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Publications
To receive a hard copy of an Upper Midwest Rural Health Research Center publication, please call (701) 777-3848.
- Far From the City: Community Orientation
and Responsiveness of Rural Hospitals - A new report from the Upper Midwest Rural Health Research Center reports the findings of a national study focused on variation in hospital community orientation and responsiveness across differing rural contexts. Study findings suggest that measures of community orientation and responsiveness differ between urban and rural hospitals, and further research is needed to develop an improved, context specific, model for community benefits.
- Health Insurance Coverage and Access to Health Care for American Indian and Alaska Native Elders - This project examines health insurance coverage and access to health care among American Indian and Alaska Native elders (Native elders) -- defined as 55 years or older. Young elders, 55 to 64 years of age, are most likely to be uninsured with one-third reporting having no insurance, while 15% of older elders, 65 years of age and over, report they are uninsured. Uninsured Native elders are about twice as likely as insured Native elders to indicate they have no regular provider. In addition, one out of 10 Native elders report they were not able to get care when they needed it during the preceding 12 months. Reasons cited for not getting health care when it was needed included long waiting times, transportation problems, and cost. The authors conclude it is essential to develop policies that address the financial, geographical, and cultural aspects that negatively impact access to culturally appropriate healthcare.
- Implementing Patient Safety Initiatives in Rural Hospitals: An Evaluation of the Tennessee Rural Hospital Patient Safety Demonstration - The Tennessee Rural Hospital Patient Safety Demonstration project included: 1) the implementation of three patient safety initiatives in eight rural Tennessee hospitals using a collaborative model and 2) an evaluation of the process and tools used in the implementation to inform future rural patient safety initiatives. Staff from the Tennessee Hospital Association, Q-Source (the state quality improvement organization), BlueCross BlueShield of Tennessee and the University of Southern Maine all provided technical assistance and resources to the hospitals. The Upper Midwest Rural Health Research Center evaluated the project.
- Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas - The purpose of this project was to describe rural emergency department staffing nationally and to assess the potential implications of staffing for the quality of emergency care provided in rural areas. A national telephone survey of a random sample of rural hospitals with less than 100 beds was conducted in June to August 2006. The study found that the majority of rural hospitals use more than one type of staffing to cover their Emergency Department (ED), including combinations of physicians on their own medical staff, contracts with emergency physician management groups and with individual physicians, and physician assistants and nurse practitioners. The study concluded that it is important to ensure that the family physicians, internists, PAs, NPs and nurses who staff rural EDs have the expertise and technical skills needed to provide optimal ED care, and that rural ED staff may benefit from additional continuing education opportunities, particularly in terms of specialized skills to care for pediatric emergency patients and trauma patients and training in working effectively in teams.
- Ambulatory Care Sensitive Condition Hospitalizations Among Rural Children - Ambulatory care sensitive conditions (ACSCs) are conditions for which inpatient hospital admissions could potentially be avoided through better outpatient care. Using hospital inpatient discharge data from six states, this study examined the relationships between children’s inpatient hospitalizations for ACSCs, rural residence, poverty, health insurance, and physician supply. Admission rates for five conditions were examined: asthma, diabetes short-term complications, gastroenteritis, urinary tract infection and perforated appendix. Hospitalization rates for four of the five conditions are significantly higher for children living in rural areas than in urban areas. Condition-specific ACSC hospitalization rates for children also vary significantly across states, even after adjusting for rurality, poverty, uninsurance, and physician supply.
- Hospital Size, Uncertainty and Pay-for-Performance - Examines whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings. Using data from the Premier Hospital Quality Incentive Demonstration and the Centers for Medicare and Medicaid Services' Hospital Compare, the report found that the smallest hospitals would, on average, experience five to seven times more uncertainty than the largest hospitals concerning their true relative performance for heart failure, pneumonia, and acute myocardial infarction. The authors conclude that all estimates of rank need to include adequate measures of uncertainty of those estimates.
- The Implementation of Pay-For Performance in Rural
Hospitals: Lessons from the Hospital Quality
Incentive Demonstration Project - A new report from the Upper Midwest Rural Health Research Center reports the findings of a national study designed to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the HQID project. Implications of those findings for future pay-for-performance (P4P) program development and strategies for helping program participants are also discussed.
- Pharmacist Staffing and the Use of Technology in Small Rural Hospitals:
Implications for Medication Safety - Assesses the capacity of rural hospitals to implement medication safety practices. The study found that many small rural hospitals have limited hours of on site pharmacist coverage. About three-quarters of the hospitals are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Hospital financial status is significantly related to pharmacist staffing, the use of technology, and implementation of medication safety practices, supporting a continuation of Medicare policies to help ensure financial stability for small rural hospitals. This publication is available in two formats:
Other related working papers, monographs, and publications can be found at:
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