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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 134 Research Studies DisplayedAmu-Nnadi CN, Ross ES, Garcia NH
Health system integration and cancer center access for rural hospitals.
This study’s goal was to assess health system integration and cancer center access for rural hospitals. The authors compared health systems with and without cancer centers based on rural hospital presence. They found that 90% of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems with more trainees more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations in non-metropolitan areas.
AHRQ-funded; HS013852.
Citation: Amu-Nnadi CN, Ross ES, Garcia NH .
Health system integration and cancer center access for rural hospitals.
Am Surg 2024 May; 90(5):1023-29. doi: 10.1177/00031348231216497..
Keywords: Health Systems, Cancer, Rural Health, Rural/Inner-City Residents, Access to Care
Kaufman BG, Holland DE, Vanderboom CE
Implementation costs of technology-enhanced transitional palliative care for rural caregivers.
Rural FCG experience higher levels of burden accessing coordinated care for their loved ones during and after hospitalization than urban family caregivers (FCG). The role of technology-enhanced transitional palliative care (TPC) on caregiver outcomes is currently being assessed in a randomized control trial. The purpose of this study was to assess resource use and health system costs of this FCG-focused TPC intervention and potential Medicare reimbursement mechanisms. The researchers randomized rural caregivers of hospitalized patients into an 8-week intervention which included video visits conducted by a registered nurse certified in palliative care, and supplemented with phone calls and texts (n = 215), or attentional control. The researchers estimated labor costs for a registered nurse and compared to scenario analyses utilizing a nurse practitioner or social worker wages. Medicare reimbursement scenarios included Transitional Care Management (TCM) and Chronic Care Management (CCM) CPT codes. The researchers found the base case, TPC cost was $395 per FCG conducted by a registered nurse, compared to $337 and $585 if conducted by a social worker or nurse practitioner, respectively. Reimbursement in the CCM-only scenario was $348 and $274 for complex and non-complex patients, respectively. Average Medicare reimbursement in the TCM-only scenario was $322 and $260 for high or moderate complexity patients, respectively. Reimbursement in the TCM+CCM scenario was $496 and $397, for high/complex and moderate/non-complex patients, respectively.
AHRQ-funded; HS026379.
Citation: Kaufman BG, Holland DE, Vanderboom CE .
Implementation costs of technology-enhanced transitional palliative care for rural caregivers.
Am J Hosp Palliat Care 2024 Jan; 41(1):38-44. doi: 10.1177/10499091231156145..
Keywords: Rural Health, Caregiving, Palliative Care, Health Information Technology (HIT)
Rains A, Sibley AL, Levander XA
"I would do anything but that": attitudes towards sex work among rural people who use drugs.
This study explored how people who use drugs in rural counties across the United States appraise sex work by themselves or other community members. The authors used qualitative interview data that came from the Rural Opioid Initiative (ROI), a project coordinated by research teams across 65 rural counties in 10 states. These interviews were individual and conducted from 2018 to 2020, with all participants reporting past 30-day opioid use and/or any injection drug use. Across sites, 355 interviews were conducted with a mean participant age of 36, 55% male, and 93% white. Negative attitudes were expressed towards sex work as a function of its criminal-legal repercussions or was framed as morally transgressive. Many appraisals were gendered, with the behavior described as being “easier” for women who were often described as "whores," with more neutral terms used to describe men. Some participants viewed sex work as an implicit “exchange” for drugs.
AHRQ-funded; HS026370.
Citation: Rains A, Sibley AL, Levander XA .
"I would do anything but that": attitudes towards sex work among rural people who use drugs.
Int J Drug Policy 2023 Dec; 122:104237. doi: 10.1016/j.drugpo.2023.104237..
Keywords: Rural Health, Vulnerable Populations, Substance Abuse, Behavioral Health
Efird CR, Barrington c, Metzl JM
"We grew up in the church": a critical discourse analysis of Black and White rural residents' perceptions of mental health.
This study’s purpose was to explore how the racialized social system potentially contributes to the mental health beliefs and attitudes of racially majoritized and minoritized rural residents. The authors conducted a secondary analysis of 29 health-focused oral history interviews from Black American (n = 16) and White American (n = 13) adults in rural North Carolina. They found nuanced discourses linked to three mental-health-related topics: mental illness, stressors, and coping. White rural residents tended to have condemning discourses that illustrated their beliefs about mental illnesses were rooted in meritocratic notions of individual choice and personal responsibility. On the other hand, Black residents offered compassionate discourses toward those who experience mental illness, and they described how macro-level mechanisms can affect individual well-being. Stressors for White residents differ from Black residents with White residents primarily concerned about perceived social changes and Black residents referencing experiences of interpersonal and structure racism. Both Black and White residents found social support from involvement in their respective religious organizations as help for coping, but only Black residents signified that a personal relationship with a higher ower was an essential positive coping mechanism.
AHRQ-funded; HS000032.
Citation: Efird CR, Barrington c, Metzl JM .
"We grew up in the church": a critical discourse analysis of Black and White rural residents' perceptions of mental health.
Soc Sci Med 2023 Nov; 336:116245. doi: 10.1016/j.socscimed.2023.116245..
Keywords: Racial and Ethnic Minorities, Rural Health, Rural/Inner-City Residents, Behavioral Health
Shear K, Rice H, Garabedian PM
Management of fall risk among older adults in diverse primary care settings.
The purpose of this study was to describe how urban and rural primary care staff and older adults manage fall risk and factors relevant to the application of computerized clinical decision support (CCDS). METHODS: Interviews, contextual inquiries, and workflow observations were analyzed. The study found that participants valued fall prevention and described similar approaches. Variations in available resources existed between rural and urban locations. Participants wanted evidence-based guidance incorporated into workflows to bridge gaps in skills.
AHRQ-funded; HS027557.
Citation: Shear K, Rice H, Garabedian PM .
Management of fall risk among older adults in diverse primary care settings.
J Appl Gerontol 2023 Nov; 42(11):2219-32. doi: 10.1177/07334648231185757..
Keywords: Falls, Elderly, Primary Care, Rural Health, Rural/Inner-City Residents
Henke RM, Fingar KR, Liang L
AHRQ Author: Liang L, Jiang HJ
Medicare Advantage in rural areas: implications for hospital sustainability.
This study examined the association between Medicare Advantage penetration levels in rural areas and hospital financial distress and closure. This retrospective study followed rural general acute hospitals open from 2008-2019 or until closure using HCUP State Inpatient Databases for 14 states. Medicare Advantage penetration at rural hospitals grew from 6.5% in 2008 to 20.6% in 2019. A 1-percentage point increase in hospital penetration was associated with an increase in financial stability of 0.04 units on the Altman Z score and a 4% reduction in risk of closure (HR, 0.96).
AHRQ-authored; AHRQ-funded; 290201800005C.
Citation: Henke RM, Fingar KR, Liang L .
Medicare Advantage in rural areas: implications for hospital sustainability.
Am J Manag Care 2023 Nov; 29(11):594-600. doi: 10.37765/ajmc.2023.89455..
Keywords: Medicare, Rural Health, Rural/Inner-City Residents, Hospitals
Bridges NC, Taber R, Foulds AL
Medications for opioid use disorder in rural primary care practices: patient and provider experiences.
This study’s purpose was to gain a better understanding of the barriers and facilitators operating at multiple levels to access or provide medications for opioid use disorder (MOUD) in rural Pennsylvania. The authors interviewed patients and providers who were involved in the Rural Access to Medication Assisted Treatment in Pennsylvania (RAMP) Project, which facilitated adoption of MOUD in rural primary care clinics. The study conducted 35 semi-structured interviews with MOUD patients and MOUD providers participating in RAMP. The interviews were coded by the study team. Themes from the qualitative interviews were organized in five nested levels: individual, interpersonal, health care setting, community, and public policy. Patients and providers agreed on many barriers (such as lack of providers, lack of transportation, insufficient rapport and trust in patient-provider relationship, and cost, etc.); however, their interpretation of the barrier, or indicated solution, diverged in meaningful ways. Patients described their experiences in broad terms pointing to the social determinants of health while providers focused on their professional roles, responsibilities, and operations within the primary care setting.
AHRQ-funded; HS025072.
Citation: Bridges NC, Taber R, Foulds AL .
Medications for opioid use disorder in rural primary care practices: patient and provider experiences.
J Subst Use Addict Treat 2023 Nov; 154:209133. doi: 10.1016/j.josat.2023.209133..
Keywords: Rural Health, Rural/Inner-City Residents, Opioids, Medication, Substance Abuse, Behavioral Health, Primary Care
Reed KG, Sun Z, Yabes JG
Assessing characteristics of populations seen at Commission on Cancer facilities using Pennsylvania linked data.
The purpose of this study was to evaluate variations among patients who do and do not visit Commission on Cancer (CoC) accredited facilities. The researchers utilized Pennsylvania Cancer Registry data linked to facility records for 87,472 patients diagnosed with cancer between 2018 and 2019. The study found that patients in the most advantaged Area Deprivation Index quartiles were more likely to visit CoC facilities compared with other quartiles. Urban patients were more likely than rural to be seen at a CoC facility as were Hispanic patients and non-Hispanic Black patients compared with White patients.
AHRQ-funded; HS027396.
Citation: Reed KG, Sun Z, Yabes JG .
Assessing characteristics of populations seen at Commission on Cancer facilities using Pennsylvania linked data.
JNCI Cancer Spectr 2023 Oct 31; 7(6). doi: 10.1093/jncics/pkad080..
Keywords: Cancer, Health Information Technology (HIT), Racial and Ethnic Minorities, Rural Health, Rural/Inner-City Residents
Benziger CP, Suess M, Allen CI
Adapting a clinical decision support system to improve identification of pediatric hypertension in a rural health system: design of a pragmatic trial.
This paper’s objective is to describe the protocol for a study that will adapt an electronic health record linked, web-based clinical decision support (CDS) tool called PedsBP that identifies hypertension (HTN) in children for use in a mostly rural health system and to evaluate the effectiveness of PedsBP for repeat of hypertensive level blood pressure (BP) measurements and HTN recognition among youth 6-17 years of age in primary care settings, comparing low-intensity and high-intensity implementation approaches. A pilot of the tool was conducted in 2 primary care clinics and modified prior to the full trial. Forty community-based primary care clinics (or clusters of clinics) were randomly allocated equally to usual care, low-intensity implementation (CDS only), or high-intensity implementation (CDS plus in-person training, monthly use reports, and ongoing communication between study staff and clinics). Eligible patient recruitment started on August 1, 2022 and will continue for 18 months. Primary outcomes will include repeating hypertensive level BP measurements at office visits and clinical recognition of HTN. Secondary outcomes will include lifestyle counseling, dietician referral, and BP at follow-up.
AHRQ-funded; HS027402.
Citation: Benziger CP, Suess M, Allen CI .
Adapting a clinical decision support system to improve identification of pediatric hypertension in a rural health system: design of a pragmatic trial.
Contemp Clin Trials 2023 Sep; 132:107293. doi: 10.1016/j.cct.2023.107293..
Keywords: Clinical Decision Support (CDS), Children/Adolescents, Rural Health, Rural/Inner-City Residents, Blood Pressure
MacDougall H, Hanson S, Interrante JD
Rural-urban differences in health care unaffordability during the postpartum period.
The purpose of this cross-sectional study was to explore health care unaffordability for rural and urban residents and by postpartum status. The study found that postpartum people reported statistically significantly higher rates of inability to pay medical bills when compared with non-postpartum people. Rural residents also reported higher rates of inability to pay their medical bills and having problems paying medical bills as compared with urban residents. In adjusted models, the predicted probability of being unable to pay medical bills among postpartum respondents was 12.8%, which was higher than among non-postpartum respondents. Similarly, postpartum respondents had higher predicted probabilities of reporting problems paying medical bills (18.4%) than compared with non-postpartum respondents. IN adjusted models, residency in a rural area was not significantly related with the health care unaffordability outcome measures.
AHRQ-funded; HS000011.
Citation: MacDougall H, Hanson S, Interrante JD .
Rural-urban differences in health care unaffordability during the postpartum period.
Med Care 2023 Sep; 61(9):595-600. doi: 10.1097/mlr.0000000000001888..
Keywords: Rural Health, Urban Health, Rural/Inner-City Residents, Maternal Care, Healthcare Costs, Women, Access to Care
Button D, Levander XA, Cook RR
Substance use disorder treatment and technology access among people who use drugs in rural areas of the United States: a cross-sectional survey.
This study evaluated how technology access (cell phone use and access to the Internet) affected substance use disorder (SUD) treatment prior to COVID-19 for people who use drugs in rural areas. The authors used data from the Rural Opioid Initiative (January 2018-March 2020), which was a cross-sectional study of people with prior 30-day injection drug or nonprescribed opioid use from rural areas of 10 states. They found that out of 3,026 participants, 71% used heroin and 76% used methamphetamine with 35% having no cell phone and 10% having no prior 30-day Internet use. Having both a cell phone and the internet was associated with increased days of medication for opioid use disorder (MOUD) use and a higher likelihood of SUD counseling in the prior 30 days. Lack of cell phone was associated with decreased days of MOUD and a lower likelihood of prior 30-day SUD counseling.
AHRQ-funded; HS026370.
Citation: Button D, Levander XA, Cook RR .
Substance use disorder treatment and technology access among people who use drugs in rural areas of the United States: a cross-sectional survey.
J Rural Health 2023 Sep; 39(4):772-79. doi: 10.1111/jrh.12737..
Keywords: Substance Abuse, Behavioral Health, Rural Health, Telehealth, Health Information Technology (HIT), Opioids, Rural/Inner-City Residents
Hogg-Graham R, Gatton KR, Ingram R
Association between insurer connectivity in Appalachian population health networks and preventable hospitalizations: evidence from Kentucky.
Capacity in community health and social services networks may be limited in geographic regions like Appalachia because of the combined effects of rurality and consistently poor health and social outcomes. The purpose of this study was to examine insurer connectivity in cross-sector networks across Kentucky’s geographic regions and the relationship between connectivity and the probability of preventable hospitalizations. The study found sizable geographic differences in the relationship between insurer connectivity in community networks and preventable hospitalization. Insurer connectivity in rural Appalachian communities was related with decreased likelihood that an individual was admitted for a preventable hospitalization.
AHRQ-funded; HS025494.
Citation: Hogg-Graham R, Gatton KR, Ingram R .
Association between insurer connectivity in Appalachian population health networks and preventable hospitalizations: evidence from Kentucky.
J Appalach Health 2023 Aug; 5(2)..
Keywords: Rural Health, Rural/Inner-City Residents, Prevention, Hospitalization, Health Insurance
Hogg-Graham R, Lang J, Waters TM
The Appalachian gap in preventable hospitalizations: are we seeing any progress? .
The purpose of this study was to explore whether within-rural variations in Kentucky’s preventable hospitalization rates exist and how these variations may be changing longitudinally. The study found that rural Appalachian counties had significantly higher preventable hospitalizations rates compared to their rural non-Appalachian and urban counterparts. A decreasing trend in overall preventable hospitalizations was witnessed for rural Appalachia over time, but trends were relatively stable for rural non-Appalachian and urban counties. Regression results revealed no significant longitudinal decrease in the “Appalachian gap.”
AHRQ-funded; HS025494.
Citation: Hogg-Graham R, Lang J, Waters TM .
The Appalachian gap in preventable hospitalizations: are we seeing any progress? .
J Appalach Health 2023 Aug; 5(2)..
Keywords: Rural Health, Rural/Inner-City Residents, Prevention, Hospitalization
Hatch BA, Kenzie E, Ramalingam N
Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making.
The purpose of this cross-sectional study was to determine how vaccine mandates affect the healthcare workforce. Between October 28, 2021- November 18, 2021, following implementation of a COVID-19 vaccination mandate for healthcare personnel, the researchers conducted a survey of Oregon primary care clinic staff. The survey included 19 questions that assessed the clinic-level effects of the vaccination mandate. Study outcomes included job loss among staff, receipt of an approved vaccination waiver, new vaccination among staff, and the perceived significance of the policy on clinic staffing. Staff from 80 clinics across 28 counties completed surveys, representing 38 rural and 42 urban clinics. The study found that clinics reported job loss (46%), use of vaccination waivers (51%), and newly vaccinated staff (60%). Significantly more rural clinics (compared to urban) used medical and/or religious vaccination waivers (71% vs 33%) and reported significant impact on clinic staffing (45% vs 21%). There was also a non-significant trend toward more job loss for rural compared to urban clinics (53% vs. 41%). Qualitative analysis revealed a decrease in clinic morale and mixed opinions of the vaccination mandate.
AHRQ-funded; HS027080.
Citation: Hatch BA, Kenzie E, Ramalingam N .
Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making.
PLoS One 2023 Jun 27; 18(6):e0287553. doi: 10.1371/journal.pone.0287553..
Keywords: COVID-19, Vaccination, Primary Care, Policy, Rural Health, Urban Health, Rural/Inner-City Residents
Loomer L, Rahman M, Mroz TM
Impact of higher payments for rural home health episodes on rehospitalizations.
This article evaluated the impact of higher Medicare payments for rural home health care on rehospitalizations. In 2010, Medicare began paying home health (HH) providers 3% more to serve rural beneficiaries. The authors used Medicare data on postacute HH episodes from 2007 to 2014 to estimate the impact of higher payments on beneficiaries outcomes using difference-in-differences analysis, comparing rehospitalizations between rural and urban postacute HH episodes before and after 2010. Their sample included 5.6 million post acute HH episodes (18% rural). After 2010 30- and 60-day rehospitalization rates declined by 10.08% and 16.49% for urban HH episodes and 9.87% and 16.08% for rural HH episodes, respectively. The difference-in-difference estimate was 0.29 percentage points and 0.57 percentage points for 30- and 60-day rehospitalization, respectively.
AHRQ-funded; HS027054.
Citation: Loomer L, Rahman M, Mroz TM .
Impact of higher payments for rural home health episodes on rehospitalizations.
J Rural Health 2023 Jun; 39(3):604-10. doi: 10.1111/jrh.12725..
Keywords: Payment, Rural Health, Rural/Inner-City Residents, Hospital Readmissions, Hospitalization
McDaniel CE, Leyenaar JK, Bryan MA
Urban-rural disparities in interfacility transfers for children during COVID-19.
This study’s goal was to identify temporal trends and differences in urban and rural pediatric interfacility transfers (IFTs) before and during the COVID-19 pandemic. The authors conducted a cross-sectional analysis of IFT among children <18 years from January 2019 to June 2022 using the Pediatric Health Information System. They calculated observed-to-expected (O-E) ratios of pre-pandemic (March 2019-Feb 2020) transfers compared to pandemic year 1 (March 2020-Feb 2021) and year 2 (March 2021-February 2022) using Poisson modeling. The O-E ratio of IFT in year 1 for urban children was 14.0% and 14.8% for rural children compared to pre-pandemic. In year 2, transfers rebounded with IFTs for rural-residing children increasing more than urban-residing children (101.7%) compared to 90.7%. For mental-health indications in year 2, rural transfer ratios were higher than urban, 126% compared to 113.7%.
AHRQ-funded; HS028683.
Citation: McDaniel CE, Leyenaar JK, Bryan MA .
Urban-rural disparities in interfacility transfers for children during COVID-19.
J Rural Health 2023 Jun; 39(3):611-16. doi: 10.1111/jrh.12746..
Keywords: COVID-19, Children/Adolescents, Disparities, Rural Health, Urban Health, Rural/Inner-City Residents
Taylor Gangnon, R R, Powell WR
Association of rurality and identifying as Black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study.
This national retrospective cohort study examined Medicare beneficiaries hospitalized with diabetic foot ulcers. Investigators sought to determine what proportion of rural patients, particularly those identifying as black, received specialty care in comparison with the national proportion. Their findings indicated that a smaller proportion of rural patients, particularly those identified as black, received specialty care compared with the overall cohort. They concluded that this might contribute to disparities in major amputations, but future studies are required to determine causality.
AHRQ-funded; HS026279.
Citation: Taylor Gangnon, R R, Powell WR .
Association of rurality and identifying as Black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study.
BMJ Open Diabetes Res Care 2023 Apr; 11(2). doi: 10.1136/bmjdrc-2022-003185..
Keywords: Rural Health, Racial and Ethnic Minorities, Diabetes, Chronic Conditions, Disparities
Carroll C, Euhus R, Beaulieu N
Hospital survival in rural markets: closures, mergers, and profitability.
This study investigated how the decline in profitability has affected rural hospital survival, either independently or with a merger. The authors assessed the rate of hospital closures and mergers in predominantly rural markets during the period 2010-18, focusing on hospitals that were unprofitable at baseline. A minority (7%) closed, with a larger share (17%) merged, most commonly with organizations from outside of their local geographic market. Most unprofitable hospitals (77%) continued to operate through 2018 without closure or merger. About half returned to profitability. Their analysis suggested that although rural hospital markets are experiencing meaningful rates of closures and mergers, many hospitals have survived despite their poor financial performance.
AHRQ-funded.
Citation: Carroll C, Euhus R, Beaulieu N .
Hospital survival in rural markets: closures, mergers, and profitability.
Health Aff 2023 Apr; 42(4):498-507. doi: 10.1377/hlthaff.2022.01191..
Keywords: Hospitals, Rural Health, Rural/Inner-City Residents
Tan MS, Heise CW, Gallo T
Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities.
The objectives of this retrospective observational study were to evaluate the relationship between a modified Tisdale QTc-risk score (QTc-RS), inpatient mortality, and length of stay in a broad inpatient population with an order for a medication with a known risk of torsades de pointes (TdP). Inpatient data from 28 healthcare facilities in the western US were used. The results indicated that there is a strong relationship between increased mortality as well as longer duration of hospitalization with an increasing QTc-RS.
AHRQ-funded; HS026662.
Citation: Tan MS, Heise CW, Gallo T .
Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities.
J Electrocardiol 2023 Mar;77:4-9. doi: 10.1016/j.jelectrocard.2022.11.008.
Keywords: Heart Disease and Health, Cardiovascular Conditions, Mortality, Rural Health, Urban Health, Risk
Logan CD, Feinglass J, Halverson AL
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
This study examined the reasons there are lower rates of surgical treatment for potentially resectable non-small cell lung cancer (NSCLC) for patients living in rural areas than in urban areas. The National Cancer Database was used to identify patients with clinical stage I-IIIA NSCLC between 2004 and 2018. Reasons for nonreceipt of surgery was evaluated for rural and urban area patients. The study included 328,785 patients with NSCLC with 13% from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery. Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery.
AHRQ-funded; HS026385.
Citation: Logan CD, Feinglass J, Halverson AL .
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
J Surg Res 2023 Mar;283:1053-63. doi: 10.1016/j.jss.2022.10.097.
Keywords: Cancer: Lung Cancer, Cancer, Disparities, Surgery, Rural Health, Access to Care
Barton AJ, Amura CR, Willems EL
Patient and provider perceptions of COVID-19-driven telehealth use from nurse-led care models in rural, frontier, and urban Colorado communities.
The aim of this study was to describe the patient and provider encounter in the unexpected telehealth application that took place with the onset of the COVID-19 pandemic. Patients and providers from 3 nurse-led models of care (federally qualified health centers, nurse midwifery practices, and the Nurse-Family partnership program) in Colorado were surveyed. Data from the Patient Attitude toward Telehealth survey and Provider Perceptions about Telehealth were collected. Patients who resided in urban areas utilized telehealth with greater frequency than in rural or frontier areas. Across each of the 5 domains assessed, rural/frontier patients had significantly lower attitude scores than urban patients. The mode of Telehealth employed differed across location, with video calls utilized more frequently by urban providers, and phone calls utilized by rural/frontier providers.
AHRQ-funded; HS028085.
Citation: Barton AJ, Amura CR, Willems EL .
Patient and provider perceptions of COVID-19-driven telehealth use from nurse-led care models in rural, frontier, and urban Colorado communities.
J Patient Exp 2023 Jan 25; 10:23743735231151546. doi: 10.1177/23743735231151546..
Keywords: COVID-19, Telehealth, Primary Care, Patient Experience, Rural Health, Urban Health, Vulnerable Populations, Provider: Nurse
Levander XA, Foot CA, Magnusson SL
Contraception and healthcare utilization by reproductive-age women who use drugs in rural communities: a cross-sectional survey.
This study’s goal was to compare contraceptive use prevalence among women who use drugs (WWUD) in rural communities with women who do not use drugs from similar rural areas. The authors used survey data from the Rural Opioids Initiative (ROI), a cross-sectional survey using respondent-driven sampling (RDS) involving eight rural U.S. regions (January 2018-March 2020) and the National Survey on Family Growth (NSFG), a nationally representative U.S. household reproductive health survey (2017-2019). Women aged 18-49 with prior 30-day non-prescribed opioid and/or non-opioid injection drug use were included. Of 855 women in the ROI, 36.8% and 38.6% reported contraceptive use, compared to 66% of rural women in the NSFG sample. Among the ROI women, 27% had received prior 30-day SUD treatment via outpatient counseling or inpatient program and these women had increased odds of contraceptive use. There was a positive association between contraception use and recent medications for opioid use disorder and prior 6-month primary care utilization that did not meet the threshold for statistical significance.
AHRQ-funded; HS02637; HS027088.
Citation: Levander XA, Foot CA, Magnusson SL .
Contraception and healthcare utilization by reproductive-age women who use drugs in rural communities: a cross-sectional survey.
J Gen Intern Med 2023 Jan; 38(1):98-106. doi: 10.1007/s11606-022-07558-6..
Keywords: Sexual Health, Women, Healthcare Utilization, Rural Health
Mohr NM, Okoro U, Harland KK
Outcomes associated with rural emergency department provider-to-provider telehealth for sepsis care: a multicenter cohort study.
The objective of this multicenter cohort study was to test the hypothesis that provider-to-provider tele-emergency department (tele-ED) care is associated with more 28-day hospital-free days and improved Surviving Sepsis Campaign (SSC) guideline adherence in rural emergency departments. Medical records of patients with sepsis were taken from rural hospitals in an established, on-demand, video tele-ED Midwestern network. Findings suggest that tele-ED cases did not have more 28-day hospital-free days or 28-day in-hospital mortality. A subgroup of patients treated by advanced practice providers suggest that mortality was lower in the cohort with tele-ED use in spite of no significant difference in complete SSC adherence. The researchers concluded that rural emergency department patients treated with provider-to-provider tele-ED care in a developed network showed similar clinical outcomes to those treated without.
AHRQ-funded; HS025753.
Citation: Mohr NM, Okoro U, Harland KK .
Outcomes associated with rural emergency department provider-to-provider telehealth for sepsis care: a multicenter cohort study.
Ann Emerg Med 2023 Jan;81(1):1-13. doi: 10.1016/j.annemergmed.2022.07.024..
Keywords: Rural Health, Emergency Department, Telehealth, Health Information Technology (HIT), Sepsis, Outcomes
Lock LJ, Channa R, Brennan MB
Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening.
The goal of this retrospective cohort study was to determine the role of level of disadvantage in diabetic eye screening to explain the effect of health systems on rural and urban disparities. Researchers used an all-payer, statewide claims database to include adult Wisconsin residents with diabetes who had claims billed throughout the baseline and measurement years. Results indicated that patients from urban underserved clinics were more likely to receive screening than those from rural underserved clinics; similar findings emerged for both Medicare and non-Medicare subgroups. The researchers concluded that health systems, especially those that serve urban underserved populations, have an opportunity to increase screening rates by leveraging health system-level interventions and supporting patients in overcoming barriers.
AHRQ-funded; HS026279.
Citation: Lock LJ, Channa R, Brennan MB .
Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening.
BMJ Open Diabetes Res Care 2022 Dec;10(6):e003174. doi: 10.1136/bmjdrc-2022-003174..
Keywords: Rural Health, Access to Care, Screening, Diabetes, Eye Disease and Health, Disparities, Chronic Conditions, Health Systems
Williams PH, Gilmartin HM, Leonard C
The influence of the Rural Transitions Nurse Program for veterans on healthcare utilization costs.
This study’s objective was to examine changes from pre- to post-hospitalization in total, inpatient, and outpatient 30-day healthcare utilization costs for Veterans Affairs Healthcare System Rural Transitions Nurse Program (TNP) enrollees compared to controls. Although findings showed no difference in change in total costs between veterans enrolled in TNP and controls, TNP was associated with a smaller increase in direct inpatient medical costs and a larger increase in direct outpatient medical costs, suggesting a shifting of costs from the inpatient to outpatient setting.
AHRQ-funded; HS024569.
Citation: Williams PH, Gilmartin HM, Leonard C .
The influence of the Rural Transitions Nurse Program for veterans on healthcare utilization costs.
J Gen Intern Med 2022 Nov;37(14):3529-34. doi: 10.1007/s11606-022-07401-y..
Keywords: Rural Health, Nursing, Transitions of Care, Healthcare Utilization, Healthcare Costs