{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T18:03:19Z","timestamp":1779818599750,"version":"3.53.1"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Rural communities in the United States face persistent gaps in health care access, workforce capacity, and outcomes despite substantial federal investment. Academic health centers (AHCs) are central to clinical care, research, and education, but remain largely urban-based and structurally misaligned with rural needs. We propose the Decentralized Academic Health Center (D-AHC), a distributed model that integrates academic institutions, rural providers, public health systems, and communities through shared governance, interoperable data infrastructure, and digital health tools. Unlike traditional hub-and-spoke systems, the D-AHC treats rural partners as co-equal participants in education, research, and care delivery. Using Wyoming as a case example, we outline 5 implementation domains: workforce development, research and data systems, clinical partnerships and digital health, community engagement and policy, and financial sustainability. We further describe provider and community readiness considerations and present a practical implementation roadmap. The D-AHC aligns with major federal initiatives, including HRSA rural investments and the 2025 Rural Health Transformation Program, offering a scalable framework for improving access, strengthening workforce pipelines, and enhancing system sustainability in rural and frontier regions.<\/jats:p>","DOI":"10.1093\/haschl\/qxag107","type":"journal-article","created":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T09:06:03Z","timestamp":1778317563000},"source":"Crossref","is-referenced-by-count":0,"title":["The decentralized academic health center: a 21st-century model for rural health innovation"],"prefix":"10.1093","volume":"4","author":[{"given":"Patrick C","family":"Hardigan","sequence":"first","affiliation":[{"name":"College of Health Sciences, University of Wyoming , Laramie, WY 82071 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6228-1741","authenticated-orcid":false,"given":"Johannes","family":"Vieweg","sequence":"additional","affiliation":[{"name":"Mass General Brigham, Harvard University , Cambridge, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"issue":"3","key":"2026052613171138100_qxag107-B1","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1377\/hlthaff.27.3.759","article-title":"The triple aim: care, health, and cost","volume":"27","author":"Berwick","year":"2008","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"2026052613171138100_qxag107-B2","article-title":"Health research in academic health systems: time for a new model","volume":"1","author":"Collard","year":"2023","journal-title":"Health Aff Sch"},{"key":"2026052613171138100_qxag107-B3","volume-title":"How academic medicine serves America\u2019s rural communities","author":"Association of American Medical Colleges (AAMC)","year":"2025"},{"key":"2026052613171138100_qxag107-B4","author":"Centers for Disease Control and Prevention (CDC)","year":"2024"},{"key":"2026052613171138100_qxag107-B5","author":"Rural Health Information Hub"},{"key":"2026052613171138100_qxag107-B6","author":"National Rural Health Association (NRHA)"},{"key":"2026052613171138100_qxag107-B7","volume-title":"Federal Office of Rural Health Policy investments: fiscal years 2024\u20132025","author":"Health Resources and Services Administration (HRSA)","year":"2025"},{"key":"2026052613171138100_qxag107-B8","author":"National Institutes of Health"},{"key":"2026052613171138100_qxag107-B9","author":"US Congress"},{"key":"2026052613171138100_qxag107-B10","doi-asserted-by":"publisher","first-page":"1605","DOI":"10.3332\/ecancer.2023.1605","article-title":"Role of digital health in coordinating patient care in a hub-and-spoke hierarchy of cancer care facilities: a scoping review","volume":"17","author":"Venkataramanan","year":"2023","journal-title":"Ecancermedicalscience"},{"issue":"2","key":"2026052613171138100_qxag107-B11","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1097\/ACM.0b013e31820469d6","article-title":"Increasing the supply of rural family physicians: recent outcomes from Jefferson Medical College's Physician Shortage Area Program (PSAP)","volume":"86","author":"Rabinowitz","year":"2011","journal-title":"Acad Med"},{"key":"2026052613171138100_qxag107-B12","volume-title":"A Research Agenda for an Evolving Public Health System: Directions for the Field of Public Health Services and Systems Research","author":"AcademyHealth","year":"2024"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxag107\/68258429\/qxag107.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/5\/qxag107\/68258429\/qxag107.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/5\/qxag107\/68258429\/qxag107.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T17:17:17Z","timestamp":1779815837000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxag107\/8674863"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":12,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,5]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxag107","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,5]]},"article-number":"qxag107"}}