PROJECT SUMMARY/ABSTRACT This Centers of Biomedical Research Excellence (COBRE) proposal establishes a Center for Rural Health Care Delivery Science at Dartmouth-Hitchcock Health (D-HH), one of the most rural academic medical centers in the United States. Nearly 20% of Americans live in non-metropolitan areas and experience poorer health outcomes, but research on rural health care has been limited by challenges associated with relatively small and geographically dispersed populations. Accordingly, our Center will concentrate on understanding and solving challenges associated with the provision of health care in rural areas, focusing on a community- engaged approach to research. The overarching goal of this COBRE is to establish a multidisciplinary research program in rural health care delivery science and to provide expert mentorship and infrastructure to train and support a critical mass of early-career clinician-scientists as they transition into independent researchers dedicated to decreasing health care disparities in rural communities. To achieve this goal, the Center will pursue the following four specific aims: (1) Integrate research expertise, mentorship, and community engagement to establish a Center for Rural Health Care Delivery Science; (2) Enhance the transition of early- career clinician-scientists into independent researchers through strong research support and dedicated mentoring; (3) Assure accountability and achievement of milestones through the implementation of a rigorous program evaluation plan; and (4) Leverage shared resources to support the Center for Rural Health Care Delivery Science as a self-sustaining scientific community. The proposed Center will bring an innovative and impactful approach to rural health care delivery research by focusing on the fundamental causes of rural health disparities across systems and processes, as well as addressing barriers that impede disease detection, access to care, and management of health conditions that are particularly prevalent in rural populations. The initial four Research Project Leaders will address disease prevention and screening (Project 1), digital health technologies for disease management (Project 2), as well as socio-economic factors and health policy that impact the management of complex conditions (Project 3) and the provision of end-of-life care (Project 4). The Center's Scientific Cores will support the Center by: (1) Strengthening methodology for mechanistic studies in rural populations; and (2) Providing needed resources for expanding and strengthening critical relationships between researchers and key stakeholders via community-based participatory research. COBRE funding, coupled with substantial institutional funding and a commitment to hire additional faculty members during Phase I, will provide an outstanding foundation for the development of a vibrant Center. In summary, the proposed Center will support the establishment of a self-sustaining, multidisciplinary research program in rural health care delivery science at D-HH.

PROJECT NARRATIVE This Centers of Biomedical Research Excellence (COBRE) proposal establishes a Center for Rural Health Care Delivery Science at Dartmouth-Hitchcock Health (D-HH), a rural academic health system. The Center will concentrate its efforts on understanding and solving challenges associated with the provision of health care in rural areas, focusing on a community-engaged approach to research. It will also mentor and support a critical mass of early-career clinician-scientists as they transition into independent researchers dedicated to decreasing health care disparities in rural communities.