Rural Health Research Program

Projects

Current Projects

North Carolina Rural Health Research and Policy Analysis Center (NC RHR&PAC) –

Extending and expanding the work of the North Carolina Rural Health Research Program at UNC-CH, this project primarily focuses on Federal insurance programs (Medicare and Medicaid) and their effect on rural populations and providers. The following five projects are under investigation:

• Volunteerism in Rural EMS

  Semi-structured telephone interviews will be used to examine issues facing rural EMS services that have converted or are considering converting from volunteer services to paid services. Respondents will be queried regarding their conversion or consideration of conversion and the effect on their ability to recruit and retain personnel, their relationship with other agencies such as fire departments and hospitals, and the overall availability of EMS services.

  Principal Investigator: Rebecca T. Slifkin, M.H.A., Ph.D

  Funding Source: Office of Rural Health Policy, HRSA

  Total Project Period: 09/07 – 05/09
  

• Rural Emergency Department Preparedness for Pediatric Care

  While many large cities have dedicated children’s hospitals or facilities with pediatric emergency departments, most general hospitals do not have either the equipment necessary to provide optimal pediatric emergency care nor staff that is specifically trained in the care of pediatric emergencies. This project will use data analysis and semi-structured interviews with emergency room directors in order to address how the availability of pediatric services, expertise and supplies in U.S. emergency departments differ between urban and rural facilities, and to determine which factors impede the availability of pediatric services, expertise, and supplies in rural emergency departments.

  Principal Investigator: Rebecca T. Slifkin, M.H.A., Ph.D

  Funding Source: Office of Rural Health Policy, HRSA

  Total Project Period: 09/07 – 12/08
  

• A Rural-Urban Comparison of Hospital Financial Performance by Medicare Payment Classification

  Many rural hospitals have taken advantage of various Medicare classifications, yet concerns for the financial status of rural hospitals that do not have critical access hospital (CAH) status remains, and both the NRHA and the American Hospital Association (AHA) have recently called for expansion of cost-based reimbursement to rural hospitals other than CAHs. As hospitals are the largest health care providers in many rural communities, and often support a broad range of services beyond inpatient care, their survival and growth is essential to assure rural access to appropriate health care. This project takes a comprehensive look at the profitability and financial performance of rural hospitals, grouped both by Medicare payment classification and by hospital size.

  Principal Investigator: Rebecca T. Slifkin, M.H.A., Ph.D

  Funding Source: Office of Rural Health Policy, HRSA

  Total Project Period: 09/08 – 08/09
  

• Medicaid and SCHIP Participation in Rural and Urban Areas

  Medicaid and the State Children’s Health Insurance Program (SCHIP) are especially important for rural populations, as they are generally poorer and less likely to have employer-sponsored insurance than their urban counterparts. Nationally, the share of residents insured by these programs is higher in rural areas than in urban areas. This project has three components aimed at expanding rural health policy stakeholders’ knowledge about Medicaid and SCHIP. The components include updating our state-level rural Medicaid website, analyzing rural-urban differences in program enrollment over time, and describing best practices in states that have been particularly successful in enrolling eligible rural children. These activities will provide state policy makers with a continued, updated source of rural-specific information on the Medicaid program.

  Principal Investigator: Rebecca T. Slifkin, M.H.A., Ph.D

  Funding Source: Office of Rural Health Policy, HRSA

  Total Project Period: 09/08 – 08/09
  

• Factors Associated with Provision of Ambulance Services by Rural Hospitals

  This project continues our work from the last three years that has focused on the provision of emergency medical services ( EMS) in rural areas. This two-part project will explore the trends in provision of EMS/ambulance services among rural and urban hospitals. National hospital data files will be used to determine the proportion of rural and urban hospitals that have ongoing EMS/ambulance services and the proportion that have recently acquired or discontinued these services, and to explore geographic and organizational factors associated with hospital ownership of ambulance services. The second part of the study will use focused in-depth interviews with hospital administrators with existing, newly acquired or discontinued ambulance services in each US Census region to gain a better understanding of the factors that influence their decision regarding ambulance service and benefits received by hospitals that offer these important prehospital health care services.

  Principal Investigator: Rebecca T. Slifkin, M.H.A., Ph.D

  Funding Source: Office of Rural Health Policy, HRSA

  Total Project Period: 09/08 – 08/09
  

• Rapid Response to Requests for Rural Data Analysis and Issue Specific Rural Research

  In order to ensure that rural policy is designed to protect and improve the health of rural residents, data and issue specific rural research on the unique characteristics of rural people, health care providers, and the health care infrastructure, and the potential impact of policy and challenges rural areas face in health care delivery must be made available to policy makers, rural organizations and ORHP in a timely manner. To that end the North Carolina Rural Health Research Program, in conjunction with the RUPRI Center, provides rapid rural-focused data analysis and issue-specific rural research studies in response to emerging policy issues.

  Principal Investigator: Rebecca T. Slifkin, M.H.A., Ph.D

  Funding Source: Office of Rural Health Policy, HRSA

  Total Project Period: 09/08 – 08/09
  

• Medicare Rural Hospital Flexibility Program Evaluation

  The North Carolina Rural Health Research and Policy Analysis Center is collaborating with the University of Minnesota and the University of Maine in a comprehensive multi-year review of the Medicare Hospital Flexibility Program (Flex Program). UNC will use a combination of primary and secondary data to evaluate the program effects in a number of focal areas, including:

   Financial Performance Measures of Critical Access Hospitals

   CAH Conversion Tracking

   Predicting Financial Distress of Critical Access Hospitals

  Principal Investigator: Rebecca T. Slifkin, M.H.A., Ph.D

  Funding Source: Office of Rural Health Policy, HRSA (subcontract with the University of Minnesota)

  Total Project Period: 09/08 – 08/09
  

• Update of Need for Assistance (NFA) Scales, Benchmarks, and Data Resource Guide

  This project will extend and enhance work done previously for the Bureau of Primary Health Care (BPHC) in the development of NFA criteria and benchmarks. This includes 1) reviewing the current NFA data requirements and the benchmarks and reference data for Barrier and Disparities measures as well as the data required for all applicants; 2) assessing the currency and applicability of the data, benchmarks, and scoring; and 3) making recommendations for changes or substitutions of data or specific criteria. In addition, the Data Resources Guide that is made available to applicants to support their background work will be updated.

  Principal Investigator: Thomas C. Ricketts, III, M.P.H., Ph.D.

  Funding Source: Bureau of Primary Health Care, HRSA

  Total Project Period: 09/26/07 – 09/25/09

  
  

Recently Completed Projects

• Update the Impact Testing of the Proposed Revised Methodology for Designating Underserved Areas –

  The previous impact testing was based on data from 1998-1999 and was conducted in 2000-2001. In order to proceed with the review process for the Notice of Proposed Rulemaking within the Department of Health and Human Services and then with the Office of Management and Budget (OMB), it is important to update the testing to judge the effectiveness of the proposed model using more up-to-date data. A number of questions regarding the impact, including identification of areas that may lose or gain eligibility for certain resources, the impact on existing programs targeting the underserved and specific questions about the proposed methodology will be addressed with the updated impact testing.

  Principal Investigator: Thomas C. Ricketts, III, M.P.H., Ph.D.

  Funding Source: Bureau of Health Professions, HRSA

  Total Project Period: 04/06/07 – 09/05/07