The purpose of this course is to provide health sciences students an understanding of major issues in rural health and the environment in which the rural health care clinicians and administrator must function.. The course will provide an understanding of the demographics, economics, and structure of the health care delivery systems in rural America. Also examined will be the current Federal and state health policy and its effect on rural areas. Special attention will be paid to public programs with major rural focus (e.g. the National Health Service Corps). The course will conclude with an exploration of current and future practices and strategies in managing rural health delivery systems.

Course Objectives:

1. Upon successful completion of the course the student will:
2. Be familiar with the issues in rural health.
3. Be familiar with the demographic, economic, and cultural environment of rural America
4. Understand the impact of State and Federal health policies on the rural community.
5. Be familiar with public rural health programs.
6. Understand the current and evolving structure of health care systems in rural areas.

Texts:

Joyce E. Beaulieu and David E. Berry (eds.), Rural Health Services: A Management Perspective, AUPHA/Health Administration Press, Ann Arbor, MI, 1994

The Beaulieu/Berry book is available in paperback at the South Carolina Book Store. The assigned journal articles are available for copying from the instructor or at Universal Copies at 1120 College Street.

Course Conduct:

The course will be conducted as a seminar with lectures provided by the instructor. Lectures and discussion will be based on the assigned readings. When possible, guest participants from the Columbia health professional community will be invited to provide personal insight into the topic under discussion (e.g. Mark Jordan, Director, Office of Primary Care, SC Department of Health and Environmental Control will discuss Federal designation of medically underserved areas and the state and National Health Service Corps loan repayment program for placement of primary care physicians in rural areas). Student comprehension of the course material will be demonstrated by: student presentations that analyze assigned readings on a particular health topic and a final examination. The final examination will be in essay form (3-5 questions) covering lectures and reading assignments. It will be handed out at the end of class on May 28th and is to be turned in prior to or on June 4th.

Course Requirements Include:

• Completing all reading assignments
• Class room participation including discussion leadership
• Student presentation on assigned readings.
• A final examination (take home)

Grades

will be computed as follows:

Classroom participation and oral presentation	40%
Final examination	60%
	100%

Classes and Readings

DAY 1 -INTRODUCTION TO RURAL HEALTH

May 12 (Introduction)

Class Objective: Student will have an overview of rural health and a clear understanding of the course outline.

Assigned Readings:

None

Day 2/3 - THE DEMOGRAPHICS OF RURAL HEALTH

May 13/14

Class Objective: Student will understand how rural populations and health status differs from their urban counterparts.

Assigned Readings:

Chapter 1 Beaulieu/Berry - Miller, et.al. "Rural Health Populations and Their Health": 3-26.

Eggebeen, D.J., And Lichter, D.T. "Health and Well-Being among Rural Americans: Variations Across the Life Course." Journal of Rural Health 9, no.2 (1993): 86-98.

Glen, N. and Alston,J. "Rural-Urban Differences in Reported Attitudes and Behavior." Social Science Quarterly 47, no.4 (March 1967):381-400.

Lassey, W.R. and Lassey, M.L. "The Physical Health Status of the Rural Elderly." The Elderly in Rural Society. Coward, R.T., Lee, G.R. eds., New York: Springer, 1985: 89-97.

Rickets, T. National Rural Health Policy Atlas. Health Services Research Center, University of North Carolina, Chapel Hill, 1991.

DAY 4 - RURAL ECONOMICS

May 15

Class Objective: Student will understand the economics of rural areas and the relationship of health services to rural economic development.

Assigned Readings:

Chapter 2 Beaulieu/Berry -Cordes, et.al. "Rural Economic Development and Health Services": 27-56.

Congress of the United States, Office of Technology Assessment. Health Care in Rural America, Pub. No. OTA-H-434. Washington, DC: Government Printing Office, September 1990.

Duncan, R. Paul, Secombe, Karen, Amey, Cheryl. "Changes in Insurance Coverage Within Rural and Urban Environments - 1977 and 1987." The Journal of Rural Health 11, no. 3 (Summer, 1995): 169-76.

Thompson, James G., Harding, Jos. "Economic Effects of the Outmigration of Obstetric Services in a Rural County." The Journal of Rural Health 12, no. 2 (Spring, 1996): 100-09.

DAY 5/6 -RURAL HEALTH POLICY

May 16/19

Class Objective: Student will understand the role of Federal and state health policy in shaping rural health service delivery.

Assigned Readings:

Chapter 3 Beaulieu/Berry -Samuels. "Policy Initiatives and Issues in Rural Health Services Development" : 57-83.

Campion, Daniel M., Dickey, Donald F. "Legislative and Policy Strategies for Supporting Rural Health Network Development: Lessons from the 103rd Congress." The Journal of Rural Health11, no. 1 (Winter, 1995): 22-31.

Congress of the United States, Office of Technology Assessment. Health Care in Rural America. Pub. No. OTA-H-434. Washington, DC: Government Printing Office, September 1990.

Lee, R. "Designation of Health Manpower Shortage Areas for Use by Public Health Service Programs." Public Health Reports 94 (January-February 1979): 49.

Rockoff, M.L., Goren, L., Kleiman, J.C. "Positive Programming: The Use of Data in Planning for the Rural Health Initiative." Journal of Community Health 4, no. 3 (Spring 1979): 204-16.

Samuels, M.E. "Federal Initiative in Rural Health: A Systems Approach." Annals of the New York Academy of Sciences 310 (21 June, 1978): 163-68.

Zuvekas, A. "Community and Migrant Health Centers: An Overview." The Journal of Ambulatory Care 13, no. 4 (1990):1-12.

DAY 7 -HEALTH PROFESSIONS

May 20

Class Objective: Student will understand how health professionals are distributed and function in rural America.

Guest Speaker:

Mark Jordan, M.A., Director,

Office of Primary Care

South Carolina Department of Health and Environmental Control

Assigned Readings:

Chapter 4 Beaulieu/Berry - Ricketts "Health Care Professionals in Rural America": 85-109.

Health Resources and Services Administration. Interdiscplinary Development of Health Professionals to Maximize Health Provider Resources in Rural Areas. Rockville, MD: HRSA, March, 1993.

Hernandez, Richard, Samuels, Michael. "Assessment of Need for Multicompetent Allied Health Practitioners in the Midlands of South Carolina." Journal of Allied Health 19, no. 4 (Fall 1990):339-50.

Ramsbottom-Lucier, Mary T., Caudill, Timothy S., Johnson, Mitzi, M.S., Rich, Eugene C. "Interaction with Colleagues and Their Effects on the Satisfaction of Rural Primary care Physicians" The Journal of Rural Health 11, no. 3 (Summer, 1995): 185-91.

Samuels, Michael E., Shi, Leiyu. Recruitment and Retention of Physicians in Rural Areas. Medical Group Management Press, Englewood, CO, May, 1993:

Shi, Leiyu, Samuels, Michael E., Rickets, T, and Konard R. "A Rural-urban Comparative Study of Nonphysician Providers in Community and Migrant Health Centers: A Rural-Urban Comparative Study." Public Health Reports 109 no.6 (1994):809-15.

DAY 8 -HOSPITALS AND LONG-TERM CARE

May 21

Class Objective: Student will understand the role of the hospital and long-term care services in rural areas..

Assigned Readings:

Chapter 5 Beaulieu/Berry -Berry/ Beaulieu. "Supply of Hospital and Long-Term Care Services in Rural Areas": 111-40.

Congress of the United States, Office of Technology Assessment. Health Care in Rural America, Pub. No. OTA-H-434. Washington, DC: Government Printing Office, September 1990.

Harrington, C., Swan, J.H. "The Impact of State Medicaid Nursing Policies on Utilization and Expenditure." Inquiry 24, no. 2 (1987):156-72.

Kenney, G.M. "Rural and Urban Differentials in Medicare Home Health Use." Health Care Financing review 14, no. 4 (Summer 1993): 39-57.

Seavey, J., Berry, D.E., Bogue, R, The Strategies and Environments of America's Small Rural Hospitals. Chicago: American Hospital Association, the Hospital research and Educational Trust, 1992.

DAY 9 - RURAL HEALTH CARE MANAGEMENT

May 22

Class Objective: Student will understand the knowledge and skills necessary to manage a health services delivery organization in a rural area.

Assigned Readings:

Chapter 6 Beaulieu/Berry -Berry/Seavey "Health Care Management Challenges in Rural Environments" :143-61.

Berry, D, Tucker, T., Seavey, J." Efficiency of System Management or Ownership as Options for Distressed Small Rural Hospitals." The Journal of Rural Health 3, no.2 (1987): 61-75.

Mick, S., Morlock, D., Salkever, G., deLissovy, G., Malitz, F., Wise, C., Jones, A. "Rural Hospital Administrators and Strategic Management Activities. "Hospital and Health services Administration, 38, no.3 (Fall, 1993):329-51.

Starkweather, D., Cook, K.S. "Organizational Environment Relations." Health Care Management, edited by S. Shortel and A. Kaluzny. New York: John Wiley and Sons, 1983: 344-378.

DAY 10 - STRATEGIC PLANNING

May 23

Class Objective: Student will understand the theory and practice of strategic planning for organizations providing health services in rural areas.

Assigned Readings:

Chapter 7 Beaulieu/Berry -Ludke, "Rural Facility Strategic Choices: Theory and Practice.": 163-202.

Brown, M., McCool, B.P. "Vertical Integration: Exploration of a Popular Strategic Concept." Health Care Management Review 11, no.4 (1986): 7-19.

Cleverly, W.O., Harvey, R.K. "Critical Strategies for Successful Rural Hospitals", Health Care Management Review 17, no.1 (1992): 27-33.

Kaluzny, A.D., Zuckerman, H.S. "Strategic Alliances: Two Perspectives for Understanding Their Effects on Health. "Hospital and Health Services Administration 37, no.4 (1992b):477-90.

Moscovice, I., Johnson, J., Finch, M., Grogan, C., Kralewski, J. "The Structure and Characteristics of Rural Hospital Consortia." The Journal of Rural Health 3, no.2 (1991): 575-88.

Summers, J. "Closing Unprofitable Services: Ethical Issues and Management Responses." Hospital and Health Services Administration 30, no.5 (1985):8-28.

Zismer, Daniel K., Hoffman, David C. "A 10-Point Checklist for Rural Health Care Systems." The Journal of Rural Health 11, no. 1 (Winter, 1995): 53-9.

DAY 11 - ACCESS TO PRIMARY AND PREVENTIVE CARE

May 26

Class Objective: Student will understand the barriers to accessing primary and preventive health care in rural America.

Assigned Readings:

Chapter 8 Beaulieu/Berry -Davis, et.al. "Primary Care Access.": 203--27.

Abramson, J. "Community-Oriented Primary Care-Strategy, Approaches, and Practice: A Review." Public Health Reviews 16 (1988): 35-95.

Congress of the United States, Office of Technology Assessment. Health Care in Rural America, Pub. No. OTA-H-434. Washington, DC: Government Printing Office, September 1990.

Cordes, S. "The Changing Rural Environment and the Relationship between Health Services and Rural Development." Health Services Research 23, no. 6(1989): 757-84.

Crandell, L., Dwyer, J., Duncan, R.P." Recruitment and Retention of Rural Physicians: Issues for the 1990's." The Journal of Rural Health 6, no.1 (1990): 19-38.

Leitner, Dennis W., Gast, Julie A., Sarvela, Paul D., Ring, Mary C., Newell, Lesley A. "An Epidemiological Approach to Assessing Primary Care Needs in Rural Illinois." The Journal of Rural Health 12, no2 (Spring, 1996): 110-19.

McManus, M., Newacheck, P. "Rural Maternal, Child and Adolescent Health." Health Services Research, 23, no.6 (February, 1989): 807-48.

Starfield, B. "Primary Care in the United States.", International Journal of Health Services 16, no. 2 (1986): 179-98.

DAY 12 -THE ELDERLY AND DISABLED

May 27

Class Objective: Student will understand the health problems and access to health care problems of the elderly and disabled in rural areas.

Assigned Readings:

Chapter 9 Beaulieu/Berry -Beaulieu. "Services for the Rural Elderly and Disabled.": 229-57.

Beaulieu, J.E. Small Rural Hospitals with Long-Term Care: 1983-1987." The Journal of Rural Health, 8, no. 2 (Spring, 1992): 121-7.

Joesph, A.E., Fuller, A.M. "Towards an Integrative Perspective on the Housing, Services and Transportation Implications of Rural Aging." Canadian Journal of Aging 10, no. 2 (1991):127-48.

Kassab, Kathy, Luloff, A.E., Kelsey, Timothy W., Smith, Stephen M. "The Influence of Insurance Status and Income on Health Care Use Among the Nonmetropolitan Elderly." The Journal of Rural Health 12, no. 2 (Spring, 1996): 89-99.

Lubben, J.E., Weiler, P.G., Chi, I., DeLong "Health Promotion for the Rural Elderly." The Journal of Rural Health 4, no. 3 (Summer, 1988):85-96.

Rabiner, Donna J. "Patterns and Predictors of Noninstitutional Health Care Utilization by Older Adults in rural and Urban America." The Journal of Rural Health 11, no. 4 (Fall, 1995): 259-73.

DAY 13/14 -HEALTH SERVICES RESEARCH

May 28/29

Class Objective: Student will understand the relevance of health services research to rural health policy.

Note: The final examination will be handed out at the end of class on May 28th and is to be turned in prior to or on June 4th.

Assigned Readings:

Arcury, Thomas A. "Risk Perceptions Among Black Farmers in the Southeastern United States." The Journal of Rural Health 11, no. 4 (Fall 1995): 240-50.

Birdwell, Stephen, Stephen W., Calesaric, Heather "Identifying Health Care Needs of Rural Ohio Citizens: An Evaluation of A Two-stage Methodology." The Journal of Rural Health, 12, no.2 (Spring 1996): 130-6.

Mick, S., Morlock, L. "America's Rural Hospitals: A Selective Review of 1980's Research.", The Journal of Rural Health 11, no. 4 (Fall, 1995): 259-73

Moscovice, Ira, Christianson, Jon B. "Measuring and Evaluating the Performance of Vertically Integrated Rural Health Networks." The Journal of Rural Health 11, no. 1 (Winter, 1995): 9-21.

Rosenblatt, R.A., Whitcomb, M.E., Cullen, T.J., Lishner, D.M., Hart, L.G. "Which Medical schools Produce Rural Physicians?" Journal of the American Medical Association268, no. 12 (1992): 1559-65.

Shi, Leiyu, Samuels, Michael E., Konard R., Porter, C., Stoskopf, CH., and Richter D. "Rural primary care program survival: An analysis of financial variables. "Journal of Rural Health10(Summer, 1994):173-82.

Sparks, Barbara T., Rageb, Nawal E., Given, Barbara A., Swanson, G. Marie "Breast Screening in Rural Populations: A Pilot Study.", The Journal of Rural Health 12, no. 2 (Spring, 1996): 120-9.

DAY 15 - THE FUTURE

May 30

Class Objective: Student will understand the issues shaping the future of rural America and it's health infrastructure.

Assigned Readings:

Chapter 10 Beaulieu/Berry -Meyers/Beaulieu. "The Future of the Rural Health Services System: Rural Communities Meet the Twenty-First Century.": 259-73.

Campion, Daniel M., Dickey, Donald F. "Lessons from the Essential Access Community Hospital Program for Rural Health Network Development." The Journal of Rural Health 11, no. 1 (Winter 1995): 32-9.

Elder, W.G., Amundson, B.A. "Building Healthcare Leadership in Rural Communities." The Journal of Rural Health 7, no. 5 (1991): 511-25.

Morrisey, Michael A., Ohsfeldt, Robert L., Johnson, Victoria, Treat, Richard " Rural Emergency Medical Services: Patients, Destinations, Times, and Services." The Journal of Rural Health 11, no. 4 (Fall 1995): 286-94.

List of Assigned Readings:

Eggebeen, D.J., And Lichter, D.T. "Health and Well-Being among Rural Americans: Variations Across the Life Course." Journal of Rural Health 9, no.2 (1993): 86-98.

Glen, N. and Alston,J. "Rural-Urban Differences in Reported Attitudes and Behavior." Social Science Quarterly 47, no.4 (March 1967):381-400.

Lassey, W.R. and Lassey, M.L. "The Physical Health Status of the Rural Elderly." The Elderly in Rural Society. Coward, R.T., Lee, G.R. eds., New York: Springer, 1985: 89-97.

Rickets, T. National Rural Health Policy Atlas. Health Services Research Center, University of North Carolina, Chapel Hill, 1991.

Congress of the United States, Office of Technology Assessment. Health Care in Rural America, Pub. No. OTA-H-434. Washington, DC: Government Printing Office, September 1990.

Duncan, R. Paul, Seccombe, Karen, Amey, Cheryl. "Changes in Insurance Coverage Within Rural and Urban Environments - 1977 and 1987." The Journal of Rural Health 11, no. 3 (Summer, 1995): 169-76.

Thompson, James G., Harding, Jos. "Economic Effects of the Outmigration of Obstetric Services in a Rural County." The Journal of Rural Health 12, no. 2 (Spring, 1996): 100-09.

Campion, Daniel M., Dickey, Donald F. "Legislative and Policy Strategies for Supporting Rural Health Network Development: Lessions from the 103rd Congress." The Journal of Rural Health11, no. 1 (Winter, 1995): 22-31.

Congress of the United States, Office of Technology Assessment. Health Care in Rural America. Pub. No. OTA-H-434. Washington, DC: Government Printing Office, September 1990.

Lee, R."Designation of Health Manpower Shortage Areas for Use by Public Health Service Programs." Public Health Reports 94 (January-February 1979): 49.

Rockoff, M.L., Goren, L., Kleiman, J.C. "Positive Programming: The Use of Data in Planning for the Rural Health Inntiative." Journal of Community Health 4, no. 3 (Spring 1979): 204-16.

Samuels, M.E. "Federal Intiative in Rural Health: A Systems Approach." Annals of the New York Academy of Sciences 310 (21 June, 1978): 163-68.

Zuvekas, A. "Community and Migrant Health Centers: An Overview." The Journal of Ambulatory Care 13, no. 4 (1990):1-12.

Health Resources and Services Administration. Interdiscplinary Development of Health Professionals to Maximize Health Provider Resources in Rural Areas. Rockville, MD: HRSA, March, 1993.

Hernandez, Richard, Samuels, Michael. "Assessment of Need for Multicompetent Allied Health Practitioners in the Midlands of South Carolina." Journal of Allied Health 19, no. 4 (Fall 1990):339-50.

Ramsbottom-Lucier, Mary T., Caudill, Timothy S., Johnson, Mitzi, M.S., Rich, Eugene C. "Interaction with Colleagues and Their Effects on the Satisfaction of Rural Primary care Physicians" The Journal of Rural Health 11, no. 3 (Summer, 1995): 185-91.

Samuels, Michael E., Shi, Leiyu. Recruitment and Retention of Physicians in Rural Areas. Medical Group Management Press, Englewood, CO, May, 1993:

Shi, Leiyu, Samuels, Michael E., Rickets, T, and Konard R. "A Rural-urban Comparative Study of Nonphysician Providers in Community and Migrant Health Centers: A Rural-Urban Comparative Study." Public Health Reports 109 no.6 (1994):809-15.

Congress of the United States, Office of Technology Assessment. Health Care in Rural America, Pub. No. OTA-H-434. Washington, DC: Government Printing Office, September 1990.

Harrington, C., Swan, J.H. "The Impact of State Medicaid Nursing Policies on Utilization and Expenditure." Inquiry 24, no. 2 (1987):156-72.

Kenney, G.M. "Rural and Urban Differentials in Medicare Home Health Use." Health Care Financing review 14, no. 4 (Summer 1993): 39-57.

Seavey, J., Berry, D.E., Bogue, R, The Strategies and Enviornments of America's Small Rural Hospitals. Chicago: American Hospital Association, the Hospital research and Educational Trust, 1992.

Berry, D, Tucker, T., Seavey, J." Efficiency of System Management or Ownership as Options for Distressed Small Rural Hospitals." The Journal of Rural Health 3, no.2 (1987): 61-75.

Mick, S., Morlock, D., Salkever, G., deLissovy, G., Malitz, F., Wise, C., Jones, A. "Rural Hospital Administrators and Strategic Management Activities. "Hospital and Health services Administration, 38, no.3 (Fall, 1993):329-51.

Starkweather, D., Cook, K.S. "Oganizational Environment Relations." Health Care Management, edited by S. Shortal and A. Kaluzny. New Yoek: John Wiley and Sons, 1983: 344-378.

Brown, M., McCool, B.P. "Vertical Integration: Explorationof a Popular Strategic Concept." Health Care Management Review 11, no.4 (1986): 7-19.

Cleverly, W.O., Harvey, R.K. "Critical Strategies for Successful Rural Hospitals", Health Care Management Review 17, no.1 (1992): 27-33.

Kaluzny, A.D., Zuckerman, H.S. "Strategic Alliances: Two Perspectives for Understanding Their Effects on Health. "Hospital and Health Services Administration 37, no.4 (1992b):477-90.

Moscovice, I., Johnson, J., Finch, M., Grogan, C., Kralewski, J. "The Structure and Characteristics of Rural Hospital Consortia." The Journal of Rural Health 3, no.2 (1991): 575-88.

Summers, J. "Closing Unprofitable Services: Ethical Issues and Management Responses." Hospital and Health Services Administration 30, no.5 (1985):8-28.

Zismer, Daniel K., Hoffman, David C. "A 10-Point Checklist for Rural Health Care Systems." The Journal of Rural Health 11, no. 1 (Winter, 1995): 53-9.

Abramson, J. "Community-Oriented Primary Care-Strategy, Approaches, and Practice: A Review." Public Health Reviews 16 (1988): 35-95.

Congress of the United States, Office of Technology Assessment. Health Care in Rural America, Pub. No. OTA-H-434. Washington, DC: Government Printing Office, September 1990.

Cordes, S. "The Changing Rural Environment and the Relationship between Health Services and Rural Development." Health Services Research 23, no. 6(1989): 757-84.

Crandell, L., Dwyer, J., Duncan, R.P." Recruitment and Retention of Rural Physicians: Issues for the 1990's." The Journal of Rural Health 6, no.1 (1990): 19-38.

Leitner, Dennis W., Gast, Julie A., Sarvela, Paul D., Ring, Mary C., Newell, Lesley A. "An Epidemiological Approach to Assessing Primary Care Needs in Rural Illinois." The Journal of Rural Health 12, no2 (Spring, 1996): 110-19.

McManus, M., Newacheck, P. "Rural Maternal, Child and Adolescent Health." Health Services Research, 23, no.6 (February, 1989): 807-48.

Starfield, B. "Primary Care in the United States.", International Journal of Health Services 16, no. 2 (1986): 179-98.

Beaulieu, J.E. Small Rural Hospitals with Long-Term Care: 1983-1987." The Journal of Rural Health, 8, no. 2 (Spring, 1992): 121-7.

Joesph, A.E., Fuller, A.M. "Towards an Integrative Perspective on the Housing, Services and Transportation Implications of Rural Aging." Canadian Journal of Aging 10, no. 2 (1991):127-48.

Kassab, Kathy, Luloff, A.E., Kelsey, Timothy W., Smith, Stephen M. "The Influence of Insurance Status and Income on Health Care Use Among the Nonmetropolitan Elderly." The Journal of Rural Health 12, no. 2 (Spring, 1996): 89-99.

Lubben, J.E., Weiler, P.G., Chi, I., DeLong "Health Promotion for the Rural Elderly." The Journal of Rural Health 4, no. 3 (Summer, 1988):85-96.

Rabiner, Donna J. "Patterns and Predictors of Noninstitutional Health Care Utilization by Older Adults in rural and Urban America." The Journal of Rural Health 11, no. 4 (Fall, 1995): 259-73.

Arcury, Thomas A. "Risk Perceptions Among Black Farmers in the Southeastern United States." The Journal of Rural Health 11, no. 4 (Fall 1995): 240-50.

Birdwell, Stephen, Stephen W., Calesaric, Heather "Identifying Health Care Needs of Rural Ohio Citizens: An Evaluation of A Two-stage Methodology." The Journal of Rural Health, 12, no.2 (Spring 1996): 130-6.

Mick, S., Morlock, L. "America's Rural Hospitals: A Selective Review of 1980's Research.", The Journal of Rural Health 11, no. 4 (Fall, 1995): 259-73

Moscovice, Ira, Christianson, Jon B. "Measuring and Evaluating the Performance of Vertically Integrated Rural Health Networks." The Journal of Rural Health 11, no. 1 (Winter, 1995): 9-21.

Rosenblatt, R.A., Whitcomb, M.E., Cullen, T.J., Lishner, D.M., Hart, L.G. "Which Medical schools Produce Rural Physicians?" Journal of the American Medical Association268, no. 12 (1992): 1559-65.

Shi, Leiyu, Samuels, Michael E., Konard R., Porter, C., Stoskopf, CH., and Richter D. "Rural primary care program survival: An analysis of financial variables."Journal of Rural Health 10 (Summer, 1994):173-82.

Sparks, Barbra T., Rageb, Nawal E., Given, Barbara A., Swanson, G. Marie "Breast Screening in Rural Populations: A Piolet Study.", The Journal of Rural Health 12, no. 2 (Spring, 1996): 120-9.

Campion, Daniel M., Dickey, Donald F. "Lessons from the Essential Access Community Hospital Program for Rural Health Network Development." The Journal of Rural Health 11, no. 1 (Winter 1995): 32-9.

Elder, W.G., Amundson, B.A. "Building Healthcare Leadership in Rural Communities." The Journal of Rural Health 7, no. 5 (1991): 511-25.

Morrisey, Michael A., Ohsfeldt, Robert L., Johnson, Victoria, Treat, Richard " Rural Emergency Medical Services: Patients, Destinations, Times, and Services." The Journal of Rural Health 11, no. 4 (Fall 1995): 286-94.

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12/31/1997
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