The Center for Health Policy Analysis and Rural Health Research (the Center) is a conduit of information concerning emerging issues in public health and health services so that UNMC researchers can be competitive for funding, and policy makers can be better informed. The research areas of the Center have included (but are not limited to):
- Public Health Services and Systems Research (PHSSR)
- Health Care Workforce
- Rural Health Care Providers
- Access to Health Care
- Economic Analysis
- Evaluation Research
- Veterans Administration (VA) Research
- UNMC/DHHS Public Health Joint Data Center
- Comparative Effectiveness Research
- Health Disparities Research
- Training doctoral students
Public Health Services and Systems Research (PHSSR). In 2008, the Center’s researchers (Dr. Li-Wu Chen as the PI) were awarded a two-year grant through the Robert Wood Johnson Foundation (RWJF) to assess the benefit, challenges, and performance of Nebraska's regional public health agency model. This initial grant examined and highlighted the infrastructure and experiences of Nebraska's regional local health departments, and laid the foundation for future work in the years to come. Since the completion of that initial project, the Center has continuously secured funding from the RWJF to conduct studies in PHSSR.
One project in particular, the Nebraska Public Health Practice-Based Research Network (PBRN), a core project in the Center, was initially funded by the RWJF in 2009. The Nebraska Public Health PBRN is co-directed by Li-Wu Chen, PhD, MHSA, professor and chair of the Department of Health Services Research and Administration, and David Palm, PhD, the former administrator of the Office of Community and Rural Health at the Nebraska Department of Health and Human Services and currently an associate professor in the Department of Health Services Research and Administration. The executive steering committee includes representation from the UNMC College of Public Health, the Nebraska Department of Health and Human Services, the Public Health Association of Nebraska, the National Association of Local Boards of Health, Nebraska Association of Local Health Directors, and several local health departments across the state.
The PHSSR research conducted by the Center and under Dr. Chen’s leadership, thus far, has systematically examined important issues related to regional and rural public health systems, including workforce capacity, governance, partnership building, resource allocation, quality improvement maturity, strategies, and cost, and accreditation readiness and strategies of public health departments. Center faculty and staff have engaged and collaborated with the Nebraska Department of Health and Human Services (DHHS) and many local health departments in these studies. The Center also collaborated with Colorado Public Health PBRN and Kansas Public Health PBRN in a two-year study (also funded by the Robert Wood Johnson Foundation) to examine the relationships among state’s investment, local health department’s quality improvement maturity and accreditation readiness, and public health services delivery. The results from these PHSSR studies have been widely disseminated to local health departments and the public health PBRNs in other states through the RWJF’s National Coordinating Center for PBRN.
Health Care Workforce. The Center has conducted several workforce planning and/or assessment projects covering the areas of primary care, nursing, pharmacy, allied health, mental health, dental health, and public health. The Center’s collaborators in these workforce projects have included faculty from UNMC’s College of Nursing, College of Allied Health Professions, and College of Dentistry, and from the Nebraska Behavioral Health Education Center (BHECN). In 2009, a comprehensive report was published and widely disseminated in the state and nationally, serving as a blueprint for health care workforce planning for policymakers and educators in Nebraska.
Rural Health Care Providers. Through a grant from the Federal Office of Rural Health Policy (FORHP), the Center researchers has conducted studies to estimate national and regional rural hospital charges due to ambulatory care sensitive conditions (ACSCs). In another FORHP-funded project, Center researchers examined the decision-making process of electronic health records adoption among rural health care providers. In addition, the Center collaborated with the Lewin Group to conduct a study to assess the effect of Performance Improvement Assessment on the financial performance of selected hospitals in the Delta Rural Hospital Performance Improvement Project.
Access to Health Care. In collaboration with the Health Management Associates, the Center conducted a study to comprehensively describe the demographic and socioeconomic characteristics of the insured, underinsured, and uninsured populations in Nebraska. Funded by the Nebraska Department of Insurance, this project intended to inform the design and development of a health exchange program in Nebraska required by the Affordable Care Act. In another study, the Center analyzed the out-migration of hospital inpatients from Wyoming to Colorado, Utah, and Nebraska. The project was funded by the Wyoming Health Care Commission. In addition, the Center conducted a study to examine inpatient hospital service utilization of the uninsured in Nebraska, informing policy discussions to address uncompensated care in Nebraska.
Economic Analysis. The Center has conducted analyses to examine the return-on-investment (ROI) of implementing electronic medical record systems for rural health care providers, including physician clinics and critical access hospitals (CAHs) in Nebraska. The Center has also conducted ROI analyses for the programs of the Nebraska DHHS, including the Every Woman Matters Program and the Tobacco Quitline Program. In addition, the Center has continuously provided support in economic analysis (e.g., cost-effectiveness analysis) to UNMC faculty in their grant applications and funded research projects.
Evaluation Research. The Center has conducted evaluation research for Nebraska DHHS programs such as the Nebraska State Rural Hospital Flexibility Program (funded by the US Health Resources and Services Administration (HRSA)), including analyzing the program effect on rural hospitals, assessing the program impact on utilization of health care services by rural residents, and evaluating the administration of the program. In addition, the Center has provided extensive services in program evaluation to community-based program initiatives, including Activate Omaha Kids, Communities Putting Prevention to Work, and the Community Transformation Grant. On behalf of Alegent Health, the Center conducted a study to evaluate the implementation and impact of a medical home pilot project on Alegent’s patient and provider experience.
Veterans Administration (VA) Research. The Center has collaborated extensively with researchers at the Nebraska-Western Iowa VA Health Care System. In particular, several VA-funded studies have been conducted to examine the barriers and enablers of effective dual care for rural veterans.
UNMC/DHHS Public Health Joint Data Center. Funded by the Centers for Disease Control and Prevention, the Center has collaborated with the Nebraska DHHS in establishing and co-directing a joint center for public health information and analysis. By combining resources from both organizations, this joint data center enhances the state’s capacity to (1) coordinate data collection and reduce major gaps, (2) develop an integrated web-based data system and improve the level of data analysis, and (3) increase the dissemination of data through dashboards and other mechanisms.
Comparative Effectiveness Research. Center faculty collaborated with UNMC College of Medicine faculty to examine outcomes and costs of care for elderly pancreatic cancer patients. Center faculty also assisted with conducting an evaluation of mortality statistics for The Nebraska Medical Center for 2007 to 2010. Another project conducted by Center faculty was a study of end-of-life care for cancer patients (in collaboration with faculty in the COPH Department of Epidemiology). Center faculty members have continuously collaborated with UNMC faculty on various outcomes research projects by contributing their expertise in health services research.
Health Disparities Research. Center faculty conducted a study (funded by the National Cancer Institute) to examine the community context of racial disparities in colorectal cancer screening. In addition, Center researchers conducted a project to support the Nebraska Cancer Coalition’s efforts to plan and implement their community activities. In another project funded by the Nebraska DHHS, Center researchers examined the association between socio-demographic characteristics and pediatric cancer hospitalizations.
Training doctoral students: Through participating in the Center’s research projects, the graduate students in the PhD program in Health Services Research, Administration, and Policy as well as in other UNMC PhD programs have obtained valuable experience in health services research, including in research design, data collection and analysis, publication development, and research dissemination. Therefore, the Center has played a critical role in training UNMC doctoral students in the area of health services research and rural health research.