Current Projects

Review of Current Research on Rural/Urban Differences in Social Determinants of Health

Social determinants of health are social, economic, and community variables that influence health outcomes. This project will synthesize the extant literature on rural/urban differences in the social determinants of health, culminating in a comprehensive report that includes a summary of information gaps and further research needs.

Principal Investigator

Katie Youngen, MPH, Research Program Manager

Rural Access to Opioid Treatment Program (OTP) Clinics and Certified Community Behavioral Health Clinics (CCBHC)

This project will identify all Certified Community Behavioral Health Clinics and Opioid Treatment Program Clinics in the U.S. and then present the number of rural and urban clinics in each state as frequency tables and map visualizations.

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

Rural/Urban Variations in Cancer Screening During the COVID-19 Pandemic

Using the National Cancer Institute Health Information National Trends Survey, we will examine how the COVID-19 pandemic has disrupted the receipt of recommended screenings for common cancers. Findings will inform policy makers about potential widening of rural/urban disparities in the receipt of cancer preventive services and the potential need to target these services toward rural residents.

Principal Investigator

Tyrone F. Borders, PhD, Professor, College of Nursing

Work Settings, Education, and Intent to Leave Practice among Rural vs. Urban Nurses

Using data from the 2022 National Nursing Workforce Survey, this project will describe rural/urban differences in nurses’ work settings, levels of education and licensure, demographic characteristics, income, and intention to retire or leave practice. Study findings could be applied to implement policies aimed at increasing nursing school output and attracting nurses to practice in rural areas.

Principal Investigator

Tyrone F. Borders, PhD, Professor, College of Nursing

Rural and Urban Cancer Survivors’ Follow-Up Care Experiences

• 2022 ATRN Health Summit

After completing treatment, cancer survivors require follow-up services for surveillance of cancer recurrence, detection of new cancers, continued care management, and the monitoring of late or long-term treatment side effects. This project will examine rural vs. urban differences in cancer survivors’ follow-up care experiences by conducting analyses of the 2017 Medical Expenditure Panel Survey (MEPS), which included a cancer survivors module. Specific aims of this study are:
1. To provide nationally representative estimates and compare/contrast the prevalence of rural and urban cancer survivors’ follow-up care experiences.
2. To understand how having a regular PCP is associated with cancer survivors’ follow- up care experiences and if this association is stronger among rural than urban cancer survivors.
3. To determine if racial/ethnic differences in cancer survivors’ follow-up care experiences vary by rural/urban residence.

Principal Investigator

Tyrone F. Borders, PhD, Professor, College of Nursing

Rural Family Physicians’ Ability to Address Patients’ Social Determinants of Health Needs

• 2021 NAPCRG Annual Meeting

Rural populations fare worse than their metropolitan counterparts in social determinants of health including access to services, economic opportunity, intimate partner violence, life expectancy and poverty. Very little research exists to describe the ability of rural primary care physicians to address patients’ non-medical social determinants of health needs. This project will make use of a unique dataset collected among family physicians nationally in 2017 through 2019.

Principal Investigator

Lars E. Peterson, MD, PhD, Vice President at American Board of Family Medicine

Rural and Urban Primary Care Physicians' Colorectal Screening Performance

Additional research is warranted to further understand the roles of primary care physicians in assuring that their patients receive recommended colorectal cancer screenings, especially considering that primary care physicians (particularly family physicians) are the predominant clinicians in rural America. Family physicians can provide endoscopy services themselves as opposed to referring patients to other specialists, such as gastroenterologists, but these numbers are low (<5% overall). Our prior research found that the percentage of rural family physicians doing colonoscopy (6% to 4%) and endoscopy (6% to 3%) both declined from 2014 to 2016, further threatening rural access to screening.
The objectives of this project are to profile, compare, and further understand rural vs. urban differences in colorectal screening performance among primary care physicians nationally. To address these issues, we will analyze data from the American Board of Family Medicine’s PRIME Registry, which captures electronic health record data from more than 2500 clinicians in approximately 800 practices located in 47 states caring for 5.4 million patients. PRIME practices are disproportionately rural, small, and independent compared to all US primary care practices.

Principal Investigator

Tyrone F. Borders, PhD, Professor, College of Nursing

Rural/Urban and Racial/Ethnic Inequities in Patient-Reported Health Care Access and Quality among Medicare Beneficiaries with Lung or Colorectal Cancer

Incidence and mortality for colorectal and lung cancer are higher in rural versus urban residents, but many rural cancer patients lack accessible, high-quality care. This study will 1) Identify rural/urban inequities in Medicare cancer patient-reported health care access and quality and 2) Determine if rural racial/ethnic minority patients have worse health care access and quality than rural White patients.

Principal Investigator

Tyrone F. Borders, PhD, Professor, College of Nursing

Diabetes Management in Urban and Rural Areas of the U.S.

• 2022 NRHA Annual Conference

This project will use the IBM MarketScan database to examine differences in type 2 diabetes prevalence and monitoring for a commercially insured sample. It will also employ definitions from the Health Effectiveness Data and Information Set (HEDIS) guidelines for comprehensive diabetes care to determine if rural residents are more or less likely to meet recommended standards for type 2 diabetes monitoring and control.

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

Disparities in Screening, Prevention, and Management of Cardiovascular Disease in Rural and Urban Primary Care

This study will use a large national primary care registry to compare cardiovascular disease (CVD) screening, prevention, and management quality measures between rural and urban primary care practices. It will also assess for disparities by patient composition (race/ethnicity, insurance) of the practice.

Principal Investigator

Lars E. Peterson, MD, PhD, Vice President at American Board of Family Medicine

Third Party Negotiated Pricing in Rural and Urban Hospitals

• 2022 ATRN Health Summit

We will use third party negotiated pricing information to compare prices in urban and rural hospitals, across a variety of common services. Because there has been poor compliance with the Centers for Medicare & Medicaid Services (CMS) requirement to publish third party negotiated pricing, we will also examine if the availability of this information differs for rural and urban hospitals.

Principal Investigator

Lindsey Hammerslag, PhD

Co-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