title: Enhancing the care continuum in rural areas: survey of community health center-rural hospital collaborations.
abstract: BACKGROUND
  Community Health Centers (CHCs) and Critical Access Hospitals (CAHs) play a significant role in providing health services for rural residents across the United States.
  
  
  OBJECTIVE
  The overall goal of this study was to identify the CAHs that have collaborations with CHCs, as well as to recognize the content of the collaborations and the barriers and facilitators to collaborations.
  
  
  METHODS
  The target population was CAHs within 60 miles of CHCs. Surveys were mailed to 386 chief executive officers of CAHs in 41 states who met the study criteria. The response rate was 40.9%. A descriptive analysis using chi-square tests compared the status of partnerships along with factors identified as barriers and facilitators to collaboration.
  
  
  RESULTS
  Out of the 161 CAH respondents, 24 (14.9%) reported having a collaborative agreement with a CHC, and 2 indicated that they planned to develop a collaborative agreement. A common reason given for not collaborating was lack of awareness of a CHC within the service area. Other barriers identified were competition with CHCs and organizational differences. External funding to start a collaborating service was the most frequently cited factor to facilitate collaborations.
  
  
  CONCLUSIONS
  The findings indicate that collaborations between CAHs and CHCs are a largely untapped resource. The rural health care services continuum may benefit from increased collaborations.
authors.affiliation: Department of Family and Community Medicine, and Office of Health Research and Development, College of Medicine, University of Kentucky, Lexington, KY 40536-0284, USA. samuels@uky.edu
authors.forename: Michael E
authors.initials: ME
authors.lastname: Samuels
authors.forename: Sudha
authors.initials: S
authors.lastname: Xirasagar
authors.forename: Keith T
authors.initials: KT
authors.lastname: Elder
authors.forename: Janice C
authors.initials: JC
authors.lastname: Probst
mesh_terms: D003151:Community Health Centers; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003299:Cooperative Behavior; D004636:Emergency Service, Hospital; D019538:Health Care Surveys; D006780:Hospitals, Rural; D006801:Humans; D014481:United States