title: Care in the country: a historical case study of long-term sustainability in 4 rural health centers.
abstract: From 1978 to 1983, researchers at the University of North Carolina conducted a National Evaluation of Rural Primary Care Programs. Thirty years later, many of the programs they studied have closed, but the challenges of providing rural health care have persisted. I explored the histories of 4 surviving rural primary care programs and identified factors that contributed to their sustainability. These included physician advocates, innovative practices, organizational flexibility, and community integration. As rural health programs look ahead, identifying future generations of physician advocates is a crucial next step in developing the rural primary care workforce. It is also important for these programs to find ways to cope with high rates of staff turnover.
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA. bradwright@unc.edu
authors.forename: D Brad
authors.initials: DB
authors.lastname: Wright
mesh_terms: D002140:California; D003153:Community Health Services / Q000458:organization & administration*; D019058:Community Networks / Q000458:organization & administration; D003659:Decision Making, Organizational; D006303:Health Services, Indigenous / Q000458:organization & administration*; D006801:Humans; D007629:Kentucky; D008145:Louisiana; D009516:New Mexico; D019982:Organizational Case Studies; D015279:Organizational Culture; D009936:Organizational Innovation; D010558:Personnel Loyalty; D010819:Physician's Role; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration*; D013714:Tennessee