Health Services Research Commons^™

Prevention Of Drug Use And Treatment Of Drug Use Disorders In Rural Settings, John A. Gale Ms

Mental Health / Substance Use Disorders

This Guide on Prevention of Drug Use and Treatment of Drug Use Disorders in Rural Settings was prepared by the United Nations Office on Drugs and Crime (UNODC) Drug Prevention and Health Branch (DHB), in the context of the global project Treatnet II: OFID-UNODC Programme to prevent HIV/AIDS through Treatnet Phase II, with the aim of providing an awareness-raising tool and guidance for policymakers, public health officials, local authorities and other stakeholders in dealing with substance use issues in rural settings in their respective countries. This Guide will serve as an awareness-raising tool and guidance for policymakers, public health officials, …

Rural Opioid Prevention And Treatment Strategies: The Experience In Four States [Policy Brief], John A. Gale Ms, Anush Yousefian Hansen Ms,Ma, Martha Elbaum Williamson Mpa

Mental Health / Substance Use Disorders

Little is known about what states with large rural populations are doing to combat opioid use disorders (OUD) in rural communities. This qualitative study identified rural challenges to the provision of OUD prevention, treatment, and recovery services and explored promising strategies to tackle the opioid crisis in rural communities.

Rural Opioid Prevention And Treatment Strategies: The Experience In Four States [Working Paper], John A. Gale Ms, Anush Hansen Ms,Ma, Martha Elbaum Williamson Mpa

Mental Health / Substance Use Disorders

Although opioid use rates are comparable in rural and urban counties, rural opioid users tend to be younger, unmarried, have lower incomes, and are more likely to lack health insurance, all vulnerabilities that may negatively impact their ability to seek treatment and recover. Additionally, the rural health care system is characterized by numerous resource, workforce, access, and geographic challenges that complicate the delivery of specialized care for OUDs in rural communities. The nature and scope of the opioid crisis vary across rural communities and require multifaceted, community-based strategies to address the problem. Based on interviews with key stakeholders in Indiana, …

Mental Health Status And Access To Health Care Services For Adults In Maine, Erika C. Ziller Phd, Barbara Leonard Mph

Access / Insurance

Maine people with poor mental health describe significant challenges with affordability and access to health care. A new report released by the Maine Health Access Foundation (MeHAF) and the University of Southern Maine, Mental Health Status and Access to Health Care Service for Adults in Maine, describes how adults 18 and older in Maine who report depression and poor mental health have many barriers to getting health care. These results have important implications for planning in a time when major changes in health insurance coverage are expected.

Analyzing data from the ongoing federal/state public health survey, the Behavioral Risk …

Access To Health Care Services For Adults In Maine [Report], Erika C. Ziller Phd

Access / Insurance

On October 17, 2016, the Maine Health Access Foundation (MeHAF) released a new research brief developed with the University of Southern Maine that found significant inequality in the ability of people in Maine to access quality health care. The authors, Barbara Leonard from MeHAF and Erika Ziller from the USM Muskie School, found that income, age and education are all closely associated with Maine people’s ability to receive appropriate and timely health care. Specifically, they found that among Maine adults 18 and older, those with family incomes less than $25,000 a year, young adults, racial and ethnic minorities, and people …

Health Insurance Co-Ops: Product Availability And Premiums In Rural Counties, Erika C. Ziller Phd, Zachariah T. Croll Ba, Andrew F. Coburn Phd

Access / Insurance

Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available.

This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of …

Health Information Exchange: A Strategy For Improving Access For Rural Veterans In The Maine Flex Rural Veterans Health Access, Karen B. Pearson Mlis, Ma, Amanda Burgess Mppm, John A. Gale Ms, Andrew F. Coburn Phd, Anush Yousefian Hansen Ms, Ma

Access / Insurance

This paper reports on the design and implementation of a first-in-the nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers. The paper reviews key factors that have contributed to implementation challenges and successes and lessons relevant to efforts to create interoperable health IT systems across multiple, complex organizational settings.

Rural Disabled Medicare Beneficiaries Spend More Out-Of-Pocket Than Their Urban Counterparts, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Access / Insurance

The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey …

Rural Adults Delay, Forego, And Strategize To Afford Their Pre-Aca Health Care, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Access / Insurance

About 40% of non-elderly adults reported problems paying medical bills or cost-related barriers to obtaining needed medical care in 2012, difficulties that are especially pronounced for the uninsured and underinsured, the chronically-ill, and those with low incomes. Given their lower incomes and higher uninsured rates compared to urban residents, rural residents may face particular cost barriers in accessing health care. Past research has shown that, compared to urban residents, rural residents are more likely to experience higher out-of-pocket costs and delayed or foregone care as a result of cost, even when covered by private health insurance. This study provides detailed …

Maine Ems Community Paramedicine Pilot Program Evaluation, Karen B. Pearson Mlis, Ma, George Shaler Mph

Emergency Medical Services (EMS)

In November 2014, the Muskie School of Public Service at the University of Southern Maine was awarded a contract to evaluate the implementation of the statewide CP Pilot Program in Maine. This report presents process level results from the evaluation. The report includes findings from interviews with the twelve community paramedicine pilot sites in Maine and with the state of Maine EMS office.

The layout of the report follows the key themes and categories from our interviews:

• Staffing
• Training
• Stakeholders and Partners
• CP Services
• CP Event
• Data Collection
• Funding
• Challenges
• Successes
• Sustainability

The report concludes with lessons learned which may …

Rural Health Clinic Readiness For Patient-Centered Medical Home Recognition: Preparing For The Evolving Healthcare Marketplace [Working Paper], John A. Gale Ms, Zachariah T. Croll Mph, David Hartley Phd, Mha

Rural Health Clinics

The patient-centered medical home (PCMH) model reaffirms traditional primary care values including continuity of care, connection with an identified personal clinician, provision of same day- and after-hours access, and positions providers to participate in accountable care and other financing and delivery system models. However, little is known about the readiness of the over 4,000 Rural Health Clinics (RHCs) to meet the PCMH Recognition standards established by the National Council for Quality Assurance (NCQA). The authors present findings from a survey of RHCs that examined their capacity to meet the NCQA PCMH requirements, and discuss the implications of the findings for …

Profile Of Rural Residential Care Facilities: A Chartbook, Jennifer D. Lenardson Mhs, Eileen Griffin Jd, Zachariah T. Croll Mph, Erika C. Ziller Phd, Andrew F. Coburn Phd

Long Term Services and Supports

Section I examines differences in rural and urban RCF characteristics. Section II explores differences in the characteristics and functional status of RCF residents. Section III profiles the services provided by rural and urban RCFs and Section IV examines rural-urban differences in admission and discharge policies and how these might reflect options for aging-in-place in rural and urban RCFs. The final section discusses policy implications for providing residential care in rural areas as part of a broader continuum of LTSS services.

Rural Residents More Likely To Be Enrolled In High-Deductible Health Plans, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, Andrew F. Coburn Phd

Access / Insurance

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance …

High Deductible Health Insurance Plans In Rural Areas, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, Andrew F. Coburn Phd

Access / Insurance

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance …

Health Insurance Coverage Of Low-Income Rural Children Increases And Is More Continuous Following Chip Implementation, Erika C. Ziller Phd

Access / Insurance

Key Findings: Prior to CHIP, low-income rural and urban children had comparable rates of public coverage and uninsurance, including chronic (a year or more) uninsurance; By the time CHIP was fully implemented, uninsured rates had declined so much among low-income rural children that they were lower than among urban children; In addition to lower uninsured rates in a given month, low-income rural children experienced dramatic increases in the continuity of their health insurance coverage following CHIP. Controlling for child and family characteristics, low-income rural children have more continuous coverage post-CHIP than do their urban counterparts.

Meaningful Use Of Electronic Health Record By Rural Health Clinics [Working Paper], John A. Gale Ms, David Hartley Phd, Mha, Zachariah T. Croll Mph

Rural Health Clinics

No abstract provided.

Meaningful Use Of Electronic Health Record By Rural Health Clinics [Policy Brief], John A. Gale Ms, David Hartley Phd, Mha, Zachariah T. Croll Mph

Rural Health Clinics

Little information is available on the rate of Electronic Health Record (EHR) adoption by Rural Health Clinics. (RHCs). This study was conducted to identify the rates of EHR adoption among a national random sample of RHCs and the extent to which RHCs that have adopted an EHR are likely to achieve Stage 1 meaningful use. To achieve Stage 1 meaningful use and qualify for meaningful use incentive payments, eligible health professionals must, at a minimum, meet CMS defined criteria for the required 14 core measures. Fifty-nine percent of RHCs report having an EHR, and independent RHCs were more likely than …

2013 Survey Of Children Served By Mainecare, Jean A. Talbot Phd, Deborah Thayer Mba, Zachariah T. Croll Mph, Kimberley Fox Mpa

Medicaid

These survey results help identify areas for improvement for future initiatives both for the MaineCare program and for providers serving this population. Key Findings: MaineCare higher than the national average on most patient experience measures. Significant improvements in MaineCare provider/family communication and care coordination. MaineCare lower than national average on customer service, availability of treatment choices, and care coordination among providers. Patient experience generally similar for Medicaid and CHIP enrollees. Many MaineCare children have special health care needs. 35% of children enrolled in MaineCare have special health care needs, according to the 2013 survey. Experience of children with special health …

Telemental Health In Today's Rural Health System, David Lambert Phd, John A. Gale Ms, Anush Yousefian Hansen Ms, Ma, Zachariah T. Croll Ba, David Hartley Phd, Mha

Mental Health / Substance Use Disorders

Telemental health has long been promoted in rural areas to address chronic access barriers to mental health care. While support and enthusiasm for telemental health in rural areas remains quite high, we lack a clear picture of the reality of telemental health in rural areas, compared to its promise. This Research & Policy Brief reports on the first part of our study—the online survey of 53 telemental health programs—and describes the organizational setting, services provided, and the staff mix of these programs. We draw from our telephone interviews with 23 of these programs to help describe the organizational context of …

Rural Acute Myocardial Infarction Survey (Ramis), Nikiah Nudell Ba, Nrp, Tom Bouthillet Nremt-P, Don Rice Md, John A. Gale Ms, Gary Wingrove Emt-P

Rural Hospitals (Flex Program)

The purpose of this study is to evaluate why current treatment goals for patients with Acute Myocardial Infarction (AMI) are not being achieved despite a large body of evidence supporting regionalized ST Elevation Myocardial Infarction (STEMI) systems. An online survey tool,developed by the research project team, was used to poll the Critical Access Hospitals in Nebraska in order to understand delay factors and other barriers to executing a STEMI system in a rural area. The authors found that the rural STEMI care system lacks a coordinated systems considered to be essential for urban areas. Several areas of potential failure in …

Children Served By Mainecare, 2012: Survey Findings, Nathaniel J. Anderson Ms, Mph, Kimberley Fox Mpa, Deborah Thayer Mba, Zachariah T. Croll Mph

Medicaid

The purpose of the annual Survey of Children Served by MaineCare is to monitor the quality of services delivered by MaineCare, the State's Medicaid and CHIP program. The 2012 survey examines the experiences of families with children. ages 0-17, who are enrolled in MaineCare using a standardized survey instrument (Consumer Assessment of Healthcare Providers and Systems--CAHPS--4.0H Child Medicaid Health Plan Survey). MaineCare scores very favorably compared with national benchmarks on CAHPS measures of Getting Needed Care, Getting Care Quickly, and How Well the Child's Doctors Community, with ratings at or above the 75th percentile on all the composites and individual …

Rural Implications Of Geographic Rating Of Health Insurance Premiums, Andrew F. Coburn Phd, Erika C. Ziller Phd, Zachariah T. Croll Ba, Elizabeth Kilbreth Phd

Access / Insurance

This brief examines how and to what extent states allow health plans to vary premiums by geographic rating area and, using insurance data from selected states, assesses the direction and magnitude of variations in rural and urban geographic rating factors. The authors conclude with a discussion of strategies that federal and state policymakers might use to help ensure that premium variations based on geography are justified. KEY POINTS: There is no clear pattern of geographic rating factors favoring rural or urban areas. This lack of a clear pattern suggests that health plans may use geographic rating for business purposes other …

Pursuing High Performance In Rural Health Care, A. Clinton Mackinney Md, Ms, Keith J. Mueller Phd, Andrew F. Coburn Phd, Jennifer P. Lundblad Phd, Mba, Timothy D. Mcbride Phd, Sidney D. Watson Jd

Health System Reform

Rural Futures Lab Foundation Papers are intended to present current thinking on the economic drivers and opportunities that will shape the future of rural America. They provide the foundation upon which it will be possible to answer the question that drives the Lab’s work—What has to happen today in order to achieve positive rural outcomes tomorrow?

Health Care Access And Use Among The Rural Uninsured [Policy Brief], Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Access / Insurance

In a landmark series of reports, the Institute of Medicine’s Committee on the Consequences of Uninsurance noted the policy significance of the “cascading” effects of uninsurance on patients, families, and communities.¹ Multiple studies confirm that rural residents are more likely to be uninsured than their urban counterparts.^2-4 Additionally, there is ample evidence that the uninsured have poorer access to care, delay care, and obtain care at levels of greater acuity than those with health insurance.⁵ However, the impact of being uninsured versus insured in rural areas, particularly compared to urban areas, is largely unknown.

Using data from …

Providing Better Care At Lower Cost: Building Maine's Health Data Infrastructure To Support Financing And Delivery System Reform, Andrew F. Coburn Phd

Health System Reform

Maine needs a robust and functional health data infrastructure to support efforts by health care providers and purchasers to improve quality, address Maine’s health care cost problems, and improve the health of individuals and populations through payment and delivery system reform. Although Maine has been a leader in building and using health data systems such as the hospital discharge data set and the all-payer claims database, new performance-based financing and delivery system arrangements are highlighting shortcomings in these systems and the need for a renewed vision of Maine’s future health data infrastructure.

The Health Data Workgroup was created by The …

Access To Mental Health Services And Family Impact Of Rural Children With Mental Health Problems, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, David Lambert Phd, Melanie M. Race Ms, Anush Yousefian Hansen Ms, Ma

Mental Health / Substance Use Disorders

Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children are more likely to go without access to all parent-reported needed mental health services and their families spend more time coordinating their care. This working paper and policy brief provide information on prevalence …

A Community Benefit Reporting Toolkit For Critical Access Hospitals, John A. Gale Ms, Melanie Race Ms

Rural Hospitals (Flex Program)

No abstract provided.

Maine Barriers To Integration Study: The View From Maine On The Barriers To Integrated Care And Recommendations For Moving Forward, John A. Gale Ms, David Lambert Phd

Mental Health / Substance Use Disorders

Following up on the Environmental Scan report (http://muskie.usm.maine.edu/Publications/rural/Barriers-to-Integration-Environmental-Scan.pdf), the authors interviewed representatives from Maine’s business community, payers, purchasers, professional associations, state legislators, advocacy organizations, state government, and provider organizations. The interviews provided a context to understand the barriers to integration in Maine and develop recommendations to overcome them. Our Final Report presents key findings from the study, recommendations for addressing barriers, and next steps for moving forward. This study recognizes the need for integration of behavioral and physical health services in all settings. Although most discussions of integration focus on the development of behavioral health services in primary care settings, …

Health Insurance Profile Indicates Need To Expand Coverage In Rural Areas, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, Andrew F. Coburn Phd, Nathaniel J. Anderson Ms, Mph

Access / Insurance

Key Findings: A greater percentage of rural residents than urban residents are uninsured, especially those living in remote areas Among adults over age 50, uninsured rates are highest in the most remote rural places Compared to urban adults, rural adults are less likely to be in employment situations where private coverage is offered.

Profile Of Rural Health Insurance Coverage: A Chartbook, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, Andrew F. Coburn Phd

Access / Insurance

More than twenty years of research has demonstrated that rural residents are at greater risk of being uninsured compared to urban residents and more recent studies point to problems of underinsurance as well. Most studies have shown that the problems of uninsurance and underinsurance are greatest among rural residents living in smaller communities located further from more urbanized areas. Section I examines recent estimates and changes since 1997 in rural health insurance coverage. Section II explores differences in the demographic, socio-economic, employment and other risk factors for uninsurance among rural and urban residents. Section III profiles the demographic and economic …