MRHRC Publications

Maine Rural Health Research Center offers working papers, research and policy briefs,and selected publications in PDF format, which are read by Adobe Acrobat Reader.

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• Working Papers and Policy Briefs: 2004 - Present
• Working Papers and Policy Briefs: 1994 - 2003
• Other Publications: 2004 - Present
• Other Publications: 1995 - 2003

Working Papers and Policy Briefs: 2004 - Present

The working papers and publications available on this site are intended for reference use only. They may not be copied or distributed without permission of the Maine Rural Health Research Center.

Working papers that are available in PDF format are indicated by the Adobe Acrobat icon . Please click on this icon to see the document in PDF format.

Title	Year	Full Text Version	Research/ Policy Brief
Adolescent alcohol use: Do risk and protective factors explain rural-urban differences?	2012
Health Care Access Among the Rural Uninsured	2011	Published. See citation below
Impact of Employment Transitions on Health Insurance Coverage of Rural Residents	2010
Access to Mental Health Services and Family Impact of Rural Children With Mental Health Problems	2010
Safety Net Activities of Independent Rural Health Clinics	2010
The Provision of Mental Health Services by Rural Health Clinics	2010
Mental Health Services in Rural Jails	2010
Availability, Characteristics, and Role of Detoxification Services in Rural Areas	2009
Rural-Urban Differences in Health Care Access Vary Across Measures	2009	Research & Policy Brief only
Private Health Insurance in Rural Areas: Challenges and Opportunities	2009	Research & Policy Brief only
Profile of Rural Health Insurance Coverage: A Chartbook	2009
Rural Coverage Gaps Decline Following Public Health Insurance Expansion	2009	Research & Policy Brief only
Access to Rural Mental Health Services: Service Use and Out-Of-Pocket Costs	2008	Published. See citation below
Use of Mental Health Services by Rural Children	2008
Rural-Urban Differences in Work Patterns Among Adults with Depressive Symptoms	2008
Active Living for Rural Youth	2008	Published. See citation below
Rural Inpatient Psychiatric Units	2007	Published. See citation below
Distribution of Substance Abuse Treatment Facilities Across the Rural-Urban Continuum	2007
Substance Abuse Among Rural Youth	2007	Published. See citation below
Uninsured Rural Families	2007	Published. See citation below
Out-of-Pocket Health Care Spending and the Rural Underinsured	2005	Published. See citation below
Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey	2005	Published. See citation below
Are Advanced Practice Psychiatric Nurses a Solution to Rural Mental Health Workforce Shortages?	2004	Published. See citation below

To request a copy, call or email:

• Karen Pearson, karenp@usm.maine.edu, (207) 780-4553 or
• Donna Reed, donnar@usm.maine.edu, (207) 780-4846
  

Other Publications: 2004 - Present

2013

• Coburn, A.F. (2013). Federal Health Care Reform: An Overview. (Policy Brief). Portland, ME: University of Southern Maine, Muskie School of Public Service.
• Nudell, M., Bouthillet, T., Rice, D., Wingrove, G., Cole, D., & Gale, J.A. (2013). Rural acute myocardial infarction survey (RAMIS). International Paramedic Practice, 2(1), 169-175.
• Pearson, K.B., & Coburn, A.F. (2013). Emergency transfers of the elderly from nursing facilities to Critical Access Hospitals: Opportunities for improving patient safety and quality. (Policy Brief #32). Portland, ME: Flex Monitoring Team. 
• Talbot, J. A., Coburn, A., Croll, Z. and Ziller, E. (2013), Rural Considerations in Establishing Network Adequacy Standards for Qualified Health Plans in State and Regional Health Insurance Exchanges. The Journal of Rural Health. doi: 10.1111/jrh.12012.
• Ziller, E.C. and Riley, T. (2013, March). Examining MaineCare’s coverage options under the Affordable Care Act. Health Policy Colloquium Brief. Portland, ME: University of Southern Maine, Muskie School of Public Service.
  
  

2012

• Coburn, A.F., Ziller, E.C., Croll, Z., & Kilbreth, E. (2012, May). Rural implications of geographic rating of health insurance premiums. (Issue Brief). Minneapolis, MN: State Health Access Reform Evaluation Program, Robert Wood Johnson Foundation.
• Croll, Z.T., Coburn, A.F., & Pearson, K.B. (2012, April). Promoting a culture of safety: Use of the Hospital Survey On Patient Safety Culture in Critical Access Hospitals. (Briefing Paper No. 30). Portland, ME: Flex Monitoring Team. Policy Brief.
• Lambert, D., & Gale, J.A. (2012). Integrating care in rural areas. In Smalley, K.B., Warren, J.C., & Rainer, J.P. (Eds.), Rural Mental Health. NY: Springer Publishing Co.
• Lenardson, J., Hartley, D., Gale, J.A., & Pearson, K.B. (2012). Substance use and abuse in rural America. In Smalley, K.B., Warren, J.C., & Rainer, J.P. (Eds.), Rural Mental Health. NY: Springer Publishing Co.
• Ziller, E.C., Lenardson, J.D., & Coburn, A.F. (2012). Health care access and use among the rural uninsured. Journal of Health Care for the Poor and Underserved, 23(3), 1327-1345.

2011

• Coburn, A.F. (2011). Federal Health Care Reform: An Overview. (Research & Policy Brief). Portland, ME: University of Southern Maine, Muskie School of Public Service.
• Coburn, A., Talbot, J., Ziller, E., & Gage-Croll, Z. (2011, June). CO-OP health plans: Can they help fix rural America's health insurance markets? Minneapolis, MN: State Health Access Reform Evaluation Program, Robert Wood Johnson Foundation.
• Hartley, D. (2011). Promoting healthy partnerships with rural communities. In E.T. Anderson, & J.M. McFarlane (Eds.), Community as Partner: Theory and Practice in Nursing. (6th ed.), (pp. 366-377). Philadelphia, PA: Lippincott, Williams & Wilkins.
• Hartley, D., Anderson, N., Fox, K., & Lenardson, J. (2011, December). How does the rural food environment affect rural childhood obesity? Childhood Obesity, 7(6), 450-61.
• OneMaine Health Collaborative. (2011). Statewide Community Health Needs Assessment 2010. Portland, Maine: The Center for Community and Public Health. [Contributors: David Hartley, Co-Principal Investigator, and John Gale]
• Yousefian, A., Leighton, A., Fox, K., & Hartley, D. (2011). Understanding the rural food environment: Perspectives of low-income parents. Rural & Remote Health, 11(online), 1631.

2010

• Gale, J. (2010, Sept-Oct). Rural America: A look beyond the images. Health Progress: Journal of the Catholic Health Association of the United States, 91(5), 8-13.
• Hartley, D., Loux, S., Gale, J., Lambert, D., & Yousefian, A. (2010, June). Inpatient psychiatric units in small rural hospitals. Psychiatric Services, 61(6), 620-623.
• Thomas, J.W., Ziller, E.C., & Thayer, D. (2010, September). The cost of defensive medicine in the United States. Health Affairs, 29(9), 1578-1584.
• Wallace Amy E., Young-Xu, Y., Hartley, D., & Weeks, W.B. (2010, January 6). Racial, socioeconomic, and rural-urban disparities in obesity-related bariatric surgery. Obesity Surgery, online.
• Yousefian, A., Hennessy, E., Umstattd, M.R., Economos, C., Hallam, J., Hyatt, R.R. & Hartley, D. (2010, January). Development of the rural active living assessment tools: Measuring rural environments. Preventive Medicine, 50(Supplement 1), S86-S92.
• Ziller, E.C., Anderson, N.J., & Coburn, A.F. (2010). Access to rural mental health services: Service use and out-of-pocket costs. Journal of Rural Health, online (early release).

2009

• Coburn, A.F. (2009, January 30). Opportunities for Health Insurance Reform in Maine: State and National Lessons. Presented at the Policy Leaders Academy Legislative Policy Forum on Health Care, Portland, ME.
• Coburn, A.F., MacKinney, A.C., McBride, T., Mueller, K., Slifkin, R.T., & Ziller, E. (2009, October 30). Assuring health coverage for rural people through health reform. Columbia, MO: Rural Policy Research Institute, RUPRI Health Panel.
• Coburn, A.F., MacKinney, A.C., McBride, T.D., Mueller, K.J., Slifkin, R.T., & Wakefield, M.K. (2008, October). Rural Policy Research Institute Health Panel response to CMS' Report to Congress: Plan to Implement a Medicare Hospital Value-Based Purchasing Program. Columbia, MO: Rural Policy Research Institute.
• Fitzgerald, P., Coburn, A., & Dwyer, S.K. (2009, June). Expanding rural elder care options: Models that work. (Proceedings from the 2008 Rural Long Term Care Access and Options Workshop). Alexandria, VA: National PACE Association and the Rural Long Term Care Workgroup.
• Gale, J., & Lenardson, J.D. (2009, January). Policy Issues Affecting Maine's Hospitals. (Issue Brief). Portland, ME: University of Southern Maine, Muskie School of Public Service.
• Gale, J.A., & Lambert, D. (2009, July). Maine Barriers to Integration Study: The view from Maine on the barriers to integratedcare and recommendations for moving forward. Portland, ME: University of Southern Maine, Muskie School of Public Service.
• Klingner, J., Moscovice, I., Tupper, J., Coburn, A., & Wakefield, M. (2009, Fall). Implementing patient safety initiatives in rural hospitals. Journal of Rural Health, 25(4), 352-357.
• Lambert, D., & Gale, J. (2009, January ). Mental Health and Substance Abuse in Maine: Building a Community-Based System. (Issue Brief). Portland, ME: University of Southern Maine, Muskie School of Public Service.
• Lenardson, J.D., Ziller, E.C., Coburn, A.F. & Anderson, N.J. (2009, June). Profile of rural health insurance coverage: A chartbook. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center.
• National Advisory Committee on Rural Health and Human Services. (2009, April). The 2009 Report to the Secretary: Rural Health and Human Services Issues. Rockville, MD: Health Resources and Services Administration, Office of Rural Health Policy, NACRHHS.
• Yousefian, A. (2009, February 20). An Environmental Assessment Instrument for Rural Communities: Development of the Rural Active Living Assessment (RALA) Tools. Presented at the Sixth Active Living Research Annual Conference, San Diego, CA.
• Yousefian, A., Ziller, E., Swartz, J., & Hartley, D. (2009). Active living for rural youth: Addressing physical inactivity in rural communities. Journal of Public Health Management and Practice: Special Issue on Rural Public Health, 15(3), 223-231.

2008

• Coburn, A.F., MacKinney, A.C., McBride, T.D., Mueller, K.J., Slifkin, R.T., & Wakefield, M.K. (2008, March). Implementing a new USDA Rural Development Program targeting small rural hospitals and their communities. Columbia, MO: RUPRI Rural Health Panel.
• Coburn, A.F. & Ziller, E.T. (2008, September 23). The Underinsured in Rural America: The Root of the Problem and Possible Solutions. Presented at The Second National Congress on the Un and Under Insured, Washington, DC.
• Gale, J.A., & Lambert, D. (2008, October). Maine Barriers to Integration Study: Environmental scan. Portland, ME: University of Southern Maine, Muskie School of Public Service.
• Hanrahan, N. P., & Hartley, D. (2008). Employment of advanced-practice psychiatric nurses to stem rural mental health workforce shortages. Psychiatric Services, 59(1), 109-111.
• Harris, D.E., Aboueissa, A.-M., & Hartley, D. (2008, June). Myocardial infarction and heart failure hospitalization rates in Maine, USA—variability along the urban-rural continuum. Rural and Remote Health [Online Journal], 8(980), online.
• Lambert, D. (2008). Meeting the mental health needs of rural older people. In Caring for the older person in rural communities. (pp. 28-35). Kansas City, MO: National Rural Health Association.
• Lambert, D., Gale, J.A., & Hartley, D. (2008, Summer). Substance abuse by youth and young adults in rural America. Journal of Rural Health, 24(3), 221-8.
• Loux, S., Coleman, R., Ralston, M., & Coburn, A. (2008). Consolidated imaging: Implementing a regional health information exchange system for radiology in Southern Maine. In K. Henriksen, J.B. Battles, M.A. Keyes, & M.L. Grady (Editors). Advances in Patient Safety: New Directions and Alternative Approaches. Vol. 4. Technology and Medication Safety. (pp. 43-54). Rockville, MD: Agency for Healthcare Research & Quality.
• McBride, T.D., Coburn, A.F., MacKinney, A.C., Mueller, K.J., Slikfin, R.T., & Wakefield, M.K. (2008). Bridging health research and policy: Effective dissemination strategies. Journal of Public Health Management and Practice, 14(2), 150-154.
• Tupper, J., Coburn, A., Loux, S., Moscovice, I., Klingner, J., & Wakefield, M. (2008). Strategies for improving patient safety in small rural hospitals. In K. Henriksen, J.B. Battles, M.A. Keyes, & M.L. Grady (Editors). Advances in Patient Safety: New Directions and Alternative Approaches. Vol. 2. Culture and Redesign. (pp. 303-313). Rockville, MD: Agency for Healthcare Research and Quality.
• Ziller, E.C., Coburn, A.F., Anderson, N.J., & Loux, S.L. (2008). Uninsured rural families. The Journal of Rural Health, 24(1), 1-11.

2007

• Coburn, A. F., MacKinney, A. C., McBride, T. D., Mueller, K. J., Slifkin, R. T., & Wakefield, M. K. (2007, March). Choosing rural definitions: Implications for health policy. (Issue Brief #2). Omaha, NE: Rural Policy Research Institute Health Panel.
• Colgan, C., & Hartley, D. (2007). The two-edged scalpel: Health care and the rural economy. In D. Vail, & L. Pohlmann (Eds.), Health care and tourism: A lead sector strategy for rural Maine. (pp. 53-72). Augusta, ME: Maine Center for Economic Policy. http://www.mecep.org/view.asp?news=211
• Gale, J.A., Coburn, A.F., Freeman, V., Gregg, W.R., & Slifkin, R. (2007, February). The community impact of Critical Access Hospitals. (Policy Brief No. 2). Portland, ME: Flex Monitoring Team.
• Gale, J., Coburn, A.F., Gregg, W., Slifkin, R., & Freeman, V. (2007, January). Exploring the community impact of Critical Access Hospitals. (Briefing Paper No. 14). Portland, ME: Flex Monitoring Team.
• Gale, J., Lenardson, J., Race, M., et al. (2007, December). State initiatives funded by the Medicare Rural Hospital Flexibility Grant Program. (Policy Brief #3). Portland, ME: Flex Monitoring Team.
• Hartley, D., Ziller, E., Loux, S., Gale, J., Lambert, D., & Yousefian, A. E. (2007). Use of Critical Access Hospital emergency rooms by patients with mental health symptoms. Journal of Rural Health, 23(2), 108-115.
• Lambert, D., & Brennan, M. (2007, January). Mental health and substance abuse in Maine: Building a community-based system. (Issue Brief). Portland, ME: University of Southern Maine, Muskie School of Public Service and the Margaret Chase Smith Policy Center at the University of Maine.
• Lenardson, J. D., & Hartley, D. (2007, January). Maine's rural health challenges. (Issue Brief). Portland, ME: University of Southern Maine, Muskie School of Public Service and the Margaret Chase Smith Policy Center at the University of Maine.

2006

• Casey, M., Wakefield, M., Coburn, A. F., Moscovice, I., & Loux, S. (2006, December). Prioritizing patient safety interventions in small rural hospitals. Joint Commission Journal on Quality and Patient Safety, 32(12), 693-702.
• Coburn, A. F., Loux, S. L., & Bolda, E. J. (2006). Rural hospitals and long-term care: The challenges of diversification and integration strategies. In R. T. Goins, & J. A. Krout (Eds.), Service delivery to rural older adults: Research, policy, and practice. (pp. 103-122). New York, NY: Springer Publishing Co.
• Gale, J. A., & Lambert, D. (2006). Mental health care in rural communities: The once and future role of primary care. North Carolina Medical Journal, 67(1), 66-70.
• Lambert, D., & Gale, J. A. (2006, October). Integrating primary care and mental health: Current practices in rural community health centers. Kansas City, MO: National Rural Health Association.
• Patterson, D. D., Gale, J. A., Loux, S., Yousefian, A. E., & Slifkin, R. T. (2006). Emergency Medical Services (EMS) activities funded by the Medicare Rural Hospital Flexibility Program. (Report No. Briefing Paper No. 8). Portland, ME: The Flex Monitoring Team.
• Pearson, K. B. (Ed). (2006). Rural health research in progress in the Rural Health Research Centers Program. (10th ed.). Portland, ME: University of Southern Maine, Edmund S. Muskie School of Public Service, Institute for Health Policy, Maine Rural Health Research Center.
• Sawyer, D., Gale, J. A., & Lambert, D. (2006). Rural and frontier mental and behavioral health care: Barriers, effective policy strategies, best practices. Waite Park, MN: National Association of Rural Mental Health.
• Ziller, E. C., Coburn, A. F., & Yousefian, A. E. (2006, Nov/Dec.). Out-of-pocket health spending and the rural underinsured. Health Affairs, 25(6), 1688-1699.

2005

• Institute of Medicine. Committee on the Future of Rural Health Care. Board on Health Care Services. (2005). Quality through collaboration: The future of rural health. Washington, DC: The National Academies Press. Contributors include Andrew Coburn and David Hartley.
• Loux, S. L., Payne, S. M. C., & Knott, A. (2005). Comparing patient safety in rural hospitals by bed count. In Advances in patient safety: From research to implementation. (Vols. 1-4), (pp. 391-402). Rockville, MD: Agency for Healthcare Research and Quality.
• Mueller, K. J., Coburn, A. F., MacKinney, A. C., McBride, T. D., Slifkin, R. T., & Wakefield, M. K. (2005). Understanding the impacts of the Medicare Modernization Act: Concerns of congressional staff. Journal of Rural Health, 21(3), 194-197.
• Pearson, K. B. (Ed). (2005). Rural health research in progress in the Rural Health Research Centers Program. (9th ed.). Portland, ME: University of Southern Maine, Edmund S. Muskie School of Public Service, Institute for Health Policy, Maine Rural Health Research Center.

2004

• Coburn, A. F., Wakefield, M., Casey, M., Moscovice, I., Payne, S. M. C., & Loux, S. (2004). Assuring rural hospital patient safety: What should be the priorities? Journal of Rural Health, 20(4), 314-326.
• Hartley, D. (2004). Rural health disparities, population health, and rural culture. American Journal of Public Health, 94(10), 1675-1678.
• Hartley, D., & Loux, S. (2005, March). Scope of services offered by Critical Access Hospitals: Results of the 2004 National CAH survey. (Briefing Paper #5). Portland, ME: University of Southern Maine, Edmund S. Muskie School of Public Service, Institute for Health Policy, Maine Rural Health Research Center.
• Lambert, D. (2004). Fighting stigma in rural areas: What's different? What works? [Web Page]. URL http://www.adscenter.org/memoranda/fall2004.htm [2004, December 14].
• Pearson, K. B. (Ed.). (2004). Rural health research in progress in the Rural Health Research Centers Program (8th ed.). Portland, ME: University of Southern Maine, Edmund S. Muskie School of Public Service, Institute for Health Policy, Maine Rural Health Research Center.
• Pearson, K. B. (Ed). (2004). Rural health research in progress: Project Summaries. Portland, ME: University of Southern Maine, Edmund S. Muskie School of Public Service, Institute for Health Policy, Maine Rural Health Research Center.
• Pink, G. H., Slifkin, R. T., Coburn, A. F., & Gale, J. A. (2004). Comparative performance data for critical access hospitals. Journal of Rural Health, 20(4), 374-382.
• Ziller, E. C., Coburn, A. F., McBride, T. D., & Andrews, C. (2004). Patterns of individual health insurance coverage, 1996-2000. Health Affairs, 23(6), 210-221.