The WAMI Rural Hospital Project. Part 1: Historical and theoretical underpinnings.

This set of six manuscripts describes the content and impact of the WAMI Rural Hospital Project (RHP), a research and development effort supported by the W.K. Kellogg Foundation, designed to improve the delivery of health services in six rural communities in the Pacific Northwest and Alaska. The major objective of the RHP--an activity which spanned a four-year period from 1985 through 1988--was to assist the project communities in improving the financial stability and quality of care of their local health care systems. Special attention was directed at helping the communities determine and implement an appropriate scope of health services, improve management and governance of the local health care enterprise, recruit and retain additional health personnel, and increase the extent to which community residents used local health services. In this first section we discuss the historical antecedents and conceptual underpinnings of the RHP and describe the five principal phases of the project. These include: (1) selection of communities for participation in the RHP, (2) comprehensive analysis of the health care system in each community, (3) community health services planning, including the development of comprehensive strategic plans, (4) implementation of techniques to improve local health services, and (5) project dissemination and evaluation. A pre-test, post-test model was employed to assess qualitative and quantitative changes in a variety of key measures of health system performance, including organization and management, scope of services, fiscal viability of the rural hospital, and utilization and patient satisfaction with health services in each community. The results of this evaluation constitute the balance of this report.