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Quality Through Collaboration: The Future of Rural Health
and engage all providers in the community. Rural communities offer excellent opportunities to establish such programs for several reasons. First, they are generally less complex than urban environments because of their smaller size and scale. Second, the scarcity of providers in rural communities should facilitate collaboration. Third, as discussed in Chapter 3, in rural areas many quality measurement and improvement activities need to involve the entire community because individual practice settings have insufficient sample sizes and expertise to support those activities. The development of such experiential learning programs should proceed in tandem with the establishment of an ICT infrastructure (see Chapter 6).
The Health Resources and Services Administration (HRSA) administers dozens of grant programs to increase the supply and enhance the training of health professionals, especially those willing to work in areas designated as having too few providers, as well as those who are members of an ethnic or racial minority group or who come from a disadvantaged background. Most but not all of these programs are authorized under Titles VII and VIII of the Public Health Service Act, and they are funded at a relatively modest level (approximately $289.5 million in fiscal year 2004) (BHPR, 2004d,e; HRSA, 2004a,b,c). Few target rural communities directly, so it is unclear the extent to which rural communities benefit. Several federal grant programs provide modest financial support for interdisciplinary training in rural communities. In the past decade, the Quentin Burdick Rural Program for Interdisciplinary Training has trained about 13,000 practicing clinicians, teachers, and students in 29 states through demonstration programs, with area health education centers often being the grantees in collaboration with other community-based organizations (BHPR, 2004d). In fiscal year 2003, the program awarded 23 grants for a total of $6.2 million. There are also a number of federal grant programs that support interdisciplinary training at specific sites, including HRSA’s Area Health Education Centers (often located in medical schools), Health Education and Training Centers in the southwestern border region ($4 million for 13 projects in fiscal year 2003), and Geriatric Education Centers ($15.6 million for 46 projects in fiscal year 2003) (BHPR, 2004a,b,c). A number of states also support interdisciplinary training programs (Buckwalter, 2004).
These programs, especially the Quentin Burdick Rural Program for Interdisciplinary Training, provide a foundation upon which to build. Additional support will be required to accomplish the objective of providing experiential training in the five core competencies for all clinicians in rural areas.