The Population Health and Health Policy (PHHP) program at the Cutler Institute conducts policy-driven research, evaluation, policy analysis and technical assistance focusing on the public health system and the delivery of healthcare services. Our research is conducted in the areas of healthcare access, quality and financing; public health systems and practice; and rural health.

We focus our work in the following areas:

  • Healthcare Access, Quality, & Financing
  • Public Health Systems & Practice
  • The Maine Public Health Institute
  • Rural Health

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2024

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Critical Access Hospital - Local Health Department Partnerships to Address Rural Community Needs, Zachariah T. Croll; Celia Jewell RN, MPH; and John A. Gale MS

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Trends in maternal opioid use disorder and neonatal abstinence syndrome in Maine, 2016-2022., Julia Dudley, Sarah M B Gabrielson, Alane B O'Connor, and Katherine A. Ahrens PhD

2023

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

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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

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

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

2022

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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

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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

2021

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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

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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

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

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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

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

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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

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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

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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

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Opioid Use Among Rural Medicare Beneficiaries, Yvonne C. Jonk PhD; Heidi O'Connor; Karen Pearson MLIS, MA; and John Gale MSU

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Harnessing the Combined Strengths of a National and a Local Funder to Bolster Maine Medicaid Expansion, Tara Oakman PhD, Barbara Leonard MPH, Kimberley S Fox MPA, Sara Kahn-Troster MPH, and Amanda Burgess MPPM

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Mental Health Services, Jean A. Talbot PhD

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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

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

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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

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

2020

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Maternal opioid use disorder at delivery hospitalization in a rural state: Maine, 2009-2018., Sarah M.B. Gabrielson, Jenny L. Carwile, A. B. O'Connor, and Katherine A. Ahrens PhD

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Provision of Mental Health Services by Critical Access Hospital-Based Rural Health Clinics, John A. Gale MS; Zachariah T. Croll MPH; Nathan First LCSW, MSW, MA; and Sara Kahn-Troster MPH

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Engaging Critical Access Hospitals in Addressing Rural Substance Use, John A. Gale MS; Sara Kahn-Troster MPH; Zachariah T. Croll MPH; and Nathan L. First LCSW, MSW, MA

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Addressing Opioid Use in Rural Communities: Examples from Critical Access Hospitals, John A. Gale MS; Sara Kahn-Troster MPH; Karen B. Pearson MLIS, MA; and Nathan First LCSW, MSW, MA

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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

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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

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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

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Pent-Up Demand for Care among Dual-Eligible Victims of Elder Financial Exploitation in Maine, Yvonne Jonk PhD, Kimberly I. Snow MHSA, Deborah Thayer MBA, Catherine McGuire BS, Stuart Bratesman MPP, Charles A. Smith PhD, and Erika C. Ziller PhD

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

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Multiple COVID-19 Outbreaks Linked to a Wedding Reception in Rural Maine — August 7–September 14, 2020, Parag Mahale MBBS, PhD; Craig Rothfuss MPA, MPH; Sarah Bly; Megan Kelley; Siiri Bennett MD; Sara L. Huston PhD; and Sara Robinson

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Rural-Urban Differences in Hospitalizations for Opioid Use-Associated Infective Endocarditis in the United States, 2003-2016., E. Katherine Nenninger, Jenny L. Carwile, Katherine Ahrens PhD, Brett Armstrong, and Kinna Thakarar

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Evaluation of Maine DOC's Medication-Assisted Treatment Pilot Program, M. Lindsey Smith PhD, George Shaler MPH, Olivia Dooley MPA, and Evelyn Ali BS

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Telebehavioral health (TBH) use among rural medicaid beneficiaries: Relationships with telehealth policies, Jean A. Talbot PhD, Yvonne Jonk PhD, Amanda Burgess MPPM, Deborah Thayer, Nathan Paluso MPH, and Andrew F. Coburn PhD

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Virtually possible: using telehealth to bring reproductive health care to women with opioid use disorder in rural Maine, Terri-Ann Thompson, Katherine A. Ahrens PhD, and Leah Coplon

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Health Care Use and Access among Rural and Urban Nonelderly Adult Medicare Beneficiaries, Erika C. Ziller PhD, Amanda Burgess MPPM, and Deborah Thayer MBA

2019

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What Is Rural? Challenges and Implications of Definitions that Inadequately Encompass Rural People and Places., Kevin J Bennett PhD; Tyrone F Borders PhD; George M. Holmes PhD; Katy Backes Kozhimannil PhD, MPA; and Erika C. Ziller PhD

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Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas, Andrew F. Coburn PhD; Erika C. Ziller PhD; Nathan Paluso MPH; Deborah Thayer MBA; and Jean A. Talbot PhD, MPH

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What to Expect with MaineCare Expansion [OpEd], Zachariah T. Croll BA

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Health Status and Access to Care among Maine's Low-Income Childless Adults: Implications for State Medicaid Expansion, Zachariah T. Croll MPH and Erika C. Ziller PhD

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Sociodemographic and Health Status Characteristics of Maine's Newly Eligible Medicaid Beneficiaries [Data Brief], Zachariah T. Croll MPH, Erika C. Ziller PhD, and Barbara Leonard MPH

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Community Impact and Benefit Activities of Critical Access, Other Rural, and Urban Hospitals, 2017, Zach T. Croll MPH, John A. Gale MS, and Jeremy Zuckero

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Association Between Rurality and Lung Cancer Treatment Characteristics and Timeliness, Kathleen M Fairfield MD, MPH, DrPH; Adam W. Black; F. Lee Lucas PhD; Kimberly Murray MPP; Erika C. Ziller PhD; Neil Korsen MDMS; Leo B. Waterston MA; and Paul K. J. Han MD, MA, MPH

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Using Public Cost Information During Low Back Pain Visits: A Qualitative Study., Kimberley S Fox, Carolyn E. Gray, Martha Elbaum Williamson, and Jennifer A. MacKenzie

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Rural Health Clinic Costs and Medicare Reimbursement, John A. Gale MS, Zachariah T. Croll MPH, and Andrew F. Coburn PhD

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Behavioral Health in Rural America: Challenges and Opportunities [EXECUTIVE SUMMARY], John A. Gale MS; Jaclyn Janis BSN, RN; and Andrew F. Coburn PhD

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Behavioral Health in Rural America: Challenges and Opportunities, John A. Gale MS; Jaclyn Janis BSN, RN; Andrew F. Coburn PhD; and Hanna Rochford MPH

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Implementation and Early Results of the Flex Program's Innovative Models Program Area (Briefing Paper #42), John A. Gale MS, Sara Kahn-Troster MPH, and Andrew F. Coburn PhD