and compared rates of inadequate prenatal care, low birthweight, neonatal and postneonatal death, and causes of death between rural AI/ANs and Caucasians in each of the three time periods, as well as over time. Funded by HRSA’s ORHP. |
Complete | 2015-09-25" | |
| Trends in Rural Perinatal Care |
Little is known about long-term national trends in birth outcomes and use of prenatal care in the... Changes in U.S. Rural Perinatal Care During the Last Decade Little is known about long-term national trends in birth outcomes and use of prenatal care in the rural population of the United States, or about intrarural differences in adverse outcome and inadequate prenatal care. In this two-year study, we examined: (1) How have rates of adverse birth outcome and prenatal care among U.S. rural residents changed in the years between 1985-1987 and 1995-1997? and (2) How have adverse birth outcomes and prenatal care changed during these periods among rural residents from racial and ethnic minority groups? We examined data from the Linked Birth Death Data Set (LBDDS), a national compilation of birth certificate data from all 50 states and the District of Columbia. We assessed inter-decade changes in rural/urban and intrarural differences in the rate of low birthweight outcome, neonatal death, postneonatal mortality, and inadequate prenatal care. We also assessed the degree to which observed changes were concentrated in particular types of rural settings or regions. Funded by HRSA’s ORHP. |
Complete | 2015-09-25" | |
| Trends in Rural Dentistry |
This study used secondary data sources such as the Area Resource File, American Dental Association... Rural Dentistry: Availability, Practice, and Access This study used secondary data sources such as the Area Resource File, American Dental Association data, and state-level professional licensure data to describe the supply of dental providers in several states, with particular attention to the supply of providers in rural areas. Surveys were administered to rural dentists in California, Maine, Missouri, and Alabama to describe the rural dental provider population in those states with respect to demography, practice characteristics, practice satisfaction, use of dental hygienists, Medicaid and CHIP practices, and attitudes towards the use of alternative sources of dental care such as using medical providers to apply sealants in the pediatric population. The study elucidates, from the dental provider perspective, the barriers to access to dental care for rural residents and what can be done to promote rural dental practice. Funded by HRSA’s ORHP. |
Complete | 2015-09-25" | |
| Tort Reform & Obstetrical Access |
As a consequence of the malpractice liability crisis, each of the four WAMI states at the time of... Tort Reform and the Obstetrical Access Crisis As a consequence of the malpractice liability crisis, each of the four WAMI states at the time of this study had modified the existing tort and/or professional liability systems in their states. This project reviewed recent studies of physicians’ obstetrical practices and major changes in tort legislation and regulation. The majority of general and family physicians in the WAMI region no longer provided obstetrical care, while over 80% of the obstetrician/gynecologists in this area still practiced obstetrics. Most rural family physicians in all four states continued to deliver babies. The majority of physicians in these states limited the amount of care they provide to Medicaid patients. All four states adopted tort reforms, yet the cost of malpractice premiums and concerns over liability continued to limit the number of physicians willing to provide obstetrical care. |
Complete | 2015-09-25" | |
| The WWAMI Rural Health Workforce |
This project compiles and presents state-level information about the rural health workforce in the... The Rural Health Workforce: Data and Issues for Policymakers in Washington, Wyoming, Alaska, Montana, Idaho This project compiles and presents state-level information about the rural health workforce in the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) region. Information was derived from the American Medical Association Masterfile, the National Sample Survey of Registered Nurses, the Area Resource File, and other sources. This series of policy briefs describes WWAMI rural health workforce challenges and opportunities, workforce numbers, resources, the importance of rural definitions, and tools for workforce policymakers and planners. |
Complete | 2015-09-25" | |
| The Walkability Project |
This study is identifying built environmental correlates of walking in rural towns and evaluating... Small Town Walkability: Measuring the Effect of the Built Environment This study is identifying built environmental correlates of walking in rural towns and evaluating the role of low socioeconomic status (SES) and Latino ethnicity on these relationships. By studying 9 rural towns from 3 diverse regions, Washington State, the Northeast, and Texas, with a varying range of socioeconomic and ethnic characteristics, this study is: (1) measuring built environmental correlates of walking among small town residents, using objective and perceived measures of the built environment and self-reported measures of walking; (2) evaluating the degree to which built environmental correlates of walking among rural town residents are influenced by SES and Latino ethnicity; and (3) validating the perceived correlates of walking using accelerometer and global positioning system measures. The study will first involve a survey of 1,800 residents of these towns on physical activity patterns and attributes of their towns that promote or impede walking, and will next recruit a sample of 270 respondents who agree to wear two small devices measuring their physical activity for 7 consecutive days. Objective measures of their physical activity will be compared to self-reported data. This work will lay the foundation for future research on the relationship between various aspects of the rural built environment and health behaviors and, ultimately, intervention trials to help rural towns better structure the built environment to promote walking and healthier life styles among their highest risk residents. |
Complete | 2015-09-25" | |
| Surgical Procedures in Rural |
This report addresses rural/urban differences in surgical practices in commonly performed inpatient... General and Specialist Surgeon Supply and Inpatient Procedural Content: A National Rural-Urban Study This report addresses rural/urban differences in surgical practices in commonly performed inpatient surgical procedures that are typically handled by general surgeons. National Inpatient Sample data from rural and urban hospitals in 24 states were used to examine the frequency of general surgical procedures, complications during hospitalizations and predicted resource demand. |
Complete | 2015-09-25" | |
| Surgery in Rural/Urban Hospitals |
Washington State hospital abstracts for 1987 and 1988 with pseudo-personal identifiers added were... Surgical Outcomes of Rural and Urban Hospitals Washington State hospital abstracts for 1987 and 1988 with pseudo-personal identifiers added were used in an analysis of readmission rates for four selected conditions by patient residential and hospital location. During the two-year period examined, there were no significant differences in readmission rates for surgeries performed in rural and urban hospitals. No evidence of low-quality care in Washington State rural hospitals was found when investigating readmission rates following common surgeries. |
Complete | 2015-09-25" | |
| Supply and Retention of Rural Surgeons |
Background: General surgeons form a crucial component of the medical workforce in rural areas of... Distribution and Retention of General Surgeons in Rural Areas of the U.S. Background: General surgeons form a crucial component of the medical workforce in rural areas of the United States. Any decline in their numbers could have profound effects on access to adequate health care in such areas. Aim: To determine the numbers, characteristics, and distribution of general surgeons currently practicing in the rural United States. Methods: The American Medical Association’s Physician Masterfile was used to identify all clinically active general surgeons as well as their location and characteristics. Their geographic distribution was examined using the ZIP code version of the Rural-Urban Commuting Areas (RUCAs). Results: Nationally, the number of general surgeons per 100,000 population varies from 6.53 in urban areas to 7.71 in large rural areas and 4.67 in small/isolated rural areas. Only 10.6% of the nation’s general surgeons were female. General surgeons in the smallest rural areas were more likely than those in urban areas to be male (92.7% versus 88.3%), 50 years of age or older (51.6% versus 42.1%), or international medical graduates (25.2% versus 20.1%). Conclusions: The overall size of the rural general surgical workforce has remained static, but its demographic characteristics suggest that numbers will decline. Many rural residents have limited access to surgical services. This project was funded by HRSA’s FORHP, with the publication Thompson et al. 2005 and Final Report #77 as deliverables. |
Complete | 2015-09-25" | |
| State Rural Health Workforce Monograph |
The uneven distribution of health care providers across rural and urban areas of the United States... State Rural Health Workforce Monograph The uneven distribution of health care providers across rural and urban areas of the United States continues to impede access to care for millions of rural residents. This book profiles that workforce with comparisons of the supply of health professionals across the 50 states and within the rural areas of each state. In addition to individual state workforce profiles, the book includes discussion of key policy and methodological issues in workforce analysis. The data and analysis show that the nature and magnitude of rural health workforce problems vary substantially both across states and within them, suggesting the dangers of “one-size-fits-all” policy solutions. This book provides a picture of the rural health workforce that will serve analysts and policy makers well as they search for workable solutions to the problem of inadequate supply of health care providers in rural America. Funded by HRSA’s FORHP. |
Complete | 2015-09-25" | |
| Staffing of Rural Hospital ERs |
All 37 rural Washington State hospitals with less than 100 beds were surveyed to determine how... Physician Staffing of Small Rural Hospital Emergency Departments All 37 rural Washington State hospitals with less than 100 beds were surveyed to determine how rural emergency departments were staffed by physicians and to estimate rural hospital payments for these services. Study data were collected through telephone interviews with hospital administrators or directors of nursing services. Results indicated that 86% of rural hospitals contracted for emergency department coverage and 59% obtained some or all of this service from nonlocal physicians. |
Complete | 2015-09-25" | |
| Specialty Care for Rural American Indians |
Background: The Indian Health Service (IHS) expenditure for American Indian and Alaska Native... Availability of Specialty Health Care for Rural American Indians (AIs) and Alaska Natives (ANs) Background: The Indian Health Service (IHS) expenditure for American Indian and Alaska Native (AI/AN) health services is less than half that spent per year on the U.S. civilian population. Many AI/ANs, especially in rural areas, depend on the IHS as their only source of funding for health care. Specialty services may be limited by a low level of contract funding. Aim: To examine access to specialty services among rural AI populations. Methods: A mail survey addressing access to specialty physicians, perceived barriers to access, and access to nonphysician clinical services was sent to primary care providers in rural Indian health clinics in Montana and New Mexico and primary care providers in rural non-Indian clinics within 25 miles of the Indian clinics. Results: Substantial proportions of rural Indian clinic providers in Montana and New Mexico reported fair or poor access to nonemergent specialty services for their patients. Montana’s rural Indian clinic providers reported poorer patient access to specialty care than rural non-Indian clinic providers, while New Mexico’s rural Indian and non-Indian providers reported comparable access. Indian clinic providers in most frequently cited financial barriers to specialty care. Indian clinic providers in both states reported better access to several nonphysician services than non-Indian clinic providers. Conclusions: Access to specialty care for rural Indian patients is limited, and is influenced by the organization of care systems and financial constraints. Funded by HRSA’s FORHP. |
Complete | 2015-09-25" | |
| Rural/Urban Obstetrical Care Quality |
Washington State vital statistics data from 1984 through 1988 were used to investigate differences... Quality of Obstetrical Care Provided to Rural Versus Urban Residents Washington State vital statistics data from 1984 through 1988 were used to investigate differences in the process and outcome of obstetrical care based on the rural/urban locations of the mothers’ residences. This study compared rural and urban obstetrical care in terms of mortality, trimester prenatal care began, adequacy of the number of prenatal visits, and birthweight. Separate analyses (1) differentiated between rural mothers who delivered in rural locations and those that delivered in urban locales and (2) partitioned low and non-low risk women. |
Complete | 2015-09-25" | |
| Rural/Urban Generalists |
This two-year project used Medicare data provided by HCFA to describe the content of practice of... Who Are the Generalists in Rural and Urban Areas? This two-year project used Medicare data provided by HCFA to describe the content of practice of physicians in rural and urban areas of Washington State. The population studied included board-certified physicians in the 12 largest ambulatory medical specialties in Washington State who were in active medical practice in 1994 and who provided ambulatory care to at least ten Medicare patients per year during that period. The diagnostic and procedural breadth of rural and urban physicians in all specialties was found to be similar, with the exception of rural general surgeons and obstetrician-gynecologists, who were more likely to care for patients outside their specialty area. Funded by HRSA’s ORHP. |
Complete | 2015-09-25" | |
| Rural U.S. Perinatal Health |
This study examined perinatal outcomes in rural areas across the United States in 2005. Low birth... Perinatal Health in the Rural United States, 2005 This study examined perinatal outcomes in rural areas across the United States in 2005. Low birth weight, a key indicator of the health of the U.S. population, and adequacy of prenatal care, a critical indicator of access and quality of health care, were explored to discover how they are related to rural or urban location, race, and ethnicity. |
Complete | 2015-09-24" | |
| Rural RNs' Choice of Work Location |
While larger numbers of registered nurses (RNs) are living in rural areas, research from the WWAMI... Factors Associated with Rural-Residing Registered Nurses’ Choices to Work in Urban Locations and Larger Rural Cities While larger numbers of registered nurses (RNs) are living in rural areas, research from the WWAMI RHRC shows that since 1980, a growing percentage are commuting from rural residences to work within urban and larger rural cities. This study explored factors that may be associated with RNs’ decisions to commute away from their rural areas of residence to work in less rural areas. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Rural RNs' Choice of Work Location |
While larger numbers of registered nurses (RNs) are living in rural areas, research from the WWAMI... Factors Associated with Rural-Residing Registered Nurses' Choices to work in Urban Locations and Larger Rural Cities While larger numbers of registered nurses (RNs) are living in rural areas, research from the WWAMI RHRC shows that since 1980, a growing percentage are commuting from rural residences to work within urban and larger rural cities. This study explored factors that may be associated with RNs’ decisions to commute away from their rural areas of residence to work in less rural areas. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Rural Physicians Waivered to Treat Opioid Addiction |
Unintentional drug overdose deaths associated with prescription opioids rose 395% between 1999 and... The Supply of Physicians Waivered to Treat Opioid Addiction in Rural America: Policy Options to Remedy Critical Shortages Unintentional drug overdose deaths associated with prescription opioids rose 395% between 1999 and 2007, and opiate misuse among adolescents is now twice as common as in the 1990s. Because methadone maintenance clinics are largely non-existent in rural areas, an effective alternative is training physicians in the use of buprenorphine, an effective addiction treatment that can be administered in outpatient practices. This study will determine the extent to which a trained workforce exists in rural America that has received the necessary waiver to treat opioid addiction in outpatient settings with buprenorphine, identifying areas with critical shortages and discussing policy options for expanding the supply of these qualified providers. Funded by HRSA’s Office of Rural Health Policy. |
Complete | 2015-09-24" | |
| Rural Physician, NP, PA Impact |
This WWAMI RHRC study will explore how many nurse practitioners (NPs), physician assistants (PAs),... What Are the Possible Impacts of Nurse Practitioners and Physician Assistants on Future Provision of Primary Care in Rural Areas? This WWAMI RHRC study will explore how many nurse practitioners (NPs), physician assistants (PAs), and physicians will be required to meet rural health care demand resulting from expanded access to health insurance through implementation of the Affordable Care Act (ACA). The study will also describe the ACA’s impact on types of primary care services that would be available under different provider mix scenarios. The study’s analyses will use simulated rural primary care demand data and rural primary care NP, PA, and physician productivity data from recent research by the WWAMI RHRC. Funded by HRSA’s Office of Rural Health Policy. |
Complete | 2015-09-24" | |
| Rural Pediatric Inpatient Care |
This study described the distribution of rural practitioners in Washington State who provide... Pediatric Inpatient Care in Rural Hospitals This study described the distribution of rural practitioners in Washington State who provide inpatient care to pediatric patients, elucidated the major diagnostic categories for which children are hospitalized in rural versus urban areas, contrasted the roles of pediatricians and family physicians providing pediatric care, and assessed the effectiveness of the system. The major source of data for this study was CHARS, which was linked to information on the training and discipline of the providers who cared for each of the patients in the study. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Rural Oral Health Challenges |
This review identifies the challenges to oral health in rural America and describes areas of... Oral Health Services in Rural America This review identifies the challenges to oral health in rural America and describes areas of innovation in prevention, delivery of dental services, and workforce development that may improve oral health for rural populations. This paper was part of a special issue of the Journal of Public Health Dentistry. The purpose of the special issue was to further develop ideas presented at the 2009 Institute of Medicine (IOM) workshop, “The Sufficiency of the U.S. Oral Health Workforce in the Coming Decade.” Using the IOM discussions as their starting point, the authors evaluate oral health care delivery system performance for specific populations’ needs and explore the roles that the workforce can play in improving the care delivery model. The contributing articles provide a broad framework for stimulating and evaluating innovation and change in the oral health care delivery system. The articles in this special issue point to many deficits in the current oral health care delivery system and provide compelling arguments and proposals for improvements. |
Complete | 2015-09-24" | |
| Rural Obstetrical Technology |
This study compared the approach to neonatal care in Wales and Washington State, studying the... A Comparison of Obstetrical Technology at Rural Hospitals in Washington and Wales This study compared the approach to neonatal care in Wales and Washington State, studying the extent of perinatal regionalization, the distribution of neonatal technologies, and birthweight-specific neonatal outcomes. In Wales, most District General Hospitals (DGH) had all the neonatal equipment recommended for a maximal neonatal intensive care unit, whether or not the DGH was a designated regional or subregional center. Sophisticated neonatal technology in Washington was concentrated in designated referral hospitals. Almost every Welsh DGH cared for infants weighing less than 1,000 grams at birth, while in Washington State most very-low-birthweight neonates were born in referral centers and the few born elsewhere were transferred immediately after birth. Despite differences in the extent of regionalization, birthweight-specific neonatal mortality rates were similar in the two countries. |
Complete | 2015-09-24" | |
| Rural NSSNP Analysis |
This WWAMI RHRC study uses data from HRSA's first National Sample Survey of Nurse Practitioners... Practice Characteristics of Rural Nurse Practitioners in the United States This WWAMI RHRC study uses data from HRSA’s first National Sample Survey of Nurse Practitioners (NSSNPs) to expand on the agency’s basic descriptive analyses of rural and urban nurse practitioners (NPs). The study compares rural and urban NPs’ demographics, education, practice, and related characteristics; and estimates basic NP labor supply models. Funded by HRSA’s Office of Rural Health Policy. |
Complete | 2015-09-24" | |
| Rural Medicine Textbook |
This book explores what is known about the content, needs, and special problems of rural health... FORHP Rural Health Research Center Book and Rural Medicine Textbook This book explores what is known about the content, needs, and special problems of rural health care. The goal was to advance the knowledge base and describe strategies used by rural health professionals in developing quality of care for rural communities and their residents. The book includes an overview of rural health care, special clinical problems and approaches in rural health care, the organization and management of rural health care, approaches to quality improvement, and education for rural practice. |
Complete | 2015-09-24" | |
| Rural Hospital Surgical Capacity |
This study examined the availability of several elective and urgent surgical procedures at rural... Surgical Capacity of Rural Washington State Hospitals This study examined the availability of several elective and urgent surgical procedures at rural hospitals, identified the specialties of rural surgery and anesthesia providers, and determined where rural residents obtained surgical services and how the utilization of services is influenced by the presence of local services. Data were obtained from telephone interviews with hospital administrators, directors of nursing services, and/or operating room charge nurses. Washington State complete hospital discharge data provided the number of selected and aggregate procedures for each hospital by diagnosis and procedure codes, as well as hospital reimbursement for surgical procedures. |
Complete | 2015-09-24" | |
| Rural Hospital Project |
The Rural Hospital Project (RHP) assisted six threatened rural hospitals in the WAMI region through... Transferability of the Rural Hospital Project The Rural Hospital Project (RHP) assisted six threatened rural hospitals in the WAMI region through a multifaceted approach to addressing their problems and strengthening health services. Subsequently, the RHP interventions were applied through a Community Health Services Development Model to other rural hospitals throughout the regional Area Health Education Centers (AHECs). This study examined the process of exporting the interventions from a university-based demonstration project to a community-based program disseminated by the AHECs. |
Complete | 2015-09-24" | |
| Rural Hospital Linkages |
Linkage refers to a rural hospital's formal and informal associations with outside entities (e.g.,... Rural Hospital Linkages in the WAMI Region Linkage refers to a rural hospital’s formal and informal associations with outside entities (e.g., joint purchasing arrangements and inter-hospital networks). This study (1) provided a descriptive analysis of rural hospital linkages in the WAMI states based on a literature review and key informant interviews, (2) determined how governmental regulations influence such linkages, and (3) performed case studies on two rural health care alliances located in different regions and formed 13 years apart. |
Complete | 2015-09-24" | |
| Rural Hospital Governing Boards Part C |
Background: Little research has been conducted to describe the factors and practices associated... Characteristics of Rural Hospital Governing Boards. Part C: Which Activities of Small Rural Hospital Boards Are Associated with Success? Background: Little research has been conducted to describe the factors and practices associated with the effectiveness of rural hospital governing boards. Aim: To identify activities and characteristics of the governing boards of small rural hospitals that are related to hospital success. Methods: We surveyed 89 rural hospital board chairs in Washington, Alaska, and Idaho about how they spent their time and how they were organized. We asked experts familiar with 74 hospitals with less than 100 beds to rate them in several key areas. Results: The eight activities of boards associated with “strong” hospitals included: one or more board retreats per year, annual review of mission and goals, lower percentage of time monitoring budget, use of board committees, clear recruitment plan to attract desirable board members, funds for continuing education of board members, owned or leased ownership, and larger hospital average daily census. In addition, the “strong” hospitals were found to have higher daily census than the “weak” hospitals (higher among hospitals with less than 100 beds). Conclusions: As long as the governance of rural hospitals is in the hands of volunteer boards, researchers and policy makers should assist these boards in identifying the most efficient and effective ways for them to spend their limited time and resources. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Rural Hospital Governing Boards Part B |
Background: To provide competent membership, a board member needs knowledge of health care... Characteristics of Rural Hospital Governing Boards. Part B: An Assessment of the Knowledge of Governing Board Members in Rural Hospitals Background: To provide competent membership, a board member needs knowledge of health care developments and the organization of the board. Aim: To provide information on the knowledge level of governing board members in hospitals in three northwestern states. Methods: This study included 130 hospitals with individual governing boards in rural areas of Alaska, Idaho, and Washington. As part of a larger survey of all rural hospital board members in these states, we asked board members questions relevant to competent membership on a governing board. This included questions concerning quantifiable aspects of the hospitals, planning, and financial reporting. Results: Knowledge on the part of the board members was strongest in the areas of the role of the governing board, planning, and scope of services. Board members were less able to quantify the capacities and utilization of services at their hospitals. Results were mixed in the area of knowledge of financial management. Length of service on the board and efficient board structures were associated with increased knowledge. Conclusions: While board members were knowledgeable about their roles and the services offered by their hospitals, their knowledge base in certain other crucial areas was limited, underscoring the need for programs that facilitate board member training. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Rural Hospital Governing Boards Part A |
Background: Literature about rural health providers has focused largely on physicians, mid-level... Characteristics of Rural Hospital Governing Boards. Part A: Who Governs Rural Hospitals? Background: Literature about rural health providers has focused largely on physicians, mid-level providers, and hospitals and their administrators, but little has been written about the boards that govern those hospitals. Aim: To describe the role and composition of rural hospital governing boards. Methods: Hospitals in Washington, Alaska, and Idaho were included in this study. Surveys related to hospital governance were administered to rural hospital board members and board chairpersons of urban and rural hospitals. Results: Board members were typically white males over the age of 50 and retired. They served an average of seven years and most typically brought business and management expertise to their positions. Board members contributed more than a dozen hours per month to board business and attended about 90% of their board and committee meetings. Fewer than one in four rural hospital board chairs indicated his or her board had a formal recruitment program, and fewer than half of the boards spent more than three hours on board member orientation. Board chairs were more likely to rate highly the performance of other community leaders, as well as members of the medical staff. Conclusions: Boards are attracting the service of individuals who are well educated, experienced, and willing to contribute more than a dozen hours a month to their board service. However, small rural boards are not investing enough time and funds in orientation and training. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Rural Hospital CEO Turnover |
This study described the tenure, rate of and reasons for turnover of hospital administrators, and... Administrator Turnover in Rural Hospitals This study described the tenure, rate of and reasons for turnover of hospital administrators, and tracked the career trajectories of rural hospital administrators. The study was performed in partnership with the WAMI Area Health Education Center and the Washington State Hospital Association. Resumes from all Washington State hospital administrators contrasted the education and professional backgrounds of rural and urban administrators. A survey of all regional rural hospital administrators who left their position during the past three years provided information on hospital characteristics, reasons that they left, effects on the hospital and community, evaluation of their performance, and gaps in training. Questionnaires were sent to a hospital board member in the same community to ascertain why the administrator left, consequences of the departure, and adequacy of the administrator’s performance. |
Complete | 2015-09-24" | |
| Rural Hospital Care for Acute Myocardial Infarction: 2000-2001 |
This project examined whether overall improvements in the quality of care for acute myocardial... Improvement in the Quality of Care for Acute Myocardial Infarction: Have Rural Hospitals Followed National Trends? This project examined whether overall improvements in the quality of care for acute myocardial infarction (AMI) among Medicare patients occurred in both rural and hospital settings. It used the Cooperative Cardiovascular Project Database and a database of measures of clinical performance, and included in the sample those Medicare beneficiaries with an AMI who were directly admitted for AMI care. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Rural Hospital Anesthesia Services |
Key to the ability of rural hospitals to maintain a surgery service is the availability of... The Provision of Anesthesia Services in Rural Hospitals Key to the ability of rural hospitals to maintain a surgery service is the availability of anesthesia personnel, yet anecdotal evidence indicates that their supply is limited and their salary costs are high. This study surveyed administrators from rural hospitals in Washington and Montana regarding their experience in recruiting and retaining nurse and physician anesthetists. Aspects of anesthesia coverage such as financial arrangements, professionals working at multiple sites, outpatient and inpatient surgery, inter-provider type professional rivalries, and licensure constraints were examined. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Rural Home Health Care |
Access to home health care can be challenging for rural Medicare clients. Key informants for this... Access to Home Care Services in the Rural United States Access to home health care can be challenging for rural Medicare clients. Key informants for this study from across the U.S. detailed these obstacles, which include financial, regulatory, workforce, and geographic issues, as well as solutions that merit consideration. Rural communities, especially those served by small and non-profit home health agencies, will likely benefit from payment reforms that reward quality services while providing incentives to innovate and use best practices in home health care. |
Complete | 2015-09-24" | |
| Rural HIT Workforce Needs |
The goal of this study is to improve understanding of health information technology (HIT) workforce... Health Information Technology (HIT) Workforce Needs in Rural America The goal of this study is to improve understanding of health information technology (HIT) workforce needs and constraints in rural primary care settings. This study will determine rural primary care practices’ current and projected level of electronic health record (EHR) and health information technology (HIT) adoption and estimate demand for workers with HIT skills. This study will survey a stratified sample (large and small rural areas) of approximately 1,600 rural primary care practices across the U.S. The questionnaire will assess EHR and HIT implementation at the facility level; their relative need for different components of the HIT workforce; and whether they train and develop HIT staff from within, hire new staff, employ consultants, and/or join forces with other institutions to fill these workforce needs. We will include questions about the institutions’ current HIT workforce, expected future demand, education and training resources available to the institution and its staff, and other workforce-related factors that support or impede the practices’ implementation and use of HIT. Our descriptive analyses will produce national rural and sub-rural estimates of findings. The study will also identify relationships between specific practice attributes and HIT workforce variables. Funded by HRSA’s Office of Rural Health Policy. |
Complete | 2015-09-24" | |
| Rural FLEX Program |
In 1997, the U.S. Congress created the Rural Hospital Flexibility Program (Flex Program) as part of... National Rural Hospital Flexibility Program Tracking Project In 1997, the U.S. Congress created the Rural Hospital Flexibility Program (Flex Program) as part of the Balanced Budget Act (BBA). This program provides for cost-based reimbursement under Medicare to eligible small, relatively remote hospitals. A companion grant program supports state emergency medical services systems (EMS) and hospital participation in the program. The reimbursement component is the responsibility of the Center for Medicare and Medicaid Services (CMS), while the grant program is the responsibility of the Federal Office of Rural Health Policy (FORHP). Funding to support the monitoring efforts of the Flex Program Tracking Team was provided under the grant program appropriation. The Tracking Team was a consortium of six rural health research centers. Each Center had lead responsibility for several research components of the study. In 2002/2003, the WWAMI Rural Health Research Center took responsibility for assessing state program evaluations, evaluating a number of workforce issues faced by critical access hospitals (CAHs, and looking at the intersection of CAHs) and another federal program, the Mississippi Delta Hospital Performance Improvement Initiative. WWAMI also provided overall project direction and coordination to the participating centers. The main national goals for implementation of the grant component of the Flex Program in the states and participating hospitals included (1) preparing a state rural health plan, (2) converting eligible and willing hospitals to critical access hospital (CAH) status, (3) improving quality of care, (4) promoting networking among hospitals, and (5) improving emergency medical services. |
Complete | 2015-09-24" | |
| Rural Family Practice Residency Programs Chartbook |
This chartbook makes previously unreported information from our national survey of 453 FP residency... Chartbook of Family Practice Graduate Medical Education Programs in Rural America This chartbook makes previously unreported information from our national survey of 453 FP residency directors available to medical educators and policy makers. As part of this survey, programs were asked to indicate the extent to which training rural physicians was part of their core mission and to specify where all residency training sponsored by their programs took place. Using the Rural-Urban Commuting Areas (RUCAs), the ZIP codes of these locations allowed us to determine the relative rurality of all U.S. family practice residency training. The chartbook presents national, regional, state, and division findings, presented by type of geography (i.e., isolated small rural, small rural, large rural, and urban), type of rural training experience (i.e., model family practice clinic, block rotations, rural training tracks, and continuity clinics), and other residency characteristics. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Rural Family Planning Services |
Considerable controversy exists about the types of family planning services that should be... Accessibility of Family Planning Services to Rural Residents Considerable controversy exists about the types of family planning services that should be available in rural areas. This study constructed an inventory of family planning services available in rural Idaho, determined the factors associated with observed variations in the range of available services, and examined the policy implications of the findings. A questionnaire was sent to physicians who were the potential providers of such services to determine service volumes and access issues. |
Complete | 2015-09-24" | |
| Rural Family Medicine Residency Training Master File |
Little is known about how well various types of rural-focused family medicine residency training... A Novel Master File of Rural Family Medicine Residency Training: Program Models and Graduate Outcomes Little is known about how well various types of rural-focused family medicine residency training programs, particularly osteopathic residencies, produce physicians for rural practice. This study examined program content and training locations as well as rural and urban practice outcomes for graduates of rural-centric family medicine residency training programs. This study is funded by HRSA’s Office of Rural Health Policy. |
Complete | 2015-09-24" | |
| Rural Family Medicine Residency Survey Follow-Up |
This two-year project updated an earlier WWAMI RHRC study of family medicine residency training in... Rural Family Medicine Residency Training Follow-Up Survey Regarding Amount and Types of Rural Training Experiences This two-year project updated an earlier WWAMI RHRC study of family medicine residency training in rural areas of the United States. In 2000 we conducted a national survey of all family medicine residency training programs in the nation to identify the type and extent of residency training that actually took place in rural locations. This study administered a follow-up mail survey to all family medicine residency training programs (about 440) using an instrument that was modified slightly to add a few key questions. This allowed us to examine changes since 2000 in the number of programs located in rural places, the nature of these programs, funding sources and staff configurations, as well as the amount of time that training takes place in federally funded health centers and other types of facilities. |
Complete | 2015-09-24" | |
| Rural EMS Workforce |
Rural populations frequently reside great distances from hospital emergency departments or urgent... The Pre-hospital Emergency Medical Services Workforce in Rural and Urban Areas Rural populations frequently reside great distances from hospital emergency departments or urgent care facilities, underscoring the need for timely and effective pre-hospital emergency medical services (EMS). Numerous reports and anecdotal evidence indicate that rural EMS agencies face significant resource challenges in terms of sustainable funding, staff recruitment and retention, and staff skill maintenance. Reliable data to quantify the extent of these problems have been lacking. This project aims to quantify systematically workforce supply and demand disparities between rural and urban EMS systems in a sample of states distributed across the U.S. Study results will inform policy options to ensure an adequate supply of EMS personnel in rural areas. This study will analyze secondary data collected via a 2008 telephone survey of all ground-based pre-hospital EMS providers in nine states. Analyses of EMS agency service area coverage, patient volume, funding basis, organizational type, staffing, vacancies, and medical direction will yield statistical comparisons between urban and three subcategories of rural areas. Findings on rural-urban EMS resource distribution will also be displayed in maps for each state. Funded by HRSA’s Office of Rural Health Policy. |
Complete | 2015-09-24" | |
| Rural Emergency Medical Services |
This study retrieved data on every vehicular injury accident occurring in Okanogan County,... Regionalization of Rural Emergency Medical Services (EMS) This study retrieved data on every vehicular injury accident occurring in Okanogan County, Washington, in 1990. Information was collected on location of accident, type and severity of injury, initial pre-hospital response, initial transportation, involvement of local health care system, transfer to facility outside county, patient outcomes, and demographics. The study included (1) a description of the type and nature of crashes and injuries and the involvement of local and distant components of the EMS, (2) an examination of the extent to which the existing rural EMS is regionalized, and (3) policy-oriented recommendations. |
Complete | 2015-09-24" | |
| Rural Definitions |
We published an article entitled "Rural Definitions for Health Policy and Research" in the American... Description of Differences Between Seclected Rural-Urban Taxonomies We published an article entitled “Rural Definitions for Health Policy and Research” in the American Journal of Public Health in which we describe and compare various rural and urban taxonomies that were in use, describing their characteristics, strengths, and weaknesses depending on the purpose at hand. |
Complete | 2015-09-24" | |
| Rural Definition Reclassification |
This project created a ZIP-code approximation of the census tract-based Rural-Urban Commuting Area... Rural Definition Reclassification Project This project created a ZIP-code approximation of the census tract-based Rural-Urban Commuting Area (RUCA) codes. |
Complete | 2015-09-24" | |
| Rural Capacity for Family Physicians |
This paper addresses the ability of smaller and underserved rural communities to financially... How Many Physicians Can a Rural Town Support? This paper addresses the ability of smaller and underserved rural communities to financially support needed physicians. We used Washington State data to test the feasibility of constructing physician income potential models. The total spending for primary care physicians was estimated using age-sex-poverty status coefficients from the National Medical Expenditure Survey, supplemented by unique Part B Medicare data on the proportion of rural physician revenue from non-office based services. Community size and the distance to other cities and towns were crucial determinants of market share and thus the capacity of small towns to attract and support primary care practices. The distribution of physicians among towns followed predicted economic potential. That potential varied dramatically even among towns with similar populations due to the pull of competing locations for primary care. Surprisingly, the types of rural communities most likely to have fewer physicians than suggested by the projected potential were not small isolated towns, but larger communities with above-average population growth, closer proximity to metropolitan areas and somewhat lower average family incomes. Strategies such as the National Health Service Corps use a one-time “signing bonus” to overcome physicians’ initial reluctance to locate in an underserved area. An alternative approach is to address long-term income disadvantages by offering continuous subsidies such as the enhanced Medicare payments for certified Rural Health Clinics or the 10% Medicare supplemental payments for care provided in a HPSA. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Rural C- Sections |
This project provided information on how physician training, community specialty mix and other... Rural C-Sections and Family Physicians This project provided information on how physician training, community specialty mix and other factors are related to the provision of c-sections in rural communities. We examined the percentage of the c-sections performed on rural service area residents that were done in small rural hospitals, whether family physicians did most of these procedures in rural hospitals where there are no obstetricians, their competence in performing c-sections, and factors associated with their performance of this procedure. Data were obtained through Computerized Hospital Discharge Database (CHARS) inpatient hospital abstracts supplemented by a telephone survey of all Washington State rural hospitals and a mail survey of rural physicians. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| RUCA Development & Description |
The Rural-Urban Commuting Areas (RUCAs) were developed at the WWAMI RHRC in collaboration with, and... RUCA Development Project: Demographic Description and Frontier Enhancement The Rural-Urban Commuting Areas (RUCAs) were developed at the WWAMI RHRC in collaboration with, and with support from, HRSA’s ORHP and the Department of Agriculture. The RUCAs are a census tract-based classification scheme that utilizes the standard Bureau of Census Urbanized Area (UA) and Urban Place (UP) definitions with commuting information to characterize the nation’s Census tracts regarding their rural and urban status and relationships. The codes are based on whether a Census tract is located in a UA or UP and on the destination of its largest and second largest commuting flows. This project (1) produced and described the base 1998 demography of the RUCA code areas, (2) created quality state maps of the RUCA codes, and (3) has made this information and the codes easily available on the Web. The demographic description of the RUCA codes involved standard cross-tabulation analysis of the code areas nationally, regionally, and by state. Technical notes and maps are posted at www.depts.washington.edu/uwruca”>UW RUCA. |
Complete | 2015-09-24" | |
| RTT Technical Assistance Program |
This project is building a national partnership between professional groups, academic units,... Distributed Expertise: Sustaining Rural Training Tracks as a Strategy in Rural Medical Education This project is building a national partnership between professional groups, academic units, governmental entities, and sustaining organizations to provide ongoing support and technical assistance to community-embedded rural health professions education. The project is (1) establishing a network of organizations and experts by visiting Rural Training Tracks (RTTs), creating RTT-state office of rural health coalitions, and convening stakeholder meetings; (2) building a Web portal with a virtual library of tools, information, and access to technical assistance; (3) developing new models and programs while sharing best practices; (4) initiating a process for identifying and training new leaders; and (5) publishing a final report. Under the NRHA umbrella and anchored by project directors and field offices in Idaho, Ohio, and Washington DC, the program is connecting RTT program directors, faculty, and staff with state offices of rural health, a rural assistance center, and a rural research center to bolster existing RTTs, foster new programs, and utilize community expertise in identifying systemic issues and remedies. While focused on rural medical education, the network will provide a model for community-embedded training and an infrastructure for training other rural health professions. UW WWAMI RHRC researchers are designing and maintaining a research data set and protocol for RTT site visits, including consents and IRB approval. The RHRC is the repository of these data-gathering efforts and will analyze and synthesize data underpinning reports and other dissemination activities. The RHRC is sharing data and coordinating its effort with the Graham Center in Washington DC to promote policy development, and assisting in the preparation of a final evaluation and report of this demonstration program. |
Complete | HRSA | 2015-09-24" |
| Family Physicians Choosing Rural Practice |
This project will survey physicians trained in rural-centric family medicine residencies to... Family Medicine Rural Training Track Graduates: Determinants of Rural and Urban Practice This project will survey physicians trained in rural-centric family medicine residencies to understand the characteristics, experiences, and attitudes that influenced their rural or urban practice choices. Understanding the factors that determine practice choices of RTT graduates can help improve recruitment of residents who will ultimately fulfill RTTs’ mission of preparing family physicians for rural practice. |
Complete | 2015-09-24" | |
| Retention of NHSC Recipients |
This study examined the retention and distribution of the 6,300 NHSC allopathic physician... National Health Service Corps Scholarship Recipient Retention Study This study examined the retention and distribution of the 6,300 NHSC allopathic physician scholarship recipients graduating from medical schools for the years 1975 through 1983. The roster of these scholarship recipients was linked with American Medical Association data to provide information on their location, specialty, and practice status. Recipients were examined in terms of their propensity to remain in their original ZIP code, county, state, and rural/urban status location. In addition, their locational patterns were compared to other graduates. Recipients’ specialty, type of practice, and NHSC length of obligation were also evaluated. |
Complete | 2015-09-24" | |
| Recruitment of Rural Women Physicians |
This study examined differences in the factors female and male generalist physicians considered... Best Strategies for Recruiting Women Physicians to Rural Practice This study examined differences in the factors female and male generalist physicians considered influential in their rural practice location choice and identified the practice arrangements that successfully recruited female generalist physicians to rural areas. We mailed questionnaires to generalist physicians recruited between 1992 and 1999 to towns of 10,000 or less in six states in the Pacific Northwest. Compared to men, recruited women were younger, less likely to be married, had fewer children, and worked fewer hours. Women were more likely than men to have been influenced by issues related to spouse/personal partner, flexible scheduling, family leave, and availability of child care, as well as the interpersonal aspects of recruitment. Commonly reported themes reflected the desire for flexibility regarding family issues and the value placed on honesty during recruitment. Men and women were equally likely to consider community factors, practice content, practice partner compatibility, and financial issues. The most common methods for obtaining information about practice opportunities were personal networking, prior training experience, recruiters, and outreach by medical practices. This study concluded that rural communities and practices recruiting physicians should place high priority on practice scheduling, spouse/partner, and interpersonal issues if they want to achieve a gender-balanced physician workforce. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Radiation Therapy in Rural U.S. |
This study used cancer registry data from 10 U.S. states to examine which rural cancer patients... Use of Recommended Radiation Therapy in the Rural U.S. This study used cancer registry data from 10 U.S. states to examine which rural cancer patients received recommended radiation therapy and what factors influenced receipt of recommended treatment. Identifying gaps in radiation therapy will inform cancer centers, rural program planners, and policy makers in rural cancer service location and cancer support program development. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Quality of Rural Perinatal Care |
The equitable provision of high-quality obstetric care is a major priority of our health care... The Process and Quality of Rural Perinatal Care: A National Study The equitable provision of high-quality obstetric care is a major priority of our health care system, and nowhere is access to such care more threatened than in rural areas. This project determined whether rural mothers receive less care and experience worse outcomes than their urban counterparts, whether racial and ethnic minorities living in rural areas experience different outcomes than their counterparts, and what other factors are associated with less care and poorer outcomes. Data were compiled from the National Center for Health Statistics’ Linked Birth/Death set and the Bureau of Health Professions’ Area Resource File. Measures of process of care included late or no prenatal care, lack of care in the first trimester, and inadequate care as measured by the Kotelchuck Index. Outcome measures included infant mortality and the percentage of children born at low and very low birthweight. This study also compared birth outcomes and process of care for minorities across rural areas and with their urban counterparts. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Prostate Cancer Treatment in Rural |
This research will use cancer registry data from 10 states to examine the degree to which rural... Do Rural Patients with Early Stage Prostate Cancer Gain Access to All Treatment Choices? This research will use cancer registry data from 10 states to examine the degree to which rural residents diagnosed with early-stage prostate cancer access the full range of surveillance, surgical, and radiation treatment options. Study findings will inform cancer centers, advocacy groups, rural program planners, and policymakers about services and programs needed to ensure that rural prostate cancer patients can choose from among all treatment options. |
Complete | 2015-09-24" | |
| Programs Producing Rural Physicians |
This national study used longitudinal data on medical school specialty and practice location choice... Which Training Programs Produce Rural Physicians? A National Health Workforce Study This national study used longitudinal data on medical school specialty and practice location choice to determine the extent to which the nation’s medical schools and residency programs varied in their production of rural physicians. This facilitated the identification of medical school and residency program characteristics associated with the highest yield of rural physicians. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Programs Producing Rural PAs |
Physician assistants (PAs) are an important part of the rural health workforce, and their roles are... Which Physician Assistant Training Programs Produce Rural Physician Assistants? A National Study Physician assistants (PAs) are an important part of the rural health workforce, and their roles are expected to grow. While PAs are more evenly distributed across the rural-urban continuum than physicians, long-term trends of medical specialization, increasing cost of training, and demographic change in the PA workforce have contributed toward decreasing PA participation in rural and primary care. This study will identify the PA training programs that are most successful at producing graduates who practice in rural areas, focusing particularly on PAs who graduated from training in the past ten years. Funded by HRSA’s Office of Rural Health Policy. |
Complete | 2015-09-24" | |
| Problem Drinking Among Rural Veterans |
This study will use national data to measure recent trends in problem drinking among VA-eligible... Problem Drinking: Trends Among Rural Veterans–A National Study This study will use national data to measure recent trends in problem drinking among VA-eligible adults in rural and urban locations and couple these data with the locations of VA services and substance abuse treatment facilities to identify rural locations where alcohol treatment services are limited. This project is funded by the Veterans Administration Office of Rural Health, through a contract with the northwest Portland, Oregon, Veterans Affairs Medical Center. |
Complete | 2015-09-24" | |
| Primary Care Trends |
This project critically reviewed the recent waning of primary care and its implications for rural... Primary Care at a Crossroads Project This project critically reviewed the recent waning of primary care and its implications for rural populations. The paper chronicled historical changes and trends, put these changes in the larger health care system context, and concluded with a set of policy recommendations that detail options available to policy makers and leaders of the nation’s medical educational establishment. |
Complete | 2015-09-24" | |
| Practice Locations of Women Physicians |
While women are becoming an increasingly large percentage of the graduates of medical schools and... The Rural/Urban Practice Location Patterns of Women Medical School Graduates While women are becoming an increasingly large percentage of the graduates of medical schools and of the generalist specialties in particular, they are much less likely to locate their practices in rural towns. If this trend were to persist, implications for access to care in rural areas would be substantial. This study involved a survey including questions about where the residents preferred to locate and how much they thought they would be practicing in the future. The study first examined national physician location patterns by medical school graduation cohort per gender differences. The second phase dealt with the production of female generalist physicians by medical schools. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Policy Activities of AMCC |
The AMCC is an ad hoc group composed primarily of private obstetrical providers and representatives... Policy-Related Activities of the Washington State Access to Maternity Care Committee (AMCC) The AMCC is an ad hoc group composed primarily of private obstetrical providers and representatives of state government responsible for the delivery of health care to women and children. The major objective of AMCC is to improve access to obstetrical care for socially vulnerable women. The committee successfully served as a forum in which to resolve administrative problems arising between private obstetrical providers and the state’s Medicaid program and was influential in persuading the state legislature to increase Medicaid eligibility, raise provider reimbursements, and improve social services to pregnant women. |
Complete | 2015-09-24" | |
| Physician Residency Rural Training |
The supply of rural physicians is in part determined by the number of family physicians who receive... Physician Residency Rural Training Baseline Study The supply of rural physicians is in part determined by the number of family physicians who receive residency training in rural areas. This study explored what proportion of all family medicine residency experience actually takes place in rural areas in the United States. Questionnaires were mailed to all 453 civilian family practice residencies in the United States in 2000. Programs were asked to indicate the extent to which training rural physicians was part of their core mission and to specify where all residency training sponsored by their programs took place. Using the Rural-Urban Commuting Areas, the ZIP codes of these locations allowed us to determine the relative rurality of all U.S. family practice residency training. Only 33 family medicine residency programs (7.4%) were located in rural areas. Most of the training sponsored by these rural programs occured in rural areas. Although over one-third of the urban programs listed rural training as an important part of their mission, only 2.3% of the training they supported took place in rural areas. For the nation, 7.5% of family medicine residency training occurred in rural areas, although 22.3% of the U.S. population lives in rural places. This study concluded that very little family medicine residency training actually took place in rural areas. To the extent that there was a link between the place of training and future practice, the lack of rural training contributed to the shortage of rural physicians. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Physician Access for Rural Elderly |
Patients in rural areas may utilize less medical care than urban patients because of differences... Access to Physician Care for the Rural Medicare Elderly Patients in rural areas may utilize less medical care than urban patients because of differences in travel distance and time and a utilization of a different mix of generalists and specialists for their care. This study compared travel times, distances, and physician specialty mix of Medicare patients in Alaska, Washington, North Carolina, South Carolina, and Idaho. We used a retrospective design, utilizing 1998 Medicare billing data. Travel time was determined by computing the road distance between the patient’s and the provider’s ZIP codes. There were 39,780 providers in the cohort: 16.1% generalists, 62% specialists, and 21% nonphysician providers. The median overall one-way travel distance and time was 7.7 miles and 11.7 minutes. Rural residents traveled two to three times farther to see medical and surgical specialists than urban residents. Rural residents with cancer, heart disease, depression, or needing complex cardiac procedures or cancer treatment traveled the farthest. Increasing rurality was related to decreased visits to specialists and increasing reliance on generalists. The majority of visits by those living in large rural areas were in large rural areas or the patients’ home ZIP codes. Residents of rural areas have increased travel distance and time compared to their urban counterparts, particularly true of rural residents with specific diagnoses or those undergoing specific procedures. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Perinatal Technology in Rural Washington |
One of the major issues confronting rural health care providers is the problem of acquiring complex... Diffusion of New Perinatal Technology into Rural Areas of Washington State One of the major issues confronting rural health care providers is the problem of acquiring complex and expensive new medical machinery, because of the relatively low volume of patients and encounters. This study described the patterns through which new perinatal technologies are adopted, the extent to which they are utilized in communities of varying sizes and levels of medical sophistication, and the impact of these technologies on obstetrical care in rural communities. We used surveys to determine which technologies are available in inpatient and ambulatory practice settings (100% response rate). |
Complete | 2015-09-24" | |
| Oral Health in Rural |
This study determined whether shortages of dentists in rural areas of the United States are... Dentist Supply, Access to Dental Care, and Oral Health Among Rural and Urban Residents: A National Study This study determined whether shortages of dentists in rural areas of the United States are associated with impaired access to dental care and a higher prevalence of dental disease. Using detailed dentist supply data from the American Dental Association Dentist Masterfile and recent survey data from the nationally-representative Behavioral Risk Factor Surveillance System, we characterized dentist supply-oral health relationships by overall rural vs. urban location and a four-level, rural-urban grouping for the nation and individual states. |
Complete | 2015-09-24" | |
| Obstetrical Access in Washington |
A survey of all potential providers of obstetrical care in Washington State was conducted in 1989,... Obstetrical Access in Washington State A survey of all potential providers of obstetrical care in Washington State was conducted in 1989, and results were compared to an earlier survey to assess the extent to which obstetrical access had changed. Although the massive exodus of family physicians from obstetrical practice appeared to have slowed during the follow-up period, there was still substantial net attrition among this group of providers. By contrast, the supply of obstetricians and midwives seemed to be stable. Despite the greater obstetrical participation rate of rural practitioners, members of this group were also quitting obstetrics faster than they could be replaced. |
Complete | 2015-09-24" | |
| NP Distribution using Available Data |
This study compared estimates of nurse practitioner (NP) supply in 12 states (statewide and rural... Assessing rural-urban nurse practitioner supply and distribution in 12 states using available data sources This study compared estimates of nurse practitioner (NP) supply in 12 states (statewide and rural vs. urban) derived from two sources: state license records and National Provider Identifier (NPI) data. Estimates of state NP supply from license data were found to be higher than NPI-derived estimates for most, but not all states. While data from both license and NPI sources can be useful for health workforce planning, the limitations of each source should be acknowledged and workforce comparisons should be limited to estimates derived from the same types of data. |
Complete | 2015-09-24" | |
| NHSC Evaluation |
A major impediment to access to care is the shortage of primary care physicians in rural locations... National Health Service Corps Evaluation A major impediment to access to care is the shortage of primary care physicians in rural locations and inner cities. This extension of an earlier study evaluated the National Health Service Corps (NHSC) scholarship program through a mail survey with phone encouragement of NHSC scholarship recipients who graduated from medical school during 1975-83. The study examined their retention experience, locational career patterns, demographic and practice characteristics, and service in rural sites. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| National PA Study, 1996 |
The WWAMI RHRC collaborated with the North Dakota Center for Rural Health Services on a national... National Study of Physician Assistants The WWAMI RHRC collaborated with the North Dakota Center for Rural Health Services on a national survey of a random sample of physician assistants (PAs). The RHRC completed a follow-up survey of all the graduates of the University of Washington’s MEDEX Northwest PA program. The follow-up study, in which North Dakota Center for Rural Health Services staff took the lead, examined differences in rural and urban PA content of practice, satisfaction, practice type, practice characteristics, and demographic characteristics. Geographical and chronological career patterns of the PAs were investigated, as well as issues related to prescriptive authority and professional autonomy. |
Complete | 2015-09-24" | |
| Medicare Bonus Payments in HPSAs |
Medicare's Incentive Payment (MIP) program provides a 10% bonus payment to providers who treat... Medicare Bonus Payments for Physician Care in HPSAs Medicare’s Incentive Payment (MIP) program provides a 10% bonus payment to providers who treat Medicare patients in areas where there is a federally designated shortage of generalist physicians. This study examined the experience of Alaska, Idaho, North Carolina, South Carolina, and Washington with the MIP program using a retrospective cohort design utilizing 1998 Medicare Part B data. Physician specialty was determined through American Medical Association Masterfile data. Rural status was determined by linking this ZIP code to its Rural-Urban Commuting Area Code (RUCA). There were 39,780 providers in the study cohort: 24.9% generalists, 53.5% medical and surgical specialists, and 21.6% nonphysician providers. Over $4 million in bonus payments were made to providers in the Health Professional Service Area (HPSA) sites, with a median overall payment of $173. Specialists and urban providers received 58% and 14% of the bonus reimbursements respectively. Nearly a third of the potential bonus payments ($2 million) were not distributed because the providers did not claim them. Over $2.8 million in bonus claims were distributed to providers who likely did not work in approved HPSA sites. Many providers who should have claimed the bonus did not, and many who likely did not qualify for the bonus claimed and received it. Consideration should be given to focusing and enlarging the bonus payments to specific providers as well as a system that prospectively determines provider eligibility. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| Medical Education and Rural Practice Review |
This literature review critically examined the research literature related to physician... Review of the Literature on Medical Education Programs Promoting Rural Practice Location This literature review critically examined the research literature related to physician undergraduate and graduate medical education and rural practice location. While topics related to rural location choices such as federal and state programs and recruitment and retention were touched upon, the emphasis of the review was on the educational programs themselves. The main objective of the review was to determine what we currently know and what gaps in the literature need to be addressed in order to develop sound public policy. Funded by HRSA’s ORHP. |
Complete | 2015-09-24" | |
| MEDEX PA Study, 1994 |
This project, performed in partnership with MEDEX Northwest in the School of Public Health,... MEDEX Northwest Physician Assistant Study This project, performed in partnership with MEDEX Northwest in the School of Public Health, examined the locational choices and role of physician assistants (PAs) in the WAMI states, explored the use of PAs as physician extenders, and described the evolution of PA training and function over the past two decades. We surveyed all MEDEX graduates to identify factors that predict selection of and retention in rural locations. Results of this study improved the ability of training programs to select trainees likely to pursue successful careers in underserved rural areas and identified the kinds of professional environments conducive to attracting and retaining mid-level health care providers. |
Complete | 2015-09-23" | |
| MD Views of Rural Hospital Closures |
This project surveyed the physicians of rural towns whose sole small general hospitals closed... Physician Perceptions of the Closing of their Small Rural Hospitals This project surveyed the physicians of rural towns whose sole small general hospitals closed between 1980 and 1988. All locatable physicians who were practicing in the hospital closure towns at the time of the closures were surveyed with a questionnaire similar to that employed in a parallel survey of hospital closure town mayors. The study concentrated on physician perceptions of the reasons the hospitals closed, the consequences of the hospital closures, and the role the physician played in the closure process. Government reimbursement policies and poor hospital management were cited as principal reasons for hospital closures. |
Complete | 2015-09-23" | |
| Mayor Views of Rural Hospital Closures |
This project involved a survey of 130 mayors of rural towns whose sole small general hospitals... Mayor Perceptions of the Closing of their Small Rural Hospitals This project involved a survey of 130 mayors of rural towns whose sole small general hospitals closed between 1980 and 1988. Mayors attributed the closure of their hospitals primarily to government reimbursement policies, poor hospital management, and lack of physicians. They reported that they had little warning that their hospitals were in imminent danger of closing. Well over three-fourths of the mayors felt that access to medical care and health status had deteriorated in their community after hospital closure, and over 90% indicated that the hospital closure had substantially impaired the community’s economy. |
Complete | 2015-09-23" | |
| Low-Risk Obstetric Care |
This study, which was predominantly funded by AHCPR but was also supported through the HRSA's ORHP,... Low-Risk Obstetric Care Resource Use This study, which was predominantly funded by AHCPR but was also supported through the HRSA’s ORHP, was part of a large multifaceted project that examined low-risk obstetric care in Washington State through surveying obstetric providers and abstracting detailed information about their patients. This study used the provider as the unit of analysis. Differences in resource use (e.g., visits, tests, and procedures) between rural and urban obstetricians and between rural and urban family physicians were examined in detail. |
Complete | 2015-09-23" | |
| Location of PA Practices |
Despite the need for generalist care providers in rural areas experiencing shortages of generalist... Physician Assistant Location and Geographic Trajectories: A National Study Despite the need for generalist care providers in rural areas experiencing shortages of generalist physicians, the percentage of physician assistants (PAs) that practice in small towns has been decreasing. This study examined PA rural and urban location behavior and their geographic trajectories over time based on national PA data collected in an earlier study. Data from sources such as the Area Resource File were used to characterize the areas where PAs were located. Factors such as PA demography, educational program type and location, preceptorship location, and previous health care provider status were examined. As the American health care delivery system changes, with workforce policies that focus more sharply on generalist care, the need to better understand PA practices is crucial. Funded by HRSA’s ORHP. |
Complete | 2015-09-23" | |
| International Medical Graduates: States' Use of Conrad 30 J-1 Visa Waivers |
States rely on international medical graduates (IMGs) to fill workforce gaps in rural and urban... The Influence of State Policies and Practices on J-1 Visa Waiver Physicians' Service in Rural Areas States rely on international medical graduates (IMGs) to fill workforce gaps in rural and urban underserved areas. This study, funded by HRSA’s Federal Office of Rural Health Policy, collected quantitative and qualitative information from states to assess how state policies and practices shape IMG recruitment and practice in underserved areas through Conrad 30 J-1 visa waiver programs. The first report provides quantitative data on trends in waiver usage. The second report describes findings from interviews with Conrad 30 program personnel in 32 states and includes information on J-1 waiver physician retention for states with available data. |
Complete | 2015-09-23" | |
| Impact of Malpractice |
We studied all family physicians (470) who purchased obstetrical malpractice insurance from the... Impact of Malpractice Claims We studied all family physicians (470) who purchased obstetrical malpractice insurance from the largest malpractice insurer in Washington State (WSPIEA) from 1982 to 1988. One-third discontinued obstetrics but remained in practice, and these physicians were older, more likely to practice in an urban area, and more likely to be in solo practice. Rural family physicians were less likely to quit practicing obstetrics than their urban colleagues. Obstetrically related malpractice claims against family physicians were relatively infrequent and are not a factor in the decision of most family physicians who stop practicing obstetrics. |
Complete | 2015-09-23" | |
| IMG On-Line Atlas |
The on-line Atlas of International Medical Graduates (IMGs) displays trends in the geographic... On-Line Atlas of International Medical Graduates The on-line Atlas of International Medical Graduates (IMGs) displays trends in the geographic distribution of IMGs over the past 20 years through a series of maps. The maps are intended to provide useful information regarding changes in the global production of IMGs and the distribution of IMGs in the United States over time. |
Complete | 2015-09-23" | |
| HPSAs and Rural Health Care Access |
This study examined the degree to which persistence of primary care health professional services... Persistent Primary Care Health Professional Shortage Areas (HPSAs) and Health Care Access in Rural America This study examined the degree to which persistence of primary care health professional services area (HPSA) designation in rural counties is associated with lower population socioeconomic status and deficiencies in access to health care services. It used a five-level classification of rural counties measuring partial- vs. whole-county persistence of primary care HPSA designation that stratified rural populations by socioeconomic status (SES), race/ethnicity, primary care supply, health insurance uptake, and access to needed health care services. The study found that those U.S. rural counties that were persistently designated as whole-county HPSAs had much lower SES, and adults residing in these counties reported substantial financial obstacles to obtaining needed health care services. Rural counties that were persistently designated as whole-county HPSAs also faced severe provider shortages, and adults residing in these locations were less likely to have a regular primary care provider. This study was funded by HRSA’s Office of Rural Health Policy. |
Complete | 2015-09-23" | |
| Hospital Closures and MD Supply |
This study determined whether the supply of physicians decreased subsequent to a rural hospital... Impact of Hospital Closures on Physician Supply This study determined whether the supply of physicians decreased subsequent to a rural hospital closure during a nine-year period ending in 1988. The study (1) examined changes in physician manpower before, after, and at the time of the closure and (2) examined the association of town size, hospital size, and distance to other hospitals with hospital closure. The hospital closure towns most likely to lose physicians had few physicians before closure, were relatively remote from both urban areas and other hospitals, were located in sparsely populated counties, and tended to have for-profit ownership. |
Complete | 2015-09-23" | |
| HIT Workforce Development in Rural Community Colleges |
Successful implementation of health information technology (HIT) in rural areas depends on the... HIT Workforce Development in Rural-Serving Community Colleges Successful implementation of health information technology (HIT) in rural areas depends on the availability of a well-trained HIT workforce, and community colleges are key educational resources for producing this workforce. This study examined HIT workforce development programs in community colleges in order to increase understanding of the types of programs offered, describe the characteristics and sources of community college HIT curricula, highlight how these programs may be reaching underserved populations and students with limitations to accessing classroom-based courses, and identify barriers faced by these programs in achieving their HIT education goals. Information about the strengths and needs of the nation’s community college HIT education programs should help inform future HIT skills training programs and contribute to growing and strengthening the HIT workforce. |
Complete | 2015-09-23" | |
| Health Professions Education in Washington |
This study used the U.S. Department of Education's Integrated Postsecondary Education Data System... Health Professions Education in Washington State: 1996-2004 Program Completion Statistics This study used the U.S. Department of Education’s Integrated Postsecondary Education Data System (IPEDS) database to determine the number, sex and race/ethnicity of persons completing postsecondary health career education programs throughout Washington State. The report shows changes over time for 36 selected programs, ranging from physician, nursing, allied health, dental health, pharmacy and other health care education programs. The 2004 study was funded by the Washington State Workforce Training and Education Board. The 2002 study was funded by HRSA’s National Center for Health Workforce Analysis through a Congressional Appropriation to the UW CHWS. |
Complete | 2015-09-23" | |
| Health Center Expansion and Recruitment in WWAMI States |
Federally qualified health centers (HCs) face major barriers in recruiting and retaining health... Results of the 2004 Health Center Expansion and Recruitment Survey for Health Centers: Analyses for Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI States) Federally qualified health centers (HCs) face major barriers in recruiting and retaining health professionals, yet there have been no projections of key health professions staffing needs for HCs and proposed new HCs. A study by the University of Washington Rural Health Research Center (RHRC) and collaborators described the current staffing needs of HCs across the United States and the staffing, recruitment, and retention issues that HC chief executive officers (CEO) regard as most critical throughout the nation as a whole. Presented here is a subset of the findings from the larger national study for HCs located in Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) overall and by urban and rural geography. |
Complete | 2015-09-23" | |
| Health Center Expansion and Recruitment |
Rural health centers (HCs) faced major barriers in recruiting and retaining health professionals,... Health Center Expansion and Recruitment Survey: Joint South Carolina Rural Health Research Center and WWAMI Rural Health Research Center Project Rural health centers (HCs) faced major barriers in recruiting and retaining health professionals, yet there were no projections of key health professions staffing needs for HCs and proposed new HCs. This collaborative study with the South Carolina RHRC described the staffing needs of rural HCs and ascertained the staffing, recruitment, and retention issues that HC CEOs regarded as most critical. The National Association of Community Health Centers administered a mail questionnaire to the CEOs of all CHCs in the nation (about 845) that profiled their current staff vacancies, projected staffing needs, recruitment and retention issues, center site expansion plans, and CEO perception of policies that would facilitate recruitment and retention. This joint center project was a collaborative one between HRSA’s FORHP, BPHC, and BHPr. |
Complete | 2015-09-23" | |
| Health Care Reform in Rural |
Since 2009, the WWAMI RHRC has carried out several rapid-turnaround analyses of rural issues... Health Care Reform Policy Briefs on Rural Health Workforce Issues Since 2009, the WWAMI RHRC has carried out several rapid-turnaround analyses of rural issues related to health care reform. The published products of these analyses have been posted to the WWAMI RHRC Web site. |
Complete | 2015-09-23" | |
| Health Care for the Rural Uninsured |
This study described the contributions of family and general practice physicians from Wyoming to... Health Care for the Uninsured: How Do the Uninsured Use the Rural Safety Net? This study described the contributions of family and general practice physicians from Wyoming to the health care safety net. We surveyed family and general practice physicians in Wyoming about provider demographics, practice composition, and policies for treating the underinsured or uninsured. From a 50% response rate, 61% made less than the national mean family physician income ($130,000), and women were less likely than men to make this mean income, even when controlling for hours worked. Close to two-thirds claimed bad debt of over $10,000, and 29.3% noted forgiven debt of over $10,000. Physicians with less income than the prior year were more likely to decrease their charity care. Wyoming family physicians provide significant amounts of informal safety net care, which is threatened by income loss. Funded by HRSA’s ORHP. |
Complete | 2015-09-23" | |
| Future Supply of Family Medicine Physicians |
This study investigated the implications of declining medical school interest in primary care... The Future of Family Medicine and Implications for Primary Care Physician Supply This study investigated the implications of declining medical school interest in primary care careers as it impacts rural and underserved areas. The study examined data from the American Association of Medical Colleges, the 2005 American Medical Association Masterfile, and the American Osteopathic Association Masterfile, as well as survey data from residency directors and students to describe recent trends in medical school interest and national match rates for family medicine and primary care. Funded by HRSA’s FORHP. |
Complete | 2015-09-23" | |
| Federal Funding and MD Production |
This study described the graduates of all American medical schools from 1976 to 1980 and from 1981... Relationship Between Federal Funding and Medical School Output This study described the graduates of all American medical schools from 1976 to 1980 and from 1981 to 1985 in terms of their specialty and geographic location and correlated these variables with the amount of Title VII funds received by specific schools during those periods. Two hypotheses that were tested were (1) Title VII has had a positive impact on increasing the proportion of graduates choosing primary care specialties and practicing in rural and underserved areas, and (2) graduates of community-based schools are more likely to choose careers in primary care and to practice in rural and underserved areas than are graduates of traditional medical schools. Data for each medical school were aggregated by school and linked with data on Title VII and other federal funding from 1976 to 1985. |
Complete | 2015-09-23" | |
| Family Medicine Residency Network Study |
This survey project contrasted the role, practice type, and characteristics of graduates from the... Long-Term Follow-Up Study of Graduates of Family Medicine Residency Network Programs This survey project contrasted the role, practice type, and characteristics of graduates from the residency network associated with the University of Washington Department of Family Medicine who were located in rural versus urban communities. The geographic trajectories by graduate cohort and program were analyzed. In addition, the extent to which the program has been successful in placing and retaining graduates within rural communities and the region was evaluated. |
Complete | 2015-09-23" | |
| Family MD Views of Assisted Suicide |
With recent laws allowing physicians to assist in a terminally ill patient's suicide under certain... Family Physician Attitudes Toward Physician-Assisted Suicide With recent laws allowing physicians to assist in a terminally ill patient’s suicide under certain circumstances, the debate concerning the appropriate and ethical role for physicians has intensified. This study used data from a 1997 survey of family physicians (FPs) and general practitioners (GPs) in Washington State to determine factors associated with attitudes toward physician-assisted suicide. A questionnaire was mailed to all active FPs/GPs in Washington State. A ZIP code system based on generalist Health Service Areas was used to designate those practicing in rural versus urban areas. One-fourth of the respondents overall indicated support for physician-assisted suicide. When asked whether this practice should be legalized, 39% said yes, 44% said no, and 18% did not know. Over half would not include physician-assisted suicide in their practices, even if it were legal. Attitudes about physician-assisted suicide varied significantly between urban females and rural males, with the former being more supportive of assisted suicide than the latter. Many respondents, especially females, were uncertain of their positions concerning the legalization of and their willingness to assist suicides. Substantial differences in opinion toward physician-assisted suicide existed between physicians based on gender and rural-urban practice location. There was a significant pattern of opposition on the part of rural male respondents compared to urban female respondents. |
Complete | 2015-09-23" | |
| Family MD Practice Locations |
In this study, responses to a survey of graduates from the residency network associated with the... Geographic Career Trajectories of Family Practice Physicians In this study, responses to a survey of graduates from the residency network associated with the University of Washington Department of Family Medicine were analyzed related to their rural and urban career trajectories. This study examined the locational patterns of the graduates in terms of initial site location, practice moves, lengths of stay, prior movement experience, gender, and graduation cohort. |
Complete | 2015-09-23" | |
| Emergency Care of Rural Elderly |
This study used Medicare data to compare emergency department (ED) use by rural and urban elderly... The Emergency Care of the Rural Elderly This study used Medicare data to compare emergency department (ED) use by rural and urban elderly beneficiaries. The Health Care Financing Administration’s National Claims File was used to identify services provided to Medicare beneficiaries in Washington State in 1994. Patients were classified by urban, adjacent rural, or remote rural residence. We identified ED visits and associated diagnostic codes, assigned severity levels for presenting conditions, and determined the specialties of physicians providing ED services. This study found that the rural elderly living in remote areas were 13% less likely to visit the ED than their urban counterparts. Causes of ED use by the elderly did not vary meaningfully by location. Most ED visits by this group were for conditions that seem appropriate for this setting. Given the similarity of diagnostic conditions associated with ED visits, local EDs must be capable of dealing with the same range of emergency conditions as urban EDs. Funded by HRSA’s ORHP. |
Complete | 2015-09-23" | |
| Educational Strategies to Encourage Rural NP Practice |
Persistent shortages of primary care physicians in rural areas have increased the need to educate... What Strategies Are Nurse Practitioner Educational Programs Using to Encourage Rural Practice? Persistent shortages of primary care physicians in rural areas have increased the need to educate nurse practitioners (NPs) for rural careers. Medical schools have identified factors associated with rural practice by physicians and used this knowledge to develop rural training programs, but less is known about factors associated with rural NP training and practice or the extent to which NP programs deploy such strategies. This study will quantify and describe NP education programs that encourage NPs to practice in rural areas and identify data sources that could be used in future studies of the effectiveness of these programs. This study is funded by HRSA’s Office of Rural Health Policy. |
Complete | 2015-09-23" | |
| Economic Impact of HRSA Rural Network & Outreach Grants |
This study analyzed the economic impact created by HRSA Network Development and Outreach grantees.... Economic Impact Analysis of HRSA’s Rural Health Care Services Outreach and Rural Health Network Development Grant Programs This study analyzed the economic impact created by HRSA Network Development and Outreach grantees. The analyses were conducted with the goal of creating transparent and easy-to-use tools that can be used by grantees and HRSA in future program efforts. While the project analyses focused on a cohort of grantees, the study used methods and data that potentially could be extended to other HRSA grantees and programs. The WWAMI RHRC had a subcontract to carry out this project in collaboration with The Lewin Group, through a grant from HRSA’s Office of Rural Health Policy. |
Complete | 2015-09-23" | |
| Economic Impact of HRSA Rural Network & Outreach Grants |
This study analyzed the economic impact created by HRSA Network Development and Outreach grantees.... Economic Impact Analysis of HRSA's Rural Health Care Services Outreach and Rural Health Network Development Grant Programs This study analyzed the economic impact created by HRSA Network Development and Outreach grantees. The analyses were conducted with the goal of creating transparent and easy-to-use tools that can be used by grantees and HRSA in future program efforts. While the project analyses focused on a cohort of grantees, the study used methods and data that potentially could be extended to other HRSA grantees and programs. The WWAMI RHRC had a subcontract to carry out this project in collaboration with The Lewin Group, through a grant from HRSA’s Office of Rural Health Policy. |
Complete | 2015-09-23" | |
| Deregionalization of Rural Perinatal Care |
The regionalization of rural perinatal care during the 1980s significantly lowered neonatal... Are Rural Perinatal Care Systems Deregionalizing? The regionalization of rural perinatal care during the 1980s significantly lowered neonatal mortality among infants born to rural residents, yet recent trends could disrupt the efficiency of regionalized systems of care. This national study determined whether there was evidence of deregionalization of rural perinatal care for high-risk women and infants and whether deregionalization had adversely affected neonatal mortality among infants born to rural residents. We analyzed national Linked Birth Death Data Set data over a 10-year period. The study population included all low-birthweight infants born to rural residents. This study demonstrated the impact of managed care on the rural health care delivery system and outcomes. Funded by HRSA’s FORHP. |
Complete | 2015-09-23" | |
| Contributions of Physicians, APNs, and PAs to Rural Primary Care |
This multi-state study examined the practices of rural physicians, advanced practice nurses (APNs),... The Current Contribution of Physicians, Advanced Practice Nurses, and Physician Assistants to the Rural Primary Care Workforce This multi-state study examined the practices of rural physicians, advanced practice nurses (APNs), and physician assistants (PAs) regarding their primary care visit productivity and scope of practice. Through surveys, this study examined the contributions of physicians, APNs, and PAs by state, degree of practice rurality, practice characteristics, and primary care HPSA status in order to provide information on a range of rural primary care workforce needs in the coming decades. Funded by HRSA’s Office of Rural Health Policy. |
Complete | 2015-09-23" | |
| Community Paramedicine Research Consensus Conference |
Background: Community paramedicine is a new model of providing access to basic health care... National Consensus Conference on Community Paramedicine: Development of a Community Paramedicine Research Agenda Background: Community paramedicine is a new model of providing access to basic health care services. Community paramedicine extends paramedics’ traditional emergency response roles through additional education that enables them to see patients in their home or community setting and perform procedures already in their skill set. Community paramedics provide care under the supervision of an ordering physician or advance practice provider. Community paramedics are providing these kinds of services for otherwise underserved communities in demonstration sites in the U.S. and Canada. While there are reports of successful implementation of this novel approach to expanding primary care access, there is a paucity of objective, systematic research on the outcomes of these programs. This project identified appropriate research questions and appropriate data to increase understanding of the outcomes of community paramedicine. Goal: This project developed a national research agenda for the emerging field of community paramedicine based on facilitated discussions at a National Consensus Conference on Community Paramedicine. Collaboration: The study was conducted collaboratively by researchers at the University of Washington (UW) WWAMI Rural Health Research Center (RHRC) and the North Central Emergency Medical Services Institute. Funding was from a conference grant by the Agency for Healthcare Research and Quality. The UW’s WWAMI RHRC researchers completed a summary of topics and key points discussed during the National Consensus Conference on Community Paramedicine (October 1-2, 2012) and a community paramedicine research agenda report. |
Complete | 2015-09-23" | |
| Chronic Illness among Rural Residents |
This study used data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine... The Burden of Chronic Illness Among Rural Residents: A National Study This study used data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine trends–by type of geographic area, race/ethnicity, and risk factors–in hypertension, diabetes, hypercholesterolemia, and asthma, as well as patterns of screening for two of these conditions. BRFSS is a nationally representative study of the adult population in the United States that collects health data on an annual basis. Funded by HRSA’s FORHP. |
Complete | 2015-09-23" | |
| Characteristics of National Rural Nurse Workforce |
This national study characterized changes in the demographic, education, and practice... Long-Term Trends in Characteristics of the Rural Nurse Workforce: A National Health Workforce Study This national study characterized changes in the demographic, education, and practice characteristics of registered nurses (RNs) in rural and urban areas from 1980 to 2004. Study data came from the National Sample Survey of Registered Nurses (NSSRN) collected between 1980 and 2004. RNs were categorized into urban, large rural, small rural, and isolated small rural by residence and work location using the Rural-Urban Commuting Area taxonomy. The study examined changes since 1980 in rural RN number, percent employed in nursing, age, gender, race/ethnicity, age at first RN degree, types of degrees attained, type of work, salaries, the types of areas where the RNs work, and their likely commuting patterns. By examining trends in rural RNs characteristics over the past two decades, this study provided important information for projecting future trends in RN supply for rural communities. |
Complete | 2015-09-23" | |
| Changes in MD Supply |
National rural health policy development depends on an accurate and up-to-date assessment of... National Changes in Physician Supply National rural health policy development depends on an accurate and up-to-date assessment of physician supply. This project described the supply of generalist physicians and osteopaths in rural areas of the United States. We used data from the AMA and Area Resource File to determine the total supply of practicing physicians in metropolitan and nonmetropolitan counties in 2005. We used Urban Influence Codes to classify nonmetropolitan counties based on their adjacency to a metropolitan county and the size of the largest urban place within the county. We assessed the supply of physicians in the smallest and most isolated areas of the country and analyzed rural physician supply on a state-by-state and regional basis. Funded by HRSA’s FORHP. |
Complete | 2015-09-23" | |
| Care for Lung Disease among Rural/Urban Medicare Beneficiaries |
This retrospective cohort study examined access of a sample of Medicare beneficiaries among rural... National Study of Rural/Urban Differences in Use of Home Oxygen for Chronic Obstructive Lung Disease: Are Rural Medicare Beneficiaries Disadvantaged? This retrospective cohort study examined access of a sample of Medicare beneficiaries among rural and urban patients hospitalized with chronic obstructive lung disease to prescribed home oxygen and the needed equipment. Funded by HRSA’s FORHP. |
Complete | 2015-09-23" | |
| Care for Acute Myocardial Infarction in Rural Hospitals: 1994-1995 |
Acute myocardial infarction (AMI) is an important condition cared for in rural hospitals. Most... Quality of Care for Acute Myocardial Infarction Patients in U.S. Rural Hospitals: 1994-1995 Acute myocardial infarction (AMI) is an important condition cared for in rural hospitals. Most recommended interventions require no sophisticated technology and should be available in rural and urban hospitals. This study examined the quality of AMI care in rural hospitals. It was a cohort study using data from the 1994 and 1995 Centers for Medicare & Medicaid Services’ Cooperative Cardiovascular Project and the 1995 American Hospital Association’s Annual Survey of Hospitals. The study included U.S. acute-care hospitals caring for patients with AMI, and Medicare beneficiaries ages 65 and older directly admitted to four types of acute-care hospitals–remote small rural, small rural, large rural, and urban–for a confirmed AMI between 1994 and 1995. Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive recommended AMI treatments. Medicare patients treated in rural hospitals were less likely than urban hospitals’ patients to receive aspirin during hospitalization or at discharge, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only one treatment–ACE inhibitors at discharge–was used more for patients in rural hospitals. Medicare patients in rural hospitals had significantly higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals. Efforts are needed to help hospital medical staffs, especially those in rural areas, develop systems to ensure that patients receive recommended AMI treatments. Funded by HRSA’s ORHP. |
Complete | 2015-09-23" | |
| Cancer Screening in Rural America |
This study examined Behavioral Risk Factor Surveillance System (BRFSS) national survey data to... Breast, Cervical, Colorectal, and Prostate Cancer Screening in Rural America: Does Proximity to a Metropolitan Area Matter? This study examined Behavioral Risk Factor Surveillance System (BRFSS) national survey data to explore the prevalence and trends in screening for four types of cancer (breast, colorectal, cervical, and prostate) among survey respondents from urban and various types of rural areas and among white compared to minority populations. BRFSS is a nationally representative study of the adult population in the United States that collects health data on an annual basis. Funded by HRSA’s FORHP. |
Complete | 2015-09-23" | |
| Cancer Care for Rural Colorectal Cancer Patients |
This study compiled a comprehensive database linking Surveillance Epidemiology and End Results... Access to Cancer Services for Rural Colorectal Cancer Medicare Patients: A Multi-State Study This study compiled a comprehensive database linking Surveillance Epidemiology and End Results (SEER) cancer registry, Medicare claims, American Medical Association Masterfile, and other data to examine access to cancer services in a sample of rural, Medicare-insured colorectal cancer patients of different racial and ethnic groups. Funded by HRSA’s FORHP. |
Complete | 2015-09-23" | |
| Birth Care for Rural/Urban American Indians |
While American Indians (AIs) constitute a substantial minority population in many rural areas,... Perinatal Risk Factors, Prenatal Care Use, Birth Outcomes, and Infant Mortality of Rural and Urban American Indian Women While American Indians (AIs) constitute a substantial minority population in many rural areas, population-based research on the health status of AI women and infants is limited. This study used the National Linked Birth Death Certificate Data Set for 1989 and 1991 to compare the perinatal risk factors, prenatal care use, birth outcomes, and infant death rates of rural AIs, urban AIs, and whites. Results from this study should help administrators and policy makers to better understand the health care needs of this population, as well as the targeted interventions needed to improve birth outcomes and infant health status. Funded by HRSA’s ORHP. |
Complete | 2015-09-23" | |
| BBA and Rural Residency Training |
This national survey examined the proportion of rural-based family medicine residencies across the... Is Rural Residency Training of Family Physicians an Endangered Species? An Interim Follow-Up to the 1999 National BBA Study This national survey examined the proportion of rural-based family medicine residencies across the United States that have ceased operations since 2000, the residency match patterns of existing programs, changing proportions of International Medical Graduates (IMGs) and U.S. Medical Graduates (USMGs), and major issues facing rural residency programs. Funded by HRSA’s FORHP. |
Complete | 2015-09-23" | |
| Barriers to Rural Residencies |
This project examined issues related to establishment and maintenance of residencies and residency... Barriers to Rural Residencies Project This project examined issues related to establishment and maintenance of residencies and residency tracks in rural America. The project involved both a literature review and interviews with key informants related to the issues surrounding rural residency programs. While the project emphasized generalist residencies, it was not limited to them. The policy paper discussed issues associated with retaining and starting rural residencies and tracks such as their training cost and clinical implications, credentialing constraints, and staffing problems. Understanding the issues surrounding the establishment of rural residencies is important for federal and state legislators and administrators as they revamp the nation’s graduate medical education system. Funded by HRSA’s ORHP. |
Complete | 2015-09-23" | |
| APRN Distribution in the U.S. |
This study analyzed 2010 Centers for Medicare and Medicaid Services' National Provider Identifier... Advanced Practice Registered Nurse Distribution in Rural and Urban Areas of the U.S. This study analyzed 2010 Centers for Medicare and Medicaid Services’ National Provider Identifier (NPI) records to assess the usefulness of the dataset to describe APRN distribution across the United States. There were adequate NPI data to describe urban and rural location of certified registered nurse anesthetists (CRNAs) and nurse practitioners (NPs) in the U.S. and relative per capita supply. Practice location was estimated by linking Rural-Urban Commuting Area codes to NPI provider ZIP codes. Chi-square testing examined provider supply by geographic locations. Multivariate hierarchical regression testing identified whether rural practice location was related to practice autonomy, per capita provider supply, or gender. Funded by the American Nurses Association. |
Complete | 2015-09-23" | |
| Ambulatory Care for Rural Elderly |
Diabetes is a common serious chronic disease where careful clinical monitoring can improve the... Ambulatory Care and the Rural Elderly Diabetes is a common serious chronic disease where careful clinical monitoring can improve the quality of care and patient outcomes. This study examined the extent to which Medicare patients in Washington State receive care that adheres to clinical guidelines and the extent to which the rural or urban residence affects the quality of care received. Medicare patients 65 years and older with two physician encounters for a diabetic condition in 1994 were included in this study. Patient residence was determined by using the ZIP code of the patient’s dwelling as listed in the Medicare National Claims History File. Adherence to guidelines was measured by determining the extent to which patients received three tests recommended by the major authoritative bodies during the study year: glycated hemoglobin, an eye examination, and a cholesterol measurement. 30,589 Medicare patients (8.4%) were considered to have diabetes; 29.1% lived in rural communities. Urban patients received virtually all their medical care in their local communities, as did over 80% of rural patients who lived in rural communities with more than 10,000 people; people living in smaller rural towns received almost half their outpatient care in other communities. Most diabetic care in all locations is provided by generalists. Patients living in large rural towns remote from metropolitan areas received higher quality care on these measures than all other groups, while those living in large communities adjacent to metropolitan areas had the lowest adherence rates. Patients who saw an endocrinologist at least once during the year were more likely to have received the recommended tests. Even though clear guidelines exist for certain routine monitoring tests–and even though Medicare pays for these tests–most patients do not get all the recommended interventions. Large rural towns remote from cities seem to have higher quality of care. Given that most diabetic care is given by generalists, the challenge is to create a system where patients and their primary care physicians can work together to improve the care of serious chronic conditions. Funded by HRSA’s ORHP. |
Complete | 2015-09-23" | |
| Allied Health Education in Community Colleges |
This study identified rural-serving community colleges across the United States and their five-year... Community Colleges’ Contributions to the Education of Allied Health Professionals in Rural Areas of the United States This study identified rural-serving community colleges across the United States and their five-year graduation trends for specific allied health professions, examined the spectrum of how rural allied health professions education currently is being allocated and delivered, and explored how community economic status and estimated regional allied health workforce demand is associated with the availability of rural community college allied health education programs. Funded by HRSA’s ORHP. |
Complete | 2015-09-22" | |
| Allied Health Education in Community Colleges |
This study identified rural-serving community colleges across the United States and their five-year... Community Colleges' Contributions to the Education of Allied Health Professionals in Rural Areas of the United States This study identified rural-serving community colleges across the United States and their five-year graduation trends for specific allied health professions, examined the spectrum of how rural allied health professions education currently is being allocated and delivered, and explored how community economic status and estimated regional allied health workforce demand is associated with the availability of rural community college allied health education programs. Funded by HRSA’s ORHP. |
Complete | 2015-09-22" | |
| Aging Rural Physician Workforce |
This study identifies rural locations with high proportions of generalist physicians nearing... The Aging of the Rural Generalist Physician Workforce: Will Some Locations Be More Affected than Others? This study identifies rural locations with high proportions of generalist physicians nearing retirement age. As fewer young physicians choose generalist careers, the retirement of older physicians may place additional strain on rural generalist supply. This study quantifies the extent to which rural generalist physician shortages may be exacerbated by physician retirement, focusing on known shortage locations. The study used data from the American Medical Association and American Osteopathic Association 2005 Masterfiles. This study was funded by HRSA’s Office of Rural Health Policy. |
Complete | 2015-09-22" | |
| Access to and Outcomes of Obstetric Care |
Previous work conducted by the WWAMI RHRC demonstrated a relationship between access to obstetrical... Relationship Between Access to Obstetrical Care and Process and Outcome of Care Previous work conducted by the WWAMI RHRC demonstrated a relationship between access to obstetrical care in rural communities and birth outcomes (see working paper #4). The Obstetrical Process and Outcome of Care Study compared rural versus obstetrical care and outcomes from birth certificates. This study examined the relationship between access to and availability of care (number of local providers available who provide obstetrical care and who care for pregnant Medicaid women) and quality and cost of care. Sources of data included Washington State birth certificates and hospital discharge abstracts, supplemented with information on hospitals, communities, and provider supply. Findings from this study further illuminate the connection between poor geographic access, Medicaid access, and poor quality care. |
Complete | 2015-09-22" | |
| 2004 Rural-Urban Commuting Areas (V2) |
This project described the new version of the Rural/Urban Commuting Areas (RUCAs) taxonomy that... Introduction to and Description of the 2004 (Version 2) Rural-Urban Commuting Areas (RUCAs) This project described the new version of the Rural/Urban Commuting Areas (RUCAs) taxonomy that defines rural and urban based on Census Bureau definitions and work commuting patterns. The RUCA taxonomy is a tool based on the sizes of cities and towns and their functional relationships as reflected by commuter patterns. Funded by HRSA’s FORHP. |
Complete | 2015-09-21" |
