This mixed-methods study aims to understand awardees' experiences in building and maintaining cohesive networks for Rural Maternity and Obstetrics Management Strategies (RMOMS)
Lead Researchers: Peiyin Hung, PhD, MSPH and Nabil Natafgi, PhD, MPH, CPH
Funded: September 2023
Anticipated Completion Date: May 2025
This project will assess changes in Medicare per-beneficiary spending across rural and urban counties from 2007 to 2020. It will examine differences in rural versus urban per-beneficiary spending on hospital inpatient, hospital outpatient, physician, and post-acute care after the Affordable Care Act (ACA).
Lead Researchers: Peiyin Hung, PhD, MSPH and Theodoros Giannouchos, PhD
Funded: September 2022
Anticipated Completion Date: May 2025
In 2021, approximately 8.6 million rural adults faced mental health challenges while millions of rural adolescents battled major depressive episodes. This study examines disparities in mental health services uptake and variation in mental health care settings across racial-ethnic and rural-urban subpopulations before and after the COVID-19 pandemic.
Lead Researcher: Peiyin Hung, PhD, MSPH
Funded: September 2023
Anticipated Completion Date: May 2025
The primary aim of this project is to use data examining health care infrastructure, chronic disease prevalence, and the socioeconomic environment to create a metric for classifying rural counties based on needs and resources.
Lead Researcher: Gabriel Benavidez, PhD, MPH and Elizabeth Crouch, PhD
Funded: September 2023
Anticipated Completion Date: May 2025
Using nationally representative Medicaid claims data, this project will determine rural-urban differences in the prevalence of early childhood caries, preventative dental visits, and restorative dental visits.
Lead Researcher: Eiizabeth Crouch, PhD
Funded: September 2024
Anticipated Completion Date: August 2025
We will compare turnover rates across nursing homes based on rurality, staff workload, ratio across different types of nursing personnel, and quality score. Using descriptive statistics and bivariate analyses, we will:
- Examine whether turnover is greater in rural or in urban counties.
- Test whether nursing homes with the lowest quartiles for nurse to resident hours have higher nursing turnover rates.
- Examine whether that relationship is the same in rural and urban counties.
- Compare the ratio of registered nurse time to other nursing staff time.
- Examine the racial composition of the county and patients and the association with nursing staff turnover.
Lead Researcher: Elizabeth Crouch, PhD
Funded: September 2023
Anticipated Completion Date: May 2025
Emergency Department (ED) Utilization is a de facto provider for untreated dental issues. Understanding rural-urban differences in ED use for dental conditions in recent years is essential to inform federal, state, and community-level dental health initiatives such as preventive dental care, tele-dentistry infrastructure expansion, and oral hygiene practices. Ongoing national efforts addressing rural disparities in dental care should target individuals most at risk for missing preventive care and utilizing the ED for dental care.
Our study will examine rural-urban differences in treat and release ED utilization and costs for dental-related conditions. Results will be stratified by levels of rurality and by age using weighted estimates from the 2021 Nationwide Emergency Department Samples (NEDS) available through the Healthcare Costs and Utilization Project (HCUP) database. A treat and release ED dental visit will be defined as a visit where services were provided by dental conditions identified through International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes. The metrics examined will include annual number of visits, annual number of visits per 100,000 people, total annual costs, individual visit costs, and monthly number of visits.
Lead Researcher: Elizabeth Crouch, PhD
Funded: September 2024
Anticipated Completion Date: August 2025
The purpose of this project is to document the recent trends of mental health care access and quality in urban and rural communities and to assess the intersectionality of residence rurality and race/ethnicity on disparities in mental health care access and quality.
Lead Researcher: Peiyin Hung, PhD
Funded: September 2021
Anticipated Completion Date: May 2025
The incidence of HIV is disproportionately high in rural areas, but these communities often lack access to evidence-based interventions to prevent new HIV diagnoses such as PrEP. Using Medicaid claims data and the Centers for Medicare & Medicaid Services Provider file, this study will determine geographic disparities (by rurality and region) in the need for PrEP and PrEP availability and identify whether PrEP availability meets the needs across geography.
Leveraging the Medicaid data, the proposed work has three aims:
- Investigate spatial distributions of the PrEP need and availability by residence rurality and Census regions using bivariate mapping.
- Examine rural-urban differences in spatial accessibility to PrEP across ZIP code tabulation areas (ZCTAs) in the United States.
- Identify the associations between the density of PrEP need and spatial accessibility to the nearest available PrEP service provider by residence rurality and census region.
Lead Researcher: Bankole Olatosi, PhD
Funded: September 2024
Anticipated Completion Date: August 2025
The impacts of state-level Medicaid bundled payment models will depend on many factors, such as maternity care facility structure, scope of services (e.g., presence of obstetric wards), and local patient bypassing behaviors during prenatal, intrapartum, and postpartum periods. For rural providers who often offer prenatal and postpartum care but not labor and delivery services, these bundled payments may impose additional financial and logistical challenges. Despite the longstanding barriers to perinatal care facing rural and minority communities, it is unclear how these bundled perinatal payments are distributed across all states and whether these have impacts on rural-urban and racial/ethnic disparities in perinatal care access and quality.
Using a mixed methods approach, this project has three aims:
- To examine state-level scope of bundled reimbursement payment model (also known as “episode-based" payment model) for perinatal care – prenatal, labor and delivery, and postpartum services – in traditional, fee-for-service Medicaid programs across all 48 states with rural counties in the United States.
- To assess state variations in perinatal care access, birthplace, workforce, and non-medically indicated labor induction or cesarean delivery from 2006-2023 by Medicaid FFS bundled payments for perinatal care.
To examine differential associations between the implementation of Medicaid perinatal bundled payments and outcomes in perinatal care access, birthplace, workforce model, and elective induction or cesarean deliveries. This analysis will be conducted overall and stratified by maternal rurality of residence and maternal race/ethnicity. Sensitivity analyses will further explore non-indicated inductions and cesarean deliveries by hospital rurality.
Lead Researcher: Peiyin Hung, PhD
Funded: September 2024
Anticipated Completion Date: August 2025
Using data from 2021- 2023 National Health Interview Survey & 2021 and 2022 CDC WONDER data, this study will examine
- Rural-urban differences in diabetes and prediabetes incidence and prevalences
- Rrural-urban differences in the management, treatment, and complications associated with diabetes
- Co-occurring risk factors for cardiovascular disease
- Diabetes mortality differences by rurality and race/ethnicity
Lead Researchers: Gabriel Benavidez, PhD, MPH and Peiyin Hung, PhD
Funded: September 2023
Anticipated Completion Date: August 2025