Sunil Sharma MD, MBA, Robert Stansbury MD, Jad Ramadan MS, Edward Rojas MD, Victor Finomore PhD, Chris Pham MD, Stuart F. Quan MD, Sijin Wen PhD
Introduction
Sleep is a key component of a healthy lifestyle and the Center for Disease Control (CDC) and prevention recommends that adults get at least 7 hours of sleep each night. Within the United States, West Virginia is among the most sleep-deprived states with 42% of the population reporting insufficient sleep per the CDC. Sleep insufficiency in rural populations is linked to disparities in health and accessibility to health care services. The study evaluated the impact of sleep hygiene (SH) education on sleep duration and quality.
Methods
A 12-week randomized controlled trial of participants residing in Harrison County, WV. Baseline data included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and sleep duration as recorded by a sleep wearable. The intervention included an SH video on weeks 3 and 5. The control arm did not receive intervention but were allowed to cross over and receive intervention at week 8.
Results
A total of 100 participants (61 females) were recruited from the community. No changes in sleep duration were observed in intention to treat analysis between Arm 1 and Arm 2 at 7 weeks. In the treatment analysis, the compliant cohort demonstrated a significant increase of 31 minutes mean sleep duration (P = .01) as well as an improvement in the PSQI (6.30 to 5.68 by week 12, P = .05).
Conclusion
The study demonstrates that the introduction of a modest SH intervention may have a beneficial effect on the duration and quality of sleep in a rural community. ClinicalTrials. gov Identifier: NCT04849572
{"title":"Sleep well and live well: Impact of sleep hygiene intervention on sleep duration in a rural community: A randomized controlled trial (THE SWELL STUDY)","authors":"Sunil Sharma MD, MBA, Robert Stansbury MD, Jad Ramadan MS, Edward Rojas MD, Victor Finomore PhD, Chris Pham MD, Stuart F. Quan MD, Sijin Wen PhD","doi":"10.1111/jrh.70002","DOIUrl":"https://doi.org/10.1111/jrh.70002","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Sleep is a key component of a healthy lifestyle and the Center for Disease Control (CDC) and prevention recommends that adults get at least 7 hours of sleep each night. Within the United States, West Virginia is among the most sleep-deprived states with 42% of the population reporting insufficient sleep per the CDC. Sleep insufficiency in rural populations is linked to disparities in health and accessibility to health care services. The study evaluated the impact of sleep hygiene (SH) education on sleep duration and quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A 12-week randomized controlled trial of participants residing in Harrison County, WV. Baseline data included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and sleep duration as recorded by a sleep wearable. The intervention included an SH video on weeks 3 and 5. The control arm did not receive intervention but were allowed to cross over and receive intervention at week 8.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 100 participants (61 females) were recruited from the community. No changes in sleep duration were observed in intention to treat analysis between Arm 1 and Arm 2 at 7 weeks. In the treatment analysis, the compliant cohort demonstrated a significant increase of 31 minutes mean sleep duration (<i>P</i> = .01) as well as an improvement in the PSQI (6.30 to 5.68 by week 12, <i>P</i> = .05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study demonstrates that the introduction of a modest SH intervention may have a beneficial effect on the duration and quality of sleep in a rural community. ClinicalTrials. gov Identifier: NCT04849572</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benjamin Carter PhD, Jasmine Denny MPH, Andrew Lohrer MD, MPH
Purpose
This study examines the impact of Medicaid expansion under the Affordable Care Act on the stage of lung cancer diagnosis among rural and urban patients in New Hampshire.
Methods
Data from the New Hampshire State Cancer Registry spanning 2010-2019 were analyzed to compare lung cancer diagnosis stages before and after the July 2014 Medicaid expansion. Rural-urban categorization utilized Rural-Urban Continuum Codes, and logistic regression with difference-in-difference analysis assessed the differential effects of Medicaid expansion on late-stage diagnoses between rural and urban patients.
Findings
Post-expansion, there was a significant decrease in the proportion of late-stage lung cancer diagnoses statewide. Rural patients initially had higher rates of late-stage diagnoses compared to urban patients, but post-expansion, this disparity diminished significantly. Logistic regression indicated reduced odds of late-stage diagnosis among rural patients after expansion (OR = 0.719, P = .035), demonstrating a greater benefit in rural areas.
Conclusions
Medicaid expansion in New Hampshire was associated with a substantial reduction in late-stage lung cancer diagnoses, particularly benefiting rural patients who historically faced higher barriers to health care access. These findings underscore the potential of Medicaid expansion to mitigate rural-urban disparities in cancer care outcomes.
{"title":"Impact of Medicaid expansion on stage of diagnosis of lung cancer for rural and urban patients in New Hampshire","authors":"Benjamin Carter PhD, Jasmine Denny MPH, Andrew Lohrer MD, MPH","doi":"10.1111/jrh.70001","DOIUrl":"https://doi.org/10.1111/jrh.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study examines the impact of Medicaid expansion under the Affordable Care Act on the stage of lung cancer diagnosis among rural and urban patients in New Hampshire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the New Hampshire State Cancer Registry spanning 2010-2019 were analyzed to compare lung cancer diagnosis stages before and after the July 2014 Medicaid expansion. Rural-urban categorization utilized Rural-Urban Continuum Codes, and logistic regression with difference-in-difference analysis assessed the differential effects of Medicaid expansion on late-stage diagnoses between rural and urban patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Post-expansion, there was a significant decrease in the proportion of late-stage lung cancer diagnoses statewide. Rural patients initially had higher rates of late-stage diagnoses compared to urban patients, but post-expansion, this disparity diminished significantly. Logistic regression indicated reduced odds of late-stage diagnosis among rural patients after expansion (OR = 0.719, <i>P</i> = .035), demonstrating a greater benefit in rural areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Medicaid expansion in New Hampshire was associated with a substantial reduction in late-stage lung cancer diagnoses, particularly benefiting rural patients who historically faced higher barriers to health care access. These findings underscore the potential of Medicaid expansion to mitigate rural-urban disparities in cancer care outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The U.S dementia belt: Commentary on “Alzheimer's disease and related dementia among Medicare beneficiaries aged ≥ 65 years in rural America, by census region and select demographic characteristics: 2020”","authors":"Qian Huang PhD","doi":"10.1111/jrh.70000","DOIUrl":"https://doi.org/10.1111/jrh.70000","url":null,"abstract":"","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kara J. Kallies MS, William J. Koehne MPH, Carissa W. Tomas PhD, Sergey Tarima PhD, Marshall A. Beckman MD, Kirsten M. Beyer PhD, MPH, Laura Cassidy MS, PhD
Purpose
Rural compared to urban populations have higher age-adjusted injury mortality rates. We sought to describe differences in traumatic injury mechanisms, severity, and mortality in Wisconsin adults in rural and urban areas.
Methods
State trauma registry data were analyzed for adult patients injured in 2021–2022. The Wisconsin Health Innovation Program's rural and urban classification scheme, consisting of urban advantaged, urban, urban underserved, rural advantaged, rural, and rural underserved groups, was used. Multivariable logistic regression models for in-hospital injury mortality and prolonged length of stay (LOS) were developed.
Findings
Overall, 47,460 patients were included; 14.3% in rural, 9.5% in rural advantaged, 4.1% in rural underserved areas, 35.4% in urban, 22.0% in urban advantaged, and 14.8% in urban underserved areas. Firearm and pedestrian injuries were more common in urban areas, and motor vehicle/transportation injuries were common in rural areas. Lower odds of prolonged LOS were observed in those residing in rural advantaged (OR = 0.70, 95%CI: 0.55–0.90; p = 0.004), rural (OR = 0.66, 95%CI: 0.53–0.82; p < 0.001), and rural underserved (OR = 0.64, 95%CI: 0.50–0.82; p < 0.001) compared to urban advantaged areas. Those in rural underserved areas had higher odds of in-hospital mortality (OR = 1.48, 95%CI: 1.15–1.91; p = 0.003) compared to urban advantaged areas.
Conclusions
Patients in rural Wisconsin experienced different injury mechanisms than in urban areas. Those in urban areas were more likely to have a prolonged hospital LOS, but those in rural underserved areas had higher in-hospital mortality. Rural populations may benefit from injury prevention specific to the mechanisms of injury in that area and resource allocation to enhance trauma services.
{"title":"A comparison of traumatic injury characteristics in rural and urban adults living in Wisconsin","authors":"Kara J. Kallies MS, William J. Koehne MPH, Carissa W. Tomas PhD, Sergey Tarima PhD, Marshall A. Beckman MD, Kirsten M. Beyer PhD, MPH, Laura Cassidy MS, PhD","doi":"10.1111/jrh.12922","DOIUrl":"https://doi.org/10.1111/jrh.12922","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Rural compared to urban populations have higher age-adjusted injury mortality rates. We sought to describe differences in traumatic injury mechanisms, severity, and mortality in Wisconsin adults in rural and urban areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>State trauma registry data were analyzed for adult patients injured in 2021–2022. The Wisconsin Health Innovation Program's rural and urban classification scheme, consisting of urban advantaged, urban, urban underserved, rural advantaged, rural, and rural underserved groups, was used. Multivariable logistic regression models for in-hospital injury mortality and prolonged length of stay (LOS) were developed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Overall, 47,460 patients were included; 14.3% in rural, 9.5% in rural advantaged, 4.1% in rural underserved areas, 35.4% in urban, 22.0% in urban advantaged, and 14.8% in urban underserved areas. Firearm and pedestrian injuries were more common in urban areas, and motor vehicle/transportation injuries were common in rural areas. Lower odds of prolonged LOS were observed in those residing in rural advantaged (OR = 0.70, 95%CI: 0.55–0.90; <i>p</i> = 0.004), rural (OR = 0.66, 95%CI: 0.53–0.82; <i>p</i> < 0.001), and rural underserved (OR = 0.64, 95%CI: 0.50–0.82; <i>p</i> < 0.001) compared to urban advantaged areas. Those in rural underserved areas had higher odds of in-hospital mortality (OR = 1.48, 95%CI: 1.15–1.91; <i>p</i> = 0.003) compared to urban advantaged areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients in rural Wisconsin experienced different injury mechanisms than in urban areas. Those in urban areas were more likely to have a prolonged hospital LOS, but those in rural underserved areas had higher in-hospital mortality. Rural populations may benefit from injury prevention specific to the mechanisms of injury in that area and resource allocation to enhance trauma services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ellen B. Rubinstein PhD, Anna-Helena Preugschas MPH, Elizabeth Skoy PharmD, Lisa Nagel PharmD, Mary Larson PhD
Purpose
Pharmacies have been a significant part of improving population health since before the COVID-19 pandemic. However, little is known about the working relationships between pharmacies and public health entities. This exploratory study describes independent community pharmacists' perceptions during COVID-19 of both pre-existing and newly created relationships with public health.
Methods
This paper is based on 42 qualitative interviews conducted as part of a broader study on North Dakota pharmacy's role in the COVID-19 pandemic. Authors analyzed interview data both deductively (based on a priori interview questions) and inductively (based on emergent themes). We used key quotes to map working relationships between pharmacy and public health on two axes: personal interactions and service provision.
Findings
Interviewees worked at 42 pharmacies (21 urban and 21 rural) and described relationships with public health entities that fell into four categories: (i) service provision with personal interactions predating the pandemic; (ii) service provision without personal interactions predating the pandemic; (iii) personal interactions that evolved during the pandemic; and (iv) service provision that evolved during the pandemic. Rural pharmacists described personal interactions and pre-pandemic service provision more often than urban pharmacists. Most urban pharmacists developed working relationships with public health entities solely because of the pandemic.
Conclusions
This study begins mapping the range of relationships that can exist between community pharmacies and public health entities. Our data suggest it may be possible to leverage pharmacists to extend public health's reach and improve the health of medically underserved, rural populations.
{"title":"“It was a good opportunity for us to be in touch with public health”: Independent community pharmacists’ experiences working with public health before and during COVID-19","authors":"Ellen B. Rubinstein PhD, Anna-Helena Preugschas MPH, Elizabeth Skoy PharmD, Lisa Nagel PharmD, Mary Larson PhD","doi":"10.1111/jrh.12921","DOIUrl":"10.1111/jrh.12921","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Pharmacies have been a significant part of improving population health since before the COVID-19 pandemic. However, little is known about the working relationships between pharmacies and public health entities. This exploratory study describes independent community pharmacists' perceptions during COVID-19 of both pre-existing and newly created relationships with public health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This paper is based on 42 qualitative interviews conducted as part of a broader study on North Dakota pharmacy's role in the COVID-19 pandemic. Authors analyzed interview data both deductively (based on a priori interview questions) and inductively (based on emergent themes). We used key quotes to map working relationships between pharmacy and public health on two axes: personal interactions and service provision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Interviewees worked at 42 pharmacies (21 urban and 21 rural) and described relationships with public health entities that fell into four categories: (i) service provision with personal interactions predating the pandemic; (ii) service provision without personal interactions predating the pandemic; (iii) personal interactions that evolved during the pandemic; and (iv) service provision that evolved during the pandemic. Rural pharmacists described personal interactions and pre-pandemic service provision more often than urban pharmacists. Most urban pharmacists developed working relationships with public health entities solely because of the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study begins mapping the range of relationships that can exist between community pharmacies and public health entities. Our data suggest it may be possible to leverage pharmacists to extend public health's reach and improve the health of medically underserved, rural populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yvonne Jonk PhD, Heidi O'Connor MS, John Gale MS, Deborah Thayer MBA
Purpose
To address the extent to which Federally Qualified Health Centers (FQHCs) and independent and provider-based Rural Health Clinics (RHCs) were using telehealth prior to and during the COVID-19 pandemic.
Methods
A nationally representative 5% sample of Medicare Fee-for-Service beneficiaries who used outpatient services at FQHCs and RHCs were identified within the 2019–2021 5% Medicare Limited Data Set Outpatient and Carrier files. Rural-Urban Continuum Codes were used to identify rural–urban clinic locations. Logistic regression included three-way interaction terms for time, rurality, and clinic type.
Findings
Telehealth use curbed the decline in outpatient visits for all clinic types during the pandemic. Telehealth use declined as the pandemic continued in 2021 yet remained higher than pre-pandemic levels. FQHCs had higher telehealth use (18%–31%) than RHCs (8%–14%) in 2020–2021. Across all years, tele-behavioral health was the primary venue for originating and distant site providers. Overall, 19%–34% of originating site providers were psychiatrists and 10%–31% were primary care providers. Likely due to patients sheltering-in-place (at home), 2020–2021 distant site providers were largely primary care providers. Urban FQHCs experienced the largest increase in telehealth use during the pandemic (24.6% increase in urban, 14.4%–15.8% in rural) followed by rural ID_RHCs (10.2%–11.7%). RHCs were less likely to provide telehealth services than FQHCs during the pandemic.
Conclusions
Telehealth played a key role in facilitating access to health services during the height of the pandemic (2020–2021). Telehealth flexibilities were associated with greater telehealth use among FQHCs and RHCs but did not make up for the overall decline in health service use.
{"title":"Medicare telehealth utilization by Rural Health Clinics and Federally Qualified Health Centers prior to and during the COVID-19 pandemic","authors":"Yvonne Jonk PhD, Heidi O'Connor MS, John Gale MS, Deborah Thayer MBA","doi":"10.1111/jrh.12920","DOIUrl":"10.1111/jrh.12920","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To address the extent to which Federally Qualified Health Centers (FQHCs) and independent and provider-based Rural Health Clinics (RHCs) were using telehealth prior to and during the COVID-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A nationally representative 5% sample of Medicare Fee-for-Service beneficiaries who used outpatient services at FQHCs and RHCs were identified within the 2019–2021 5% Medicare Limited Data Set Outpatient and Carrier files. Rural-Urban Continuum Codes were used to identify rural–urban clinic locations. Logistic regression included three-way interaction terms for time, rurality, and clinic type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Telehealth use curbed the decline in outpatient visits for all clinic types during the pandemic. Telehealth use declined as the pandemic continued in 2021 yet remained higher than pre-pandemic levels. FQHCs had higher telehealth use (18%–31%) than RHCs (8%–14%) in 2020–2021. Across all years, tele-behavioral health was the primary venue for originating and distant site providers. Overall, 19%–34% of originating site providers were psychiatrists and 10%–31% were primary care providers. Likely due to patients sheltering-in-place (at home), 2020–2021 distant site providers were largely primary care providers. Urban FQHCs experienced the largest increase in telehealth use during the pandemic (24.6% increase in urban, 14.4%–15.8% in rural) followed by rural ID_RHCs (10.2%–11.7%). RHCs were less likely to provide telehealth services than FQHCs during the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Telehealth played a key role in facilitating access to health services during the height of the pandemic (2020–2021). Telehealth flexibilities were associated with greater telehealth use among FQHCs and RHCs but did not make up for the overall decline in health service use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jenna Shi , Ty A. Robinson EdM, Preena Loomba PhD, Brittany Murley PhD, RN, Larkin L. Strong PhD, Karen Basen-Engquist PhD, MPH, Scherezade K. Mama DrPH
Purpose
This qualitative study assessed internet access and use, barriers and facilitators to participating in digital health interventions or programs, and the engagement experience in virtual versus in-person health interventions among rural adults and rural cancer survivors.
Methods
Rural adults (n = 10) and rural cancer survivors (n = 10) were recruited from previous studies to participate in an in-depth interview. The interview guide contained eight open-ended questions related to participation in technology-based programs. Interviews were recorded and transcribed, and transcripts were analyzed for emergent themes using a thematic content analysis approach.
Findings
Rural adults were younger (M age = 37.9 ± 11.8 years), more likely to be non-Hispanic Black (90.0%), and reported higher educational attainment (50.0% earned a master's or doctoral degree) compared with rural cancer survivors (M age = 63.0 ± 9.1 years, 70.0% non-Hispanic White, and 20.0% earned a master's or doctoral degree). Participants discussed performance and effort expectancies related to using digital health technologies or participating in virtual programs and cited positive and negative aspects of in-person and virtual platforms. Participants emphasized the need for social connections and missed opportunities in current virtual offerings along with factors that influence their use of technologies (e.g., prior experience, tech anxiety).
Conclusions
Findings from this qualitative study provide an in-depth understanding of the intricate experiences of rural adults and rural cancer survivors when engaging with digital health technologies. Integrating the experiences of rural adults and rural cancer survivors may aid in developing clinical and community-based interventions and policies that support increasing access to digital health services and programs for rural communities.
{"title":"“Everything cannot be handled virtually”: Understanding intention and use of digital health technologies among rural adults and rural cancer survivors","authors":"Jenna Shi , Ty A. Robinson EdM, Preena Loomba PhD, Brittany Murley PhD, RN, Larkin L. Strong PhD, Karen Basen-Engquist PhD, MPH, Scherezade K. Mama DrPH","doi":"10.1111/jrh.12926","DOIUrl":"10.1111/jrh.12926","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This qualitative study assessed internet access and use, barriers and facilitators to participating in digital health interventions or programs, and the engagement experience in virtual versus in-person health interventions among rural adults and rural cancer survivors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Rural adults (<i>n </i>= 10) and rural cancer survivors (<i>n </i>= 10) were recruited from previous studies to participate in an in-depth interview. The interview guide contained eight open-ended questions related to participation in technology-based programs. Interviews were recorded and transcribed, and transcripts were analyzed for emergent themes using a thematic content analysis approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Rural adults were younger (<i>M</i> age = 37.9 ± 11.8 years), more likely to be non-Hispanic Black (90.0%), and reported higher educational attainment (50.0% earned a master's or doctoral degree) compared with rural cancer survivors (<i>M</i> age = 63.0 ± 9.1 years, 70.0% non-Hispanic White, and 20.0% earned a master's or doctoral degree). Participants discussed performance and effort expectancies related to using digital health technologies or participating in virtual programs and cited positive and negative aspects of in-person and virtual platforms. Participants emphasized the need for social connections and missed opportunities in current virtual offerings along with factors that influence their use of technologies (e.g., prior experience, tech anxiety).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings from this qualitative study provide an in-depth understanding of the intricate experiences of rural adults and rural cancer survivors when engaging with digital health technologies. Integrating the experiences of rural adults and rural cancer survivors may aid in developing clinical and community-based interventions and policies that support increasing access to digital health services and programs for rural communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Suhas Babu MS, James N. Weinstein DO, MS, Juan M. Lavista Ferres PhD, MS, William B. Weeks MD, PhD, MBA
<p>Over the past 14 years, 149 rural hospitals (comprising 6% of all rural hospitals) have closed or no longer provide inpatient services because of financial distress, staff shortages, and resource constraints.<span><sup>1</sup></span> In addition, more than 20% of rural hospitals are currently at risk of closing.<span><sup>2</sup></span> Nearly every state has rural hospitals at risk,<span><sup>3</sup></span> and many rural facilities are cutting services to stay afloat.<span><sup>4</sup></span></p><p>These closures and service restrictions reduce access to essential healthcare for underserved communities, many of which already face higher health risks and geographic isolation. Rural hospitals are critical for local economies and provide vital emergency care, making their closures a significant public health and economic concern.<span><sup>5</sup></span></p><p>To survive, rural clinics and hospitals need to remain relevant to their service populations, demonstrate value, and remain technologically current. While the White House has recently launched an admirable initiative to support cybersecurity in rural hospitals,<span><sup>6</sup></span> ecosystem transformation could better address the broader challenges needed to create sustainable partnerships between rural and urban healthcare systems.<span><sup>7</sup></span></p><p>Without significant changes to reimbursement policies, financial pressures on rural hospitals will persist. Although critical access hospitals have a unique Medicare payment system designed to support their survival,<span><sup>8</sup></span> these financial challenges will continue to hinder their ability to attract and retain an adequate workforce, invest in new technologies, and serve their communities.</p><p>Generally, rural hospitals have been standalone facilities with minimal support from larger systems. One solution to the challenges that rural hospitals face would be to create regionally shared resources that allow rural hospitals to collaborate and integrate with larger regional centers in a federal reserve-like model (“Hub and Spoke model”).<span><sup>9</sup></span> Such integration could provide rural hospitals with rotating or virtual staff and modernized technology that could improve patient care and outcomes. The right design could also serve as a philanthropic initiative for partners, allowing them to expand the scope of their impact and services, and for those that are not-for-profit, meet community benefits requirements necessary to maintain a not-for-profit status.</p><p>One mechanism that could encourage formalized affiliations between larger academic or nonacademic hospitals and rural hospitals would be to use community health needs assessments (CHNAs) to facilitate the affiliation process between these centers. Using technology to match changing needs identified by CHNAs to resources available at the larger centers, this facilitation process could also provide care coordination, technological access, and
{"title":"Improving Rural Healthcare by Creating Academic- and Nonacademic-Rural Hospital Partnerships Based on Community Health Needs Assessments and Technological Needs","authors":"Suhas Babu MS, James N. Weinstein DO, MS, Juan M. Lavista Ferres PhD, MS, William B. Weeks MD, PhD, MBA","doi":"10.1111/jrh.12927","DOIUrl":"10.1111/jrh.12927","url":null,"abstract":"<p>Over the past 14 years, 149 rural hospitals (comprising 6% of all rural hospitals) have closed or no longer provide inpatient services because of financial distress, staff shortages, and resource constraints.<span><sup>1</sup></span> In addition, more than 20% of rural hospitals are currently at risk of closing.<span><sup>2</sup></span> Nearly every state has rural hospitals at risk,<span><sup>3</sup></span> and many rural facilities are cutting services to stay afloat.<span><sup>4</sup></span></p><p>These closures and service restrictions reduce access to essential healthcare for underserved communities, many of which already face higher health risks and geographic isolation. Rural hospitals are critical for local economies and provide vital emergency care, making their closures a significant public health and economic concern.<span><sup>5</sup></span></p><p>To survive, rural clinics and hospitals need to remain relevant to their service populations, demonstrate value, and remain technologically current. While the White House has recently launched an admirable initiative to support cybersecurity in rural hospitals,<span><sup>6</sup></span> ecosystem transformation could better address the broader challenges needed to create sustainable partnerships between rural and urban healthcare systems.<span><sup>7</sup></span></p><p>Without significant changes to reimbursement policies, financial pressures on rural hospitals will persist. Although critical access hospitals have a unique Medicare payment system designed to support their survival,<span><sup>8</sup></span> these financial challenges will continue to hinder their ability to attract and retain an adequate workforce, invest in new technologies, and serve their communities.</p><p>Generally, rural hospitals have been standalone facilities with minimal support from larger systems. One solution to the challenges that rural hospitals face would be to create regionally shared resources that allow rural hospitals to collaborate and integrate with larger regional centers in a federal reserve-like model (“Hub and Spoke model”).<span><sup>9</sup></span> Such integration could provide rural hospitals with rotating or virtual staff and modernized technology that could improve patient care and outcomes. The right design could also serve as a philanthropic initiative for partners, allowing them to expand the scope of their impact and services, and for those that are not-for-profit, meet community benefits requirements necessary to maintain a not-for-profit status.</p><p>One mechanism that could encourage formalized affiliations between larger academic or nonacademic hospitals and rural hospitals would be to use community health needs assessments (CHNAs) to facilitate the affiliation process between these centers. Using technology to match changing needs identified by CHNAs to resources available at the larger centers, this facilitation process could also provide care coordination, technological access, and","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12927","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite expanding health insurance coverage under the Patient Protection and Affordable Care Act (ACA), many Americans struggle with financial barriers to health care. Medicaid expansion was meant to help alleviate these barriers, particularly for rural communities, but has shown mixed results. The American Indian and Alaska Native (AI/AN) community, which faces both racial and geographic disparities, is a group that should benefit from Medicaid expansion. This paper examines differences in medical debt and cost avoidance for rural American Indian and Alaskan Native households in Medicaid expansion and nonexpansion states.
Methods
This study uses data from the National Financial Capability Study in binomial logistic regression models to examine whether AI/AN households in rural areas are more likely to have medical and engage in cost avoidance than their urban counterparts.
Findings
The results show no differences between Medicaid expansion status but do find a higher likelihood of medical debt for those living in rural areas. The results also show a higher likelihood of medical debt and cost avoidance for those living farther from Indian Health Services (IHS)/Tribal health care facilities.
Discussion/Conclusions
The results indicate that rural AI/AN individuals continue to face financial barriers to health care despite the expansion of Medicaid under the ACA. This suggests that rural AI/AN individuals are seeking care outside of the IHS/Tribal system due to limited access to IHS providers. Addressing these barriers may require policies and programs focusing on rural AI/AN communities.
{"title":"Not enough: Medicaid expansion, medical debt, and cost avoidance in rural American Indian and Alaska Native households","authors":"Sean Hubbard PhD","doi":"10.1111/jrh.12925","DOIUrl":"10.1111/jrh.12925","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Despite expanding health insurance coverage under the Patient Protection and Affordable Care Act (ACA), many Americans struggle with financial barriers to health care. Medicaid expansion was meant to help alleviate these barriers, particularly for rural communities, but has shown mixed results. The American Indian and Alaska Native (AI/AN) community, which faces both racial and geographic disparities, is a group that should benefit from Medicaid expansion. This paper examines differences in medical debt and cost avoidance for rural American Indian and Alaskan Native households in Medicaid expansion and nonexpansion states.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study uses data from the National Financial Capability Study in binomial logistic regression models to examine whether AI/AN households in rural areas are more likely to have medical and engage in cost avoidance than their urban counterparts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The results show no differences between Medicaid expansion status but do find a higher likelihood of medical debt for those living in rural areas. The results also show a higher likelihood of medical debt and cost avoidance for those living farther from Indian Health Services (IHS)/Tribal health care facilities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion/Conclusions</h3>\u0000 \u0000 <p>The results indicate that rural AI/AN individuals continue to face financial barriers to health care despite the expansion of Medicaid under the ACA. This suggests that rural AI/AN individuals are seeking care outside of the IHS/Tribal system due to limited access to IHS providers. Addressing these barriers may require policies and programs focusing on rural AI/AN communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tyler L. Malone PhD, George H. Pink PhD, George M. Holmes PhD
Purpose
To provide a new approach for defining rural hospital markets.
Methods
First, we estimated models of hospital choice. We defined hospitals in the choice set using nationwide hospital data from the Healthcare Cost Report Information System (HCRIS). We modeled hospital choice using conditional logit regression and 2019 Medicare Fee-for-Service (FFS) claims data from the Centers for Medicare & Medicaid Services (CMS) Virtual Research Data Center. Next, we calculated estimated inpatient and emergency department utilization by patient ZIP code. We then estimated the total Medicare FFS volume for each hospital as well as the percent of each hospital's volume attributable to each ZIP code. We sorted ZIP codes by the patient volume attributable to the given hospital (from most volume to least volume) and then added ZIP codes to the market until at least 50% of the hospital's total patient volume was represented.
Findings
The average rural hospital market included three ZIP codes, an estimated population total of 37,221, and an estimated 5385 Medicare FFS beneficiaries. Furthermore, the average rural hospital had an estimated market share of 29%. A lower estimated market population was found for Critical Access Hospitals, hospitals unaffiliated with a system, hospitals with a smaller number of acute beds, and hospitals with fewer staff.
Conclusions
We developed a new approach for defining rural hospital markets. This approach can be used to inform health services researchers, policymakers, and communities about key market predictors of rural hospital financial distress, populations adversely affected by rural hospital closure, and more.
{"title":"A new model-based approach for estimating rural hospital markets","authors":"Tyler L. Malone PhD, George H. Pink PhD, George M. Holmes PhD","doi":"10.1111/jrh.12924","DOIUrl":"10.1111/jrh.12924","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To provide a new approach for defining rural hospital markets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>First, we estimated models of hospital choice. We defined hospitals in the choice set using nationwide hospital data from the Healthcare Cost Report Information System (HCRIS). We modeled hospital choice using conditional logit regression and 2019 Medicare Fee-for-Service (FFS) claims data from the Centers for Medicare & Medicaid Services (CMS) Virtual Research Data Center. Next, we calculated <i>estimated</i> inpatient and emergency department utilization by patient ZIP code. We then estimated the total Medicare FFS volume for each hospital as well as the percent of each hospital's volume attributable to each ZIP code. We sorted ZIP codes by the patient volume attributable to the given hospital (from most volume to least volume) and then added ZIP codes to the market until at least 50% of the hospital's total patient volume was represented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The average rural hospital market included three ZIP codes, an estimated population total of 37,221, and an estimated 5385 Medicare FFS beneficiaries. Furthermore, the average rural hospital had an estimated market share of 29%. A lower estimated market population was found for Critical Access Hospitals, hospitals unaffiliated with a system, hospitals with a smaller number of acute beds, and hospitals with fewer staff.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We developed a new approach for defining rural hospital markets. This approach can be used to inform health services researchers, policymakers, and communities about key market predictors of rural hospital financial distress, populations adversely affected by rural hospital closure, and more.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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