Current Projects

When rural residents leave their community for care that is available in their community (hospital bypass), the local hospital’s financial condition may be adversely impacted, ultimately impairing access to care in the community. This project will estimate the rural hospital bypass rate using all-payer claims data for a set of states and compare patients based on the inpatient treatments and procedures received relative to those routinely provided by rural facilities. More info...

The use of evidence-based interventions (EBIs), programs and practices that have demonstrated effectiveness at improving outcomes, is often preferred, or even required, by funders of health programs and others. This project will investigate the benefits of piloting and researching interventions in rural areas to build the rural evidence base as a step in addressing health disparities and improving health conditions in rural communities. More info...

Little is known about the degree to which evidence-based buprenorphine therapy is being accessed consistently and equitably by pregnant and postpartum women with opioid use disorder (OUD). The objective of this study is to analyze prescription claims from a national commercial insurance database to 1) characterize buprenorphine therapy initiation, persistence, and adherence among pregnant and postpartum women with OUD and 2) assess differences in buprenorphine OUD treatment characteristics among rural and urban pregnant/postpartum women.  More info...

Area-level indices of vulnerability, deprivation, prosperity, and the like are increasingly being applied in policy, reimbursement methods, and resource allocation. The purpose of this study is to compare the area-level indices and score missingness by measures of rurality. Further, researchers will examine associations between indices and health-related outcomes of interest.  More info...

Federal funding, including through block grants, provides states with considerable flexibility in allocating funds. States therefore allocate these funds in a variety of ways and based on different factors, including recently popularized area-level measures such as the Social Vulnerability Index (SVI), and measures of population size, poverty, and rurality.

The purpose of this study is to model how funding formula structures within states affect allocation amounts to counties overall and by county-level measures of rurality, race, and ethnicity.  More info...

This project explores health care accessibility in rural U.S. areas from 2010-2022, examining Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs). It leverages data from the Health Resources and Services Administration's Data Warehouse and demographic statistics to analyze trends, spatial patterns, and the intersections of demographics and health care access. More info...

This study describes and compares the differences in the utilization of emergency department (ED) services among rural and urban Medicare Fee-For-Service enrollees during 2018-2021. We will identify factors associated with differences in ED use, including shifts in volume, primary diagnoses, and admission source, before and since the COVID-19 public health emergency in rural and urban areas.  More info...

Access to post-acute services is an important component in the continuum of care and as part of value-based care payment models. This study will provide important information on how utilization and outcomes differ by coverage for rural Medicare beneficiaries and by region of the country, rurality, and race and ethnicity.  More info...

Rural communities face challenges in accessing hospital services, which may be most pronounced when a hospital closes. However, closure of specific hospital service lines also affects access to care and is understudied. The purpose of this study is to estimate hospital service line closures over time by rurality, hospital type, and community characteristics, and estimate changes in distance to the nearest facilities after a service line closure. More info...

This CMS Hierarchical Condition Category (CMS-HCC) risk score study will investigate differences in underlying health between rural and urban populations using recent data and analyze which factors drive observed differences.  More info...

Several surveys conducted during the COVID-19 pandemic showed that adults delayed or skipped healthcare services during the initial months of the COVID-19 pandemic. This study examines changes in healthcare utilization for primary and preventative care among rural and urban Medicare fee-for-service enrollees since the COVID-19 pandemic.  More info...

Sepsis is one of the costliest and most common causes of inpatient stays and contributes to approximately 350,000 deaths per year. This study explores differences in sepsis mortality rates between rural and urban hospitals, linking factors such as resource constraints and transfer delays. The study uses a retrospective cohort design, analyzing Nationwide Readmissions Database data from 2016 to 2021 to track sepsis-related hospital discharges and mortality, including postoperative sepsis and septic shock.  More info... 

This study will include an analysis of 2018/2019 Medicare, Medicaid and Commercial claims to compare the penetration of SBIRT and its different components (i.e., screening and brief intervention and referral to treatment) in rural compared to urban healthcare settings. Findings will be analyzed within the context of county-level substance use rates, historical enactment of state SBIRT billing codes, overdoses, and alcohol poisoning-based hospital admissions contrasting trends in SBIRT administration with a proxy for community need.  More info...

Suicide contributes to significant mortality in the United States, accounting for over 48,000 deaths in 2021 alone. There are multiple risk factors for suicide, including age, access to mental health care, geographic isolation, stigma, at-risk substance use, access to firearms, and socioeconomic factors. This project will examine the variation in suicide rates by geography and explore its driving factors among urban and rural areas in the United States from 2018 to 2021. More info...

Health data are commonly used for decision-making, population health efforts, funding, and reporting at the national, state, and local level. Despite their importance, systematic assessment of the challenges of rural health data and how these challenges may be addressed is lacking. This study will systematically review a subset of the published rural health literature in order to summarize the most common challenges of rural health data, types of data used, and efforts used by researchers in the field to overcome these limitations.  More info...