Category: Rural Health Research Gateway

Community Characteristics and Financial and Operational Performance of RHCs

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:

 

Prehospital Emergency Medical Services Personnel Study

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:

Racial/Ethnic Differences in Adverse and Positive Childhood Experiences Across Rural Communities

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:

Click to view Research Alert. 

Comparison of Cancer Treatment Services Across Hospitals

Date: May 16, 2022

Comparison of Cancer Treatment Services Across Hospitals

The percentage of Critical Access Hospitals, urban Prospective Payment System hospitals, and rural Prospective Payment System hospitals with comprehensive oncology services, chemotherapy services, and radiation therapy were reported for the period between 2008 and 2017. Oncology care services based on the number of miles to the nearest cancer hospital are reported for all hospitals and small hospitals.

Contact Information:

Jan Eberth, PhD
Rural and Minority Health Research Center
Phone: 803.576.7384
jmeberth@mailbox.sc.edu

Additional Resources of Interest:

Click to view Research Alert.

The Northern Boarder Region: A Health-Focused Landscape Analysis

Date: May 2, 2022

The Northern Border Region: A Health-Focused Landscape Analysis

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, the Maine Rural Health Research Center highlighted the counties with the worse performance on a measure, compared with the rest of the counties in the Northern Border Region. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.

Access the chartbooks:

Contact Information:

Katherine Ahrens, PhD, MPH
Maine Rural Health Research Center
Phone: 207.780.4847
katherine.ahrens@maine.edu

Additional Resources of Interest:

Predictors of Hospital Choice among Rural Patients Seeking Elective Surgery: A Scoping Review

Date: March 4, 2022

Predictors of Hospital Choice among Rural Patients Seeking Elective Surgery: A Scoping Review

Hospital choice for surgery affects both patient outcomes and hospital viability, a greater understanding of rural patients’ surgical care-seeking behavior could enhance rural health and rural hospital financial stability. Specifically, insight on modifiable determinants of care-seeking behavior can inform policies to promote behavior that is consistent with evidence-based public health recommendations (e.g., undergoing common, low-risk surgeries at local hospitals and undergoing complex, high-risk surgeries at high-volume hospitals). Although previous research has examined rural surgical care-seeking behavior, to date, there is no published comprehensive scoping review of the literature. The purpose of this scoping review was to identify literature describing determinants of hospital choice among rural patients seeking elective surgery.

Contact Information:

Tyler Malone, MS
North Carolina Rural Health Research and Policy Analysis Center
Phone: 309.825.1667
tmalone@live.unc.edu

Additional Resources of Interest:

Click to view Research Alert.

Rural Hospital Profitability During the Global COVID-19 Pandemic Requires Careful Interpretation

Date: March 29, 2022

Rural Hospital Profitability during the Global COVID-19 Pandemic Requires Careful Interpretation

This findings brief describes the pre-pandemic (2011-19) trend of rural hospital profitability and explains why possible increases in reported profitability during the pandemic (2020-21) may mask the long-term financial challenges of rural hospitals.

  • In the nine years before the COVID-19 pandemic began (2011-19), the median total margin of rural hospitals was on a downward trajectory, ranging between 1.5% and 3.1%, and the percentage with a negative total margin was increasing.
  • In 2020, rural hospitals and urban Inpatient Prospective Payment System (IPPS) hospitals reported receiving over $32 billion in federal support, primarily from the Provider Relief Fund (PRF), to compensate for loss of revenue and increased expenses from the pandemic.
  • The PRF and Paycheck Protection Program (PPP) funds and timing differences in reporting could temporarily distort reported profitability measures and conceal the long-term financial challenges facing rural hospitals.

PRF and PPP funds were an important financial lifeline for many rural hospitals. However, the PRF and PPP funds are temporary and will be fully distributed at some point in 2022. Unless Congress authorizes additional funding, we expect rural hospitals to return to pre-pandemic levels of profitability.

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:

More information from the Rural Health Information Hub’s topic guide: Rural Health Policy.

Click to view Research Alert.

Rural-Urban Differences in Adverse and Positive Childhood Experiences

Date: March 18, 2022

Webinar Recording Available: Rural-Urban Differences in Adverse and Positive Childhood Experiences

Access Archived Webinar Resources

Adverse childhood experiences (ACEs) are events of abuse, neglect, and household dysfunction that occur between birth and 17 years of age. Multiple studies have established the association between ACEs and risky behaviors and poor physical and mental health outcomes in childhood and beyond. Rural and minority children often have higher rates of ACE exposure than their peers. Yet previous results on ACEs and rurality have shown mixed results due to differences in: 1) geographic coverage of studied datasets, 2) measurement of ACEs, and 3) sampling methodologies. Furthermore, examinations of intra-rural differences in ACEs among racial/ethnic groups, particularly among American Indian/Alaska Native populations, have been limited.

During this webinar, Dr. Elizabeth L. Crouch discussed research findings that: 1) examine whether ACE and positive childhood experience (PCE) exposure differs between rural and urban children by type and by count; 2) quantify racial/ethnic disparities in ACE and PCE exposure across rural communities; and 3) document the proportion of children with ACEs who lack PCE exposure among rural children.

Click to view Research Alert.

Rural Health Research Gateway

Date: March 8, 2022

Since 1990, Rural Hospital Closures Have Increasingly Occurred in Counties that Are More Urbanized, Diverse, and Economically Unequal

Between 1990 and 2020, there were 334 documented rural hospital closures in 44 states. Closures were more likely to occur in a county with more non‐white residents between 1990 and 2020; and conversely, the share of white residents decreased in rural closure counties. It was also found that between 1990 and 2020, rural closure counties became more economically unequal, with higher unemployment, lower per capita income, and lower median household incomes compared with rural counties overall. Finally, it was found that between 1990 and 2020, rural closure counties were increasingly likely to be primary care and dental health service professional shortage areas prior to the closure of a hospital within their borders.

Contact Information:

Arrianna Marie Planey, PhD, MA
North Carolina Rural Health Research and Policy Analysis Center
amplaney@email.unc.edu

Additional Resources of Interest:

More information from the Rural Health Information Hub’s topic guides: Healthcare Access in Rural Communities, Rural Hospitals, Rural Health Disparities, Rural Health Policy

Click to view Research Alert.

Rural Health Research Gateway

Date: March 2, 2022

Click to view Research Alert.

Upcoming Webinar: Rural-Urban Differences in Adverse and Positive Childhood Experiences

Webinar Date: March 15, 2022

Time: 9:00 AM Pacific, 10:00 AM Mountain, 11:00 AM Central, 12:00 PM Eastern

Website: ruralhealthresearch.org/webinars/childhood-experiences

Adverse childhood experiences (ACEs) are events of abuse, neglect, and household dysfunction that occur between birth and 17 years of age. Multiple studies have established the association between ACEs and risky behaviors and poor physical and mental health outcomes in childhood and beyond. Rural and minority children often have higher rates of ACE exposure than their peers. Yet previous results on ACEs and rurality have shown mixed results due to differences in: 1) geographic coverage of studied datasets, 2) measurement of ACEs, and 3) sampling methodologies. Furthermore, examinations of intra-rural differences in ACEs among racial/ethnic groups, particularly among American Indian/Alaska Native populations, have been limited.

During this webinar, Dr. Elizabeth L. Crouch will discuss research findings that: 1) examine whether ACE and positive childhood experience (PCE) exposure differs between rural and urban children by type and by count; 2) quantify racial/ethnic disparities in ACE and PCE exposure across rural communities; and 3) document the proportion of children with ACEs who lack PCE exposure among rural children.

Registration is free and required. Attendance of the live webinar is limited to 500 persons. If you are unable to attend, you will be able to access the recording, archived on the Gateway website.

Registration

Additional Resources of Interest: