Residents of rural communities have poorer health status than people living in more populated areas. For example, The Urban and Rural Health Chartbook notes that the age-adjusted death rate among younger (1-24 years of age) persons who live in the most rural counties is 31 percent higher than those who live in the most urban counties and 65 percent higher for those who live in suburban counties (Eberhardt, Ingram, Makuc et al., 2001). Explanation for the health disparity experienced by rural residents is complex due to the influence of both community factors and the socioeconomic and behavior patterns of individuals. Access to health care, including preventive care, as well as substantial challenges with health literacy, higher instances of smoking, and lack of health insurance among rural residents, are some of the main causes of this disparity. Rural health networks have been touted by many involved with rural health issues as an effective way to address the health disparity experienced by rural areas. The last fifteen years have seen a growth in the development of rural health networks, with a growing number of grantors, e.g. the Health Resources and Services Administration, The Robert Woods Johnson Foundation and states such as New York, Florida, and West Virginia, funding their development. However, little research has been done on the effectiveness of rural health care networks. While some have evaluated rural health networks, Wellever explains that many questions are left unanswered with "the most fundamental question — whether rural health networks benefit either their members or the rural residents they serve" (1999, p. 133). Thus, it needs to be determined if health networks are in fact a viable means for improving the disparity in rural health and, more importantly, what can be done to make them more effective. This research provides insight into the correlates of effectiveness for a type of health network, vertically integrated rural health networks. Provan and Milward's (2001) framework for evaluating the effectiveness of public-sector organizational networks, which proposes three levels of analysis, i.e., the community, network, and organization/participant, was adapted to analyze the effectiveness of vertically integrated rural health networks. One-on-one interviews, questionnaires, and archival data were used to collect data on the networks sampled. Primarily, data was collected from four networks that were chosen from a larger sample of twenty-one networks to serve as best practices. Analysis of the data collected revealed a few significant predictors for the effectiveness of vertically integrated rural health networks. Financing was found to be the most important predictor, as it was significant at both the community and network levels. Both cohesiveness and the number of problems in the rural environment were also found to be significant predictors but only at the network level. No significant predictors were found at the organizational level; however, organizational and network-level effectiveness were found to be strongly correlated with each other. Overall, networks were found to be more favorable about their effectiveness at the network and organizational levels. / Ph. D.

Rural hospitals in America hold a critical position within their communities because they possess the duty and responsibility of not only providing adequate healthcare services for the population, but also bearing the heavy burden of functioning as one of the main socio-economic engines within the area. These factors, along with drastically inadequate operating budgets, often create programmatic and operational challenges for these entities to confront as they fight to provide the technologically current facilities and services needed to adequately care for their community. All of this must be done in the most cost effective way possible. This thesis will look at current trends being administered within the widespread replacement effort of these facilities, and propose several alternative strategies aimed at facilitating feasible solutions to these and other issues that are not currently being addressed. Design resolution strategies will be formulated and tested. These will then be directly implemented through a specific project design exercise that will then be evaluated.