{"id":"https://openalex.org/W7160708346","doi":"https://doi.org/10.1093/haschl/qxag107","title":"The decentralized academic health center: a 21st-century model for rural health innovation","display_name":"The decentralized academic health center: a 21st-century model for rural health innovation","publication_year":2026,"publication_date":"2026-05-01","ids":{"openalex":"https://openalex.org/W7160708346","doi":"https://doi.org/10.1093/haschl/qxag107","pmid":"https://pubmed.ncbi.nlm.nih.gov/42205359"},"language":"en","primary_location":{"id":"doi:10.1093/haschl/qxag107","doi":"https://doi.org/10.1093/haschl/qxag107","is_oa":true,"landing_page_url":"https://doi.org/10.1093/haschl/qxag107","pdf_url":null,"source":{"id":"https://openalex.org/S4387290458","display_name":"Health Affairs Scholar","issn_l":"2976-5390","issn":["2976-5390"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Affairs Scholar","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1093/haschl/qxag107","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5058624286","display_name":"Patrick C. Hardigan","orcid":"https://orcid.org/0000-0001-6965-1766","observed_orcids":["https://orcid.org/0000-0001-6965-1766"]},"institutions":[{"id":"https://openalex.org/I12834331","display_name":"University of Wyoming","ror":"https://ror.org/01485tq96","country_code":"US","type":"education","lineage":["https://openalex.org/I12834331"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Patrick C Hardigan","raw_affiliation_strings":["College of Health Sciences, University of Wyoming , Laramie, WY 82071 ,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"College of Health Sciences, University of Wyoming , Laramie, WY 82071 ,","institution_ids":["https://openalex.org/I12834331"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5038463405","display_name":"Johannes Vieweg","orcid":"https://orcid.org/0009-0003-6228-1741","observed_orcids":["https://orcid.org/0009-0003-6228-1741"]},"institutions":[{"id":"https://openalex.org/I136199984","display_name":"Harvard University","ror":"https://ror.org/03vek6s52","country_code":"US","type":"education","lineage":["https://openalex.org/I136199984"]},{"id":"https://openalex.org/I48633490","display_name":"Mass General Brigham","ror":"https://ror.org/04py2rh25","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I48633490"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Johannes Vieweg","raw_affiliation_strings":["Mass General Brigham, Harvard University , Cambridge, MA ,"],"raw_orcid":"https://orcid.org/0009-0003-6228-1741","affiliations":[{"raw_affiliation_string":"Mass General Brigham, Harvard University , Cambridge, MA ,","institution_ids":["https://openalex.org/I136199984","https://openalex.org/I48633490"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5058624286"],"corresponding_institution_ids":["https://openalex.org/I12834331"],"apc_list":{"value":3150,"currency":"USD","value_usd":3150},"apc_paid":{"value":3150,"currency":"USD","value_usd":3150},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.3659086,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"4","issue":"5","first_page":"qxag107","last_page":"qxag107"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11990","display_name":"Global Health Workforce Issues","score":0.6366999745368958,"subfield":{"id":"https://openalex.org/subfields/3604","display_name":"Emergency Medical Services"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11990","display_name":"Global Health Workforce Issues","score":0.6366999745368958,"subfield":{"id":"https://openalex.org/subfields/3604","display_name":"Emergency Medical Services"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.18690000474452972,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T14186","display_name":"Healthcare Systems and Practices","score":0.04879999905824661,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/rural-health","display_name":"rural health","score":0.8650000095367432},{"id":"https://openalex.org/keywords/health-workforce-development","display_name":"health workforce development","score":0.7360000014305115},{"id":"https://openalex.org/keywords/health-care-access","display_name":"health care access","score":0.6079999804496765},{"id":"https://openalex.org/keywords/shared-governance","display_name":"shared governance","score":0.671999990940094},{"id":"https://openalex.org/keywords/digital-health-tools","display_name":"digital health tools","score":0.8560000061988831},{"id":"https://openalex.org/keywords/clinical-collaboration","display_name":"clinical collaboration","score":0.6549999713897705},{"id":"https://openalex.org/keywords/community-engagement","display_name":"community participation","score":0.9639999866485596},{"id":"https://openalex.org/keywords/financial-sustainability","display_name":"financial sustainability","score":0.777999997138977},{"id":"https://openalex.org/keywords/wyoming","display_name":"Wyoming","score":0.45100000500679016},{"id":"https://openalex.org/keywords/borderlands","display_name":"borderlands","score":0.5249999761581421}],"concepts":[{"id":"https://openalex.org/C2778139618","wikidata":"https://www.wikidata.org/wiki/Q13440398","display_name":"Workforce","level":2,"score":0.7056999802589417},{"id":"https://openalex.org/C2779968149","wikidata":"https://www.wikidata.org/wiki/Q8034851","display_name":"Workforce development","level":3,"score":0.6420999765396118},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.5827000141143799},{"id":"https://openalex.org/C2779958979","wikidata":"https://www.wikidata.org/wiki/Q3473027","display_name":"Rural health","level":3,"score":0.5318999886512756},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.4945000112056732},{"id":"https://openalex.org/C39549134","wikidata":"https://www.wikidata.org/wiki/Q133080","display_name":"Public relations","level":1,"score":0.4869000017642975},{"id":"https://openalex.org/C20136886","wikidata":"https://www.wikidata.org/wiki/Q749647","display_name":"Interoperability","level":2,"score":0.4699999988079071},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.46810001134872437},{"id":"https://openalex.org/C2780433410","wikidata":"https://www.wikidata.org/wiki/Q5276090","display_name":"Digital health","level":3,"score":0.46540001034736633},{"id":"https://openalex.org/C2775951005","wikidata":"https://www.wikidata.org/wiki/Q3473024","display_name":"Community health","level":3,"score":0.44029998779296875},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.4075999855995178},{"id":"https://openalex.org/C93678727","wikidata":"https://www.wikidata.org/wiki/Q7380583","display_name":"Rural management","level":4,"score":0.3928999900817871},{"id":"https://openalex.org/C129047720","wikidata":"https://www.wikidata.org/wiki/Q175185","display_name":"Rural area","level":2,"score":0.3928000032901764},{"id":"https://openalex.org/C66204764","wikidata":"https://www.wikidata.org/wiki/Q219416","display_name":"Sustainability","level":2,"score":0.3880000114440918},{"id":"https://openalex.org/C147268084","wikidata":"https://www.wikidata.org/wiki/Q5635796","display_name":"HRHIS","level":4,"score":0.35010001063346863},{"id":"https://openalex.org/C2250968","wikidata":"https://www.wikidata.org/wiki/Q1512929","display_name":"Health equity","level":3,"score":0.3433000147342682},{"id":"https://openalex.org/C2778571376","wikidata":"https://www.wikidata.org/wiki/Q1355821","display_name":"Frontier","level":2,"score":0.31610000133514404},{"id":"https://openalex.org/C120912362","wikidata":"https://www.wikidata.org/wiki/Q136822","display_name":"Higher education","level":2,"score":0.3095000088214874},{"id":"https://openalex.org/C47344431","wikidata":"https://www.wikidata.org/wiki/Q1519812","display_name":"Health policy","level":3,"score":0.3070000112056732},{"id":"https://openalex.org/C2776193868","wikidata":"https://www.wikidata.org/wiki/Q5154950","display_name":"Community engagement","level":2,"score":0.2904999852180481},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.2888999879360199},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.2824000120162964},{"id":"https://openalex.org/C173655357","wikidata":"https://www.wikidata.org/wiki/Q244752","display_name":"Digital divide","level":3,"score":0.2800000011920929},{"id":"https://openalex.org/C3116431","wikidata":"https://www.wikidata.org/wiki/Q31728","display_name":"Public administration","level":1,"score":0.27709999680519104},{"id":"https://openalex.org/C193395930","wikidata":"https://www.wikidata.org/wiki/Q3247219","display_name":"International health","level":4,"score":0.27300000190734863},{"id":"https://openalex.org/C155663085","wikidata":"https://www.wikidata.org/wiki/Q1056396","display_name":"Workforce planning","level":3,"score":0.2700999975204468},{"id":"https://openalex.org/C2779891985","wikidata":"https://www.wikidata.org/wiki/Q46994","display_name":"Telemedicine","level":3,"score":0.2676999866962433},{"id":"https://openalex.org/C113807197","wikidata":"https://www.wikidata.org/wiki/Q60894","display_name":"Health education","level":3,"score":0.26440000534057617},{"id":"https://openalex.org/C185618831","wikidata":"https://www.wikidata.org/wiki/Q1851928","display_name":"Health promotion","level":3,"score":0.263700008392334},{"id":"https://openalex.org/C2781050511","wikidata":"https://www.wikidata.org/wiki/Q46994","display_name":"Telehealth","level":4,"score":0.26350000500679016},{"id":"https://openalex.org/C108170787","wikidata":"https://www.wikidata.org/wiki/Q3951828","display_name":"Agency (philosophy)","level":2,"score":0.25119999051094055}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.1093/haschl/qxag107","doi":"https://doi.org/10.1093/haschl/qxag107","is_oa":true,"landing_page_url":"https://doi.org/10.1093/haschl/qxag107","pdf_url":null,"source":{"id":"https://openalex.org/S4387290458","display_name":"Health Affairs Scholar","issn_l":"2976-5390","issn":["2976-5390"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Affairs Scholar","raw_type":"journal-article"},{"id":"pmid:42205359","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42205359","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health affairs scholar","raw_type":"Journal Article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13207580","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13207580/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13207580/pdf/qxag107.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Health Aff Sch","raw_type":"Text"}],"best_oa_location":{"id":"doi:10.1093/haschl/qxag107","doi":"https://doi.org/10.1093/haschl/qxag107","is_oa":true,"landing_page_url":"https://doi.org/10.1093/haschl/qxag107","pdf_url":null,"source":{"id":"https://openalex.org/S4387290458","display_name":"Health Affairs Scholar","issn_l":"2976-5390","issn":["2976-5390"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Affairs Scholar","raw_type":"journal-article"},"sustainable_development_goals":[{"score":0.9629999995231628,"display_name":"Reduced inequalities","id":"https://metadata.un.org/sdg/10"},{"score":0.6240000128746033,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"sustainable_development_goals_aurora":[{"score":0.44359272718429565,"display_name":"Partnerships for the goals","id":"https://metadata.un.org/sdg/17"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":3,"referenced_works":["https://openalex.org/W2164510796","https://openalex.org/W2316999663","https://openalex.org/W4387013685"],"related_works":[],"abstract_inverted_index":{"Rural":[0,150],"communities":[1,64],"in":[2,9,87,168],"the":[3,45,79,148],"United":[4],"States":[5],"face":[6],"persistent":[7],"gaps":[8],"health":[10,22,61,73],"care":[11,91],"access,":[12,160],"workforce":[13,104,162],"capacity,":[14],"and":[15,31,37,63,71,90,107,112,117,119,126,130,147,164,170],"outcomes":[16],"despite":[17],"substantial":[18],"federal":[19,141],"investment.":[20],"Academic":[21,47],"centers":[23],"(AHCs)":[24],"are":[25],"central":[26],"to":[27],"clinical":[28,110],"care,":[29],"research,":[30,89],"education,":[32,88],"but":[33],"remain":[34],"largely":[35],"urban-based":[36],"structurally":[38],"misaligned":[39],"with":[40,139],"rural":[41,58,82,145,169],"needs.":[42],"We":[43,122],"propose":[44],"Decentralized":[46],"Health":[48,151],"Center":[49],"(D-AHC),":[50],"a":[51,96,132,155],"distributed":[52],"model":[53],"that":[54],"integrates":[55],"academic":[56],"institutions,":[57],"providers,":[59],"public":[60],"systems,":[62,78,109],"through":[65],"shared":[66],"governance,":[67],"interoperable":[68],"data":[69,108],"infrastructure,":[70],"digital":[72,113],"tools.":[74],"Unlike":[75],"traditional":[76],"hub-and-spoke":[77],"D-AHC":[80,137],"treats":[81],"partners":[83],"as":[84,95],"co-equal":[85],"participants":[86],"delivery.":[92],"Using":[93],"Wyoming":[94],"case":[97],"example,":[98],"we":[99],"outline":[100],"5":[101],"implementation":[102,134],"domains:":[103],"development,":[105],"research":[106],"partnerships":[111],"health,":[114],"community":[115,127],"engagement":[116],"policy,":[118],"financial":[120],"sustainability.":[121],"further":[123],"describe":[124],"provider":[125],"readiness":[128],"considerations":[129],"present":[131],"practical":[133],"roadmap.":[135],"The":[136],"aligns":[138],"major":[140],"initiatives,":[142],"including":[143],"HRSA":[144],"investments":[146],"2025":[149],"Transformation":[152],"Program,":[153],"offering":[154],"scalable":[156],"framework":[157],"for":[158],"improving":[159],"strengthening":[161],"pipelines,":[163],"enhancing":[165],"system":[166],"sustainability":[167],"frontier":[171],"regions.":[172]},"counts_by_year":[],"updated_date":"2026-09-26T08:19:03.415552","created_date":"2026-05-10T00:00:00"}