Paper looks at rural health policy initiatives, future opportunities

A recent paper from the Rural Policy Research Institute (RUPRI) Health Panel examines the progress of national health policy initiatives and the gaps that remain as they affect rural people, places, and providers.

Professor and Interim Dean Keith Mueller.
Keith Mueller

According to Keith Mueller, RUPRI Health Panel Chair, professor of health management and policy, and interim dean at the University of Iowa College of Public Health, the paper lays out clear policy trajectories in seven major subject areas that can enhance access and affordability of high quality services in rural America into the future. The subject areas included are Medicare, Medicaid and CHIP, Insurance Coverage and Affordability, Quality, Health Care Finance and System Transformation, Workforce, and Population Health.

Each chapter begins with a summary of policy opportunities, followed by a background section on rural trends and challenges that summarizes rural-related policy advances and continued gaps. Each chapter concludes with a “Looking Ahead” section that highlights the most pressing issues in today’s rural health care system environment and suggests future policy directions related to each issue.

“We wanted to take a look at national policy initiatives such as Medicare, Medicaid, and insurance reform to take stock of progress made for rural communities and to develop clear statements of remaining challenges,” says Mueller. “Ultimately our goal is to help build a roadmap to achieve a high performance health system in all of rural America.”

A PDF of the paper is available at

Co-authors are Charles Alfero, Hidalgo Medical Services (HMS); Dr. Andrew F. Coburn, University of Southern Maine; Dr. Jennifer P. Lundblad, Stratis Health; Dr. A. Clinton MacKinney, University of Iowa; Dr. Timothy D. McBride, Washington University in St. Louis; and Dr. Paula Weigel, University of Iowa.

This report was funded by the by the Leona M. and Harry B. Helmsley Charitable Trust, grant number 2017PG-RHC006.

Telemedicine improves rural ER response time

Emergency department patients at rural hospitals using telemedicine see a clinician six minutes sooner than patients in hospitals that have no such technology, a new study from University of Iowa shows. And if that first clinician assessment is through a telemedicine encounter, the door-to-provider time is shortened by nearly 15 minutes, says study lead author Nicholas Mohr, MD, an emergency physician and associate professor at the Carver College of Medicine at the University of Iowa.
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Additional Media Coverage

UI College of Public Health

Becker’s Hospital Review

Emergency department telemedicine shortens patients’ time-to-provider


Rural hospitals using telemedicine services reduce the time between patients entering the emergency department to receiving physician care by six minutes, according to a new study led by University of Iowa researchers.

The research team, headed by Nicholas Mohr, UI associate professor of emergency medicine and anesthesia, measured the impact of emergency department (ED)-based telemedicine services on timeliness of care in rural hospitals. The study looked at data collected from 14 hospitals in Iowa, Kansas, Nebraska, North Dakota, and South Dakota that subscribe to telemedicine services from a single ED-based telemedicine provider. The team matched 2,857 emergency department cases that used telemedicine services with non-telemedicine controls.

Emergency Signs at Hospital

The results, published online Jan. 2 in Telemedicine and e-Health, showed that telemedicine decreased door-to-provider time by six minutes. This provider could be either a local provider physically assessing the patient or a telemedicine provider—whoever was available first. The first provider seeing the patient was a telemedicine provider in 41.7 percent of telemedicine encounters, and in these cases, telemedicine was 14.7 minutes earlier than local providers.

The researchers also noted that among patients who were transferred to other hospitals, ED length-of-stay at the first hospital was shorter in patients who had telemedicine consulted. The authors suggest that this reduced time may be due to remotely located staff completing administrative and charting tasks, allowing local staff to concentrate on patient care.

The study team included Tracy Young, Karisa Harland, and Marcia Ward from the University of Iowa; and Brian Skow, Amy Wittrock, and Amanda Bell from Avera eCare.

The project was supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services and the analysis was conducted by the Rural Telehealth Research Center at the University of Iowa.

View additional media coverage…

Celebrate National Rural Health Day Nov. 16

National Rural Health Day Logo In 2010, the National Organization of State Offices of Rural Health (NOSORH) created National Rural Health Day as a way to applaud the ongoing efforts, contributions, and collaborations occurring in rural communities to address the unique challenges in accessing and delivering health care services.

Take Part

This year’s national events will highlight the Power of Rural. Here are a few ways to join in:

CPH and Rural Health

In the College of Public Health, three Collective Areas of Excellence — Rural Health, Comparative Effectiveness Research, and Community Engagement — inform collegiate growth and innovation in research, academics, and outreach for public health impact.

We’re proud to be home to numerous experts, centers, studies, and projects that focus on the health and well-being of rural populations. Here’s just a sample of some of our recent work:

MPH student initiates new study on rural mental health care

A portrait of Lauren Pass of the University of Iowa College of Public Health.Lauren Pass, an MPH student in community and behavioral health, is the principal investigator of a new study examining how anxious and depressive disorders are managed in rural cardiovascular disease patients. Under the guidance of Dr. Korey Kennelty, assistant professor in the UI College of Pharmacy and co-investigator, the study utilizes patient interviews to identify mental health care needs in high-risk rural Iowa populations.

“Cardiovascular disease and mood disorders often go hand-in-hand,” says Pass. “Patients with mood disorders are at higher risk for developing cardiovascular disease and often have poorer cardiac outcomes than those without mood disorders. For rural patients, access to mental health care can be scarce, so it’s important that we identify ways of improving the delivery of mental health care within the settings most widely available to patients — their primary care clinics.”

The study is sub-project of the Improved Cardiovascular Risk Reduction to Enhance Rural Primary Care (ICARE) clinical trial lead by Dr. Barry Carter in the UI College of Pharmacy. The study examined whether clinical pharmacists can be implemented in primary care offices to improve the care of patients at risk for developing cardiovascular disease.



Ward to present CPH Distinguished Faculty Lecture Aug. 30

UI College of Public Health 2017 Distinguished Faculty Lecture

Telehealth in the Rural Emergency Department: Using Mixed Methods to Explore Benefits

Marcia Ward,  PhD
Professor and Interim Head, Department of Health Management and Policy
College of Public Health, The University of Iowa

Wednesday, August 30
12:30 p.m.
Callaghan Auditorium
N110 College of Public Health Building

A reception will follow in the CPHB atrium.