Policy Perspective: Rural Health
A recent brief by KFF describes five key takeaways from the $50 billion Rural Health Transformation Program (referred to here as the “rural health fund”) Notice of Funding Opportunity that was recently released. The brief includes information about how CMS intends to review state applications and distribute funds and ongoing questions about the impact on rural hospitals, the distribution of funds across rural hospitals and states, and issues related to oversight and transparency. The rural health fund was established by the tax and spending reconciliation law of 2025. It was created to help offset the impact on rural areas of the law—particularly given ongoing concerns about the financial vulnerability of many rural hospitals and reports of hospital closures.
Several IHPS faculty study rural health access. Susan Chapman, RN, PhD, FAAN, and colleagues have studied telehealth access by rural residents, often considered a method to reduce rural health shortages and disparities. Their findings substantiate concerns of rural telehealth access disparities, particularly among patients who are older, of minoritized race or ethnicity, and Spanish-speaking. Tracy Lin, PhD, and colleagues conducted a cost analysis to evaluate the cost of a rural mobile health clinic (MHC) and a time motion study (TMS) to assess human resource allocation across different rural communities. Their findings present an understanding of how MHCs operate differently with different patient populations. Additionally, their study provides insight into the impact of a community-health worker within a community-based intervention.
| | IHPS FACULTY SPOTLIGHT CONVERSATION | | |
"I hope if it's feasible and effective, this intervention (pairing follow up from a crisis call center to youth who are treated at an ED with suicide risk) can be expanded to all of the different areas where a crisis call center already exists. So that means it would reach potentially youth that are even at higher risk - who live in a rural communities or areas that really don't have any access to a pediatric mental health provider."
Ashley Foster, MD is an Assistant Professor in Emergency Medicine and Pediatrics in the Department of Emergency Medicine and Division of Pediatric Emergency Medicine. She practices both general emergency medicine as well as pediatric emergency medicine at Zuckerberg San Francisco General Hospital and UCSF Benioff Children’s Hospital Mission Bay. Her research interests are improving the care of children and adolescents in behavioral health crisis within the emergency department setting as well as outside of acute care settings. She is currently investigating a collaborative follow-up contact intervention between a local crisis center and the emergency department for youth at increased risk of suicide.
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What are you currently working on?
Right now, I'm ramping up efforts to study how burnout is impacted by the use of a Clinical Assistant to enhance and streamline discharge workflows for our UCSF Hospitalists at Parnassus. I'm also tying up quality improvement manuscripts summarizing findings of a chart review project evaluating 6 years of "Against Medical Advice" discharges, and decreasing the use of stigmatizing language. We're completing qualitative interviews of nurses and physicians evaluating how psychological safety can be improved for these events in clinical practice. Finally, I'm also drafting a manuscript exploring harm assessment scores in diagnostic error evaluations and working on a rapid qualitative evaluation of safety in the diagnostic process, informed by focus groups of hospitalists across the country.
What drew you to work on this?
I enjoy working on projects that are close to clinical questions I consider on-shift every day. I especially enjoy emphasis on areas related to possible litigation against hospital-based clinicians (discharge, against medical advice discharge) and regulatory aspects of hospital-based practice (diagnostic error).
What's next?
Once I have these projects squared away, I'm hoping to conduct a qualitative study of how hospitalized patients use MyChart while hospitalized to communicate about their health and understand what is happening during their hospitalization. After we are done with our qualitative evaluation of against medical advice discharges, we hope the results can inform quality improvement efforts as well as policy change to support marginalized patients who are especially vulnerable to systemic pressures to discharge before they are medically ready to do so.
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Sophie Morse, PhD, Jennifer Yarger, PhD, Marissa Raymond-Flesch, MD, MPH, and Cynthia Harper, PhD, published "Intimate Partner Violence and Delays in Obtaining Contraception Among Young People in California and Texas", in Contraception. They found young women experiencing intimate partner violence (IPV) across states with widely divergent reproductive policies, California and Texas, were significantly more likely to delay obtaining contraception they thought they needed. Community outreach for trauma-informed IPV screening and accessible SRH services can mitigate these delays and address salient health equity needs across state policy contexts.
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| |  | Sara Ackerman, PhD, MPH, and colleagues published "Should a Genomic Diagnosis be a Ticket or a Roadmap? Threats to Equity in the Pursuit of Developmental Services in Early Childhood", in The American Journal of Bioethics. They concluded that treating a genomic diagnosis as only a “ticket” to developmental services carries the potential to create new disparities due to deep flaws in current systems of care and limited resources for early childhood services. They share three recommendations that would prevent or lessen such disparities: 1) increase funding for early childhood services, 2) improve family navigation and advocacy skills, and 3) build an evidence base linking genetic diagnoses with knowledge about developmental trajectories and early intervention outcomes. By enabling a genomic diagnosis to serve as a roadmap rather than merely a ticket, we can move toward a world in which children, families, and service providers can work within efficient service systems to achieve their fullest potential.
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Julie Ann Sosa, MD, MA, FACS, and colleagues published "Health Care Utilization Following the Adoption of U.S. Paid Sick Leave Mandates: A Cohort Study Using Health Insurance Claims Data",in The Lancet Regional Health - Americas. The U.S. is one of the only developed countries in the world without a federal requirement that employers provide paid sick leave (PSL) to workers. The researchers evaluated the association between state and local PSL mandates and health care utilization among U.S. workers.Their findings provide robust evidence that PSL mandates increase healthcare utilization, especially among workers in industries with lower pre-mandate PSL coverage. This evidence suggests that PSL may help reduce barriers to healthcare and encourage care-seeking among workers who might otherwise forego medical visits.
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Dan Ciccarone:
(The Voice of San Francisco)
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Alicia Fernandez:
(Bioengineer.org)
| | | Remembering Drummond Rennie | | |
Drummond Rennie, former IHPS faculty member, among many other roles, died on September 12, 2025. He was a JAMA editor for 30 decades and is remembered in this JAMA article.
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Philip R. Lee Fellowship Fund | Since its founding 50 years ago, IHPS has been dedicated to training the next generation of leaders in interdisciplinary research to solve our most important health policy issues. In celebration of our 50th anniversary and to honor our founders, Phil Lee and Lew Butler, we established an endowment fund for the Philip R. Lee Fellowship. We hope to continue to keep this fund and our fellowship program robust. | Photo: Kim Felder Rhoads, MD, MS, MPH & Fellow for 2007-2008 with Philip R. Lee, MD, Founder of the Institute for Health Policy Studies |
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