Research

Link

A complete list of my academic publications may be found in my Google Scholar profile or on my CV.

My research focuses on rural health systems. In my work, I aim to challenge the dominant thinking on rural health challenges and disparities. Instead, I hope to question the assumptions upon which these deficit-oriented views are based and to suggest ways in which alternative points of view can be integrated into health services knowledge systems.

Throughout my research career, I hope to explore and expand our understanding of the ways in which structural urbanism impacts rural health. Structural urbanism refers to the idea that urban assumptions, norms, and conditions are built into the foundations and structures of our health system. Rural organizations and communities deviate from these assumed (urban) norms to varying degrees, which complicates their efforts to sustainably and equitably deliver health care services. 

This page highlights some of my current and recent research endeavors with a focus on the outputs and impacts of my work. Since my research is frequently locally situated and applied, the outputs and impacts are often found outside of traditional academic channels. 

🌱Ongoing Doctoral Research: Exploring Urbanist Ideology in Rural Hospital Strategic Decision-Making

Description 

My doctoral research explores the ways that urbanist ideology shows up in rural hospital strategic decision-making. I am examining the literature about rural hospital mergers with a larger health network to understand whether affiliation with a system impacts the types of knowledge that are used in considering health services delivery changes.

Health services provision in rural areas is complicated by geographic, economic, and social factors. The post-Affordable Care Act healthcare landscape has seen a strong trend towards health system consolidation. Despite a decade of increasing incidence, relatively little research has been reported regarding the reasons for and outcomes of rural hospital mergers. The evidence that does exist reflects a mix of positive and negative impacts. What the literature does and does not say about the effects of rural hospital affiliations on the acquired hospitals and their communities reflects dominant ideas about what knowledge is worth knowing and sharing. 

This work expands the nascent field of structural urbanism by uncovering epistemic blind spots in the literature and in health systems management and practice. Structural urbanism in healthcare is currently understood as “emerging from a focus on individuals rather than infrastructure when designing health care and public health interventions” (Probst et al., 2019). This study seeks to deepen our understanding of this phenomenon by uncovering the taken-for-granted assumptions about and orientation towards rural experience and knowledge that underpin and uphold the dominant urban view of how health care should be.

Funding/Support

My doctoral research is funded in part through a Social Sciences and Humanities Research Council (SSHRC) Joseph-Armand Bombardier Canada Graduate Scholarship. I am supported by my supervisors, Dr. Agnes Grudniewicz and Dr. Suhaib Riaz.

Outputs

Discovering Diversity in Rural New York State

Description

The New York State Association for Rural Health (NYSARH) serves an advocacy and education role for rural health communities throughout New York State. The rural-urban dimension of health equity has always been our primary concern. NYSARH's core work is to advocate for the interests of rural New York health communities and to provide education to better support rural health needs. 

As we evaluate our health equity work going forward, we acknowledge that we serve the majority of our stakeholders well, but that there are hidden intersectional dimensions of inequity that affect rural New Yorkers. Our organization has begun to look at the diversity characteristics of our stakeholders, our members, and our board to better understand our gaps. Are there sub-populations within New York State that merit better representation at NYSARH? Our most pressing question to broaden our health equity work to be more inclusive is, "What does diversity look like in rural New York State?"  

I led a partnership with Common Ground Health to analyze US Census and American Community Survey data for New York State and to create an intuitive interface for this data for use by our stakeholders. The NYSARH Diversity Dashboard provides map-based visualizations of data related to demographics, socioeconomics, and determinants of health for our rural coverage area. Ongoing and future work with this data will highlight areas of opportunity for NYSARH to expand its educational and health equity advocacy services and to new recruit members and board members from currently under-represented groups. 

Funding/Support

This project is funded by the National Rural Health Association (NRHA) through a State Rural Health Association Health Equity Pilot Grant. The support for this initiative comes through a subaward from HRSA/HHS/FORHP U16RH03702: Technical Assistance Pilot Award for Best Practices and Community Development.

Outputs

Impact

Rural Research and Advocacy Projects

Description

The New York State Association for Rural Health (NYSARH) serves an advocacy and education role for rural health communities throughout New York State. In fall of 2022, I led the development of a Research and Policy Fellowship modeled on the NRHA Rural Health Fellows program. Fellows select a timely topic that is aligned with the annual policy priorities of NYSARH. During the first half of the program they research their issue and write a Research Brief. In the second half of the year, they identify policy levers and allies related to their issue and produce a Policy Brief. 

Funding/Support

This project is supported by New York State Association for Rural Health (NYSARH) We are seeking additional funding to support the further growth and development of the program.

Outputs

Impact

NRHA Fellowship on Rural Health Workforce

Description

In 2021-22, I was named a National Rural Health Association Rural Health Fellow. Teammates Dr. Whitney Zahnd, Dr. Courtney Burgin and I were challenged to develop a policy brief identifying policy levers related to the rural health workforce and setting a five-year agenda for workforce policy research and advocacy.  

Funding/Support

This work was unfunded, but supported by the National Rural Health Association Rural Health Fellows program. We also acknowledge the support and contribution of Carrie Cochran-McClain, NRHA Chief policy officer.  

Outputs

Impact

Health Workforce Strategies in the COVID Pandemic

Description

From the earliest days of the COVID-19 pandemic it was clear that a huge impact could be expected on the health workforce. In response to a triple threat of increased volume of patients, increased acuity of illness, and increased workforce absenteeism, we sought to identify best practices from the existing literature as well as learn about new workforce strategies to address these workforce challenges. We suggest a three-part framework to increase the numbers of health workers, to increase the flexibility of the workforce, and to sustain workers in practice. 

This project collected data and curated knowledge through a diversity of methods. A rapid scoping review of the extant literature was performed to identify the readily available knowledge about health workforce responses to emergencies. An extensive review of Canadian "grey literature" - non academic literature reflecting other sources of knowledge, such as policy documents, white papers, and web pages - identified hundreds of suggested or implemented strategies related to the COVID demands on the health workforce. Finally, collaboration with our national and international partners and stakeholders resulted in a "crowd-sourcing" of practices from around the world. Our primary output from this work consists of a publicly accessible and searchable database of health workforce strategies. We encourage future work using this extensive resource.

I co-led this project along with Dr. Ivy Bourgeault. We worked with a talented team of undergraduate and graduate researchers including Mara Mihailescu and Asli-Oubah Fuad.

Funding/Support

This Canadian Health Workforce Partners project was supported by the Canadian Foundation for Healthcare Improvement (now Healthcare Excellence Canada). Mara Mihailescu is supported in part by funding from the Canadian Institutes of Health Research. Alison Coates is supported in part by funding from the Social Sciences and Humanities Research Council of Canada.

Outputs

Impact

Rural Hospital Transfers

Description

I worked with Dr. Richard Fleet of Université Laval to analyze quantitative and qualitative data about rural hospital transfers in Canada.  The quantitative data were provided by the Canadian Institute for Health Information (CIHI) through consultation with the Rural Roadmap Implementation Committee (RRMIC). Qualitative data were collected by RRMIC staff and their analysis was provided to us. We were tasked with understanding, from these data, what we know about the transfers of rural patients and their return to their community. 

This project supported Action 11 from the Rural Road Map, a broader collaborative initiative between the College of Family Practice of Canada (CFPC) and the Society for Rural Physicians of Canada (SRPC).   

Funding/Support

This analysis was funded by RRMIC which, in turn, is jointly funded by CFPC and SRPC. Dr. Fleet and I were supported by a committee consisting of RRMIC members Dr. Ruth Wilson, Dr. Ivy Oandasan, and Carmela Bosco.

Outputs

Impact

NW Cares: Learning from COVID

Description

Northwest Cares, a community coalition of health services organizations in northwestern Connecticut, asked what they might learn from the early phase of the COVID-19 pandemic to inform their response to an expected "second wave." In response to this need, I, along with my colleague Dr. Carrie Roseamelia, designed a community based participatory research project that was co-led by a steering committee of community partners: Lori Fedewa, Connecticut Office of Rural Health; Rick Lynn, Northwest Hills Council of Governments; Kevin O’Connell, The Geer Corporation; Gertrude O’Sullivan, Foundation for Community Health; and Julie Scharnberg, Northwest Connecticut Community Foundation. 

We collected data from community stakeholders within the northwest Connecticut region through qualitative surveys, focus groups, and key informant interviews. Our analysis yielded a set of challenges encountered during the first wave of the COVID Pandemic,  the region's organizational responses to those challenges. We discovered the organizational characteristics that enabled responses. We explored participants' views of collaboration and communication during COVID, and we heard about some "silver linings." Analysis of the data yielded five opportunities for system strengthening, along with concrete recommendations for action.

Funding/Support

This project was funded by the Connecticut Office of Rural Health with support from the Foundation for Community Health, NW Hills Council of Governments, Geer Village Senior Community, NW Cares and Northwest Connecticut Community Foundation. This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant H95RH00151, State Offices of Rural Health, $230,000. 

Outputs

Impact