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.

Current Projects

Rural and Urban Differences in Access to Psychiatric Partial Hospitalization Programs

Project Link: Rural Health Research Gateway

Psychiatric partial hospitalization programs (PHPs) allow patients to reside at home while receiving intensive and structured services, routine psychiatric evaluation, medication management, and individual and group counseling, in outpatient settings during the day. Although some evidence indicates that PHP service utilization has grown overall over the past two decades, very little information exists about the availability of psychiatric PHPs in non-metropolitan (rural) as compared to metropolitan (urban) areas. Similarly, very little information exists about the provision of psychiatric PHPs by Medicare-designated critical access hospitals (CAHs), rural referral hospitals, and sole community hospitals serving rural clientele. Analyzing the American Hospital Association Annual Survey of hospitals, the purpose of this project is to describe the availability of psychiatric PHPs amongst hospitals in metropolitan, micropolitan, and other non-metropolitan areas nationally. Because psychiatric PHP services are financed by Medicare and Medicaid, the project findings will have federal policy relevance for improving the accessibility of outpatient mental health services.

Principal 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

Serious Mental Illness and Access to Care among Rural and Urban Adults

Project Link: Rural Health Research Gateway

The federal government defines serious mental illness (SMI) as satisfying criteria for at least one Diagnostic and Statistical Manual (DSM) disorder, excluding substance use disorders, that leads to substantial functional life impairment. The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates the prevalence of SMI from the National Survey on Drug Use and Health (NSDUH). The etiology and treatment of SMI has been recognized as a Department of Health and Human Services priority, but little research has investigated this issue among rural residents in recent years. Consequences of untreated SMI include drug and alcohol abuse, suicide, and overall premature mortality from so-called deaths of despair, all of which have risen to the national forefront of public health concerns in rural areas.

This project will provide up-to-date estimates of the prevalence and correlates of past-year SMI and, among persons with SMI, treatment utilization, unmet treatment needs, and treatment barriers among metropolitan and non-metropolitan adults nationally. From a policy perspective, the project is timely because Federal agencies and policymakers need information about the prevalence and correlates to SMI and treatment access to more effectively target services across geographic areas.

Principal 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

Medicare Beneficiaries’ Access to Preventive Services: Diabetes Self-Management Training (DSMT), Medical Nutrition Therapy (MNT), and Health and Behavior Assessment and Intervention (HBAI)

Project Link: Rural Health Research Gateway

Diabetes self-management education and training (DSMT) is an important part of clinical management of diabetes that is associated with increased use of primary and preventive services and lower use of acute, inpatient hospital services. Furthermore, nutrition-based interventions have proven to be both effective at producing physical indicators of increased metabolic health and cost-effective in terms of savings generated by their usage. However, previous studies have shown that utilization of DSMT services is altered by geographic region and availability of such services (Strawbridge, Lloyd, Meadow, Riley, & Howell, 2015; Remler et al., 2007), despite coverage by Medicare Part B.

Using the publicly available Medicare Provider Utilization and Payment Data supplemented by unique clinic site and physician-level information for 30,000 family physicians nationally that is only available through the American Board of Family Medicine, we propose to investigate geographic disparities (i.e., rural versus urban) in the provision of DSMT, Medical Nutrition Therapy (MNT), and Health and Behavior Assessment and Intervention (HBAI) and identify whether challenges or barriers exist for rural providers in billing for these services, as well as propose solutions to addressing challenges faced by providers in billing for these services in disparate populations. Using national county-level aggregate totals of DSMT, MNT, and HBAI services among Medicare fee-for-service beneficiaries from 2012 to 2015, we will compare rural and urban providers to determine characteristics of the practice sites on a national level.

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

The Association of Occupation with Mental Illnesses and Death by Suicide

Project Link: Rural Health Research Gateway

Globally, suicide accounts for 1.4% of all deaths, making it the 18th leading cause of mortality worldwide. However, in the United States, suicide accounts for 1.8% of all deaths and is the 10th largest cause of mortality. Previous research has linked depression, psychological distress, and lower levels of well-being with substantially higher risk of suicide. However, recent data suggest more than half of suicide victims did not have any prior mental health diagnosis, indicating that factors other than mental illness should be explored. Higher risks for suicide have been associated with select occupations. This project will evaluate the association of occupational risk factors with mental illnesses, all-cause mortality, and suicide using the National Health Interview Survey (NHIS) and the Panel Study of Income Dynamics (PSID) datasets.

Principal Investigator

Ahmed A. Arif, PhD, CPH, FACE, Associate Professor of Public Health Sciences at UNCC


Previous Projects

Substance Use, Depression, and Suicide: What are the Individual and Policy-Modifiable Correlates amongst Metropolitan and Non-Metropolitan Adults?

Project Link: Rural Health Research Gateway
Presentations:

Very little research has investigated the associations between substance use, depression, and suicidal ideation amongst adults residing in rural and urban areas nationally. Using nationally representative data from the National Survey on Drug Use and Health (NSDUH), this study will a) estimate the prevalence of major depression and suicidal ideation and attempts in metropolitan, micropolitan, and other non-metropolitan areas nationally and b) investigate the individual-level (e.g., demographic, socioeconomic, region of residence, and health status) and policy-modifiable health care (e.g., insurance, access to a regular health care provider, and access to mental health and substance use treatment) correlates of depression and suicide indicators among metropolitan, micropolitan, and other non-metropolitan residents.

Principal 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

Mental Health Treatment Access: How do Mental Health Treatment Use and Unmet Treatment Need Vary among Rural and Urban Adults Nationally?

Project Link: Rural Health Research Gateway
Presentations:

Recent research indicates that residents of rural areas have similar rates and residents of semi-rural areas have higher rates of mental health illnesses than residents of large metro areas. Although rural residents on average need mental health services just as much as their urban counterparts, a dearth of research has investigated unmet mental health treatment need and treatment utilization amongst rural and urban residents with mental health problems. Using nationally representative data from the National Survey on Drug Use and Health, this study will a) estimate rates of unmet treatment need and treatment utilization and b) investigate the individual-level (e.g., demographic, socioeconomic, region of residence, and health status) and policy-relevant health care (e.g., insurance and access to a regular health care provider) correlates of unmet need and treatment utilization among metropolitan, micropolitan, and other non-metropolitan residents. In addition, we will repeat our analyses of rates and correlates of unmet need and treatment use amongst Native Americans/American Indians.

Principal 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

Lung Diseases among Coal Miners

Project Link: Rural Health Research Gateway
Presentations:

Coal mining is considered one of the most dangerous and hazardous occupations worldwide. In the U.S., rates of fatal and non-fatal injuries are substantially higher among coal miners as compared to those working in private jobs. Coal miners are at increased risk of both restrictive and obstructive lung diseases such as coal worker’s pneumoconiosis (CWP), progressive massive fibrosis (PMF), rapidly progressive pneumoconiosis (RPP), and COPD. Using the Medicare administrative claims data, Kentucky (KY) Medicaid claims data, and the National Health Interview Survey (NHIS), we propose to determine factors related to respiratory health effects among miners and non-miners, assess and compare health care utilization among patients with and without CWP across regions, and map health care utilization of CWP and other lung diseases relative to HRSA-funded Black Lung Clinics.

Principal Investigator

Ahmed A. Arif, PhD, CPH, FACE, Associate Professor of Public Health Sciences at UNCC

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

Predictors of Buprenorphine Prescribing by Family Physicians in Rural Areas Nationally

Project Link: Rural Health Research Gateway

Family physicians are the most prevalent physician specialty in rural America and can treat opioid use disorder (OUD) with buprenorphine if they complete training to obtain a special Drug Enforcement Agency license. However, the uptake of buprenorphine prescribing by family physicians has been low. This study will examine rural vs. urban and intra-rural variation in family physicians’ prescribing of buprenorphine nationally and will examine how physician and practice-level factors are associated with prescribing buprenorphine. To address these questions, we will conduct a multilevel logistic regression analysis of a nationally representative cohort of family physicians registering for the American Board of Family Medicine (ABFM) recertification examination.

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.

Barriers and Disparities Associated with Pneumococcal Immunization among Rural Elderly Adults

Project Link: Rural Health Research Gateway
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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 (Trish) Rippetoe 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

Project Link: Rural Health Research Gateway
Publication:

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

Project Link: Rural Health Research Gateway
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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

Project Link: Rural Health Research Gateway
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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.