Rural Healthcare Research

As a multidisciplinary Center, our researchers are studying various aspects of rural healthcare. The following research programs are currently underway.

Community-Based Participatory Research: Prevention and Screening

Understanding Rural Patient and Provider Preferences for Mobile Lung Cancer Screening Clinics

Project lead: Rian Hasson, MD, MPH

Mentors: Steven Bernstein MD; Konstantin Dragnev, MD

The primary objectives of this proposed study are to:

  • Identify provider and population barriers and facilitators that predict referral to, and utilization of, Lung Cancer Screening (LCS) in rural spaces
  • Assess the feasibility and acceptability of mobile clinics for screening
  • Test a mobile unit intervention


Despite the fact that outcomes are best when treatment is given in the early stages of lung cancer, less than 6% of eligible high-risk people who need medical care participate in LCS, with even lower participation in rural populations. Data from the National Lung Screening Trial (NLST), a multi-institutional randomized controlled study of over 50,000 people, demonstrated the utility of LCS by comparing low-dose computed tomography (CT) with chest X-ray. It found that LCS with low-dose CT was associated with a 20% reduction in lung cancer-specific mortality, as well as an overall mortality reduction of 6.7%.

Many organizations have subsequently published guidelines supporting annual LCS. Nevertheless, 10 years later, despite multiple studies confirming the results of the NLST, and revised guidelines based on continued research into its efficacy, low-dose CT is still underutilized, and a disproportionate number of high-risk people are either not referred or do not undergo screening.

While the reasons for this are multifactorial, the need to better understand the current rural screening landscape, and rural provider and population barriers leading to low participation, is imperative to resolve this public health dilemma. Additionally, given these hard-to-reach locations, the use of a community-based approach is vital to developing an intervention that would be well-utilized.

This study seeks to deliver LCS designed to reduce logistical and psychosocial barriers. In rural areas, a mobile unit should be feasible and acceptable to people who need medical care and to providers, and may serve to supplement traditional hospital or clinic-based screening. Based on the success of mobile breast and cervical cancer screening programs, the research team seeks to determine whether a mobile unit will be more successful in increasing screening in rural areas than a traditional hospital-based approach.

Findings from this study will aid in the development of a scalable, feasible intervention acceptable to people who need medical care and to providers in rural areas to improve LCS. Further, by understanding the needs of rural communities and enhancing opportunities for LCS closer to home, earlier detection, prompter treatment, and improved cancer outcomes can be achieved.

Digital Health Utilization Research: Remote access and care

Identifying Disparities in Care of Rural Patients with Cardiac Implantable Electronic Devices

Project lead: Emily Zeitler, MD, MHS

Mentors: James O'Malley, PhD, MS; Mark Creager, MD

With the guidance of the community, this work incorporates mixed methods to:

  • Better understand barriers and facilitators of Remote Monitoring (RM) in rural areas
  • Identify geographic disparities in Cardiac Implantable Electronic Devices (CIED) care
  • Exploit variation in RM referral networks to understand characteristics associated with optimal CIED care in rural areas


People who need medical care in rural settings have significantly worse outcomes from cardiovascular conditions compared with those in non-rural settings, including treatment of arrhythmias with a CIED, like a pacemaker or defibrillator. These ubiquitous implantable devices store copious amounts of medical information related to device function and disease progression, among other items.

These data are available to treating physicians and other clinicians through RM, which relies on wireless connectivity between people who need medical care, a remote server, healthcare facilities and treating physicians. Monitoring of people who need medical care with a CIED through this RM paradigm as an adjunct to periodic in-person evaluations has been associated with a variety of improved outcomes over in-person evaluations alone, ranging from improvements in individual satisfaction to decreased mortality. Thus, RM is unequivocally recommended in combination with in-person evaluations. While known disparities in RM exist among the uninsured and elderly, the geographic distribution of RM remains unstudied.

A number of factors suggest that RM of CIEDs may be particularly vulnerable to geographic disparities. For one, people who need medical care in rural areas face greater barriers to connectivity, including less access to high-speed internet and less-consistent cell phone coverage. These barriers couple with the challenge of greater geographic distances that must be traveled to access in-person subspecialty services, a necessary aspect of CIED care.