Date: June 16, 2022

Non-Metropolitan and Metropolitan Trends in Mental Health Treatment Availability in Community Health and Community Mental Health Centers

Community mental health centers (CMHCs) and community health centers (CHCs) are two types of federally funded sites where persons may seek mental health treatment. The purpose of this study was to show how the supply of CMHCs and CHCs delivering mental health services changed over time, in non-metropolitan and metropolitan areas.

It was found that the supply of CMHCs decreased substantially from 2000 to 2019 in non-metropolitan counties. However, the supply of CHCs offering mental health services increased substantially over the same time period. These gains were pronounced in both non-metropolitan and metropolitan counties, although growth was faster in metropolitan counties.

Contact Information:

Ty Borders, PhD
Rural and Underserved Health Research Center
Phone: 859.218.2041
ty.borders@uky.edu

Additional Resources of Interest:

• More information about the Rural and Underserved Health Research Center
• More information from the Rural Health Information Hub’s topic guides: Federally Qualified Health Centers (FQHCs) and the Health Center Program, Healthcare Access in Rural Communities, Rural Mental Health, Rural Health Disparities, Substance Use and Misuse in Rural Areas

Click to view Research Alerts.

Date: June 6, 2022

The Racial and Ethnic Diversity of the Family Physician Workforce in Non-Metropolitan and Metropolitan Counties

In general, physicians are disproportionately White and male compared to the U.S. workforce and population, but little is known about racial and ethnic distribution of family physicians (FPs) according to rurality and how this compares to urban FPs. The objective was to determine the distribution of FPs in rural areas by race/ethnicity and also whether rural minority physicians were more likely to be in underserved rural areas.

Key Findings

• The family physician workforce is becoming more racially diverse; however, non-metropolitan family physicians are not.
• Early career family physicians are more diverse than later career physicians.
• Minority non-metropolitan family physicians, particularly Black and Native American/Alaska Native physicians, are more likely to practice in persistent poverty counties.

Contact Information:

Lars E. Peterson, MD, PhD
Rural and Underserved Health Research Center
Phone: 859.538.7180
lpeterson@theabfm.org

Additional Resources of Interest:

• More information about the Rural and Underserved Health Research Center
• More information from the Rural Health Information Hub’s topic guides: Healthcare Access in Rural Communities, Rural Healthcare Workforce, Recruitment and Retention for Rural Health Facilities, Rural Health Disparities

Click to view Research Alert.

Date: June 1, 2022

Trends in Revenue Sources among Rural Hospitals

This study estimates changes in outpatient care as a source of revenue for rural hospitals. It uses 2011-2019 data from the Healthcare Cost Report Information System to analyze trends in the percent of patient revenue coming from outpatient care.

For the average hospital in the sample of 1,866 rural hospitals, the percent of revenue coming from outpatient services increased from 66.5% in 2011 to 74.2% in 2019. Furthermore, total outpatient revenue for the average rural hospital increased by 56.4% from 2011-2019, after inflation adjustment. Conversely, total inpatient revenue for the average rural hospital only increased by 9.3% from 2011-2019, after inflation adjustment.

The findings suggest that many rural hospitals now receive most of their revenue from outpatient sources.

Contact Information:

George H. Pink, PhD
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919.843.2728
gpink@email.unc.edu

Additional Resources of Interest:

• Decline in Inpatient Volume at Rural Hospitals
• Medicare Covers a Lower Percentage of Outpatient Costs in Hospitals Located in Rural Areas
• More information about the North Carolina Rural Health Research and Policy Analysis Center
• More information from the Rural Health Information Hub’s topic guides: Rural Hospitals, Rural Health Policy

Click to view Research Alert.

Date: May 31, 2022

Association Between Rural Hospital Service Changes and Community Demographics

This brief investigated the association between the proportion of a rural community belonging to an Agency for Healthcare Research and Quality-identified priority population and local hospital service changes. The results suggest that recent trends in service availability are often similar when comparing hospitals in non-metro counties with larger versus smaller priority populations. In aggregate, from 2011-2017, hospitals in non-metro counties generally experienced a net decrease in the availability of obstetric services and skilled nursing services and a net increase in the availability of oncology services, hospital-based outpatient services, orthopedic services, and emergency psychiatric services. Aggregate changes in the availability of home health and chemotherapy were generally smaller in magnitude. These aggregate results are consistent with previous work on rural hospital-based service availability.

Contact Information:

George H. Pink, PhD
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919.843.2728
gpink@email.unc.edu

Additional Resources of Interest:

• Changes in Provision of Selected Services by Rural and Urban Hospitals Between 2009 and 2017
• More information about the North Carolina Rural Health Research and Policy Analysis Center
• More information from the Rural Health Information Hub’s topic guides: Healthcare Access in Rural Communities, Rural Hospitals, Rural Health Policy

Click to view Research Alert.

Date: May 24, 2022

Community Characteristics and Financial and Operational Performance of Rural Health Clinics in the United States: A Chartbook

This chartbook provides an overview of Rural Health Clinic (RHC) characteristics and issues using data from the Centers for Medicare and Medicaid Services’ (CMS) Provider of Services file, Medicare cost reports, and the Robert Wood Johnson Foundation’s County Health Ranking and will be useful to policymakers and others interested in the performance of RHCs nationally. It can also be useful to RHC administrators to benchmark staffing patterns, productivity, and efficiency. Finally, it provides a discussion of the challenges related to collection and reporting of RHC quality data.

Contact Information:

John A. Gale, MS
Maine Rural Health Research Center
Phone: 207.228.8246
john.gale@maine.edu

Additional Resources of Interest:

• More information about the Maine Rural Health Research Center
• More information from the Rural Health Information Hub’s topic guide: Rural Health Clinics (RHCs)

Date: May 24, 2022

Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Professional Experience and Provision of Evidence-Based Care

This study describes the relationship between prehospital emergency medical services (EMS) providers’ levels of experience and provision of evidence-based care for rural and urban populations. Using electronic prehospital EMS patient care record data, Washington, Wyoming, Alaska, Montana, Idaho (WWAMI) Rural Health Research Center examined four EMS Compass performance measures of evidenced-based care for seizure, stroke, hypoglycemia, and trauma.

Compared with EMS agencies serving predominantly urban patient populations, rural-serving agencies less often provided evidence-based care according to performance measures for stroke, hypoglycemia, and trauma. The rural/urban difference was more pronounced with increasing rurality. Using daily 911 encounters and total time spent on 911 encounters as measures of accumulated experience, WWAMI Rural Health Research Center found that EMS professionals at rural agencies had lower levels of accumulated experience than professionals at urban agencies. Experience levels decreased as agency rurality increased. Patients were more likely to receive evidenced-based care for seizure and trauma when the lead EMS professional at the encounter had accumulated more total time responding to 911 encounters. Measures of experience were not associated with evidence-based care for stroke or hypoglycemia.

Contact Information:

Davis Patterson, PhD
WWAMI Rural Health Research Center
Phone: 206.543.1892
davisp@uw.edu

Additional Resources of Interest:

• More information about the WWAMI Rural Health Research Center
• More information from the Rural Health Information Hub’s topic guides: Education and Training of the Rural Healthcare Workforce, Rural Emergency Medical Services (EMS) and Trauma, Rural Healthcare Quality, Rural Healthcare Workforce

Date: May 23, 2022

Racial/Ethnic Differences in Adverse and Positive Childhood Experiences Across Rural Communities: Results from the National Survey of Children’s Health

Both positive and adverse events that occur during childhood and adolescence have been shown to be associated with physical and mental health outcomes in adulthood. This study examined whether adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) exposure varied by race/ethnicity among rural children. Key findings include:

ACEs

• There were higher rates of four or more ACEs among racial/ethnic minority children living in rural areas.
• Asian/Pacific Islander rural children had the highest rates of three out of six ACEs: parental death, witnessing neighborhood violence, and economic hardship.
• Economic hardship was prevalent among rural children, with 26.2% of this population experiencing economic hardship, and over 40% of Black and Asian/Pacific Islander children experiencing economic hardship.

PCEs

• There were lower rates of each type of PCE among racial/ethnic minority rural children.
• Asian/Pacific Islander children had the lowest proportion of each of the following PCEs: after school activities (60.5%), community volunteer (33.4%), guiding mentor (85.7%), supportive neighborhood (34.8%), and resilient family (80.4%).

Contact Information:

Elizabeth Crouch, PhD
Rural and Minority Health Research Center
Phone: 803.576.6055
crouchel@mailbox.sc.edu

Additional Resources of Interest:

• More information about the Rural and Minority Health Research Center
• More information from the Rural Health Information Hub’s topic guides: Rural Mental Health, Social Determinants of Health for Rural People

Click to view Research Alert.