SCRHRC Releases New Report: Post-Acute Stroke Care Delivery for Rural Medicare Beneficiaries
Stroke is the fourth leading cause of death and the leading cause of long-term disability in the United States. Post-discharge care has been shown to be vital in preventing long-term morbidity and improving functionality and quality of life for stroke patients.The most appropriate post-discharge rehabilitation care (PDRC) setting for stroke patients depends on several factors including the patient'S clinical profile, patient preferences, provider recommendations, and proximity to available resources. Limited evidence suggests geographic as well as racial and ethnic disparities in receipt of PDRC. We sought to examine the following research questions... Click here to read the Finding Brief.
SCRHRC Releases New Report: Role of Free Clinics in the Rural Safety Net
This brief explores two issues. First, we examine where free clinics are located and describe their availability in rural counties across all 50 states. This information was derived from clinic listings on the website of the National Association of Free and Charitable Clinics (NAFC). Second, through telephone interviews with leadership at 14 of the 21 state free clinic associations, we explore issues facing free clinics during the current period of change. Issues examined include perceived changes in demand subsequent to implementation of the Affordable Care Act and different funding models and strategies used by free clinics. ... Click here to read the Finding Brief.
SCRHRC Releases New Report: Intensity of Service Provision for Medicare Beneficiaries Utilizing Home Health Services
Medicare pays for home health (HH) services for beneficiaries who are homebound or for whom travel for care would be difficult or detrimental to health. These HH services are paid on a per-episode basis with an episode consisting of all services provided over a 60-day period. Each episode or claim can entail a varying number of visits; payment is adjusted to account for large differences in the number of visits. Patients with ongoing problems can receive more than one episode of care.
SCRHRC Releases Releases Border Health Chartbook II
The forty-four U.S. counties in states that adjoin the border with Mexico (Arizona, California, New Mexico and Texas) share many health concerns with corresponding counties in Mexico. The U.S.-Mexico Border Health Commission established health goals for the region, in which eight of ten leading causes of death are the same across both countries.[1] Within the U.S. Department of Health and Human Services, the Office of Rural Health Policy is responsible for facilitating intra-agency border health activities and addressing collaboration across programs to leverage resources and services of the Health resources and Services Administration along the border. The chartbook presents a cross-sectional analysis of border counties, urban and rural, comparing these counties to other counties within the four border states and to rural and urban counties in the rest of the U.S.
SCRHRC Releases Differences in Case-Mix between Rural and Urban Recipients of Home Health Care Report
Home health care is both an important part of the care continuum for Medicare beneficiaries and a major program cost. However, little information about the actual health status and needs of the population receiving home health services has been published. Thus, the purpose of the analysis reported here is to provide a thorough, clinically based description of the health status and service needs of rural and urban Medicare home health patients based on a professional assessment of their condition at the start of care. The Centers for Medicare and Medicaid Services (CMS) requires that each home health care recipient be assessed at the start of care using a set of questions developed to reflect the specific needs of home health patients. Our report is based on a review of 1,468,465 unique beneficiary assessments from the 2010 Outcome Assessment Information Set (OASIS).
A Doctoral Student Was Awarded Excellent Poster Presentation at 2014 Southeastern Conference Symposium
Tushar Trivedi, an epidemiology doctoral student associated with the SCRHRC, was awarded first place in the graduate student "Excellence in Poster Presentation" competition at the SEC Symposium on Obesity, held in Atlanta in September.

Mr. Trivedi's poster was entitled "Obesity and Obesity-Related Behaviors Among Rural and Urban Adults in the United States
SCRHRC Releases Home Health Care Agency Availability In Rural Counties Report
We used Medicare Compare Home Health Agency files for 2008 to examine two aspects of home health care (HHC) across the U.S.: HHC agency availability and quality of services provided. Home health agencies are required to report the geographic areas they serve by ZIP Code; they are also required to report quality results across a range of 12 outcomes. This report is based on agency reports; we did not independently verify that services were actually provided within all listed areas.
SCRHRC Announces the Passing of its Founding Director, Dr. Michael E. Samuels
It is with deep sorrow that the South Carolina Rural Health Research Center announces the passing of its founding Director, Dr. Michael E. Samuels.

Dr. Samuels, subsequent to service with the US Navy, had an outstanding public health career and a pronounced effect on rural health across the US. Read our BLOG for more about Dr. Samules: Loss of a public health champion...
Dr. Jan Probst is a featured guest on an program of Carolina Business Review
Dr. Jan Probst, director of the S.C. Rural Health Research Center, is a featured guest on an program of Carolina Business Review, which airs on Educational TV.

The program, titled "Mental Health Policy in the Carolinas," airs in two parts. Now the aired programs are carried on YouTube -- Part 1:; Part 2, Please visit Arnold School news here for more details.

SCRHRC Responds to MedPAC Suggestion that Rural Medicare Supports Are Too Broad
In the November, 2013 issue of Health Affairs, Jeffrey Stensland and associates from the Medicare Payment Advisory Commission published an analysis of use of services by rural and urban Medicare beneficiaries The authors suggest that rural and urban beneficiaries generally have similar levels of access and satisfaction. Because of this approximate equality, they conclude that financial supports to rural providers are no longer broadly needed and should be restricted to specific target areas.

The SCRHRC believes that the conclusion that rural programs are no longer needed is based on flawed assumptions and does not fully consider all of the populations affected. Our response to the article by Stensland and associates is now available on the Health Affairs site [Link here]. While only one author is noted, all SCRHRC senior faculty participated in developing this assessment (Bennett, Glover, Martin, Probst).
SCRHRC Releases Racial and Rural Differences in Cervical Cancer Prevention and Control Practices Report
We examined differences in receipt of cervical cancer screening and HPV vaccination associated with residence and race/ethnicity. Data for the study were drawn from two nationally representative samples of medical practices, the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS).

Questions should be directed to Dr. Jessica D. Bellinger, PhD at

Click here to download the Report Summary, or here to download the full report.

SCRHRC Releases Dental Sealant Utilization Among Rural and Urban Children Report
We examined the proportion of rural children who have received dental sealants, thin plastic materials applied to the surface of the teeth to prevent or delay the development of dental decay. Our principal source of information was the Survey of Income and Program Participation (SIPP) of the Census Bureau (2001-2004 panel, the most recent SIPP version available when the project was initiated), which asked parents about children's teeth. To confirm findings based on parental report, we also examined dental results from the 2003-2004 National Health and Nutrition Examination Survey (NHANES), which are based on professional examination of children's teeth.

Key findings:
  • Similar proportions of rural (43.7%) and urban (43.0%) children had sealants.
  • Within racial/ethnic groups, rural white children were significantly less likely to have parentally reported sealants than were urban white children; there were no significant differences based on residence for black or Hispanic children.
  • Across racial/ethnic groups, white children (47.9%) were significantly more likely to have sealants than Hispanic children (35.3%) while black children were the least likely of all three racial/ethnic groups to report having sealants. Within rural children, 45.2% of white children, 35.6% of black children, and 39.3% of Hispanic children were reported to have sealants (not significantly different).
Children at greatest risk of subsequent decay because they lack dental sealants include minority children, children receiving public insurance or without insurance, and those from low-income and low-education households.

Click here to download the Report Summary, or here to download the full report.

Dr. Jan Probst Served As The Keynote Speaker At The Ninth Annual Jean Mills Health Symposium, March 1, 2013
Dr. Jan Probst, Director of the SC Rural Health Research Center, served as the keynote speaker at the ninth annual Jean Mills Health Symposium on March 1, 2013. The event, held at the East Carolina Heart Institute at ECU, was presented by the College of Allied Health Sciences in collaboration with the ECU Medical & Health Sciences Foundation and the ECU Office of Continuing Studies.

You can click here to watch the video broadcast event at ECU.

Dr. Nathan L. Hale Awarded Best Manuscript of 2012
The Editorial Board of Women's Health Issues is pleased to announce that the Charles E. Gibbs Leadership Prize for the best paper published in Women's Health Issues in 2012 (Volume 22) has been awarded to Nathan L. Hale, PhD, Research Assistant Professor, Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina. Dr. Hale'µŸ ž ןž  ™s manuscript, Postpartum Screening for Diabetes among Medicaid-Eligible South Carolina Women with Gestational Diabetes, was co-authored by Janice C. Probst, PhD, Jihong Liu, ScD, Amy Brock Martin, DrPH, Kevin J. Bennett, PhD, and Saundra Glover, PhD.
The Charles E. Gibbs Leadership Prize is awarded annually to recognize excellence in research on women's health care or policy. Priority is given to manuscripts that report the results of original research and that improve understanding of an important women's health issue. Members of the staff and Editorial Board of Women's Health Issues are not eligible. The prize includes a $1,000 award.
SCRHRC Releases Dialysis Availability in Rural America Report
End stage renal disease (ESRD), a potential consequence of diabetes, hypertension and other chronic conditions, leaves the individual in need of a kidney transplant or kidney dialysis to survive. Depending on their clinical condition and service availability, patients may receive hemodialysis, generally performed in a clinic, or peritoneal dialysis, which can be performed at home. We used the Medicare Dialysis Compare files, which contain information about dialysis facilities in 2008, and the Standard Analysis File of the US Renal Data System, which contains information about ESRD patients in 2008, to explore the availability of services in rural America. Our research questions were:
  • What is the current distribution of dialysis facilities, by characteristics and capacity, across levels of rurality?
  • How does the distribution of facilities compare to estimated need, defined as patients with ESRD?
  • How do dialysis facility performance measures compare across levels of rurality?

Click here to download the Report Summary, or here to download the full report.

SCRHRC Releases HIV/AIDS in Rural America Report:
This report examines two main subjects: the prevalence of HIV/AIDS in rural counties across 28 states in 2008, and the rural-versus-urban distribution of Ryan White providers. The latter provide care for uninsured and financially vulnerable individuals and serve nearly half of all persons living with HIV/AIDS in the rural United States. While many individuals receive care from other sources, the Ryan White Programs national scope and large service population make it good proxy for the availability of services for persons living with HIV/AIDS in rural counties.

Click here to download the Report Summary, or here to download the full report.

SCRHRC Releases Rural Border Health Chartbook:
The chartbook adds to existing knowledge regarding conditions in the border region by examining potential geographic and ethnic disparities among U.S. border residents. Our chartbook describes select indicators related to access to care, women's preventive services, oral health, infectious and communicable diseases and mental health that have been previously identified as serious disparities warranting programmatic and policy interventions. We examine these issues among residents of the four border states, Arizona, California, New Mexico, and Texas, comparing indicators by ethnicity (Hispanic vs. non-Hispanic), rurality (rural vs. urban), and proximity to border (border vs. non-border). Our findings should be useful in educating public health officials, policymakers and intervening organizations such as the United States Border Health Commission, the Office of Rural Health Policy, and the National Rural Health Association.

Click here to download the Report Summary, or here to download the full report.

Visiting Rural: Celebrating National Rural Health Day at ECH:

The SCRHRC staff went all out for National Rural Health Day (November 15, 2012) - all the way out to Edgefield, SC to join the South Carolina Office of Rural Health and an assortment of others in celebrating at Edgefield County Hospital, a Critical Access Hospital, which was definitely in a rural community. Continue reading through SCRHRC's Blog: Visiting rural, lots of us >>

In addition, here are some highlights from the local media: National Rural Health Day Celebrated At ECH.

ORHP Announces Seven Rural Health Research Centers for 2012-2016

The Federal Office of Rural Health Policy has announced seven Rural Health Research Centers (RHRCs) for 2012-2016, not six as we reported on Wednesday. The amended and complete list, including the RUPRI Center for Rural Policy Analysis, follows:

  • Maine Rural Health Research Center
    Institution: University of Southern Maine
    Director: David Hartley, PhD, MHA
  • North Carolina Rural Health Research Center
    Institution: University of North Carolina
    Director: G. Mark Holmes, PhD
  • RUPRI Center for Rural Policy Analysis
    Institution: University of Iowa
    Director: Keith J. Mueller, PhD
  • Rural Health Reform Policy Research Center
    Partner Institutions: University of North Dakota; NORC Walsh Center for Rural Health Analysis
    Director: L. Gary Hart, PhD
  • South Carolina Rural Health Research Center
    Institution: University of South Carolina
    Director: Janice C. Probst, PhD
  • University of Minnesota Rural Health Research Center
    Institution: University of Minnesota
    Director: Ira Moscovice, PhD
  • WWAMI Rural Health Research Center
    Institution: University of Washington
    Director: Eric H. Larson, PhD

For more informaiton, please visit Rural Health Research Gateway at

Doctoral Candidate, Samuel D. Towne, received two national awards for original research at APHA 2012

The awards included:

2012 Medical Care, American Public Health Association: Student Paper Presentation Award for the abstract "Electronic Health Record Use among Residential Care Facilities: National Estimates" (authors: Samuel D. Towne, MPH, CPH; Janice C. Probst, PhD & Zhimin Chen, MS)

2012 Aging and Public Health Section, American Public Health Association: Rural and Environment Research Award for the manuscript "Poorer Quality Outcomes of Medicare-certified Home Health Care in Areas with High Levels of Native American/Alaska Native Residents" (authors: Samuel D. Towne, MPH, CPH; Janice C. Probst, PhD; Jordan Mitchell, PhD; & Zhimin Chen, MS)

In addition, he was awarded the 2012 Phi Kappa Phi Love of Learning Award for his doctoral studies by Phi Kappa Phi National Honor Society.


Dr. Jan Probst, director of the South Carolina Rural Health Research Center, describes results of a Center study examining mortality differences between rural and urban adults.

For more SCRHRC's videos, watch us on
State Policy Levers for Addressing Preventive Dental Care Disparities for Rural Children: Medicaid Reimbursement to Non-Dental Clinicians for Fluoride Varnish and Dental Hygiene Supervision in Primary Care Safety Net Settings
Previous work has found that rural children are less likely to receive preventive dental services or any dental services at all, during the year than are urban children. The children’s oral health care safety net can be characterized in terms of the settings in which care is offered, the clinicians who offer it, and the sources of payment. In this report we examine two questions:
(1) To what degree have states expanded access to and reimbursement of fluoride varnish applications by allowing non-dental clinicians to provide this service?
(2) To what extent can dental hygienists provide select preventive dental services in primary care safety net settings without supervision or under general, indirect, or public health supervision?
Click here to download the Report Summary, or here to download the full report.
Health Outcomes Among Children and Families Living in Rural Communities Conference webcast
The Center for information Technology at National Institutes of Health will videocast Health Outcomes Among Children and Families Living in Rural Communities Conference, December 1-2, 2011. You can click on the picture below or this link to the NIH VideoCasting and Podcasting Website for these seminars.
The SC Rural Health Research Foundation recently sent four of our graduate students and one research assistant professor to the American Public Health Association Annual Meeting in Washington, DC.

Students Deshia Leonhirth, MBA; Jordan Mitchell, MBA; Kristin Schuller, MHA; and Samuel Towne, MPH, CPH attended and participated in the poster presentations to include the topics of HIV, Maternal and Child Health, and Home Health. In addition, Jessica Bellinger, PhD, participated in a Cancer Forum session and served with Elena Ong as an organizer for an invited Women's Caucus session. See more on Dr. Bellinger's panel below.

Dr. Jessica Bellinger, Program Chair of the Women's Caucus, organized an APHA special invited session, "Women's Health in All Policies," with Elena Ong, a Caro Executive Fellow
Moderated by Adriane Casalotti, Health & Women's Policy Advisor, Office of Congresswoman Lois Capps, the panelists were Avra Siegel of the White House Council on Women and Girls; Marcia Greenberger, JD, National Women's Law Center; Heidi Hartmann, PhD, Institute for Women's Policy Research; and Alina Salganicoff, PhD, Kaiser Family Foundation.

L-R: Kim Dauner (WC Policy Chair), Sarah Gareau (WC Co-Chair), Jessica Bellinger (WC Program Chair, Session Organizer), Alina Salganicoff (Vice President & Director of Women's Health Policy, Kaiser Family Foundation), Adriane Casalotti (Health & Women's Policy Advisor, Office of Congresswoman Lois Capps), Marcia Greenberger (Co-President, National Women's Law Center), Heidi Hartmann (President, Institute of Women's Policy Research), Elena Ong (Session Organizer).
Higher Risk Of Death In Rural Blacks And Whites Than Urbanites Is Related To Lower Incomes, Education, And Health Coverage - Health Affairs October 2011
The South Carolina Rural Health Research Center at the Arnold School of Public Health, the University of South Carolina is pleased to announce the publication of Higher Risk Of Death In Rural Blacks And Whites Than Urbanites Is Related To Lower Incomes, Education, And Health Coverage in the October 2011 issue of Health Affairs. The authors on this article are Dr. Janice C. Probst, Dr. Jessica D. Bellinger, Dr. Katrina M. Walsemann, Dr. James Hardin, and Dr. Saundra H. Glover. This article which documents research into rural disparities in mortality is funded by the Office of Rural Health Policy.
The following link will direct you to the article's abstract on Health Affairs website:
Health Status in the Delta: Comparisons to other urban and rural U.S. Residents
In this Fact Sheet we examined geographic differences in health behaviors, access to care, receipt of appropriate preventative services, and quality of diabetes care among residents in the Delta region. We compared their findings to non-delta urban and non-delta rural. Data from the 2005 Behavioral Risk Factor Surveillance System was linked with the 2008 Area Resource File for the analysis.
Click here to download the Fact Sheets.
Jordan Mitchell, Health Services Policy and Management/PhD:Jordan's dissertation, "Association between Clinical Decision Support Systems and Healthcare Disparities" has been funded by the Agency for Healthcare Research and Quality (AHRQ).
This dissertation encompasses two major health services research topics, being health information technology along with health disparities. By integrating health information technology research with examinations of healthcare quality disparities, this dissertation will offer an innovative direction for addressing disparities in care based on race and area of residence. His dissertation committee consists of: Dr. Janice Probst (chair), Dr. Amy Martin, Dr. Kevin Bennett, Dr. Saundra Glover, and Dr. James Hardin. Jordan plans to defend his dissertation in February, and graduate in May.
"New! " Handling the Handoff: Rural and Race-Based Disparities in Post Hospitalization Follow-up Care Among Medicare Beneficiaries with Diabetes"
Diabetes is one of the most common chronic diseases, affecting an estimated 23.6 million people in the United States (7.8% of the total population). Rural African American and Hispanic residents with diabetes are less likely to exhibit good control of their condition, putting them at greater risk for the consequences of this disease, such as kidney failure, blindness and amputation. Effective outpatient care is key to diabetes management.

Absence of such care, conversely, may play a role in poorer diabetes control in rural areas. The present report uses information regarding Medicare beneficiaries with diabetes to examine the provision of care in rural America. It provides estimates of hospital admission rates for rural Medicare beneficiaries with diabetes, tracks the proportion of patients who receive adequate outpatient care post discharge, and assesses subsequent readmissions to the hospital. It also explores the potential for race-based disparities in care for diabetes.
Click here to download the executive summary, or here to download the full report.
Sunday, April 24, 2011, In memoriam

pictureThe faculty and staff of the South Carolina Rural Health Research Center mourn the passing of Rosemary McKenzie, minority health liaison and program services manager at the National Rural Health Association (NRHA). Rosemary had been part of the South Carolina family since our Center was founded in 2000. As an advocate for rural minority health, Ms. McKenzie served on our national advisory workgroup from 2000 until her recent death. Her passion for populations often lost in the majority white demographics of rural America kept us honest and engaged. Over the years, we used Rosemary's guidance as we developed our multiple presentations for the annual NRHA Rural Multiracial and Multicultural Health conferences, as well as for NRHA's annual conference. We remember Rosemary as a spirited, stylish woman whose energy lit up every room she entered. If the Father's house has many mansions, we are assured that she is lighting those up, as well.

Picture: Rosemary at a meeting in the South Carolina Rural Health Research Center, 2004.
"New! " Diet, Physical Activity and Sedentary Behaviors as Risk Factors for Childhood Obesity: An Urban and Rural Comparison
Previous research found that rural children, paradoxically, were more likely to be overweight or obese and more likely to be physically active than urban children. The current report expands on prior work by using information from the 1999-2006 NHANES.
Click here to download the executive summary, or here to download the full report.
"New!" Is Your Hospital's Board Prepared to Govern? Rural Acute Care Hospital Boards Of Directors: Education and Development Needed
We found that many rural chairs and CEOs lacked full confidence in their board's ability to conduct its oversight and governance functions effectively.
Click here to download the executive summary, or here to download the full report.
"New! Dr. Jan Probst leads the Alma Mater at the hooding ceremony for the Arnold School of Public Health held on May 6th, 2010
Over the years one of the University's most revered tradition has arisen of raising the right hand, with fingers cupped, when the phrase "Here's A Health, Carolina" occurs, as if offering a toast.
Click here to see the larger photo.
Rural residents lag in preventive services use; Lag increases with service complexity
This research brief describes the receipt of preventive services among rural adults and explores the factors that are related to disparities in utilization.
Click here to see the preventive services policy brief.
The South Carolina Rural Health Research Center is pleased to announce an on-line email process for subscription to the SC Rural Health Research Center List Serve.
To subscribe: send an email with no subject and no signature to The body of the email should read SUBSCRIBE SCRHRC-L yourfirstname yourlastname.
Click here to see the details.
" 'New!' Health Disparities: A Rural-Urban Chartbook, is now available for download
This chartbook presents information on health, health behavior, and preventive services use indicators across rural America, with detailed information for white, African American, Hispanic, American Indian, and Asian/Pacific Islander populations.
Click here to download the executive summary, or here to download the Health Disparities  Chartbook.
"New! " The SCRHRC has started a blog to keep folks informed of news and events that might not be big enough for a formal release
If you wish to track our goings-on and thoughts, and add your own commentary, visit
Click here to visit our blog.
Although children’s dental health in the U.S. has improved over recent decades, a subset of children continues to suffer dental disease severe enough to constitute a public health problem. SCRHRC is publishing a Chartbook about this issue.
Click here to download the executive summary, or here to download the Oral Health Chartbook.
The National Rural Health Association has named SCRHRC scientist Dr. Janice Probst its 2008 Outstanding Researcher.
Click here to see the details.
Dr. Amy Brock Martin has been named 2008 Rural Educator of the Year and president-elect of the S.C. Rural Health Association.
Click here to see the details.
As the nation's first report on obesity and physical inactivity among rural youth, the Center's study shows that children living in rural areas are more likely to be overweight or obese than their urban peers.
Click here to see the details.
Click here to download the executive summary, or here to download the  Obesity Chartbook.
Documentary film-making: Dr. Amy Martin, Deputy Director of the SC Rural Health Research Center, collaborated with Susan Hogue, instructor in Media Arts in the College of Arts and Sciences, University of South Carolina, to bring a new look to rural studies.
Click here to preview the documentary.
Special guests: Dr. Oscar Lovelace, a family physician from Newberry County SC, spoke on emerging rural health issues at the SCRHRC Annual Rural Health Grand Rounds on September 27, 2006.
Click here to view the picture.
Dean of the Arnold School of Public Health, Dr. Donna Richter,  shakes hands with Cocky, the USC Mascot and this year’s Special Guest at the Annual Open House.
Click here to view the photo gallery.
Maps of simulated "Katrina-level" hurricane event damage in South Carolina were created from hurricane wind models using ArcGIS 9.1.
Click here to view the maps.
Dr. Janice Probst, Center Director, and Jessica Bellinger, a graduate student staffer, contributed two presentations to the Leadership Summit on Eliminating Racial and Ethnic Disparities in Health, sponsored by the Office of Minority Health, USDHHS.
Click here to view the pictures.
We are now providing an Online Report Request System!
You can choose either paper or electronic copy for the full report you need. we will send out the requested report to you via postal mail (paper copy) or email (electronic copy) within 7~10 days.
This service had been stopped.
USC President Dr. Andrew Sorensen visits the South Carolina Rural Health Research Center for our open house, and sings with the GameChords, USC’s own barbershop quartet.
Click here to view the picture.
Special guests: USC President Dr. Andrew Sorensen, Dr. Michael Samuels, Dean Donna Richter, and more joined us for Open House on September 19, 2005.
Click here to view the photo gallery.
Dr. Samuels lectures at the first of the Rural Health Grand Rounds educational series, being initiated by the SCRHRC. The topic: "The History, Evolution, Current Status and Issues of Community Health Centers".
Click here to view the presentation PowerPoint file.