Center for Rural Health Research

Overview of Need and Populations Served. The proposed Center for Rural Health Research will conduct rural health services and policy research with a focus on impoverished and underserved rural areas of the U.S. Impoverished rural areas, including Appalachia, the Mississippi Delta region, and predominantly Hispanic areas of the West, arguably face substantial economic challenges that impact rural health care systems, access to care, and population health. Yet, little research has compared and contrasted these and other rural areas of the U.S. Proposed services. The Center will produce research findings that are national in scope utilizing several existing nationally representative insurance claims and survey data sets. Our 5 propose projects include: 1. Evaluating Rural Hospital Contributions to the Rural Public Health System. This proposed project will first evaluate geographic variation in the delivery of core public health activities in rural communities and rural hospital contribution to those core public health activities. This study will then examine the association between rural public health systems and rural hospital charity care, or uncompensated care. 2. Variation in Scope of Practice and Medical Services Available at Family Physician Practices within Rural Areas. Using data collected during recertification examination registration of family physicians certified by the American Board of Family Medicine (ABFM), this project will examine the variation in scope of practice of family physicians and the services available in the primary practice site by degree of rurality and within rural categories by community level deprivation. Additionally, we will examine variation by Patient Centered Medical Home (PCMH) status. 3. Exploring the Impacts of HRSA’s Rural Health Network Outreach, Development and Planning program. HRSA has invested over $211 million in network planning, outreach and development grants between 2009 and 2015. This project will build upon an early evaluation that focused only on the planning projects by exploring the comprehensive impact of each of the four programs designed to spur collaborative behavior and improved and efficient access to health services. 4. Barriers and Disparities Associated with Pneumococcal Immunization among Rural Elderly Adults. This proposal seeks to identify the barriers and disparities associated with pneumococcal immunization among rural Medicare beneficiaries. The study will focus on the variation in the delivery of these immunizations based on patient demographics, comorbidities, and patient’s location using survey data from the Centers for Disease Control (CDC) Behavioral Risk Factor Surveillance System (BRFSS), and health claims data from two nationally representative large commercial health insurers. 5. The Impact of Medicaid Expansion on Rural Access to Substance Use Treatment. This project will examine how Medicaid expansion is associated with rural/urban variations in key indicators of substance use treatment access (e.g., past year use of formal and informal substance use treatment, the locations of substance use treatment, and perceived unmet need for substance use treatment). To address these questions, we will conduct analyses of the National Survey on Drug Use and Health (NSDUH).