Lambrew J M, Ricketts T C, Morrissey J P
University of North Carolina, Cecil G. Sheps Center for Health Services Research, Chapel Hill 27599-7590.
Public Health Rep. 1993 Jan-Feb;108(1):19-29.
As rural communities struggle to sustain health services locally, innovative alternatives to traditional programs are being developed. A significant adaptation is the rural health network or alliance that links local health departments and community health centers. The authors describe how a rural local health department and community health center, the core organizations in publicly sponsored primary care, came to share a building and administrative and service activities. Both the details of this alliance and its development are examined. The case history reveals that circumstance and State involvement were the catalysts for service integration, more so than the need for or the benefits of the arrangement. The closure of a county-owned hospital created a situation in which State officials were able to broker a cooperative agreement between the two agencies. This case study suggests two hypotheses: that need for integrated services alone may not be sufficient to catalyze the development of primary care alliances and that strong policy support may override any local and internal resistance to integration.
由于农村社区努力在当地维持卫生服务，正在开发传统项目的创新替代方案。一个重要的适应性举措是将当地卫生部门和社区卫生中心联系起来的农村卫生网络或联盟。作者描述了农村当地卫生部门和社区卫生中心（公共资助初级保健的核心组织）是如何开始共享一栋建筑以及行政和服务活动的。文中对该联盟的细节及其发展情况都进行了研究。案例历史表明，情况和州政府的介入是服务整合的催化剂，比这种安排的需求或益处更具催化作用。一家县属医院的关闭创造了一种局面，州政府官员得以促成这两个机构之间的合作协议。本案例研究提出了两个假设：仅对综合服务的需求可能不足以催化初级保健联盟的发展，以及强有力的政策支持可能会压倒对整合的任何地方和内部阻力。
