Current Projects

Funded by the Federal Office of Rural Health Policy, HRSA:

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.

Expected completion date: December 2009. (Contact: Victoria Freeman, RN, DrPH freeman@schsr.unc.edu, 919/966-6168)

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.

Expected completion date: December 2009. (Contact: Victoria Freeman, RN, DrPH, freeman@schsr.unc.edu, 919/966-6168)

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.

Expected completion date: October 2009. (Contact: George Pink, PhD gpink@email.unc.edu, 919/966-5541)

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 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.

Expected completion date: November 2009. (Contact: Victoria Freeman, RN, DrPH freeman@schsr.unc.edu, 919/966-6168)

The Importance of Surgery to Rural Hospital Financial Condition and Market Share

This study explores the provision of surgical services in rural hospitals and its relationship to financial performance. The percentage of rural hospitals that offer surgical services and the number that have discontinued surgical services over the last decade will be described, and, for those that have discontinued services, the impact on financial condition will be explored.

Expected completion date: August 2010. (Contact: George Pink, PhD gpink@email.unc.edu, 919/966-5541)

Rural Medicaid and CHIP Mini-Studies

Medicaid and the Children’s Health Insurance Program (CHIP) are important sources of health insurance coverage in rural communities and it is likely that the importance of Medicaid/CHIP will grow as job-based health insurance coverage continues to erode and policymakers pursue the goal of expanding coverage. This project is composed of three mini-studies that: 1) Update our State Profiles of Medicaid and CHIP in Rural and Urban Areas website, adding information on Medicaid Disproportionate Share Hospital (DSH) payments to rural hospitals; 2) Analyze trends in Medicaid/CHIP enrollment in rural and urban areas over the past two to three years; and 3) Explore the future role of CHIP given increasing levels of childhood poverty.

Expected completion date: August 2010. (Contact: Rebecca Slifkin, PhD slifkin@schsr.unc.edu, 919/966-4640)

Mini-studies to Inform Health Reform Efforts

Rural health care systems are far more vulnerable to changes in federal health care policy than are those in urban areas. The purpose of this project is to conduct rapid turnaround mini-studies that will be essential to maintain an effective rural voice in both the ongoing adjustments to current policies and the development of new policies.

Expected completion date: August 2010. (Contact: Rebecca Slifkin, PhD slifkin@schsr.unc.edu, 919/966-4640)