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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract No. 282-99-0045, T.O. #14 between the National Academy of Sciences and the Health Resources and Services Administration and the Agency for Healthcare and Research Quality. Support was also provided by Contract No. 03M00025301D from the Substance Abuse and Mental Health Services Agency and Contract No. P0105938 from the W. K. Kellogg Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

Library of Congress Cataloging-in-Publication Data

Quality through collaboration : the future of rural health / Committee on the Future of Rural Health Care, Board on Health Care Services.

p. ; cm.

Includes bibliographical references and index.

ISBN 0-309-09439-9 (hardcover)

1. Rural health—United States. 2. Rural health services—United States.

[DNLM: 1. Rural Health Services—trends—United States. 2. Delivery of Health Care, Integrated—trends—United States. 3. Health Policy—United States. 4. Quality of Health Care—trends—United States. ] I. Institute of Medicine (U.S.). Committee on the Future of Rural Health Care.

RA771.5.Q34 2005



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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museum in Berlin.

Cover photos reprinted with permission: (1) Town of Clear Lake, Iowa, copyright 2002 Roger F. Bindl; (2) Aquilla Walker, PharmD, Manatee County Rural Health Services, Inc., copyright 2004 University of South Florida AHEC; (3) Tomah Memorial Hospital, copyright 2004 Tomah Memorial Hospital; (4) Home Health Care Nurse, copyright 2004 Jeff Joiner; (5) A Rural Ambulance Nissan 4WD near Bright, Victoria, copyright 2004 Driver Improvement Consultancy Pty Ltd.; (6) UCL Telemedicine Program, copyright 1999 University College London. Other photos available publicly: (1) Performing Breathing Test, Indian Health Service Photo Gallery, Image #206; (2) Small Farms, Agricultural Research Service, Image #K8502-1; (3) Child Being Examined by Physicians, National Institute of Allergy and Infectious Disease.

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