All Maine Rural Health Research Center Publications | Maine Rural Health Research Center (MRHRC) | University of Southern Maine

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The Maine Rural Health Research Center focuses on barriers to health access for rural residents and related topics, including insurance coverage, Medicaid, behavioral health, long term services & supports, and challenges faced by rural providers (rural health clinics & critical access hospitals) in delivering and sustaining services. For over 20 years, the Maine Rural Health Research Center’s research agenda has focused on some of the most intractable health access problems facing rural residents, especially those with mental health and substance abuse issues and those facing financial barriers due to lack of insurance and under-insurance. That body of research has helped reveal the effects of policy and health system organization and financing on rural health access. The Center is committed to enhancing policy making and improving the access, delivery and financing of rural health services by effectively linking its research to the policy development process through appropriate dissemination strategies.

2023 2023

Year 3 Evaluation Report: Evaluation of the EMS Supplemental Funding Grants, John Gale MS and Karen Pearson MLIS, MA

A Consensus Panel Approach to Estimating the Start-Up and Annual Service Costs for Rural Ambulance Agencies, Yvonne Jonk PhD; Gary Wingrove FACPE, CP-C; Nikiah Nudell MS, MPhil, NRP, FACPE; and Kevin McGinnis MPS

Federal Telehealth Policy Changes During the COVID-19 Public Health Emergency: Associations with Telemental Health Use among Rural and Urban Medicare Beneficiaries, Jean A. Talbot PhD, MPH; Amanda R. Burgess MPPM, MPH; Yvonne C. Jonk PhD; and Heidi O'Connor MS

Mental Health Within 24 Months After Delivery Among Women with Common Pregnancy Conditions., Katherine Ahrens MPH, PhD; Kristin Palmsten; Heather S Lipkind; Mariah Pfeiffer RN, MPH; Catherine Gelsinger RN; and Christina Ackerman-Banks

Association of Prenatal Depression With New Cardiovascular Disease Within 24 Months Postpartum., Christina M Ackerman-Banks; Heather S Lipkind; Kristin Palmsten; Mariah Pfeiffer RN, MPH; Catherine Gelsinger RN; and Katherine Ahrens MPH, PhD

Ambulance Deserts: Geographic Disparities in the Provision of Ambulance Services [Chartbook], Yvonne Jonk PhD; Carly Milkowski MPH; Zachariah Croll MPH; and Karen Pearson MLIS, MA

Rural Working-Age Adults Report More Cost Barriers to Health Care, Erika C. Ziller PhD; Carly Milkowski MPH; and Amanda Burgess MPPM, MPH

Twenty-five Years of the Medicare Rural Hospital Flexibility Program: The Past as Prologue, John Gale MS

Rural-Urban Residence and Sequelae of Hypertensive Disorders of Pregnancy in the First Year Postpartum, 2007 – 2019, Mariah Pfeiffer BSN, RN; Catherine Gelsinger BSN, RN; Kristin Palmsten; Heather S. Lipkind; Christina Ackerman-Banks; and Katherine Ahrens PhD

Rural-Urban Differences in Workers' Access to Paid Sick Leave., Erika Ziller PhD, Carly Milkowski MPH, Zachariah Croll, and Yvonne Jonk PhD

2022 2022

Maternal Hepatitis C Prevalence and Trends by County, US: 2016-2020, Katherine Ahrens PhD; Lauren M. Rossen PhD, MS; Amanda R. Burgess MPPM, MPH; and Kristin Palmsten ScD

Patterns of Health Care Use among Rural-Urban Medicare Beneficiaries Age 85 and Older, 2010-2017, Yvonne Jonk PhD, Heidi O'Connor MS, Amanda Burgess MPPM, and Carly Milkowski MPH

Community Paramedicine: Presentation to the Blue Ribbon Commission to Study EMS, Karen Pearson MLIS, MA

Community Characteristics and Financial and Operational Performance of Rural Health Clinics in the United States: A Chartbook, John Gale MS, Zachariah Croll MPH, Jamar Croom MS, Louisa Munk MPH, and Yvonne Jonk PhD

Maine: A Health-Focused Landscape Analysis, Katherine Ahrens PhD; Amanda Burgess MPPM, MPH; Carly Milkowski MPH; Yvonne Jonk PhD; Louisa Munk MPH; and Erika Ziller PhD

Vermont: A Health-Focused Landscape Analysis, Katherine Ahrens PhD; Amanda Burgess MPPM, MPH; Carly Milkowski MPH; Louisa Munk MPH; Yvonne Jonk PhD; and Erika C. Ziller PhD

New York: A Health-Focused Landscape Analysis, Katherine Ahrens PhD; Amanda Burgess MPPM, MPH; Carly Milkowski MPH; Louisa Munk MPH; Yvonne Jonk PhD; and Erika Ziller PhD

New Hampshire: A Health-Focused Landscape Analysis, Katherine Ahrens PhD; Amanda Burgess MPPM, MPH; Carly Milkowski MPH; Louisa Munk MPH; Yvonne Jonk PhD; and Erika C. Ziller PhD

The Northern Border Region: A Health-Focused Landscape Analysis, Katherine Ahrens PhD; Amanda Burgess MPPM, MPH; Carly Milkowski MPH; Louisa Munk MPH; Yvonne Jonk PhD; and Erika Ziller PhD

Year Two Evaluation of the Flex EMS Supplemental Funding Projects: Building an Evidence Base through Outcome Measurement, John Gale MS; Karen Pearson MLIS, MA; and Sara Kahn-Troster MPH

An Inventory of State Flex Program Population Health Initiatives for Fiscal Years 2019-2023, Celia Jewell RN, MPH; Sara Kahn-Troster MPH; Zach T. Croll MPH; and John Gale MS

Evaluating State Flex Program Population Health Activities, John Gale MS; Celia Jewell RN, MPH; Sara Kahn-Troster MPH; and Zachariah T. Croll MPH

Out-of-Hospital Births and Infant Mortality in the United States: Effect Measure Modification by Rural Maternal Residence, Elora Way; Jenny L. Carwile ScD, MPH; Erica C. Ziller PhD; and Katherine Ahrens PhD

Rural-urban differences in maternal mortality trends in the US, 1999-2017: Accounting for the impact of the pregnancy status checkbox, Lauren M. Rossen PhD; Katherine A. Ahrens PhD; Lindsay S. Womack PhD; and Sayeedha F.G. Uddin MD, MPH

2021 2021

Opioid Use Among Rural Medicare Beneficiaries, Yvonne C. Jonk PhD; Heidi O'Connor; Karen Pearson MLIS, MA; Zachariah T. Croll MPH; and John Gale MS

Outcome Measures for State Flex Program Financial and Operational Improvement Interventions, John Gale MS, Sara Kahn-Troster MPH, and Zachariah T. Croll MPH

Use of Electronic Health Records to Manage Tobacco Screening and Treatment in Rural Primary Care, Jean A. Talbot PhD, Erica C. Ziller PhD, and Carly Milkowski MPH

The State of Health in Maine: A 20-Year Retrospective, Erika C. Ziller PhD, Carly Milkowski MPH, Amanda R. Burgess MPPM, and Barabara Leonard MPH

Community Impact and Benefit Activities of Critical Access, Other Rural, and Urban Hospitals, 2019 [State Data Report], Zachariah T. Croll and John Gale MS

Experiences of Stigma among Individuals in Recovery from Opioid Use Disorder in a Rural Setting: A Qualitative Analysis, Amanda Burgess MPPM, MPH; Emily Bauer MPH; Shane Gallagher MS; Brianne Karstens BS; LeeAnna Lavoie MPH, CHES; Katherine A. Ahrens PhD; and Alane O'Connor DNP

HIV and Hepatitis C in Rural Areas: Prevalence, Service Availability, and Challenges [Webinar], Katherine Ahrens PhD and Amanda Burgess MPPM

Health Insurance, Erica C. Ziller PhD and Yvonne Jonk PhD

Mental Health Services, Jean A. Talbot PhD

Evaluation of the Use of Critical Access Hospital [CAH] Cohorts for Quality Improvement Activities, John Gale MS; Celia Jewell RN, MPH; Sara Kahn-Troster MPH; and Nathan First LCSW, MSW, MA

Medication for Addiction Treatment and Postpartum Health Care Utilization Among Pregnant Persons With Opioid Use Disorder., Katherine Ahrens PhD, Carole A McBride PhD, Alane O'Connor DNP, and Marjorie C Meyer MD

Monitoring State Flex Program Financial and Operational Improvement Activities, John Gale MS; Sara Kahn-Troster MPH; Zachariah T. Croll MPH; and Nathan First LCSW, MSW, MA

Rural-Urban Residence and Emergency Contraception Use, Access, and Counseling in the United States, 2006-2017, Carly Milkowski MPH, Erika Ziller PhD, and Katherine Ahrens PhD

Opioid and Substance Use Strategies for Critical Access Hospitals [Webinar], John Gale MS; Sara Kahn-Troster MPH; Karen Pearson MLIS, MA; and Nathan First LCS, MSW, MA

Rural-urban residence and maternal hepatitis C infection, United States: 2010-2018, Katherine A. Ahrens PhD, MPH; Laura M. Rossen PhD, MS; Amanda R. Burgess MPPM; Kristin K. Palmsten ScD; and Erika C. Ziller PhD, MS

Rural HIV Prevalence and Service Availability in the United States: A Chartbook, Katherine Ahrens PhD, Amanda Burgess MPPM, Louisa Munk, and Erika Ziller PhD

Capacity of Rural Counties to Address an HIV or Hepatitis C Outbreak, Jennifer Lenardson MHS; Jaclyn Janis RN, MPH; Amanda Burgess MPPM; Karen Pearson MLIS, MA; and Martha Elbaum MPA

Opioid-Related Visits to Rural Emergency Departments, Erika C. Ziller PhD, Jean A. Talbot PhD, Deborah Thayer MBA, and Carly Milkowski MPH

Voices From the Field: A Qualitative Study of the Challenges and Promising Practices of Rural Public Health in Addressing HIV and Hepatitis C, Martha Elbaum Williamson MPA; Karen B. Pearson MLIS, MS; Amanda R. Burgess MPPM; Jennifer D. Lenardson MHS; and Erika C. Ziller PhD

Advancing Population Health in Rural Places: Key Lessons and Policy Opportunities, Keith J. Mueller PhD; Delaney P. Bounds MPH; Andrew F. Coburn PhD; Alana D. Knudson PhD; Jennifer P. Lundblad PhD, MBA; A. Clinton MacKinney MD, MS; and Timothy D. McBride PhD

2020 2020

Substance Use among Rural and Urban Youth and Young Adults, Jennifer D. Lenardson MHS, Nathan Paluso MPH, and Erika C. Ziller PhD

Telehealth Use in a Rural State: A Mixed-Methods Study Using Maine's All-Payer Claims Database., Yvonne Jonk PhD, Amanda Burgess MPPM, Martha Elbaum Williamson MPA, Deborah Thayer MBA, Jennifer A. MacKenzie, Catherine McGuire BS, Kimberley S Fox MPA, and Andrew F. Coburn PhD

Implementation of Flex EMS Supplemental Funding Projects: Year One Activities, Karen B. Pearson MLIS, MA; John A. Gale MS; and Sara Kahn-Troster MPH

Supporting Critical Access Hospitals (CAHs) during the COVID-19 Pandemic: Summary Results of a Survey of State Flex Coordinators, John Gale MS; Zachariah T. Croll MPH; Yvonne Jonk PhD; Sara Kahn-Troster MPH; and Karen Pearson MLIS, MA

Supporting CAHs during the COVID-19 Pandemic: Results of a Survey of State Flex Coordinators, John Gale MS; Zachariah T. Croll MPH; Yvonne Jonk PhD; Sara Kahn-Troster MPH; and Karen Pearson MLIS, MA

Rebuilding the Foundation of Rural Community Health after COVID-19, John A. Gale MS, Alana Knudson, and Shena Popat

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