Widening Disparities In Infant Mortality And Life Expectancy Between Appalachia And The Rest Of The United States, 1990-2013.

Appalachia-a region that stretches from Mississippi to New York-has historically been recognized as a socially and economically disadvantaged part of the United States, and growing evidence suggests that health disparities between it and the rest of the country are widening. We compared infant mortality and life expectancy disparities in Appalachia to those outside the region during the period 1990-2013. We found that infant mortality disparities widened for both whites and blacks, with infant mortality 16 percent higher in Appalachia in 2009-13, and the region's deficit in life expectancy increased from 0.

Rural and urban differences in children's Medicaid and CHIP participation.

Efforts to increase enrollment in Medicaid and the Children's Health Insurance Program (CHIP) among uninsured children would benefit from an understanding of how program participation varies in rural and urban areas. Using Current Population Survey data from the period 2006-2007, rural participation rates were slightly higher than urban rates in the nation overall. There was no rural-urban difference when comparisons were based on within-state variation, independent of adjustment for individual characteristics.

What does the clinical doctorate in physical therapy mean for rural communities?

Background And Purpose: The transition to the Doctor of Physical Therapy (DPT) as the entry-level degree for physical therapists in the United States is nearly complete. Little is known about how the transition has affected the characteristics of the physical therapy workforce or the provision of physical therapy services. Effects may be particularly acute in rural communities with persistent health-care provider shortages.

Designated medical directors for emergency medical services: recruitment and roles.

Context: Emergency medical services (EMS) agencies rely on medical oversight to support Emergency Medical Technicians (EMTs) in the provision of prehospital care. Most states require EMS agencies to have a designated medical director (DMD), who typically is responsible for the many activities of medical oversight.

Purpose: To assess rural-urban differences in obtaining a DMD and in their responsibilities.

Developing financial benchmarks for critical access hospitals.

This study developed and applied benchmarks for five indicators included in the CAH Financial Indicators Report, an annual, hospital-specific report distributed to all critical access hospitals (CAHs). An online survey of Chief Executive Officers and Chief Financial Officers was used to establish benchmarks. Indicator values for 2004, 2005, and 2006 were calculated for 421 CAHs and hospital performance was compared to the benchmarks.

Recruitment and retention in rural and urban EMS: results from a national survey of local EMS directors.

Maintaining an adequate staff is a challenge for rural emergency medical services (EMS) providers. This national survey of local EMS directors finds that rural EMS are more likely to be freestanding, that is, not affiliated with other public services, to employ only emergency medical technician-basics (EMT-Bs), and to be all volunteer. Rural EMS directors are more likely than urban ones to report that they are not currently fully staffed.

Variations in financial performance among peer groups of critical access hospitals.

Context: Among the large number of hospitals with critical access hospital (CAH) designation, there is substantial variation in facility revenue as well as the number and types of services provided. If these variations have material effects on financial indicators, then performance comparisons among all CAHs are problematic.

Purpose: To investigate whether indicators of financial performance and condition systematically vary among peer groups of CAHs.

Rural/urban differences in barriers to and burden of care for children with special health care needs.

Purpose: To examine the barriers and difficulties experienced by rural families of children with special health care needs (CSHCN) in caring for their children.

Methods: The National Survey of Children with Special Health Care Needs was used to examine rural-urban differences in types of providers used, reasons CSHCN had unmet health care needs, insurance and financial difficulties encountered, and the family burden of providing the child's medical care. We present both unadjusted and adjusted results to allow consideration of the causes of rural-urban differences.

Intensive care in critical access hospitals.

Context: Although critical access hospitals (CAHs) have limitations on number of acute care beds and average length of stay, some of them provide intensive care unit (ICU) services.

Purpose: To describe the facilities, equipment, and staffing used by CAHs for intensive care, the types of patients receiving ICU care, and the perceived impact of closing the ICU on CAH staff and the local community.

Methods: A semistructured interview of directors of nursing at CAHs that provide intensive care services.

Financial indicators for critical access hospitals.

Context: There is a growing recognition of the need to measure and report hospital financial performance. However, there exists little comparative financial indicator data specifically for critical access hospitals (CAHs). CAHs differ from other hospitals on a number of dimensions that might affect appropriate indicators of performance, including differences in Medicare reimbursement, limits on bed size and average length of stay, and relaxed staffing rules.

The effect of rural hospital closures on community economic health.

Objective: To examine the effect of rural hospital closures on the local economy.

Data Sources: U.S.

The effect of rural residence on dental unmet need for children with special health care needs.

Background: Unmet need for dental care is the most prevalent unmet health care need among children with special health care needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special health care needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs.

Objective: To examine the effects of rural residence on unmet dental need for CSHCN.

Understanding the impacts of the Medicare Modernization Act: concerns of congressional staff.

Sweeping changes to the Medicare program embodied in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), including a new prescription drug benefit, changes in payment policies, and reform of the Medicare managed-care program, have major implications for rural health care. The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in September 2004 to identify a set of researchable questions concerning the impact of the MMA on rural health care.

How might the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 affect the financial viability of rural pharmacies? An analysis of preimplementation prescription volume and payment sources in rural and urban areas.

Context: Passage of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) has created interest in how the legislation will affect access to prescription drugs among rural beneficiaries. Policy attention has focused to a much lesser degree on the implications of the MMA for the financial viability of rural pharmacies.

Purpose: This article presents descriptive information on mail-order prescriptions, volume, and payer type of retail prescriptions in rural vs urban areas.

Comparative performance data for critical access hospitals.

Context: Among small rural hospitals, there is a growing recognition of the need to measure and report on the use of resources and the safety and quality of the services provided. Dashboards, clinical value compasses, and balanced scorecards are approaches to performance measurement that have been adopted by many health care organizations. However, there exists very little comparative performance data specific for critical access hospitals.

Moving from Medicaid to North Carolina Health Choice: changes in access to dental care for NC children.

Objective: The objective of this study is to identify the extent to which access to dental care changes as children move from a public program with low provider reimbursement and a reputation of non-compliant beneficiaries to another public program with higher reimbursement levels and enrollees that may be viewed differently by providers.

Study Design: The pre- and post-enrollment dental experience of NC Health Choice enrollees who were previously on Medicaid is compared to those who were uninsured prior to NC Health Choice enrollment.

Data Source: Parents of newly-eligible NC Health Choice children were sent a survey within two weeks of enrollment to determine their child's experience prior to program enrollment.

The changing metropolitan designation process and rural America.

In June 2003, the Office of Management and Budget (OMB) released new county-based designations of Core Based Statistical Areas (CBSAs), replacing Metropolitan Statistical Area designations that were last revised in 1990. In this article, the new designations are briefly described, and counties that have changed classifications are identified. The new designations identify 2 categories of counties or county clusters within CBSAs: Metropolitan Statistical Areas and Micropolitan Statistical Areas.

Unmet need for routine and specialty care: data from the National Survey of Children With Special Health Care Needs.

Objective: To assess the prevalence of unmet needs for routine and specialty care among children with special health care needs (CSHCN) and to identify factors associated with the likelihood of having unmet need for medical care.

Methods: Data come from the respondents for 38 866 children interviewed for the National Survey of Children With Special Health Care Needs. Bivariate analyses were used to assess differences in unmet need for medical care by various environmental, predisposing, enabling, and need factors.

Rural hospital wages and the area wage index.

We examined data on hospital hourly wages and the prospective payment system (PPS) wage index from 1990 to 1997, to determine if incremental changes to the index have improved its precision and equity as a regional cost adjuster. The differential between average rural and urban PPS hourly wages has declined by almost one-fourth over the 8-year study period. Nearly one-half of the decrease is attributable to regulatory and reporting changes in the annual hospital wage survey.

Effect of the North Carolina State Children's Health Insurance Program on Beneficiary Access to Care.

Background: In the fall of 1998, North Carolina implemented its State Children Health Insurance Program, North Carolina Health Choice for Children (NCHC). This stand-alone, fee-for-service program quickly enrolled large numbers of children and has been considered one of the State Children Health Insurance Program success stories.

Objective: To explore the perceptions of parents of children enrolled in NCHC regarding their children's access to health care services before and after enrollment in the NCHC.

Developing policies responsive to barriers to health care among rural residents: what do we need to know?

A substantial body of research has been devoted to the subject of access to health care services for rural residents, much with the intention of shaping government policies to remove barriers or equalize the distribution of health care services. A number of programs and policies have grown out of or been affected by access research, yet despite identifiable successes of the policy research process, barriers to health care services still exist in rural areas. This article attempts to stimulate discussion about ways that rural health researchers can build on past research on access to care.