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UMRHRC Projects 2011-2012

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Has the Medicare Part D Program Improved Medication Access and the Health Status of Rural Beneficiaries? 
This project will use Medicare Current Beneficiary Survey data to assess the impact of the Medicare Part D Program on medication access and the health status of rural Medicare beneficiaries. Prior to the start of the Medicare Part D program, rural beneficiaries were less likely than urban beneficiaries to have prescription drug coverage. Recent studies have analyzed the availability of Part D plans in rural areas and rural beneficiary enrollment in Medicare Part D plans, but the impact of Medicare Part D on rural beneficiaries has not been examined.

The purpose of this project is to assess the impact of the Medicare Part D Program on medication access and the health status of rural Medicare beneficiaries. We will assess access to drugs, satisfaction with drug plans, use of pharmacies of choice, out of pocket drug expenditures, and health and functional outcomes. Data from the Medicare Current Beneficiary Survey will be used to estimate a difference-in-differences model and measure changes in drug utilization and costs for rural Medicare beneficiaries. Two part models will be used to address enrollment in Part D and the factors that influence levels of prescription utilization and cost. Multivariate regression models will be used to analyze the relationship between health care utilization and health and functional outcomes, as well as satisfaction with care. Descriptive analyses will be used to document the most recent trends in rural enrollees’ health and functional status, access to care, and plan satisfaction.

High Quality Rural Hospitals and Post-Acute Care Providers
Public reporting of quality measures has expanded to include process and outcome measures in a variety of health care settings, including hospitals, nursing homes and home health agencies. Many small rural hospitals participate in public reporting, and a number of measures address conditions commonly treated by rural hospitals, such as pneumonia and heart failure. However, low volume remains a problem, especially for calculating outcome measures such as mortality and readmission rates for rural providers.

The first year of this project focused on modeling alternative ways of identifying high quality rural hospitals and analyzing factors related to quality in rural hospitals. The second year will examine the relationship between the quality of care provided by rural hospitals and the quality of care provided by nursing homes and home health agencies within rural communities.

Progress toward Meaningful Use of Health Information Technology among Rural Physician Practices
This project will assess progress toward the meaningful use of health information technology among rural physician practices, using several sources of data. This empirical analysis will be supplemented by a qualitative assessment of rural physician practices’ experiences with the meaningful use of health IT, working with two quality improvement organizations (QIOs)/Regional Extension Centers (RECs). Currently, little is known about the extent of EHR adoption by rural physician practices, their intentions to apply for meaningful use incentive payments or their likelihood of achieving meaningful use within established timeframes.

The purpose of this project is to assess progress toward the meaningful use of health information technology (IT) among rural physician practices. Methods: We will employ regression techniques to measure progress towards the meaningful use of health IT in rural physician practices. Our analysis will employ a novel database of physician practice health IT data, the IMS Healthcare Organization Services database. These data will be supplemented with additional sources, including: the AHA Health IT Supplement; the National Ambulatory Medical Care Survey; and the Area Resource File.