Our research team has identified topical areas warranting further investigation to inform federal and state health policy makers, health insurers, health system managers, and providers about how to more effectively organize, finance, and deliver care in highly impoverished/underserved and other rural areas across America.

Specifically, the Rural and Underserved Health Research Center aims to expand the evidence base about how the organization of health services differs between highly impoverished/underserved and other rural areas, including public health system and hospital collaborations, rural health networks, and family physician scope of practice. The goal is to discover strategies for better organizing care in highly impoverished/underserved and other rural areas, including how to optimally organize public health system and hospital partnerships to improve hospitals' financial viability, organize rural health networks to achieve efficiencies and improve population health, and promote patient-centered medical care. We are also examining the impact of the Affordable Care Act (ACA) on access, including access to substance use treatment services, which is of critical need in many rural areas with high rates of illicit and licit drug abuse.

Current Projects

Barriers and Disparities Associated with Pneumococcal Immunization among Rural Elderly Adults

Vaccines offer a cost-effective means of preventing illnesses at the population level. However, very little research has investigated rural/urban variations in vaccine utilization. Our Center will conduct analyses of national survey data and unique insurance claims data sets (UK has a collaborative agreement with Humana) to identify how rurality of residence and key demographic (including race and ethnicity), social, and economic characteristics serve as barriers or facilitators to vaccination against pneumococcal disease, which is relatively common among older Americans.

Principal Investigator

Jeffery Talbert, PhD, Professor in the Department of Pharmacy Practice and Science, and Director of the Institute for Pharmaceutical Outcomes and Policy in the UK College of Pharmacy.

Co-Investigator

Patricia R. Freeman, PhD, Director of the Center for the Advancement of Pharmacy Practice, Clinical Associate Professor in the Pharmacy Practice and Science Department, and Faculty Associate in the Institute for Pharmaceutical Outcomes and Policy in the UK College of Pharmacy.

Project Data Scientist-Statistician

Aric Schadler, MS, Data Scientist Manager/Statistician in the UK College of Pharmacy.

Variation in Scope of Practice and Medical Services Available at Family Physician Practices within Rural Areas

Family physicians are the foundation of medical care in many rural areas and, as such, are frequently required to have a broader scope of practice, defined as the ranges of services they provide, than their urban counterparts. A family physician offering the full scope of practice can provide ambulatory and urgent/emergent care, staff rural hospitals, and deliver all non-surgical care to a rural population. Despite the importance of family physicians to rural health care delivery systems, very little research has investigated their scope of practice in rural areas, particularly in socioeconomically disadvantaged areas. Using data collected during recertification examination registration of family physicians certified by the American Board of Family Medicine (ABFM), this project will examine variation in the scope of practice of family physicians and services available in the primary practice site by degree of rurality and within rural categories by community-level deprivation. Additionally, we will examine variation by Patient-Centered Medical Home (PCMH) status.

Principal Investigator

Lars E. Peterson, MD, PhD, Research Director of the American Board of Family Medicine and Associate Professor of Family and Community Medicine at UK.

The Impact of Medicaid Expansion on Rural/Urban Variations in Access to Substance Use Treatment

Abuse of illicit drugs, such as cocaine and methamphetamine, as well as licit drugs, such as prescription opioids, is a substantial public health problem in many rural areas of the U.S. One explanation for these high rates of drug misuse is that some persons residing in impoverished areas use drugs to cope with hopelessness associated with poor prospects of employment and other opportunities. Regardless of the underlying causes of drug use, research indicates that substance use treatment access is insufficient in rural areas. With implementation of the ACA, substance use treatment funding has been expanded, particularly through Medicaid expansion in many states. However, it is not clear if and how Medicaid expansion has impacted substance use treatment in rural localities. We will make use of our rare access to restricted use NSDUH data to offer new insights about the impact of Medicaid expansion on access to substance abuse treatment among individuals with substance abuse disorders. We will conduct analyses of 13 years (2004-2016).

Principal Investigator

Hefei Wen, PhD, Assistant Professor in the Department of Health Management and Policy in the UK College of Public Health.

Co-Investigator

Tyrone F. Borders, PhD, Professor and Endowed Chair in Rural Health Policy, Department of Health Management and Policy in the UK College of Public Health.

Exploring the Impact of Rural Hospital Closures on use of Emergency Medical Services

Since 2010 over 70 hospitals have closed their emergency department doors or the entire hospital. These closures have primarily occurred in the southern United States, but the closures are expected to broaden around the country and more than 250 hospitals are vulnerable to closure. In the wake of such closures, access to a hospital for real emergencies—and the distance and time to the next nearest hospital—could mean the difference between life and death. We expect to see increased reliance on Emergency Medical Services (both air and ambulance) to transport patients further distances at high cost. Rural, lower-income households, and older individuals tend to use the emergency department more than others; thus the impact of rural hospital closures will likely disproportionately affect these same populations. Additional considerations include the non-uniform geographic distribution of rural hospitals and how emergency transportation service resources in a community are affected by a rural hospital closure. Using a unique national database, The Enterprise Data Trust, we will explore pre- and post-closure emergency department use with specific emphasis on those who used public emergency medical transportation, testing for significant changes. This study will be the first to look at the impacts of rural hospital closure at the patient level.

Principal Investigator

Alison F. Davis, PhD, Professor in the UK Department of Agriculture Economics and Executive Director of the Community & Economic Development Initiative of Kentucky.

Previous Projects

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