Measuring the Quality of Swing-Bed Care in Critical Access Hospitals
The lack of nationally comparable swing-bed quality measure data for CAHs means that they are not able to demonstrate the quality of care provided to swing-bed patients, and limits their ability to participate in alternative payment models that include post-acute care.This project will identify quality measures to be used by CAHs to assess the quality of care provided to their swing-bed patients, and recommend appropriate uses of the measures.
Obstetric Unit and Hospital Closures and Maternal and Infant Health in Rural Communities
As rural hospital and obstetric unit closures continue to affect rural communities across the US, little is known about the consequences of these closures in terms of access to maternity care and outcomes of childbirth for women and infants. Data to inform policy efforts are needed, as no current research documents the county-level effects of the loss of obstetric services on maternity care, location of childbirth, or birth outcomes. Further, little is known about the strategies rural women use to obtain maternity care in the wake of a closure and the effects of a closure on clinicians and communities. This project will examine the relationship between closure of an obstetric unit or hospital and maternity care and outcomes of childbirth in rural US counties including prenatal care, distance to delivery hospital, out-of-hospital birth, and infant health outcomes.
Paving the Way: Addressing Transportation as a Social Determinant of Health for Rural Residents
Rural areas face unique challenges related to transportation, including distance to health care and other services, the impact of adverse weather on travel conditions, and limited availability of public and private transportation services. Rural residents cannot receive health care services without transportation to access facilities and providers. Beyond direct access to care, transportation is essential for accessing basic necessities for health and wellness, such as food, recreation, employment, education, and social support. This project will use a mixed-methods design to examine ways in which transportation operates as a social determinant of health for vulnerable rural residents, and to identify exemplar transportation programs that are successfully improving health and well-being of those residents.
Skilled Nursing Facility Care for Rural Residents with Complex Care Needs
With the aging of the U.S. population, the number of adults with complex care needs is rising, particularly in rural areas. Despite this, nursing homes often lack the staffing, funding, and infrastructure to adequately care for them. As a result, access to appropriate, timely long-term care in skilled nursing facilities may be constrained for rural residents who need it most. This project will examine barriers to skilled nursing facility placement for rural residents with complex care needs, including obesity, dementia, and behavioral health problems, and explore potential implications for access to and quality of care.