Projects

The following projects are underway for 2023-2024.

  • EB TNP Grantee Data Collection Launch
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2023
    Anticipated completion date: August 2024
    • RTRC has been charged by OAT with identifying approaches that can be used across the EB TNP grantees to enhance the evidence base for direct-to-consumer telehealth use in rural communities. This year’s project will continue the process by launching data collection among the 11 grantee networks.

  • Virtual Nursing: Reducing Burden and Improving Care
    Lead researcher: Saif Khairat, PhD, MPH
    919-843-5413, saif@unc.edu
    Project funded: September 2023
    Anticipated completion date: August 2024
    • Many healthcare systems in the US are using telehealth to supplement the nursing shortage by offering remote expert nursing to unit nurses, also known as virtual nursing (VN). VN is a new phenomenon in healthcare and therefore, there is a dearth of knowledge on the effect of VN on patient and nurse outcomes. This project will examine the effect of VN in emergency departments on the quality and equity of care.

  • Repeat Hospitalizations and Emergency Department Visits Among Rural and Urban Chronically Ill Medicare Patients Using Telehealth Services Post-Discharge
    Lead researcher: Yvonne Jonk, PhD
    207-228-8038, yvonne.jonk@maine.edu
    Project funded: September 2023
    Anticipated completion date: August 2024
    • This study will address the effectiveness of telehealth as a follow-up modality for Medicare Fee-for-Service (FFS) patients discharged from the hospital or emergency department. This project builds on previous work identifying telehealth visits using the 2019-2021 Medicare Limited Data Set (LDS) Inpatient, Outpatient, and Carrier claims files and will benefit from a relatively stream-lined on-line request process to obtain the 2019-2022 Home Health and 2022 Inpatient, Outpatient, and Carrier files.

  • Role of Licensure Portability in Increasing Utilization of Outpatient Telehealth during the COVID-19 Public Health Emergency
    Lead researchers: Nicholas Mohr, MD, MS; Priyanka Vakkalanka, PhD, ScM
    319-384-8285, nicholas-mohr@uiowa.edu; 319-384-8285, priyanka-vakkalanka@uiowa.edu
    Project funded: September 2023
    Anticipated completion date: August 2024
    • The COVID-19 public health emergency (PHE) led to significant transient changes in state-level cross-state licensure requirements. The purpose of this proposed project is to measure the association between relaxed state-level cross-state licensure policy and outpatient telehealth utilization among Medicare beneficiaries, both by in-state and out-of-state health care providers.

  • Developing Measures of Telehealth Integration, Cost, and Quality for Post-Partum Maternal and Early-life Pediatric Services
    Lead researcher: Christopher Shea, PhD
    919-9661938, chris_shea@unc.edu
    Project funded: September 2023
    Anticipated completion date: August 2024
    • A lack of integration of in-person and telehealth services within a health system can contribute to fragmentation of services for patients and have negative effects on cost and quality. This project will engage providers, health system administrators, and payers to identify key elements of telehealth integration, telehealth implementation costs, and quality of care delivered via telehealth for postpartum and pediatric services and then seek consensus on how to measure the key elements. These newly developed measures will provide a foundation for future studies focusing on telehealth implementation and telehealth impacts on quality of care.

The following were 2022-2023 projects.

  • Data Collection Preparation and Initiation for EB TNP Grantees
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2022
    Anticipated completion date: August 2023
    • RTRC has been charged by OAT with identifying approaches that can be used across the EB TNP grantees to enhance the evidence base for direct-to-consumer telehealth use in rural communities. This year’s project continued the process by developing a data collection tool and initiating data collection among the grantee networks.

  • Telehealth Adoption and Outcomes in Underserved Populations During the Public Health Emergency: A Living Systematic Review
    Lead researcher: Nicholas M. Mohr, MD, MS
    319-384-8285, nicholas-mohr@uiowa.edu
    Project funded: September 2022
    Anticipated completion date: August 2023
    • COVID-19 led to significant changes in telehealth policy, use, and research. The purpose of this living systematic review was to collate and summarize evidence testing telehealth interventions in the context of the global COVID-19 pandemic, with a focus on outcomes in underserved populations.

  • Medicare Telehealth Utilization by Rural Health Clinics and Federally Qualified Health Centers
    Lead researcher: Yvonne Jonk, PhD
    207-228-8038, yvonne.jonk@maine.edu
    Project funded: September 2022
    Anticipated completion date: August 2023
    • This study used a mixed methods approach to address the extent to which RHCs and FQHCs were using telehealth prior to and during the COVID-19 Public Health Emergency (PHE), for what types of services, how these clinics are reimbursed for providing care through telehealth, and whether they are facing financial barriers to using telehealth. This project built on previous work identifying telehealth visits using the 2019-2020 Medicare Limited Data Set (LDS) Outpatient and Carrier claims files and benefited from a relatively stream-lined on-line request process to obtain the 2021 files.

  • The Role of Telehealth in Addressing Workforce Needs for Behavioral Health in Critical Access Hospitals During the Public Health Emergency
    Lead researcher: Christopher M. Shea, PhD
    919-966-1938, chris_shea@unc.edu
    Project funded: September 2022
    Anticipated completion date: August 2023
    • The goal of the study was to understand how the increased availability of telehealth related to the COVID-19 public health emergency (PHE) affected the rural hospital behavioral health workforce. We employed a combination of qualitative semi-structured interviews and a quantitative analysis of Medicare claims to examine the role of telehealth availability and use on (1) behavioral health staff experience, (2) the types of professionals providing rural tele-behavioral health services, and (3) critical access hospital billing.

  • Evaluation of Telehealth Services for Patients Treated with Pharmacotherapies for Opioid Use Disorder in the Veterans Health Administration
    Lead researcher: Priyanka Vakkalanka, PhD
    319-384-6468, priyanka-vakkalanka@uiowa.edu
    Project funded: September 2022
    Anticipated completion date: August 2023
    • Using data from the Veterans Health Administration, we evaluated the impact of telehealth services incorporated during treatment with buprenorphine or naltrexone for opioid use disorder on emergency department utilization, inpatient admissions, and mortality. 

These were 2021-2022 projects.

  • Telehealth for Chronic Disease Management in the Veterans Health Administration, Year 2
    Lead researcher: Nicholas M. Mohr, MD, MS
    319-384-8285, nicholas-mohr@uiowa.edu
    Project funded: September 2021
    Anticipated completion date: August 2022
    • This project was designed to measure the impact of chronic disease telehealth within the Veterans Health Administration (VHA) on health care utilization and cost. The project capitalized on a productive collaboration between the Rural Telehealth Research Center (RTRC) and the Veterans Administration (VA) Office of Rural Health.

  • EB THNP/SAT TNGP Comparative Effectiveness Analysis and Publication Development
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2021
    Anticipated completion date: August 2022
    • RTRC has worked to establish data collection protocols and tools on a set of measures used for several HRSA grant programs including the Evidence Based Tele-Behavioral Health Network Program (EB THNP) and the Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP). Continuing those efforts, the purpose of this project was to analyze EB THNP/SAT TNGP data and develop publications to further the evidence base for tele-behavioral health.

  • Identifying EB TNP Data Elements for Direct-to-Consumer Telehealth Networks
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2021
    Anticipated completion date: August 2022
    • RTRC has worked cooperatively to establish data collection protocols and tools on a set of measures used for four previous HRSA telehealth grant programs. Continuing those efforts, the purpose of this project was to identify a set of data elements for a new Evidence Based Telehealth Network Program (EB TNP) focused on direct-to-consumer telehealth applications within established healthcare networks.

  • Federal Telehealth Policy Changes during the COVID-19 Public Health Emergency: Associations with Telebehavioral Health Use among Rural and Urban Medicare Beneficiaries
    Lead researcher: Yvonne Jonk, PhD
    207-228-8038, yvonne.jonk@maine.edu
    Project funded: September 2021
    Anticipated completion date: August 2022
    • The objective of the project was to assess rural-urban differences in patterns of telebehavioral health service use among Medicare beneficiaries before and during the COVID-19 public health emergency.

  • Implications of Telehealth Visits on Patterns of Health Services Use and Cost:  Are Telehealth Visits Serving as Substitutes for In-Person Care?
    Lead researcher: Yvonne Jonk, PhD
    207-228-8038, yvonne.jonk@maine.edu
    Project funded: September 2021
    Anticipated completion date: August 2022
    • During the COVID-19 public health emergency (PHE) people were generally reluctant to receive in-person care, which provides a unique opportunity (natural experiment) to assess whether telehealth was effectively serving as a substitute for in-person care. This study was national in scope and addressed rural-urban differences in patterns of health services use and cost among Medicare fee-for-service beneficiaries using telehealth relative to matched controls who were not using telehealth pre-PHE and during the PHE.

These were 2020-2021 projects.

  • Telehealth for Chronic Disease Management in the Veterans Health Administration
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2020
    Anticipated completion date: August 2021
    • This project capitalized on the aggressive adoption of telehealth within the Veterans Health Administration (VHA). The overall purpose of this jointly funded collaborative project was to better understand key factors impacting how VHA chronic disease management telehealth has reduced healthcare utilization outcomes and cost.

  • EB THNP/SAT TNGP, SB TNGP, and EB TNP Measure and Data Activities
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2020
    Anticipated completion date: August 2021
    • There were three components to this project: 1) continue data collection from Evidence Based Tele-Behavioral Health Network Program (EB THNP) and Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) grantees to assess tele-behavioral health; 2) analyze School Based Telehealth Network Grant Program (SB TNGP) data and prepare publications to further the evidence base for telehealth; and 3) identify a set of candidate data elements for a new Evidence Based Telehealth Network Program (EB TNP) activity.

  • Evaluating the Role of Tele-Emergency Care in Healthcare Costs and Long-Term Outcomes for Rural Medicare Beneficiaries with Sepsis
    Lead researcher: Nicholas M. Mohr, MD, MS
    319-384-8285, nicholas-mohr@uiowa.edu
    Project funded: September 2020
    Anticipated completion date: August 2021
    • Sepsis is a life-threatening emergency for which provider-to-provider telemedicine has been used to improve quality of care. The objective of this study was to measure the impact of rural tele-emergency consultation on long-term healthcare costs and outcomes, specifically through decreasing organ failure, hospital length-of-stay, and readmissions.

  • Telehealth Use among Children in Medicaid Managed Care and Fee-for-Service Programs
    Lead researcher: Yvonne Jonk, PhD
    207-228-8038, yvonne.jonk@maine.edu
    Project funded: September 2020
    Anticipated completion date: August 2021
    • This project assessed differences in the use of telehealth services among rural and urban children by enrollment in state Medicaid managed care organizations (MCOs) and fee-for-service (FFS) programs using national administrative claims datasets.
  • Opportunities for Increasing Access to Maternal Telehealth Services
    Lead researcher: Christopher M. Shea, PhD
    919-966-1938, chris_shea@unc.edu
    Project funded: September 2020
    Anticipated completion date: August 2021
    • Rural residents face barriers to healthcare access that contribute to higher maternal morbidity and infant mortality than in urban areas. This project used nationally representative data to identify opportunities for increasing access to maternal health services via telehealth and implementation barriers to sustaining telehealth services.

These were 2019-2020 projects.

  • Telehealth for Heart Attack and Stroke in Rural Hospitals
    Lead researcher: Christopher M. Shea, PhD
    919-966-1938, chris_shea@unc.edu
    Project funded: September 2019
    Anticipated completion date: August 2020
    • The primary purpose of this project is to examine telehealth for heart attack and stroke in national samples of hospitals. Research questions include (1) What have been the trends in adoption of telehealth services for heart attack and stroke among hospitals since 2010, and what factors have contributed to this trend? (2)  What telestroke processes and implementation strategies are in place, and how do these processes and strategies differ across levels of rurality?

  • Continuing Data Collection on a Common Set of Measures for the School-Based TNGP Grantees
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2019
    Anticipated completion date: August 2020
    • The primary purpose of this project will be to continue data collection from SB TNGP grantees to evaluate school-based telehealth using a common set of measures that will help build the evidence base and inform future policy changes and sustainability efforts.

  • Investigating Differences in School-based Telehealth Implementation and Services in the SB TNGP Grantees
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2019
    Anticipated completion date: August 2020
    • The primary purpose of this project is to gather information through stakeholder interviews on the practicalities of delivering telehealth services in school settings that will help explain the heterogeneity across the grantees and identify implementation best practices and lessons learned to inform future initiatives.

  • Launching Data Collection on a Common Set of Measures for the EB THNP and SAT TNGP Grantees
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2019
    Anticipated completion date: August 2020
    • The primary purpose of this project will be to launch data collection among EB THNP and SAT TNGP grantees using an EXCEL-based data collection tool, to perform regular quality checks and data management activities, and to begin descriptive statistical analysis.

These were 2018-2019 projects.

  • Analyzing Data from the Evidence-Based Telehealth Network Grant Program (EB TNGP) Grantees and Preparing Manuscripts to Further the Evidence Base for Tele-ED
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2018
    Completion date: August 2019
    • The primary purpose of this project was to analyze data using the revised Tele-Emergency Performance Assessment Reporting Tool (T-PART) from the Evidence-Based Tele-Emergency Network Grant Program (EB TNGP) grantees on all their tele-ED cases and a matched sample of non-tele-ED records to conduct comparative effectiveness analysis to help establish the evidence base for tele-ED.

  • Launching Data Collection on a Common Set of Measures for the School-Based TNGP Evaluation
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2018
    Completion date: August 2019
    • The primary purpose of this project was to launch data collection from SB-TNGP grantees using an EXCEL-based data collection tool, to perform regular quality checks and data management activities, and to begin descriptive statistical analysis.

  • Understanding Trends in Telehealth Use: An All-Payer Analysis in Maine
    Lead researcher: Andrew F. Coburn, PhD
    207-780-4435, andrew.coburn@maine.edu
    Project funded: September 2018
    Anticipated completion date: August 2019
    • This project's primary purpose was to use Maine’s All-Payer Claims Database (APCD) and key informant interviews to develop a descriptive overview of telehealth use in Maine, examining how telehealth use has changed over time (2008-2017) among rural and urban patients and providers and whether there are discernable patterns in those changes by telehealth modality, payer, provider type, diagnosis, and service.

  • Establishing a Common Set of Measures for Tele-Behavioral Health and Tele-Substance Abuse
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2018
    Completion date: August 2019
    • The primary purpose of this project was to establish data collection protocols and tools for use in a cross-grantee evaluation of the Evidence-Based Tele-Behavioral Health Network Program (EB THNP).

These were 2017-2018 projects.

  • Collecting and analyzing data from the Evidence-Based Telehealth Network Grant Program (EB TNGP) grantees using the revised Tele-Emergency Performance Assessment Report Tool (T-PART)
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2017
    Completion date: August 2018
    • The primary purpose of this project was to collect and analyze data from the EB TNGP grantees using the revised T-PART on all their tele-ED cases and a matched sample of non-tele-ED cases to conduct comparative effectiveness analysis to help establish the evidence base for tele-ED.

  • Establishing data collection protocols on a common set of measures for the School-Based Telehealth Network Grant Program (SB TNGP) evaluation
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2017
    Completion date: August 2018
    • RTRC worked cooperatively with FORHP to establish data collection protocols and tools on a set of measures that could be used for cross-grantee evaluation of the SB TNGP.

  • Rates of telemental health use among rural Medicaid enrollees: Associations with telehealth policy and mental health access
    Lead researcher: Andrew F. Coburn, PhD
    207-780-4435, andrew.coburn@maine.edu
    Project funded: September 2017
    Anticipated completion date: August 2018
    • This study examined telemental health use among rural and urban Medicaid beneficiaries with mental illness. Primary study goals were: 1) to compare rates and patterns of telemental health use among rural and urban enrollees; 2) to assess how rural telemental health use rates are associated with state-level Medicaid telehealth policies; and 3) to determine the extent to which telemental health provides acces to care for rural beneficiaries who do not receive mental health services through other means.

  • Identify Measures for Use with Tele-Behavioral Health
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2017
    Completion date: August 2018
    • RTRC identified a set of measures that could be used to evaluate of tele-behavioral health services.

These were 2016-2017 projects.

  • Collecting and analyzing data on a uniform set of measures from the Evidence-Based Telehealth Network Grant Program grantees
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2016
    Completion date: August 2017
    • The primary purpose of this project was to routinely collect and analyze data on a uniform set of measures reported by the EB TNGP grantees to help establish the evidence base for tele-ED.

  • Provide guidance on measures for the School-Based Telehealth Network Grant Program evaluation
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2016
    Completion date: August 2017
    • RTRC worked cooperatively with FORHP to provide guidance on a set of measures that could be used for a cross-grantee evaluation of the SB TNGP. A secondary goal wass to identify lessons learned from this effort that could be useful in designing future TNGP cooperative agreements.

  • Use of telehealth services among rural Medicaid enrollees: A baseline inventory
    Lead researcher: Andrew F. Coburn, PhD
    207-780-4435, andrew.coburn@maine.edu
    Project funded: September 2016
    Completion date: August 2017
    • This project used data from the Medicaid Analytic Extract (MAX) for 2011 to create a 50-state, baseline inventory of telehealth services provided to Medicaid enrollees in rural and urban settings. The project provided important information on the feasibility of using MAX data to study the effects of Medicaid telehealth policies on rural telehealth use and on the accessibility and quality of care delivered to rural Medicaid populations.

  • Telestroke adoption, cost, and quality in hospitals in North Carolina
    Lead researcher: Christopher M. Shea, PhD, MA, MPA
    919-966-1938, chris.shea@unc.edu
    Project funded: September 2016
    Completion date: August 2017
    • This project examined hospitals in North Carolina to: 1) identify all hospitals serving as a telestroke originating site and summarize their structure, market, and community caracteristics; 2) compare these structural, market, and community characteristics to hospitals that do not provide telestroke; and 3) within a sample of telestroke originating sites, examine the influence of telestroke program characteristics and process measures on quality measures and costs, using a combination of secondary and primary data.

These were 2015-2016 projects.

  • Designing a study for collection of uniform measures by the Evidence-Based Telehealth Network Grant Program grantees
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2015
    Completion date: August 2016
    • FORHP funded six grantees through the Evidence-Based Telehealth Network Grant Program (EB TNGP) to implement and evaluate tele-emergency services in rural areas. The purpose of this project was to design study concepts whereby the EB TNGP grantees will be able to collect data on a uniform set of measures to help establish the evidence base for tele-emergency.

  • Launch of a study for collection of uniform measures by the Evidence-Based Telehealth Network Grant Program grantees
    Lead researcher: Marcia M. Ward, PhD
    319-384-3815, marcia-m-ward@uiowa.edu
    Project funded: September 2015
    Completion date: August 2016
    • Once study concepts were vetted, protocols were developed and this project launched a study where the EB TNGP grantees begin to collect data on a uniform set of measures to help establish the evidence base for tele-ED.

  • The impact of emergency telemedicine on timeliness, process of care, and clinical outcomes in rural North Dakota trauma care
    Lead researcher: Nicholas M. Mohr, MD, MS
    319-353-6360, nicholas-mohr@uiowa.edu
    Project funded: September 2015
    Completion date: August 2016
    • This project was a comparative effectiveness study of North Dakota trauma patients to measure the impact of telemedicine-enabled emergency care between 2008-2014 on: 1) time to arrival at definitive care; 2) diagnostic imaging performed in rural hospitals; 3) probability of transfer to tertiary trauma center; and 4) survival. This research measured the effectiveness of telemedicine to influence rural trauma care in a real-world application, and will provide data for a subsequent cost-effectiveness study.

  • Use of telehealth services among rural Medicaid enrollees: A baseline inventory
    Lead researcher: Andrew F. Coburn, PhD
    207-780-4435, andrew.coburn@maine.edu
    Project funded: September 2015
    Completion date: August 2016
    • This project used data from the Medicaid Analytic Extract (MAX) for 2011 to create a 50-state, baseline inventory of telehealth services provided to Medicaid enrollees in rural and urban settings. The project provided important information on the feasibility of using MAX data to study the effects of Medicaid telehealth policies on rural telehealth use and on the accessibility and quality of care delivered to rural Medicaid populations.