Current Projects

Updating Rural–Urban Disparities in Diabetes Self Management Training Utilization Among Fee for Service Medicare Beneficiaries, 2017–2023

Diabetes Self Management Training (DSMT) is a covered Medicare benefit shown to improve clinical outcomes and reduce avoidable utilization among beneficiaries with diabetes. In 2020, the Rural and Underserved Health Research Center conducted a national analysis of rural–urban disparities in DSMT utilization among fee for service (FFS) Medicare beneficiaries using 2016 data. That study identified pronounced geographic disparities, with DSMT services concentrated in urban counties and limited availability across rural areas, despite comparable diabetes prevalence.

Since the release of the original report, multiple additional years of Medicare data have become available. This project proposes to replicate and update the 2020 analysis using 2017–2023 data to assess longitudinal trends in DSMT utilization, evaluate whether access gaps persist, and provide updated evidence to inform HRSA, policymakers, and rural health stakeholders. The updated analysis will maintain methodological consistency with the original study to enable direct comparison over time.

Principal Investigator

Jeffery Talbert, PhD, Chair of the Department of Artificial Intelligence and Health, Medical College of Georgia (MCG) at Augusta University

Impact of High Deductible Health Plans on Rural Populations

Using data from Merative MarketScan insurance claims, this study will investigate utilization, spending, and care patterns of rural members enrolled in high deductible health plans (HDHP) compared to traditional plans. Trends in health outcomes before and after HDHP growth will be assessed to inform policy design tailored to rural residents.

Principal Investigator

Jeffery Talbert, PhD, Chair of the Department of Artificial Intelligence and Health, Medical College of Georgia (MCG) at Augusta University

Rural/Urban Variations in Drug and Alcohol Use Treatment

Using the National Survey on Drug Use and Health, this study will investigate rural vs. urban variations in treatment utilization for alcohol use disorder (AUD) and, separately, drug use disorder (DUD). It will yield prevalence estimates of any treatment receipt and sources of treatment among persons with past year AUD and DUD as well as the receipt of medication therapy among those treatable with medications.

Principal Investigator

Tyrone F. Borders, PhD, Professor and Chair, Department of Applied Health Sciences, Harris College of Nursing and Health Sciences, TCU

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 and Chair, Department of Applied Health Sciences, Harris College of Nursing and Health Sciences, TCU

Risky Substance Use among Rural and Urban Adults: An Update

Very little research has examined rural vs. urban differences in substance misuse and treatment access nationally. Using public and nationally representative data from the NSDUH, this project will 1) Estimate and compare alcohol use and binge drinking and 2) Estimate and compare drug use (marijuana, other illicit drugs, and non-medical use of other drugs) between non-metropolitan and metropolitan adults.

Principal Investigator

Tyrone F. Borders, PhD, Professor and Chair, Department of Applied Health Sciences, Harris College of Nursing and Health Sciences, TCU

Availability and Characteristics of Outpatient and Residential Substance Use Treatment in Rural and Urban Areas

This study will look at: 1) the availability of residential and outpatient treatment centers in rural and urban counties, including identifying counties with no facilities; and 2) characteristics of services offered (e.g., residential, outpatient), demographics of persons treated, and insurance plans accepted by rural vs urban centers.

Principal Investigator

Tyrone F. Borders, PhD, Professor and Chair, Department of Applied Health Sciences, Harris College of Nursing and Health Sciences, TCU

Co-Investigator

Jeffery Talbert, PhD, Chair of the Department of Artificial Intelligence and Health, Medical College of Georgia (MCG) at Augusta University

Project Data Scientist-Statistician

Aaron P. Smith, PhD

Mental Health Treatment among Rural and Urban Adults at Risk for Suicide

This study will look at rural/urban disparities in 1) the receipt and sources of mental health treatment among adults with suicidal thoughts and attempts using data from the National Survey on Drug Use and Health (NSDUH); and 2) mental health follow-up visits among adults with a hospital admission or emergency department visit for self-inflicted harm using data from a national insurance claims dataset.

Principal Investigator

Tyrone F. Borders, PhD, Professor and Chair, Department of Applied Health Sciences, Harris College of Nursing and Health Sciences, TCU

Co-Investigator

Jeffery Talbert, PhD, Chair of the Department of Artificial Intelligence and Health, Medical College of Georgia (MCG) at Augusta University

Project Data Scientist-Statistician

Aaron P. Smith, PhD