Hospital-sponsored medical groups: their impact on access to primary care in rural communities.

Rural communities have traditionally been underserved in terms of the availability of primary medical care services and providers. The Robert Wood Johnson Foundation launched a major program in the mid-1970s to improve the delivery of primary care to previously underserved rural, small town, inner city and other urban communities through their Community Hospital Program (CHP). This program provided grant funds to over 50 community hospitals throughout the country to develop primary care-oriented group practices. Twelve of the 53 programs eventually funded were sampled for a national evaluation of the impact of the CHP groups on access to care in the communities they served. The analyses reported here summarize the access impact of this innovation on the four rural and small town communities included in the larger evaluation. Baseline surveys in these four communities established that, in general, access was poorer in the rural areas, in particular, compared to the national average. The new groups tended to attract a cross-section of the communities they served. In general, they tended to do as well or better as other sources of care in the area in providing access to care. The most successful groups were those that most closely mirrored the traditional private practitioner--"family doctor"--model of care.