Journal of Rural Health最新文献

{"title":"Examining geographic disparities in access to no-cost naloxone in North Carolina: A cross-sectional survey of naloxone distribution programs","authors":"Grace Marley PharmD,&nbsp;Caroline Shubel MPh,&nbsp;Carolyn T. Thorpe PhD MPh,&nbsp;Izabela E. Annis M.S.,&nbsp;Paul Delamater PhD,&nbsp;Delesha Carpenter PhD MSPh,&nbsp;Bayla Ostrach PhD, MA, CIP","doi":"10.1111/jrh.70069","DOIUrl":"https://doi.org/10.1111/jrh.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The objective of this study was to comprehensively identify the programs that distribute naloxone at no-cost in North Carolina, identify where and to whom these programs distribute naloxone, and evaluate disparities in reported naloxone distribution by geographic area.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional online survey was delivered to potential no-cost naloxone distributors in NC identified by a community advisory panel. Descriptive statistics and Fisher exact tests were utilized to identify disparities in naloxone access by population served (people who use drugs, people who inject drugs) and location of naloxone distribution (rural; urban/suburban).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Approximately 76.5% (241/315) of respondents representing 341 different programs reported that their program(s) distributed no-cost naloxone to community members. Programs represented included health departments (<i>n</i> = 81), treatment programs/centers (<i>n</i> = 59), and syringe service programs(SSPs) (<i>n</i> = 41), among others. Programs reported distributing naloxone most frequently to people who use drugs (94.2%) and people with a substance use disorder history (94.3%). No-cost naloxone distribution was reported less frequently to all patient populations in rural ZIP codes when compared to urban ZIP codes, including justice-involved populations (86.4% vs. 98.3%) and individuals leaving treatment or detox (87.9% vs. 98.6%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study indicates that although most areas in NC were served by at least one no-cost naloxone program, distribution to rural populations may be limited, indicating a need for increased public investment in no-cost naloxone distribution to populations at greatest risk of overdose.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767561","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}

{"title":"Route and efficiency analysis of cancer health care (REACH): Investigating sociodemographic and rurality of metastatic breast cancer patients at an NCI-designated facility","authors":"Amanda Golden MD,&nbsp;Sarah Humble MS,&nbsp;Rachelle Roy BPH,&nbsp;Allison B. Anbari PhD, RN, CLT,&nbsp;Lindsay L. Peterson MD, MSCR,&nbsp;Ashley J. Housten OTD, MSCI","doi":"10.1111/jrh.70063","DOIUrl":"https://doi.org/10.1111/jrh.70063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Breast cancer is one of the most common malignancies affecting women worldwide. Metastatic breast cancer (MBC) patients experience unique challenges regarding access to care, particularly rural populations. Geographic location may increase travel, impacting time to treatment and adding to patient burden. This study aimed to evaluate the association between rurality and access to care by examining travel distance, time to treatment, and sociodemographic factors in patients with MBC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using data from Siteman Cancer Center (SCC) Oncology Data Services registry from 2011–2021 with 519 female MBC patients. Rurality was defined by state definition. We used Geographic Information Systems (GIS) software to calculate travel distances and times from patients’ homes to treatment site. We evaluated travel distance (miles) and time to treatment initiation (days) using <i>t</i>-tests and ANOVA and evaluated any differences based on sociodemographic characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>We found that rural patients traveled farther for treatment compared to urban patients (mean 87.3 miles vs. 18.0 miles; <i>p</i> &lt; 0.001). There was no statistically significant difference found with time to treatment initiation between groups (mean 36.1 vs. 35.0 days; <i>p</i> = 0.68). No difference in travel time or treatment initiation was found when comparing sociodemographic factors, including insurance status and comorbidity scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural MBC patients face longer travel times, which may contribute to barriers to care. However, we found no difference for time to treatment initiation. Future studies characterizing rural patients' experiences can contribute to the development of targeted interventions to mitigate rural patient burden and improve access to cancer care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767707","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":"Rural–urban differences in health care access for postpartum parent and infant dyads","authors":"Sara C. Handley MD, MSCE,&nbsp;Julia D. Interrante PhD, MPH,&nbsp;Emily F. Gregory MD, MHS,&nbsp;Katy B. Kozhimannil PhD, MPA","doi":"10.1111/jrh.70062","DOIUrl":"https://doi.org/10.1111/jrh.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To examine differences in perinatal health between rural and urban postpartum parents and infants and within postpartum parent–infant dyads.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional analysis of the National Health Interview Survey (NHIS) data. Accounting for the complex survey design, we calculated weighted proportions of measures of self-rated health, health care utilization, and barriers to care and used chi-squared tests to assess rural–urban differences between postpartum parents and between infants, and repeated measures to test postpartum parent–infant differences within households in rural and urban counties.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The study included 2019 rural postpartum parents, 2191 rural infants, 12,112 urban postpartum parents and 13,088 urban infants. Compared to urban postpartum parents, those living in rural areas were less likely to see an obstetrician–gynecologist (<i>p</i> = 0.002) had more emergency department (ED) visits (<i>p</i> = 0.030), reported more hospitalizations (<i>p</i> = 0.041), more frequently experienced uninsurance (<i>p</i> = 0.006), and lost Medicaid coverage after pregnancy (<i>p</i> = 0.006). While a higher proportion of urban infants were hospitalized than their rural counterparts (<i>p</i> = 0.019), other measures were similar. Accounting for dyad correlations, compared to infants, postpartum parents generally reported worse health (fair or poor self-rated health), and were more likely to experience ED visits, hospitalizations, loss of health care coverage, and barriers to care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural postpartum parents experience worse health than their urban counterparts and compared to their infants. Rural–urban differences in access were less common among infants, thus leveraging infant care systems for services to both the infant and postpartum parent may improve household health in all communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767509","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}

{"title":"Evaluation of the Ask Suicide-Screening Questions (ASQ) tool, Item 9 of the Patient Health Questionnaire (PHQ), pain, and opioid screening to detect suicide risk among rural adult primary care patients","authors":"Mary Christensen PhD,&nbsp;Stacey Culp PhD,&nbsp;John V. Campo MD,&nbsp;Jeffrey A. Bridge PhD,&nbsp;Lisa Horowitz PhD","doi":"10.1111/jrh.70064","DOIUrl":"https://doi.org/10.1111/jrh.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study evaluated psychometric properties of the Ask Suicide-Screening Questions (ASQ) and Item Nine of the Patient Health Questionnaire (PHQ Item 9) to detect suicide risk in rural adult primary care and whether pain and opioid screening contributed to suicide risk detection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A sample of adult rural primary care patients (<i>N</i> = 214) completed suicide risk, pain, and opioid screening measures electronically; 48% of participants also completed a follow-up survey. Using the Adult Suicidal Ideation Questionnaire (ASIQ) as the criterion measure, psychometric properties for the ASQ and the PHQ Item 9 were compared using McNemar's test for proportions. Bivariate and multivariable regression analyses explored associations between suicide risk, pain, opioid measures, and ASIQ results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Approximately 4% (<i>N</i> = 8) of participants screened positive for suicide risk on the ASIQ relative to 11.7% (<i>N</i> = 25) on the ASQ and 3.7% (<i>N</i> = 8) on the PHQ Item 9. The ASQ had higher sensitivity (75.0%) than the PHQ Item 9 (50.0%); the difference was not statistically significant but may have clinical relevance. The PHQ Item 9 had significantly higher specificity (98.1%) than the full ASQ (91.0%, <i>p</i> &lt; 0.001). The ASQ, PHQ Item 9, depression scores, and LGBTQ+ status were significant predictors of ASIQ scores. Pain and opioid misuse were not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings from this small sample provide preliminary support for the ASQ and PHQ Item 9 as suicide risk screens in rural adult primary care, but psychometric studies in larger samples are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144751527","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":"Understanding the influence of social determinants of health on symptom reporting in pediatric cancer","authors":"Micah A. Skeens PhD,&nbsp;Adelaide Booze BA,&nbsp;Mark Ranalli MD,&nbsp;Anna Olsavsky PhD","doi":"10.1111/jrh.70071","DOIUrl":"https://doi.org/10.1111/jrh.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Children with cancer experience significant symptom burden, worsened by social deprivation. This study examines social determinants of health, including Appalachian residency, influence on symptom burden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Caregiver-child dyads were recruited within 1 year of cancer treatment. Addresses were coded for social determinants of health (SDOH) measures: Area Deprivation Index (ADI), rurality, medically underserved areas (MUA), and Appalachian residency. Total child symptom scores (0–31) were calculated for dyad reports using the Memorial Symptom Assessment Scale. Provider matching symptom reports were extracted from electronic medical records. Descriptive statistics and correlations examined associations between child, caregiver, and provider symptom reports and SDOH. Significant correlations informed three multiple linear regression models examining SDOH predictors of child symptoms by reporter.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Fifty-five caregiver-child dyads were recruited. Caregivers were 65.5% female and 87.3% White. Children were 50.9% male, 85% White, an average of 12 years old, 30.9% rural, and 20.0% Appalachian. ADI scores (<i>M</i> = 4.22) indicated moderate disadvantage, and 14.5% were medically underserved. On average, children reported 8.61 symptoms, while caregivers reported 7.15, and providers recorded 1.87 child symptoms. For children, a bivariate association and significant regression model revealed Appalachian children experienced a higher number of symptoms. For caregivers, bivariate associations indicated a higher ADI was associated with more symptoms. For providers, bivariate associations revealed higher symptoms were associated with rurality, MUA, and Appalachian residency, though only Appalachian residency remained significant in the regression model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Results suggest Appalachian residency is associated with higher symptom burden for children with cancer. Findings support culturally sensitive care to minimize symptom burden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758585","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}

{"title":"Metropolitan/nonmetropolitan differences of the impact of COVID-19 on cancer survivors' care","authors":"Whitney E. Zahnd PhD,&nbsp;Jason T. Semprini PhD, MPP,&nbsp;Robin C. Vanderpool DrPH,&nbsp;Sarah H. Nash PhD, MPH,&nbsp;Erin L. Van Blarigan ScD,&nbsp;Mindy C. DeRouen PhD, MPH,&nbsp;Angela L. W. Meisner MPH,&nbsp;Chuck Wiggins PhD","doi":"10.1111/jrh.70061","DOIUrl":"https://doi.org/10.1111/jrh.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate pandemic-related changes in cancer-related care for cancer survivors residing in nonmetropolitan and metropolitan areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data from the Health Information National Trends-Surveillance Epidemiology End Results (HINTS-SEER) survey administered to cancer survivors from the Greater San Francisco Bay Area, Iowa, and New Mexico between January and August 2021. Respondents were queried on changes to their cancer-related care, including treatment, follow-up appointments, and routine cancer screening/preventive care. We calculated weighted percentages and Rao-Scott chi-square tests for reported differences between nonmetropolitan and metropolitan areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Compared to survivors residing in metropolitan areas, a higher proportion of those in nonmetropolitan areas reported that their cancer treatment or follow-up appointments were unaffected by the pandemic (38.6% vs 28.1%; <i>P</i> = .008). Survivors in metropolitan areas experienced more of a shift in cancer treatment or follow-up appointments to telehealth (12.5% vs 5.7%, <i>P</i> = .003), but there was no difference in appointment cancellations. More survivors residing in metropolitan versus nonmetropolitan areas reported shifts to telehealth for preventive care (8.2% vs 2.9%, <i>P</i> = .005). There was no difference across nonmetropolitan and metropolitan survivors reporting that cancer-related care was cancelled, that routine cancer screening or preventive care was unaffected by the pandemic, or that providers discussed COVID-19 risks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Survivors in nonmetropolitan compared to metropolitan areas had less perceived change in cancer follow-up and treatment schedules. It will be important to assess whether shifts in follow-up and preventive care to telehealth for cancer survivors in need of care during the COVID-19 pandemic affect their long-term outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740115","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}

{"title":"Urban–rural differences in the age of US physicians","authors":"Ryan J. Crowley MPhil,&nbsp;Jag S. Lally MPhil,&nbsp;David M. Kline PhD,&nbsp;Amanda M. Bunting PhD","doi":"10.1111/jrh.70054","DOIUrl":"https://doi.org/10.1111/jrh.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To assess county-level and specialty-level age differences between urban and rural physicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We linked the 2008–2021 Medicare Data on Provider Practice and Specialty (MD-PPAS) dataset with the 2024 Doctors and Clinicians national downloadable file. We assessed specialty-level differences in the age of rural versus urban physicians using Rural–Urban Continuum Codes (RUCC) with four groups: urban (RUCC 1–3), large rural (RUCC 4–5), small rural (RUCC 6–7), and isolated rural (RUCC 8–9). We analyzed the relationship between rurality and physician age using choropleth graphs, spatial clustering, and univariable regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Our final cohort comprised 571,886 physicians. The mean ages of physicians were higher in rural counties (large rural: 53.1 years; small rural: 53.3 years; isolated rural: 53.5 years) than urban counties (52.5 years; <i>p</i> value &lt;0.001). Some specialties including medical oncology, palliative care, and thoracic surgery showed particularly large age differences with older physicians in more rural areas. There were clusters of older physicians in the South and clusters of younger physicians in the Mountain West and Midwest. Rurality was strongly associated with clusters of older physicians (odds ratio [OR]: 3.8; 95% confidence interval [CI], 2.6–5.5), and the percentage of households with broadband internet subscription was strongly associated with clusters of younger physicians (OR: 2.6; 95% CI, 2.2–3.0).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural physicians were older than urban physicians with certain specialties and regions demonstrating large age disparities. The aging of rural physicians could worsen existing urban–rural health care disparities. Initiatives focusing on recruiting and retaining rural physicians should target specific regions and specialties to ameliorate these inequities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144725611","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":"Financial resilience of rural hospitals: Prepandemic vulnerabilities and Provider Relief Funds’ role during COVID-19","authors":"Saleema A. Karim MHA, MBA, PhD,&nbsp;Nathan W. Carroll PhD,&nbsp;Paula H. Song PhD,&nbsp;Adam Atherly PhD","doi":"10.1111/jrh.70060","DOIUrl":"https://doi.org/10.1111/jrh.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Rural hospitals struggling with prepandemic financial instability faced heightened challenges during COVID-19. While Provider Relief Funds (PRFs) offered essential support, their impact varied, highlighting the need to examine how prepandemic financial health influenced rural hospitals’ financial performance during the pandemic. This study evaluates PRF's role across three hospital categories: financially strained (low operating margin), financially vulnerable (midrange operating margin), and financially strong (high operating margin).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cohort study with a pre–post research design analyzed 2243 US rural hospitals from 2017 to 2022. The sample included short-term general acute nonfederal hospitals and Critical Access Hospitals in nonmetropolitan counties and rural tracts within metropolitan counties. Financial health was assessed using operating margin measures and total margins with and without PRF across four time periods: pre-COVID-19 (2017–2019), COVID-19 Year 1 (2020), Year 2 (2021), and Year 3 (2022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Financially strained and vulnerable hospitals represented 85% of rural hospitals. Financially strained hospitals had the lowest average operating margins from patient services (−17.36%), trailing financially vulnerable (−3.09%), and financially strong (8.04%). In COVID-19 Year 1, operating margins declined across all categories. PRF increased total margins for financially strained hospitals to 8.39% in 2021 before dropping to 0.76% in 2022. Financially vulnerable hospitals also benefited, while financially strong hospitals remained profitable even without PRF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PRF played a critical role in stabilizing rural hospitals, mitigating financial declines, and preventing closures. Its expiration leaves many hospitals facing renewed financial pressures. Addressing long-term financial challenges through sustainable funding strategies and operational adaptations will be essential to preserving health care access in rural communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687986","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":"Financial performance of rural and urban nursing homes: A comparative analysis","authors":"Gregory N. Orewa PhD, MBA, MSc,&nbsp;Rohit Pradhan PhD, MPA,&nbsp;Akbar Ghiasi PhD,&nbsp;Shivani Gupta PhD, MBA,&nbsp;Robert Weech-Maldonado PhD, MBA","doi":"10.1111/jrh.70053","DOIUrl":"https://doi.org/10.1111/jrh.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The financial sustainability of nursing homes is increasingly critical as the aging US population continues to grow. Rural facilities often encounter more significant economic challenges than urban counterparts. This study investigates the disparities in financial performance between rural and urban nursing homes in the United States, emphasizing the influence of organizational and environmental factors. A comprehensive understanding of these differences is necessary for the implementation of effective policy and management interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study used a longitudinal dataset (2018–2022) comprising 66,056 nursing home-year observations. Data sources included Centers for Medicare and Medicaid Services (CMS) Cost Reports, Payroll-Based Journal, Care Compare, LTCFocus, and the Area Health Resource File. The dependent variable was the operating margin. The primary independent variable, geographic location, was classified using Rural–Urban Commuting Area (RUCA) codes. We conducted multivariable linear regression with facility-level random effects and two-way fixed effects (state and year) to assess rural–urban financial disparities while controlling for organizational and environmental factors and the impact of COVID-19.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Rural nursing homes had lower operating margins than urban facilities in unadjusted models. However, after adjusting for organizational factors such as size, occupancy, and payer mix, the rural–urban difference was no longer significant. Environmental factors, including population demographics and income levels, contributed to financial disparities. COVID-19 exacerbated financial challenges, disproportionately affecting rural facilities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Financial disparities between rural and urban nursing homes are not solely due to geographical location, but also stem from structural challenges. These insights have significant policy implications suggesting that addressing reimbursement rates, operational efficiency, and resource allocation is crucial to ensure the financial sustainability and quality care for aging populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681156","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}

{"title":"Use of telehealth did not mitigate persistent disparities in prenatal care access among American Indian women in North Dakota","authors":"Tara Stiller PhD, MPH,&nbsp;Anna Charlotta Kihlstrom MPH,&nbsp;Nishat Sultana  ,&nbsp;Grace Njau PhD,&nbsp;Matthew Schmidt MPH,&nbsp;Anastasia Stepanov  ,&nbsp;Andrew D. Williams PhD, MPH","doi":"10.1111/jrh.70056","DOIUrl":"https://doi.org/10.1111/jrh.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In North Dakota (ND), American Indian (AI) women face a persistent disparity in prenatal care (PNC) access compared to other women. During the COVID pandemic, the expansion of telehealth emerged as a potential solution to disparate access to health care. We examined whether telehealth use mitigated disparities in PNC in ND.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were drawn from the 2020 to 2021 ND Pregnancy Risk Assessment Monitoring System (weighted <i>n</i> = 10,189). PNC initiation &gt;13 weeks gestation or not receiving PNC was considered “late/no PNC.” Maternal race/ethnicity was self-reported. Use of telehealth for prenatal visits was self-reported and categorized as “any telehealth use” versus “no telehealth use.” Those not using telehealth self-reported eight barriers to telehealth (e.g., lacking internet, no appointments). Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for late/no PNC among AI and other race/ethnicity women compared to White women. Models included maternal sociodemographic and health factors. Chi-square was used to examine prevalence of telehealth barriers by race/ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to White women, AI/AN women were twice as likely to receive late/no PNC (OR: 2.40; 95% CI, 1.08, 5.35). When telehealth was accounted for, the AI–White disparity was lowered by only 2% (OR: 2.35; 95% CI, 1.05, 5.26). Compared to White and other race/ethnicity women, a higher prevalence of AI/AN women reported a lack of telehealth appointments (<i>p</i> &lt; 0.01), no computers (<i>p</i> &lt; 0.01), no phones (<i>p</i> &lt; 0.01), and no physical space (<i>p</i> &lt; 0.01) as barriers to telehealth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The use of telehealth did not mitigate PNC disparities in ND. Infrastructure investments and culturally safe initiatives are needed to improve PNC access for AI/AN women.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673028","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}