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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 20 of 20 Research Studies DisplayedLock 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
Friedman HR, Holmes GM
Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals.
This study looked at trends in admission to urban hospitals by rural Medicare FFS beneficiaries from 2010 to 2018. The authors combined data from the 2010 to 2018 Hospital Service Area File (HSAF) and the 2010-2017 American Hospital Association (AHA) survey. They found that controlling for distance to the nearest hospitals, an increase of 1 year was associated with a 2.0% increase in the number of admissions to urban hospitals from each rural ZIP code. New system affiliation of the nearest rural hospital was associated with an increase of 1.7%.
AHRQ-funded; HS000032.
Citation: Friedman HR, Holmes GM .
Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals.
Health Serv Res 2022 Oct;57(5):1029-34. doi: 10.1111/1475-6773.14017..
Keywords: Medicare, Rural Health, Hospitals, Access to Care
Fraze TK, Lewis VA, Wood A
Configuration and delivery of primary care in rural and urban settings.
This study examined configuration and delivery of rural primary care of Medicare beneficiaries compared to more urban settings. The study included over 27 million participants with qualifying visits who were assigned to practices. The authors characterized practices’ structures, capabilities, and payment reform participation and measured beneficiary utilization by rurality. Rural practices were smaller, more primary care dominant and system owned with more beneficiaries per practice. Rural area beneficiaries were more likely to be from high-poverty areas and disabled. There was less engagement in quality-focused payment programs than in metropolitan practices. There was less preventive care, such as fewer beneficiaries with diabetes receiving an eye exam, fewer mammograms, and higher overall and condition-specific readmissions. While most isolated beneficiaries traveled to more urban practices for outpatient care, those receiving care in rural practices had similar outpatient and inpatient utilization to urban counterparts except for readmissions and quality metrics that rely on services outside of primary care.
AHRQ-funded; HS024075.
Citation: Fraze TK, Lewis VA, Wood A .
Configuration and delivery of primary care in rural and urban settings.
J Gen Intern Med 2022 Sep;37(12):3045-53. doi: 10.1007/s11606-022-07472-x..
Keywords: Primary Care, Healthcare Delivery, Rural Health, Urban Health, Medicare
Herb J, Holmes M, Stitzenberg K
Trends in rural-urban disparities among surgical specialties treating cancer, 2004-2017.
The purpose of this study was to assess trends over time in rural and urban disparities in the supply of surgeons treating patients with cancer. The researchers utilized the Area Health Resource File to conduct a retrospective observational study of medical workforce changes from 2004-2017. The study found that the density of surgical specialists in rural areas declined from 16 to 14 per 100,000 population and in urban areas from 33 to 31 per 100,000 population for a rural-urban disparity increase of 8%. The percentage increase in the supply disparity between the rural and urban workforce was largest for colorectal surgeons (66%) and general surgeons (72%). The study concluded that temporal changes in the rural-urban physician workforce depend on community factors, region, and area of specialization.
AHRQ-funded; HS000032.
Citation: Herb J, Holmes M, Stitzenberg K .
Trends in rural-urban disparities among surgical specialties treating cancer, 2004-2017.
J Rural Health 2022 Sep;38(4):838-44. doi: 10.1111/jrh.12658..
Keywords: Rural Health, Disabilities, Surgery, Cancer, Workforce
Mohr NM, Schuette AR, Ullrich F
An economic and health outcome evaluation of telehealth in rural sepsis care: a comparative effectiveness study.
The purpose of this study will be to assess the impact of provider-focused video telehealth in rural hospital emergency departments (ED) on costs and long-term outcomes for patients with sepsis. Using Medicare administrative claims, the researchers will compare telehealth-subscribing hospitals and control hospitals to assess the differences in total health care expenditures, category-specific costs, length of stay, readmissions, and mortality. The researchers intend for the study results to demonstrate the association between telehealth utilization and sepsis care total expenditures.
AHRQ-funded; HS025753.
Citation: Mohr NM, Schuette AR, Ullrich F .
An economic and health outcome evaluation of telehealth in rural sepsis care: a comparative effectiveness study.
J Comp Eff Res 2022 Jul;11(10):703-16. doi: 10.2217/cer-2022-0019..
Keywords: Telehealth, Health Information Technology (HIT), Sepsis, Rural Health, Healthcare Costs
Jiang HJ, Fingar KR, Liang L
AHRQ Author: Jiang HJ, Liang L
Risk of closure among independent and multihospital-affiliated rural hospitals.
The purpose of this study was to examine the association between affiliation and rural hospital closure. Using HCUP data, findings showed that, among financially distressed hospitals, affiliation was associated with lower risk of closure compared with being independent; conversely, among hospitals that were financially stable, affiliation was associated with higher risk of closure compared with being independent. Further, for-profit ownership was strongly associated with closure for hospitals that were financially stable.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Jiang HJ, Fingar KR, Liang L .
Risk of closure among independent and multihospital-affiliated rural hospitals.
JAMA Health Forum 2022 Jul;3(7):e221835. doi: 10.1001/jamahealthforum.2022.1835..
Keywords: Rural Health, Hospitals
Eiraldi R, McCurdy BL, Khanna MS
Development and evaluation of a remote training strategy for the implementation of mental health evidence-based practices in rural schools: pilot study protocol.
This paper describes a pilot study protocol to develop and evaluate a remote training strategy for the implementation of mental health evidence-based practices (EBPs) in rural schools. Rural schools are increasingly implementing multi-tier positive behavioral interventions and supports (PBIS) to address school-climate problems. The study will use a mixed-methods approach for the development of the training platform, and a hybrid type 2, pilot randomized controlled trial to examine the implementation and student outcomes of two training strategies: Remote Video vs. Remote Video plus Coaching. The EPBs will be evaluated on appropriateness, feasibility, acceptability, usability, and preliminary student outcomes of the two online training strategies for the implementation of EPBs at PBIS Tier 2.
AHRQ-funded; HS027755.
Citation: Eiraldi R, McCurdy BL, Khanna MS .
Development and evaluation of a remote training strategy for the implementation of mental health evidence-based practices in rural schools: pilot study protocol.
Pilot Feasibility Stud 2022 Jun 17;8(1):128. doi: 10.1186/s40814-022-01082-4..
Keywords: Children/Adolescents, Behavioral Health, Evidence-Based Practice, Rural Health, Training
Roberson ML, Nichols HB, Olshan AF
Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality.
The authors sought to examine trends in the surgical treatment of breast cancer by age, rurality, and among Black women in a populous, racially diverse, state in the Southeastern United States of America. Using data from the North Carolina Central Cancer Registry, they found declining mastectomy rates in the early 2000s in a Southern US state with a racially and geographically diverse population. These decreasing trends were consistent among key subgroups affected by cancer inequities, including Black and White rural women.
AHRQ-funded; HS027299.
Citation: Roberson ML, Nichols HB, Olshan AF .
Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality.
Breast Cancer Res Treat 2022 Jun;193(2):445-54. doi: 10.1007/s10549-022-06564-w..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery, Racial and Ethnic Minorities, Rural Health
Bunting AM, Dickson M, Staton M
Polysubstance use and re-incarceration in the 12-months after release from jail: a latent transition analysis of rural Appalachian women.
The purpose of this study was to: 1) identify the patterns of polysubstance use of rural Appalachian justice-involved women, 2) examine how women's participation in polysubstance use changed in the 12-months after initial release from jail, and 3) determine if changes in women's substance use patterns were correlated with re-incarceration during the 12-months of follow-up after release. The researchers randomly recruited 339 women with a recent history of substance use from three rural jails, and analyzed their substance use from baseline (in jail) to 6 and 12-months. The study found three latent classes: High Polysubstance/injection drug use (IDU) (36.3% baseline), Opioid/Benzo (Benzodiazepine) Involved Polysubstance Use (57.3% baseline), and Low Use (6.4% baseline). After release, and especially in the first 6 months, women transitioned to latent classes of reduced substance use and/or reduced injection drug use. Women who were re-incarcerated during follow-up were likely to remain engaged in, or transition to, the High Polysubstance/IDU class. The researchers concluded that a crucial period for changes in substance use lies in the six-months post-release.
AHRQ-funded; HS026120.
Citation: Bunting AM, Dickson M, Staton M .
Polysubstance use and re-incarceration in the 12-months after release from jail: a latent transition analysis of rural Appalachian women.
Am J Drug Alcohol Abuse 2022 May 4;48(3):356-66. doi: 10.1080/00952990.2021.1995402..
Keywords: Substance Abuse, Behavioral Health, Rural Health, Women
Gilmartin HM, Warsavage T, Hines A
Effectiveness of the rural transitions nurse program for veterans: a multicenter implementation study.
This study evaluated the effectiveness of the rural Transitions Nurse Program (TNP), a program to help veterans transferred from rural areas to urban VA Medical Centers for care. A case-control study was conducted from April 2017 to September 2019 with 3001 veterans enrolled in TNP and 6002 matched controls. Interventions were led by a transition nurse who assessed discharge readiness, provided postdischarge communication with primary care providers (PCPs), and called the Veteran within 72 h of discharge home to assess needs, and encouraged follow-up appointment attendance. Controls had no change to their care. Primary outcomes evaluated were PCP visits within 14 days of discharge and all-cause 30-day readmissions, with secondary outcomes 30-day emergency department (ED) visits and 30-day mortality. Patients were matched by their length of stay, prior hospitalizations and PCP visits, urban/rural status, and 32 Elixhauser comorbidities. The veterans enrolled in TNP were more likely to see their PCP within 14 days of discharge than their matched controls. TNP enrollment was not associated with reduced 30-day ED visits or readmissions but was associated with reduced 30-day mortality.
AHRQ-funded; HS024569.
Citation: Gilmartin HM, Warsavage T, Hines A .
Effectiveness of the rural transitions nurse program for veterans: a multicenter implementation study.
J Hosp Med 2022 Mar;17(3):149-57. doi: 10.1002/jhm.12802..
Keywords: Rural Health, Transitions of Care, Nursing, Healthcare Delivery
Holtrop JS, Mullen R, Curcija K
The balance between serving the community and the reality of treating opioid use disorder in rural primary care practices.
The purpose of this qualitative study was to investigate clinician and staff perceptions related to medication assisted treatment (MAT) for opioid use disorder, particularly buprenorphine treatment, in rural primary care practices. Staff members from rural 42 practices were interviewed. Although there was almost no provision of MAT, policies and procedures to reduce opioid prescribing were usually in place and many practices expressed interest in learning more to help their patients and local communities.
AHRQ-funded; HS025056.
Citation: Holtrop JS, Mullen R, Curcija K .
The balance between serving the community and the reality of treating opioid use disorder in rural primary care practices.
J Health Care Poor Underserved 2022; 33(1):253-67. doi: 10.1353/hpu.2022.0019..
Keywords: Opioids, Substance Abuse, Behavioral Health, Primary Care, Rural Health, Medication
Michelson KA, Cushing AM, Bucholz EM
Association of county-level availability of pediatricians with emergency department visits.
This study examined whether children in counties with more pediatricians had fewer emergency department (ED) visits. The authors conducted a cross-sectional study of all ED visits among children younger than 18 years from 6 states. Each additional pediatrician per 1000 children was associated with a 13.7% decrease in ED visits in the state-adjusted model. In the full model however, there was no association. Other factors such as presence of an urgent care facility, high socioeconomic status, urban status and higher proportions of White race and nonpublic insurance were also associated with decreased ED visit rates.
AHRQ-funded; HS026503.
Citation: Michelson KA, Cushing AM, Bucholz EM .
Association of county-level availability of pediatricians with emergency department visits.
Pediatr Emerg Care 2022 Feb;38(2):e953-e57. doi: 10.1097/pec.0000000000002502..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Healthcare Utilization, Workforce, Provider: Physician, Rural Health
Curcija K, Zittleman L, Fisher M
Does a rural community-based intervention improve knowledge and attitudes of opioid use disorder and medication-assisted treatment? A report from the IT MATTTRs study.
As part of the Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado study, this paper describes the implementation of community-based interventions developed by rural community members and researchers to increase awareness and to promote positive attitudes toward medication-assisted treatment (MAT) for opioid use disorder (OUD) and explores changes in community members' OUD and MAT knowledge and beliefs. Findings showed that partnering with local community members resulted in the successful development and implementation of community-based interventions, exposure to which was associated with OUD knowledge and beliefs. Locally-created interventions should be included in comprehensive approaches to stem the OUD epidemic.
AHRQ-funded; HS025065.
Citation: Curcija K, Zittleman L, Fisher M .
Does a rural community-based intervention improve knowledge and attitudes of opioid use disorder and medication-assisted treatment? A report from the IT MATTTRs study.
J Rural Health 2022 Jan;38(1):120-28. doi: 10.1111/jrh.12545..
Keywords: Opioids, Substance Abuse, Behavioral Health, Medication, Rural Health
Zittleman L, Curcija K, Nease DE
Increasing capacity for treatment of opioid use disorder in rural primary care practices.
Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation described the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado.
AHRQ-funded; HS025065.
Citation: Zittleman L, Curcija K, Nease DE .
Increasing capacity for treatment of opioid use disorder in rural primary care practices.
Ann Fam Med 2022 Jan-Feb;20(1):18-23. doi: 10.1370/afm.2757..
Keywords: Opioids, Rural Health, Primary Care, Substance Abuse, Behavioral Health, Training, Implementation, Medication
Davidson L, Haynes SC, Favila-Meza A
Parent experience and cost savings associated with a novel tele-physiatry program for children living in rural and underserved communities.
This study investigated patient and therapist experience and cost savings from the payer perspective associated with a novel tele-physiatry program for children living in rural and underserved communities. Study setting was four school-based clinics in Northern California with a total of 268 encounters (124 telemedicine and 144 in-person). Parent and therapists reported no difference in experience and perceived quality of care between telemedicine and in-person encounters. For parents whose children received a telemedicine encounter, 54.8% reported no preference for their child’s subsequent encounter, 28.8% preferred a physiatrist telemedicine visit, and 12 preferred a physiatrist in-person visit. There was also an average cost savings of $100 per clinic owing to physician milage for in-person visits.
AHRQ-funded; HS025714.
Citation: Davidson L, Haynes SC, Favila-Meza A .
Parent experience and cost savings associated with a novel tele-physiatry program for children living in rural and underserved communities.
Arch Phys Med Rehabil 2022 Jan;103(1):8-13. doi: 10.1016/j.apmr.2021.07.807..
Keywords: Children/Adolescents, Telehealth, Health Information Technology (HIT), Healthcare Costs, Rural Health, Vulnerable Populations, Disabilities, Rural/Inner-City Residents
Mohr NM, Wu C, Ward MJ
Transfer boarding delays care more in low-volume rural emergency departments: a cohort study.
Emergency department (ED) crowding is increasing and is associated with adverse patient outcomes. The objective of this retrospective cohort study was to measure the relative impact of ED boarding on timeliness of early ED care for new patient arrivals, with a focus on the differential impact in low-volume rural hospitals. The investigators concluded that patients seen in EDs with more crowding had small, but additive, delays in early elements of ED care, and transferring patients with nonmental health diagnoses from rural facilities were associated with the greatest impact.
AHRQ-funded; HS025753.
Citation: Mohr NM, Wu C, Ward MJ .
Transfer boarding delays care more in low-volume rural emergency departments: a cohort study.
J Rural Health 2022 Jan;38(1):282-92. doi: 10.1111/jrh.12559..
Keywords: Emergency Department, Rural Health, Hospitals
Sun N, Hua CL, Qiu X
Urban and rural differences in trajectories of depressive symptoms in later life in the United States.
This research had two primary goals: to examine the relationship between urban residence and trajectories of depressive symptoms and to investigate whether this relationship differs by social isolation and loneliness. The investigators conducted latent growth curve analysis to predict both baseline and trajectories of depression based on urban or rural residency. Findings of this study served to better understand how social and geographic contexts shaped long-term well-being of older adults.
AHRQ-funded; HS000011.
Citation: Sun N, Hua CL, Qiu X .
Urban and rural differences in trajectories of depressive symptoms in later life in the United States.
J Appl Gerontol 2022 Jan;41(1):148-57. doi: 10.1177/0733464820972527..
Keywords: Elderly, Rural Health, Depression, Behavioral Health
Pignone MP, Crutchfield TM, Brown PM
Using a discrete choice experiment to inform the design of programs to promote colon cancer screening for vulnerable populations in North Carolina.
This study used a discrete choice experiment (DCE) to learn about how vulnerable individuals in North Carolina value different aspects of CRC screening programs. It found that follow-up cost coverage was most frequently found to be the most important attribute from the DCE (47 percent); followed by test reward/copayment (33 percent).
AHRQ-funded; HS019468.
Citation: Pignone MP, Crutchfield TM, Brown PM .
Using a discrete choice experiment to inform the design of programs to promote colon cancer screening for vulnerable populations in North Carolina.
BMC Health Serv Res 2014 Nov 30;14:611. doi: 10.1186/s12913-014-0611-4..
Keywords: Cancer: Colorectal Cancer, Health Promotion, Rural Health, Screening, Social Determinants of Health
Shaikh U, Nettiksimmons J, Joseph JG
Collaborative practice improvement for childhood obesity in rural clinics: the Healthy Eating Active Living Telehealth Community of Practice (HEALTH COP).
The authors assessed the impact of participation in a virtual quality improvement (QI) learning network on adherence to clinical guidelines for childhood obesity prevention in rural clinics. They found that children who received care from clinicians who led the implementation of the intervention at their clinic showed significant improvements in nutrition and physical activity. Virtual QI learning networks in geographically dispersed clinics can significantly increase clinicians' adherence to guidelines for childhood obesity and improve access to recommended care for rural and underserved children.
AHRQ-funded; HS018567.
Citation: Shaikh U, Nettiksimmons J, Joseph JG .
Collaborative practice improvement for childhood obesity in rural clinics: the Healthy Eating Active Living Telehealth Community of Practice (HEALTH COP).
Am J Med Qual 2014 Nov-Dec;29(6):467-75. doi: 10.1177/1062860613506252.
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Keywords: Children/Adolescents, Evidence-Based Practice, Health Information Technology (HIT), Lifestyle Changes, Nutrition, Obesity, Prevention, Quality Improvement, Rural Health, Telehealth