title: Primary Care Clinics and Accountable Care Organizations.
abstract: BACKGROUND
  The Accountable Care Organization (ACO) is one of the new models of health care delivery in the U.S. To date, little is known about the characteristics of health care organizations that have joined ACOs. We report on the findings of a survey of primary care clinics, the objective of which was to investigate the opinions of clinic management about participation in ACOs, and the characteristics of clinic organizational structure that may contribute to joining ACOs or be willing to do so.
  
  
  METHODS
  A 27-item survey questionnaire was developed and distributed by mail in 3 annual waves to all Rural Health Clinics (RHCs) in 9 states. Two dependent variables - participation in ACOs and willingness to join ACOs - were created and analyzed using a generalized estimating equation (GEE) approach.
  
  
  RESULTS
  257 RHCs responded to the survey. A small percentage (5.2%) of the respondent clinics reported that they were participating in ACOs. RHCs in isolated areas were 78% less likely to be in ACOs (odds= 0.22, p= 0.059). Non-profit RHCs indicated a higher willingness to join an ACO than for-profit RHCs (B= 1.271, p= 0.054). There is a positive relationship between RHC size and willingness to join an ACO (B= 0.402, p=0.010).
  
  
  CONCLUSIONS
  At this early stage of ACO development, many RHC personnel are unfamiliar with the ACO model. Rural providers' limited technological and human resources, and the lack of ACO development in rural areas, may delay or prevent their participation in ACOs.
authors.affiliation: Research Associate Professor, College of Health and Public Affairs, University of Central Florida, Orlando, FL, Address: P.O. Box 162369, Orlando, FL 32816, Tel: (407) 823-6145.
authors.forename: Judith
authors.initials: J
authors.lastname: Ortiz
authors.affiliation: Independent Scholar, Rural Health Research Group, University of Central Florida, Orlando, FL, Address: P.O. Box 162369, Orlando, FL 32816, Tel: (407) 823-6146.
authors.forename: Chiung-Ya
authors.initials: CY
authors.lastname: Tang
authors.affiliation: Graduate Research Associate, College of Health and Public Affairs, University of Central Florida, Orlando, FL, Address: P.O. Box 162369, Orlando, FL 32816, Tel: (407) 823-6146.
authors.forename: Yi-Ling
authors.initials: YL
authors.lastname: Lin
authors.affiliation: Independent Scholar, Rural Health Research Group, University of Central Florida, Orlando, FL, Address: P.O. Box 162369, Orlando, FL 32816, Tel: (407) 823-6146.
authors.forename: Maysoun Dimachkie
authors.initials: MD
authors.lastname: Masri
keywords: Accountable Care Organizations; Family Health; Practice Management; Primary Care; Rural Health