Examining the Legal Landscape in Rural America: Implications for the Healthcare Workforce, Access to Care, and Population Health
Many rural areas are classified as Health Professional Shortage Areas because of the lack of available professionals that can provide primary, dental, or mental health care. The litigiousness nature of health care in the U.S. may have some bearing on the healthcare workforce and the availability of healthcare providers in rural versus urban areas. This project explores whether there are any differences between urban and rural health care providers in the prevalence of malpractice claims, clinical privilege actions, and state licensure actions. This research also explores whether variations in nurse practitioner scope of practice laws affect rural residents differentially, especially with respect to preventive care. Data used for this project includes: National Practitioner Data Bank; National (Nationwide) Inpatient Sample; State Emergency Department Databases; and Area Health Resources File.
Are Rural Mothers and Infants Benefitting from Changes in National Women, Infants and Children (WIC) Policy?
A primary aim of the Women, Infants and Children (WIC) Program policy changes (i.e, new WIC Food Packages) is to improve infant health outcomes via incentivizing breastfeeding and other feeding/eating behaviors. Yet, it is not known if these changes to the WIC Program benefit low-income rural infants and women. This study explores breastfeeding practices among rural WIC participants, and examine differences before and after a major federal policy change involving the WIC program. Data from the National Food and Nutrition Survey, conducted before and after (repeated cross-section) implementation of the WIC policy changes, will be used to examine effects on breastfeeding rates, infant feeding practices, and food/beverage consumption among low-income infants and women in rural areas. Evaluation of policy effects on outcomes among highly vulnerable populations such as low-income rural infants and their families is a critical step to improving health outcomes.
Provision of Skilled Nursing in Rural America: Skilled Nursing Facilities and Swing Beds
Swing beds and skilled nursing facilities provide critical skilled nursing services in rural areas, which are often lacking appropriate options for long term care. While swing beds are important sources of care for rural residents, and increasingly essential sources of revenue for critical access hospitals, we have very little current information on characteristics of swing beds, swing bed providers, swing bed residents, and how swing beds compare to skilled nursing facilities in terms of location, care provision, and case mix. The proposed study will allow researchers and policy makers to understand the nature of swing bed and skilled nursing facility care provision in rural areas, and the potential benefits of swing beds to rural communities, through development of a national picture of swing beds and skilled nursing facilities in rural areas of the U.S. and comparison of swing beds and skilled nursing facilities with regard to facility, resident, and care characteristics.
The Burden of Diabetes in Rural America
Jane N. Bolin, PhD, JD, BSN
The purpose of this project is to determine rural versus urban differences in type 2 diabetes mellitus (T2DM) prevalence, morbidity and mortality in the U.S. Diabetes prevalence is higher in rural areas than urban areas, with numerous studies demonstrating that rural persons with diabetes have higher morbidity from certain diabetes-related complications. Diabetes education may also be less accessible in rural areas. This project will examine rural versus urban differences and disparities in T2DM rates and associated demographics pre-and post-Affordable Care Act implementation. We will include analyses of controlled and uncontrolled diabetes and associated complications across rural versus urban geographic regions of the U.S. The project will be national in scope and will utilize data from the Behavioral Risk Factor Surveillance System and selected Healthcare Cost and Utilization Project state emergency department and inpatient survey databases.