Maine Rural Health Research Center
Projects
The Center's current research agenda focuses on Behavioral Health, Rural Insurance, and Rural Health Clinics.
Current Projects
funded by the Federal Office of Rural Health Policy
- Out-of-Pocket Costs Among Rural Medicare Beneficiaries
- The Transformation of Rural Health Clinics: Are They Ready to Serve as Patient-Centered Medical Homes?
- Challenges and Opportunities for Improving Rural Long-term Care Systems and Services under the Affordable Care Act (ACA)
Ongoing Projects
- Adolescent Alcohol Use in Rural Areas: What Are the Issues?
- Health Insurance Stability among Rural Children Following Public Coverage Expansions
- Patterns of Care for Rural and Urban Children with Mental Health Problems
- Prevalence and Impact of High Deductible Health Insurance Plans in Rural Areas
- Role of Rural Health Clinics in a Changing Rural Primary Care Landscape
- Rural E-Mental Health: Models that Enhance Access, Service Delivery, and Integration of Care
Current Projects
Out-of-Pocket Costs Among Rural Medicare Beneficiaries
Using the 2006-2009 panels of the Medical Expenditure Panel Survey (MEPS), this study seeks to address the following research questions: 1) Do out-of-pocket costs for medical care differ for rural and urban Medicare beneficiaries and, if so, to what extent? 2) How do different supplemental coverage options affect these cost differences (e.g. do rural residents with employer-sponsored supplemental plans look like urban beneficiaries with comparable coverage)? and 3) How do out-of-pocket costs vary for different types of services (e.g. hospital, ambulatory and physician services, home health, prescription drugs)?
Expected completion date: August 2012
Principal Investigators: Andrew Coburn, PhD, andyc@usm.maine.edu, (207) 780-4335 and Erika Ziller, MS, eziller@usm.maine.edu, (207) 780-4615
The Transformation of Rural Health Clinics (RHCs): Are They Ready to Serve as Patient-Centered Medical Homes (PCMH)?
This mixed methods study will use quantitative data from the current RHC survey to describe key characteristics indicating implementation of or readiness to implement elements of a PCMH, and qualitative data from case studies of 5-6 RHCs that are recognized PCMHs to describe the challenges faced in implementing and sustaining the PCMH model.
Expected Completion Date: August 2012
Principal Investigator: John Gale, MS (207) 228-8246; jgale@usm.maine.edu
Challenges and Opportunities for Improving Rural Long-Term Services and Supports under the Affordable Care Act (ACA)
This project will examine strategies, models, and policy options for improving access to, and quality of, rural long-term services and supports. Through focused policy analyses, we will highlight the rural options, opportunities, and barriers of implementing the coordinated care, health home, and long-term services and supports provisions in the Affordable Care Act.
Expected Completion Date: August 2012
Principal Investigators: Andy Coburn, PhD and Erika Ziller, MS
Ongoing Projects
Adolescent Alcohol Use in Rural Areas: What Are the Issues?
This study is using the National Survey on Drug Use and Health (NSDUH) to examine the effect of developmental, individual, and environmental factors on adolescent alcohol use across the urban-rural continuum.
Expected completion date: December 2011
Principal Investigator: David Hartley, PhD, davidh@usm.maine.edu, (207) 780-4513 and John Gale, MS, jgale@usm.maine.edu, (207) 228-8246
Health Insurance Stability among Rural Children Following Public Coverage Expansions
The study is investigating changes in insurance stability among rural and urban children following CHIP, and whether this is affected by specific state eligibility and enrollment policies or clusters of policies.
Expected completion date: January 2012
Principal Investigators: Andrew Coburn, PhD, andyc@usm.maine.edu, (207) 780-4435 and Erika Ziller, MS, eziller@usm.maine.edu, (207) 780-4615
Patterns of Care for Rural and Urban Children with Mental Health Problems
This study will assess whether use of office-based care and psychotropic medicine by children differs between rural and urban areas, as well as the role of insurance coverage and availability of mental health providers on use of these services.
Expected completion date: December 2011
Principal Investigator: David Hartley, PhD, davidh@usm.maine.edu, (207) 780-4513
Project Director: Nath Anderson, MPH, nanderso@usm.maine.edu, (207) 228-8187
Prevalence and Impact of High Deductible Health Insurance Plans in Rural Areas
This study will use national health survey data to examine whether privately insured rural residents are more likely than their urban counterparts to have plans with high deductibles. It will also assess whether high deductible health plans create health care barriers for rural residents, and if these differ from the barriers experiences by those in urban areas.
Expected completion date: December 2011
Principal Investigators: Andrew Coburn, PhD, andyc@usm.maine.edu, (207) 780-4435 and Erika Ziller, MS, eziller@usm.maine.edu, (207) 780-4615
Role of Rural Health Clinics in a Changing Rural Primary Care Landscape
This project builds upon our past work with Rural Health Clinics (RHCs) and is examining the challenges faced by RHCs in serving as part of the rural health care safety net; expanding service capacity to include mental health, dental, and obstetrical care; coping with primary care and other workforce shortages; implementing health information technology; and preparing for proposed changes in conditions of participation requirements and payment provisions.
Expected completion date: December 2011
Principal Investigators: David Hartley, PhD, davidh@usm.maine.edu, (207) 780-4513 and John Gale, MS, jgale@usm.maine.edu, (207) 228-8246
Rural E-Mental Health: Models that Enhance Access, Service Delivery, and Integration of Care
Viewing rural e-mental health programs in terms of their clinical functions (e.g. direct delivery of mental health services; support services for mental health and primary care providers; care coordination) we will examine how different models have been use and their impact on access, service delivery and integration in rural areas. Research staff will interview a sample of 24-30 rural e-mental health programs which met the criteria of being operational for a minimum of 18 months and providing at least one of the clinical functions and services mentioned above.
Expected completion date: December 2011
Principal Investigators: David Lambert, PhD, davidl@usm.maine.edu, (207) 780-4502
Project Director/Contact: John Gale, MS, jgale@usm.maine.edu, (207) 228-8246
Rural Hospital Flexibility Program/Flex Monitoring Team Projects (USM)
Principal Investigator: Andrew F. Coburn, PhD (207) 780-4435, andyc@usm.maine.edu
Contact Person: John A. Gale, MS (207) 228-8246, jgale@usm.maine.edu
Understanding the Community Benefit and Safety Net Activities Provided by Critical Access and Other Rural Hospitals
The purpose of this project is to 1) identify the community benefit activities of CAHs and describe their roles as safety net providers; (2) assess the community benefit and safety net strategies adopted by CAHs; and (3) recommend policy and/or other strategies to support CAHs in serving the unmet health care and safety needs of their communities.
Role of CAHs in Addressing Long Term Care Needs
This project profiles trends in CAH ownership/involvement in the provision of skilled nursing facility (SNF), nursing facility (NF), home health agency (HHA), and other long term care (LTC) services in order to understand the financial, staffing, and market factors that have enabled some CAHs to maintain SNF services and led others to drop them over the past three years.
Improving Patient Safety: Use of Transfer Protocols to Improve Care Transitions from Nursing Facilities to Critical Access Hospitals
This project will (1) Identify evidence-based transfer protocols and other approaches/tools for effecting safe care transitions between community nursing facilities (NF) and Critical Access Hospitals (CAHs); (2) Identify and assess the strategies that Flex Programs, CAHs, and CAHs Quality Collaboratives are using to implement NF to hospital transfer tools and protocols; and (3) Recommend best practice tools and strategies.
EMS Systems of Care at the Community and Regional Level: State Flex Program Initiatives and Support
This project will identify and assess Flex Program initiatives to support the development of local and regional systems of emergency care. This project fits continues the FMT's focus on health system development, community engagement, and community impact activities by examining the ways in which State Flex Program have undertaken efforts to support the development of community and regional systems of EMS care and to integrate these EMS systems into the continuum of care in rural communities. Through a review of state Flex Program EMS activity along with a review of the literature, we will categorize Flex Program initiatives by type of activities, and select six to eight programs for in-depth study.
Developing an Evaluation Framework to Support the Flex Medicare Beneficiary Quality Improvement Projec (MBQIP)
Staff from the University of Southern Maine will lead this project and work with the federal Office of Rural Health Policy (ORHP) and the state participants to help: 1) clarify project strategies; 2) describe the underlying logic of project activities; 3) articulate the project's "theory of change"; 4) assess the appropriateness of the project design, strategies, resources, and implementation mechanisms; 5) identify appropriate short, medium, and long term outcome targets and measures; and 6) identify potential obstacles to implementation. In addition, we will seek consensus on a logic model for the MBQIP to connect the program's resources, activities, and plans to intended outcomes.
For additional projects of the Flex Monitoring Team, please visit their web site at http://flexmonitoring.org.