Scholars@Duke
Brystana G. Kaufman

Brystana G. Kaufman

Assistant Professor in Population Health Sciences
Population Health Sciences

Selected Publications

Economic Value of Unpaid Family Caregiver Time Following Hospital Discharge and at End of Life.

Journal Article J Pain Symptom Manage · December 2024 CONTEXT: Family caregivers (FCGs) play a crucial role in care for people with serious illness, yet unpaid care is often overlooked in estimates of care recipient (CR) care costs. OBJECTIVES: This study quantifies the economic value of unpaid caregiving by ... Full text Link to item Cite

The impact of internet connectivity when conducting a virtual clinical trial with participants living in rural areas

Journal Article Contemporary Clinical Trials Communications · December 1, 2024 Aim: The purpose of this secondary analysis was to describe issues related to internet connections during a virtual randomized clinical trial (v-RCT) that included family caregiver participants living in rural areas. Background: Success of v-RCTs depends o ... Full text Cite

Veterans' use of inpatient and outpatient palliative care: The national landscape.

Journal Article J Am Geriatr Soc · November 2024 BACKGROUND: Palliative care improves the quality of life for people with life-limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpat ... Full text Link to item Cite

EXpanding Technology-Enabled, Nurse-Delivered Chronic Disease Care (EXTEND): Protocol and Baseline Data for a Randomized Trial.

Journal Article Contemp Clin Trials · November 2024 BACKGROUND: Approximately 10-15 % of individuals with type 2 diabetes have persistently poorly-controlled diabetes mellitus (PPDM) despite receiving available care, and frequently have comorbid hypertension. Mobile monitoring-enabled telehealth has the pot ... Full text Open Access Link to item Cite

Transitional Palliative Care for Family Caregivers: Outcomes From a Randomized Controlled Trial.

Journal Article J Pain Symptom Manage · November 2024 CONTEXT: Patients receiving inpatient palliative care often face physical and psychological uncertainties during transitions out of the hospital. Family caregivers often take on responsibilities to ensure patient safety, quality of care, and extend palliat ... Full text Link to item Cite

Is more care recipient time at home also a family caregiver-centered quality of life measure?

Journal Article J Am Geriatr Soc · October 2024 BACKGROUND: Time in healthcare facilities is associated with worse patient quality of life (QoL); however, impact on family caregiver QoL is unknown. We evaluate care recipient days not at home-days in the emergency department (ED), inpatient (IP) care, an ... Full text Link to item Cite

A stepped wedge cluster randomized trial to evaluate the effectiveness of a multisite family caregiver skills training program.

Journal Article Health Serv Res · August 13, 2024 OBJECTIVE: To assess the effects of an evidence-based family caregiver training program (implementation of Helping Invested Families Improve Veteran Experiences Study [iHI-FIVES]) in the Veterans Affairs healthcare system on Veteran days not at home and fa ... Full text Link to item Cite

Healthcare use and out-of-pocket costs for rural family caregivers and care recipients in a randomized controlled trial.

Journal Article J Am Geriatr Soc · August 2024 BACKGROUND: Rural family caregivers (FCGs) in the United States often experience high economic costs. This randomized controlled trial compared a transitional palliative care intervention (TPC) to support FCGs of seriously ill care recipients (CRs) to an a ... Full text Link to item Cite

ACO leakage among gynecologic cancer patients: Incidence, predictors, and impact on annual Medicare expenditure.

Journal Article Gynecol Oncol · August 2024 OBJECTIVE: To examine patterns of Accountable Care Organizations (ACO) leakage, the receipt of healthcare by ACO-assigned patients from institutions outside assigned ACO network, among patients with gynecologic cancer. ACO leakage was estimated as rates of ... Full text Link to item Cite

Caregiver recruitment strategies for interventions designed to optimize transitions from hospital to home: lessons from a randomized trial.

Journal Article Trials · July 4, 2024 Challenges to recruitment of family caregivers exist and are amplified when consent must occur in the context of chaotic healthcare circumstances, such as the transition from hospital to home. The onset of the COVID-19 pandemic during our randomized contro ... Full text Link to item Cite

Improving Transitions in Care for Patients and Family Caregivers Living in Rural and Underserved Areas: The Caregiver Advise, Record, Enable (CARE) Act.

Journal Article J Aging Soc Policy · July 3, 2024 In this Perspective, we contend bold action is needed to improve transitions from hospitals to home for aging patients and their family caregivers living in rural and underserved areas. The Caregiver Advise, Record, Enable (CARE) Act, passed in over 40 US ... Full text Link to item Cite

Pharmacogenetic testing in primary care could bolster depression treatment: A value proposition.

Journal Article Clin Transl Sci · June 2024 Pharmacogenetic testing could reduce the time to identify a safe and effective medication for depression; however, it is underutilized in practice. Major depression constitutes the most common mental disorder in the US, and while antidepressant therapy can ... Full text Link to item Cite

The business case for hospital mobility programs in the veterans health care system: Results from multi-hospital implementation of the STRIDE program.

Journal Article Health Serv Res · April 17, 2024 OBJECTIVE: To conduct a business case analysis for Department of Veterans Affairs (VA) program STRIDE (ASsisTed EaRly MobIlization for hospitalizeD older VEterans), which was designed to address immobility for hospitalized older adults. DATA SOURCES AND ST ... Full text Link to item Cite

Racial Disparities in Low-Value Care in the Last Year of Life for Medicare Beneficiaries With Neurodegenerative Disease.

Journal Article Neurol Clin Pract · April 2024 BACKGROUND AND OBJECTIVES: There are racial disparities in health care services received by patients with neurodegenerative diseases, but little is known about disparities in the last year of life, specifically in high-value and low-value care utilization. ... Full text Link to item Cite

Changes in Outpatient Health Care Use After COVID-19 Infection Among Veterans.

Journal Article JAMA Netw Open · February 5, 2024 IMPORTANCE: The association of COVID-19 infection with outpatient care utilization is unclear. Many studies reported population surveillance studies rather than comparing outpatient health care use between COVID-19-infected and uninfected cohorts. OBJECTIV ... Full text Link to item Cite

Evaluation of strategies to support implementation of a hospital walking program: protocol for a type III effectiveness-implementation hybrid trial.

Journal Article Implement Sci Commun · January 12, 2024 BACKGROUND: STRIDE is a supervised walking program designed to address the negative consequences of immobility during hospitalization for older adults. In an 8-hospital stepped wedge randomized controlled trial, STRIDE was associated with reduced odds of h ... Full text Link to item Cite

Implementation Costs of Technology-Enhanced Transitional Palliative Care for Rural Caregivers.

Journal Article Am J Hosp Palliat Care · January 2024 OBJECTIVES: Compared to urban family caregivers (FCG), rural FCG experience greater burdens accessing coordinated care for their loved ones during and after hospitalization. The impact of technology-enhanced transitional palliative care (TPC) on caregiver ... Full text Link to item Cite

Opportunities for Integration in the Dual Medicare-Medicaid Population: North Carolina Landscape Analysis

Journal Article North Carolina Medical Journal · January 1, 2024 BACKGROUND NC Medicaid is amid a transformation to value-based care models. The transformation requires the consideration of models that may best serve the 1 in 5 NC Medicaid beneficiaries who are dually enrolled in Medicare. The lack of integration of Med ... Full text Cite

Informing a home time measure reflective of quality of life: A data driven investigation of time frames and settings of health care utilization.

Journal Article Health Serv Res · December 2023 OBJECTIVE: To evaluate short- and long-term measures of health care utilization-days in the emergency department (ED), inpatient (IP) care, and rehabilitation in a post-acute care (PAC) facility-to understand how home time (i.e., days alive and not in an a ... Full text Link to item Cite

Linking Medicare-Medicaid Claims for Patient-Centered Outcomes Research Among Dual-Eligible Beneficiaries.

Journal Article Med Care · December 1, 2023 BACKGROUND: Evaluation of Medicare-Medicaid integration models' effects on patient-centered outcomes and costs requires multiple data sources and validated processes for linkage and reconciliation. OBJECTIVE: To describe the opportunities and limitations o ... Full text Link to item Cite

Group physical therapy for knee osteoarthritis: protocol for a hybrid type III effectiveness-implementation trial.

Journal Article Implement Sci Commun · October 12, 2023 BACKGROUND: Knee osteoarthritis (OA) is a leading cause of chronic pain and disability and one of the most common conditions treated in outpatient physical therapy (PT). Because of the high and growing prevalence of knee OA, there is a need for efficient a ... Full text Open Access Link to item Cite

Dementia and Parkinson's disease diagnoses in electronic health records vs. Medicare claims data: a study of 101,980 linked patients.

Journal Article BMC Neurol · September 12, 2023 BACKGROUND: Medicare claims and electronic health record data are both commonly used for research and clinical practice improvement; however, it is not known how concordant diagnoses of neurodegenerative diseases (NDD, comprising dementia and Parkinson's d ... Full text Link to item Cite

Implementation intensification to disseminate a skills-based caregiver training program: protocol for a type III effectiveness-implementation hybrid trial.

Journal Article Implement Sci Commun · August 16, 2023 BACKGROUND: Family caregiver training decreases caregiver psychological burden and improves caregiver depressive symptoms and health-related quality of life. Caregivers FIRST is an evidence-based group skills training curriculum for family caregivers and w ... Full text Link to item Cite

Knowledge, goals, and misperceptions about palliative care in adults with chronic disease or cancer.

Journal Article Palliat Support Care · August 10, 2023 OBJECTIVES: Limited evidence investigates how knowledge, misconceptions, and beliefs about palliative care vary across patients with cancerous versus non-cancerous chronic disease. We examined the knowledge of and misconceptions about palliative care among ... Full text Link to item Cite

Racial/ethnic disparities in dementia incidence, outcomes, and health-care utilization.

Journal Article Alzheimers Dement · June 2023 INTRODUCTION: Racial/ethnic disparities exist in many aspects of health care, but data on racial/ethnic disparities for neurodegenerative diseases (NDDs), such as dementia and Parkinson's disease (PD), are limited. METHODS: We used North and South Carolina ... Full text Link to item Cite

Health Care Use and Spending Among Need-Based Subgroups of Medicare Beneficiaries With Full Medicaid Benefits.

Journal Article JAMA health forum · May 2023 ImportanceBeneficiaries dual eligible for Medicare and Medicaid account for a disproportionate share of expenditures due to their complex care needs. Lack of coordination between payment programs creates misaligned incentives, resulting in higher ... Full text Cite

A Methodological Approach for Documenting Multi-Component Interventions Targeting Family Caregivers.

Journal Article J Appl Gerontol · March 2023 Managing the complex care needs of seriously ill patients transitioning from hospital to home can have detrimental effects on family caregivers (FCG). Multi-component interventions tailored to FCG needs are most effective at reducing caregiver burden, dist ... Full text Link to item Cite

IMPROVING THE VALUE OF SERIOUS ILLNESS CARE

Conference INNOVATION IN AGING · 2023 Cite

Socioeconomic status and modification of atherosclerotic cardiovascular disease risk prediction: epidemiological analysis using data from the atherosclerosis risk in communities study.

Journal Article BMJ Open · November 7, 2022 OBJECTIVE: Examine whether the relationship between the pooled cohort equations (PCE) predicted 10-year risk for atherosclerotic cardiovascular disease (ASCVD) and absolute risk for ASCVD is modified by socioeconomic status (SES). DESIGN: Population-based ... Full text Link to item Cite

Using a home time measure to differentiate ACO performance for seriously ill populations.

Journal Article J Am Geriatr Soc · September 2022 BACKGROUND: Alternative Payment Models (APMs) piloted by the Centers for Medicare and Medicaid Services (CMS) such as ACO Realizing Equity, Access and Community Health (REACH) seek to improve care and quality of life among seriously ill populations (SIP). ... Full text Link to item Cite

Cost and Quality of Life Outcomes of the STepped Exercise Program for Patients With Knee OsteoArthritis Trial.

Journal Article Value Health · April 2022 OBJECTIVES: This study aimed to evaluate the cost-effectiveness of the randomized clinical trial STEP-KOA (STepped Exercise Program for patients with Knee OsteoArthritis). METHODS: The trial included 230 intervention and 115 control participants from 2 Vet ... Full text Link to item Cite

Accountable and Transparent Palliative Quality Measures Will Improve Care.

Journal Article J Palliat Med · April 2022 How do we build on the proven successes of hospice and palliative care and build clinical programs to serve those who need it in the context of real-world health care? Experiences with glide pathways have clearly shown that changes in financial incentives ... Full text Link to item Cite

Polypharmacy in Palliative Care for Advanced Heart Failure: The PAL-HF Experience.

Journal Article J Card Fail · February 2022 BACKGROUND: Palliative care (PC) in advanced heart failure (HF) aims to improve symptoms and quality of life (QOL), in part through medication management. The impact of PC on polypharmacy (>5 medications) remains unknown. METHODS AND RESULTS: We explored p ... Full text Link to item Cite

Alternative Payment Models and Associations With Stroke Outcomes, Spending, and Service Utilization: A Systematic Review.

Journal Article Stroke · January 2022 Stroke contributes an estimated $28 billion to US health care costs annually, and alternative payment models aim to improve outcomes and lower spending over fee-for-service by aligning economic incentives with high value care. This systematic review evalua ... Full text Cite

Comparing Palliative Care Knowledge in Metropolitan and Nonmetropolitan Areas of the United States: Results from a National Survey.

Journal Article J Palliat Med · December 2021 Background: Despite recent growth in access to specialty palliative care (PC) services, awareness of PC by patients and caregivers is limited and misconceptions about PC persist. Identifying gaps in PC knowledge may help inform initiatives that seek to red ... Full text Link to item Cite

Access to outpatient services in rural communities changes after hospital closure.

Journal Article Health Serv Res · October 2021 OBJECTIVE: Between January 2005 and July 2020, 171 rural hospitals closed across the United States. Little is known about the extent that other providers step in to fill the potential reduction in access from a rural hospital closure. The objective of this ... Full text Link to item Cite

State variation in effects of state social distancing policies on COVID-19 cases.

Journal Article BMC Public Health · June 28, 2021 BACKGROUND: The novel coronavirus disease 2019 (COVID-19) sickened over 20 million residents in the United States (US) by January 2021. Our objective was to describe state variation in the effect of initial social distancing policies and non-essential busi ... Full text Link to item Cite

The Cost-Effectiveness of Palliative Care: Insights from the PAL-HF Trial.

Journal Article J Card Fail · June 2021 BACKGROUND: In a randomized control trial, Palliative Care in Heart Failure (PAL-HF) improved heart failure-related quality of life, though cost-effectiveness remains unknown. The aim of this study was to evaluate the cost-effectiveness of the PAL-HF trial ... Full text Link to item Cite

Selection Bias in Observational Studies of Palliative Care: Lessons Learned.

Journal Article J Pain Symptom Manage · May 2021 CONTEXT: Palliative care (PC) programs are typically evaluated using observational data, raising concerns about selection bias. OBJECTIVES: To quantify selection bias because of observed and unobserved characteristics in a PC demonstration program. METHODS ... Full text Link to item Cite

Association of ACO Shared Savings Success and Serious Illness Spending.

Journal Article J Healthc Manag · May 2021 Accountable care organizations (ACOs) need confidence in their return on investment to implement changes in care delivery that prioritize seriously ill and high-cost Medicare beneficiaries. The objective of this study was to characterize spending on seriou ... Full text Link to item Cite

National Trends in Hospice Facility Deaths in the United States, 2003-2017.

Journal Article J Pain Symptom Manage · February 2021 CONTEXT: Hospice facilities are increasingly preferred as a location of death, but little is known about the characteristics of patients who die in these facilities in the U.S. OBJECTIVES: We sought to examine the trends and factors associated with death i ... Full text Link to item Cite

State Policy Responses to COVID-19 in Nursing Homes

Journal Article Journal of Long-Term Care · January 1, 2021 Context: COVID-19 has a high case fatality rate in high-risk populations and can cause severe morbidity and high healthcare resource use. Nursing home residents are a high-risk population; they live in congregate settings, often with shared rooms, and requ ... Full text Cite

Recent Trends in Neurodegenerative Disease Burden in North and South Carolina

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · 2021 Cite

Comparing Associations of State Reopening Strategies with COVID-19 Burden.

Journal Article J Gen Intern Med · December 2020 BACKGROUND: The novel coronavirus disease 2019 (COVID-19) infected over 5 million United States (US) residents resulting in more than 180,000 deaths by August 2020. To mitigate transmission, most states ordered shelter-in-place orders in March and reopenin ... Full text Link to item Cite

Disease Burden Following Non-Cardioembolic Minor Ischemic Stroke or High-Risk TIA: A GWTG-Stroke Study.

Journal Article J Stroke Cerebrovasc Dis · December 2020 BACKGROUND: Limited real-world data are available on outcomes following non-cardioembolic minor ischemic stroke (IS) or high-risk transient ischemic attack (TIA), particularly in the United States (US). We examined outcomes and Medicare payments following ... Full text Link to item Cite

Prospective or retrospective ACO attribution matters for seriously ill patients.

Journal Article Am J Manag Care · December 2020 OBJECTIVES: Since 2019, the Medicare Shared Savings Program (MSSP) has allowed accountable care organizations (ACOs) to choose either retrospectively or prospectively attributed ACO populations. To understand how ACOs' choice of attribution method affects ... Full text Link to item Cite

Correction to: Comparing Associations of State Reopening Strategies with COVID-19 Burden.

Journal Article J Gen Intern Med · November 9, 2020 In the original version of this paper, an author was misidentified. The corrected author listing appears here, and has been updated in the online version. ... Full text Link to item Cite

Half of Rural Residents at High Risk of Serious Illness Due to COVID-19, Creating Stress on Rural Hospitals.

Journal Article J Rural Health · September 2020 PURPOSE: During the COVID-19 epidemic, it is critical to understand how the need for hospital care in rural areas aligns with the capacity across states. METHODS: We analyzed data from the 2018 Behavioral Risk Factor Surveillance System to estimate the num ... Full text Link to item Cite

Future research prioritization in cardiac resynchronization therapy.

Journal Article Am Heart J · May 2020 BACKGROUND: Although cardiac resynchronization therapy (CRT) is effective for some patients with heart failure and a reduced left ventricular ejection fraction (HFrEF), evidence gaps remain for key clinical and policy areas. The objective of the study was ... Full text Link to item Cite

Top Ten Tips Palliative Care Clinicians Should Know About Integrating Population Health Principles into Practice.

Journal Article J Palliat Med · April 2020 The field of palliative care (PC) has spent the past decade demonstrating that it improves outcomes for patients, clinicians, and health systems. Forward-thinking organizations preparing for a reimbursement system rooted in value have built robust inpatien ... Full text Link to item Cite

Trends and Factors Associated with Place of Death for Individuals with Dementia in the United States.

Journal Article J Am Geriatr Soc · February 2020 OBJECTIVES: To assess trends and factors associated with place of death among individuals with Alzheimer's disease-related dementias (ADRD). DESIGN: Cross-sectional analysis. SETTING: Centers for Disease Control and Prevention Wide-ranging OnLine Data for ... Full text Link to item Cite

Use of Hospital Referral Regions in Evaluating End-of-Life Care.

Journal Article J Palliat Med · January 2020 Background: Hospital referral regions (HRRs) are often used to characterize inpatient referral patterns, but it is unknown how well these geographic regions are aligned with variation in Medicare-financed hospice care, which is largely provided at home. Ob ... Full text Link to item Cite

Adaptation and Implementation of a Family Caregiver Skills Training Program: From Single Site RCT to Multisite Pragmatic Intervention.

Journal Article J Nurs Scholarsh · January 2020 PURPOSE: We describe an approach to rapidly adapt and implement an education and skills improvement intervention to address the needs of family caregivers of functionally impaired veterans-Helping Invested Families Improve Veterans' Experience Study (HI-FI ... Full text Link to item Cite

COST-EFFECTIVENESS OF THE PALLIATIVE CARE IN HEART FAILURE TRIAL

Conference MEDICAL DECISION MAKING · January 1, 2020 Link to item Cite

The Medicare Shared Savings Program and Outcomes for Ischemic Stroke Patients: a Retrospective Cohort Study.

Journal Article J Gen Intern Med · December 2019 BACKGROUND: Post-stroke care delivery may be affected by provider participation in Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) through systematic changes to discharge planning, care coordination, and transitional care. OBJE ... Full text Link to item Cite

TRENDS AND FACTORS ASSOCIATED WITH PLACE OF DEATH AMONG INDIVIDUALS WITH CARDIOVASCULAR DISEASE IN THE UNITED STATES

Journal Article Innovation in Aging · November 8, 2019 AbstractWhile most patients prefer to die at home, trends and factors associated with place of death for patients dying of cardiovascular disease (CVD) remain unknown. Using data from the National Center for ... Full text Cite

Trends in Location of Death for Individuals With Cerebrovascular Disease in the United States.

Journal Article JAMA Neurol · November 1, 2019 This cohort study examines data from the WONDER database for all deaths attributed primarily to cerebrovascular disease between 2003 and 2017 to examine trends in location of death. ... Full text Link to item Cite

Paying for Palliative Care in Medicare: Evidence From the Four Seasons/Duke CMMI Demonstration.

Journal Article J Pain Symptom Manage · October 2019 CONTEXT: Palliative care improves patient and family outcomes and may reduce the cost of care, but this service is underutilized among Medicare beneficiaries. OBJECTIVES: To describe enrollment patterns and outcomes associated with the Center for Medicare ... Full text Link to item Cite

Medicare Shared Savings ACOs and Hospice Care for Ischemic Stroke Patients.

Journal Article J Am Geriatr Soc · July 2019 OBJECTIVES: Palliative care services have the potential to improve the quality of end-of-life care and reduce cost. Services such as the Medicare hospice benefit, however, are often underutilized among stroke patients with a poor prognosis. We tested the h ... Full text Link to item Cite

Impact of Accountable Care Organizations on Utilization, Care, and Outcomes: A Systematic Review.

Journal Article Med Care Res Rev · June 2019 Since 2010, more than 900 accountable care organizations (ACOs) have formed payment contracts with public and private insurers in the United States; however, there has not been a systematic evaluation of the evidence studying impacts of ACOs on care and ou ... Full text Link to item Cite

ACO Serious Illness Care: Survey And Case Studies Depict Current Challenges And Future Opportunities.

Journal Article Health Aff (Millwood) · June 2019 Care for people living with serious illness is suboptimal for many reasons, including underpayment for key services (such as care coordination and social supports) in fee-for-service reimbursement. Accountable care organizations (ACOs) have potential to im ... Full text Link to item Cite

Health Services Research.

Journal Article Stroke · May 2019 Full text Link to item Cite

Predicting Length of Hospice Stay: An Application of Quantile Regression.

Journal Article J Palliat Med · August 2018 BACKGROUND: Use of the Medicare hospice benefit has been associated with high-quality care at the end of life, and hospice length of use in particular has been used as a proxy for appropriate timing of hospice enrollment. Quantile regression has been under ... Full text Link to item Cite

Guideline-Directed Medical Therapy and Survival Following Hospitalization in Patients with Heart Failure.

Journal Article Pharmacotherapy · April 2018 BACKGROUND: Modification of guideline-directed medical therapy (GDMT) in hospitalized patients with heart failure (HF) has not been extensively evaluated. METHODS: The community surveillance arm of the Atherosclerosis Risk in Communities Study identified 6 ... Full text Link to item Cite

Disease understanding in patients newly diagnosed with atrial fibrillation.

Journal Article Heart · March 2018 OBJECTIVE: To describe self-reported disease understanding for newly diagnosed patients with atrial fibrillation (AF) and assess (1) how disease understanding changes over the first 6 months after diagnosis and (2) the relationship between patient understa ... Full text Link to item Cite

Predicting Hospice Length of Use: An Application of Quantile Regression

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · 2018 Cite

Are Trends in Hospitalization Prior to Hospice Use Associated With Hospice Episode Characteristics?

Journal Article Am J Hosp Palliat Care · November 2017 This study expands current knowledge of factors associated with initiation of hospice care by examining prehospice patterns of medical care leading to Medicare hospice use and the relationships to hospice episode characteristics. Data from the Atherosclero ... Full text Link to item Cite

Predicting Financial Distress and Closure in Rural Hospitals.

Journal Article J Rural Health · June 2017 PURPOSE: Annual rates of rural hospital closure have been increasing since 2010, and hospitals that close have poor financial performance relative to those that remain open. This study develops and validates a latent index of financial distress to forecast ... Full text Link to item Cite

Medicaid Expansion Affects Rural And Urban Hospitals Differently.

Journal Article Health Aff (Millwood) · September 1, 2016 Rural hospitals differ from urban hospitals in many ways. For example, rural hospitals are more reliant on public payers and have lower operating margins. In addition, enrollment in the health insurance Marketplaces of the Affordable Care Act (ACA) has var ... Full text Link to item Cite

The Rising Rate of Rural Hospital Closures.

Journal Article J Rural Health · 2016 PURPOSE: Since 2010, the rate of rural hospital closures has increased significantly. This study is a preliminary look at recent closures and a formative step in research to understand the causes and the impact on rural communities. METHODS: The 2009 finan ... Full text Link to item Cite