Introduction

Collaborations between public health and healthcare organizations are common and may form for a variety of reasons, including to develop needs assessments, support emergency preparedness and response, and infectious disease response. In rural settings, these collaborations may look different from those in urban settings due to workforce shortages, resource scarcity, and other challenges faced by rural local health departments (LHDs). Conversely, there is some evidence that rural areas also tend to have stronger social ties, as well as a more stable workforce, which may support robust collaborations. The benefits and barriers of these types of collaborations are supported by the literature, but there has been a lack of focus on rural settings or evidence since the COVID-19 pandemic. In an effort to share examples of successful collaborations in rural settings across the United States, we developed a series of four case studies, each focused on a unique collaboration. We hope that these case studies bring attention to the strengths and innovation happening in rural areas and provide strategies that can inform and support future collaborations between rural-serving public health and healthcare organizations. Strategies and examples highlighted in these case studies may also be valuable to local organizations as they develop implementation plans for Rural Health Transformation Program efforts.

What did we do?

We developed four case studies highlighting successful collaborations between rural-serving LHDs and healthcare organizations. Convenience sampling was used to identify examples from across the United States with different purposes as a part of a larger study. Organizations needed to be located in a rural area or serve a largely rural population to be included. Case studies were developed from semi-structured group interviews conducted via Zoom in April and May of 2025. The interviews included representation from local public health, local healthcare, and, when relevant, other local organizations that participated in the collaborations. Interview topics included the context, purpose, structure, development, sustainment, and impacts of the collaboration. Interviews were analyzed using a rapid coding approach. The final case studies were reviewed and approved by the participating organizations.

What did we find?

The following four case studies highlight collaborations from across the country that focus on addressing different health needs (Figure 1). These collaborations were selected based on this variation, as well as their potential to serve as examples for other organizations.

Figure 1. Case study locations and purposes

Case Study 1: Supporting Families After Childbirth

The first case study describes a collaboration between Jefferson County Public Health and St. Charles Madras, a critical access hospital that is part of the St. Charles Health System, both located in Jefferson County, Oregon. The two entities are co-located on the same campus, which facilitated the development of a hospital visiting program designed to improve maternal and child health. When a patient gives birth at St. Charles Madras, hospital nurses ask the parent(s) if they would be interested in connecting with public health staff about available resources and programs. With parental approval, public health staff visit interested parents before discharge to share information about the opportunities provided through Jefferson County Public Health, specifically The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Family Connects, a home-visiting program. Several positive impacts were seen as a result of this collaboration, including increased family awareness of available resources and the development of a sense of community and professional fulfillment among leadership and staff across organizations.

Case Study 2: A Community Paramedicine Program

The second case study highlights collaborative efforts between Aspirus Health, the Wausau Fire Department, and the Marathon County Health Department to establish a community paramedicine program in Marathon County, Wisconsin. The collaboration began in 2024 in response to several factors, including fall prevention being recognized as a goal of both the hospital and health department, the need to prevent unnecessary emergency department (ED) visits, and to address both health-related and social determinants of health needs among those who frequently utilized emergency medical services (EMS) and ED services. With funding from the partnering organizations, the city, and various foundations and grants, the Wausau Fire Department employs a community paramedic who provides a variety of services designed to reduce the burden on EMS and the ED by meeting the needs of patients that are not emergent, as well as addressing the underlying causes of EMS calls and ED visits. Since the program’s inception, there have been significant impacts for both patients and the supporting organizations, such as a 65% reduction in 911 calls and a diversion of 83 encounters from 911, translating to savings of over $82,000. Other patient needs have also been addressed, such as medication support, home safety checks, and fall-risk reduction

Case Study 3: Hospital and Health Department Data Sharing

The third case study explores a data-sharing collaboration between three organizations in Hancock County, Ohio: Blanchard Valley Hospital, Hancock County Public Health, and the Center for Civic Engagement as part of the larger Be Health Now Hancock County coalition. Through these collaborations, organizations collect, share, or use data for infectious disease prevention and control, for Community Health Assessments (CHAs), and for Community Health Improvement Plans (CHIPs). These processes have facilitated more direct communication between organizations, allowing for more timely sharing of infectious disease information, expertise, and the development of a formalized process to collaboratively complete CHAs and CHIPs to best address the needs of the organizations and community.

Case Study 4: Emergency Response for a Train Derailment

The final case study details a collaboration between the Pennsylvania Department of Health and Primary Health Network (one of the largest networks of federally qualified health centers in the state) that occurred in response to the 2023 derailment of a train carrying hazardous materials that impacted Beaver County and Darlington Township, both located in Pennsylvania. The derailment resulted in evacuation and shelter-in-place orders within a two-mile radius of the crash. In response to concerns from residents and elected officials, the Pennsylvania Department of Health (including a locally stationed community health nurse), Primary Health Network, and other partners established a temporary Health Resource Center (HRC) in Darlington Township. It was noted that strong communication and trust between the organizations contributed to a unified and efficient response. The collaboration was seen as a success by both organizations and could possibly be utilized in the future as a model for emergency response. During a three-week time period, they were able to design and coordinate a response that met the needs of their community, serving a total of 563 residents. The Pennsylvania Department of Health is also modifying existing state-level emergency response plans to better prepare for future incidents based on this experience.

Key Takeaways

• Rurality can support collaboration and encourage innovation, particularly when resources are limited.
• Collaborations between rural-serving LHDs and healthcare organizations can yield benefits for participating organizations as well as the individuals and communities served. These types of collaborations, for example, can improve organizational reach, foster a sense of fulfillment among the public health and healthcare workforce, and improve patient outcomes.
• Aligning collaboration goals and purpose with the mission, vision, and values of participating organizations can assist in collaboration development and sustainability, as well as garnering local support.
• Strong leadership and clear, consistent communication are necessary to support and sustain collaborations.
• Sharing organizational data can improve assessment processes and contribute to a more thorough understanding of community needs.
• Collecting data to document program effectiveness and growth can be essential for maintaining funding and community support.

Conclusions

Although these collaborations differ in location and purpose, they all highlight the importance of partnerships between LHDs and healthcare organizations in rural communities. By working together, these organizations leveraged each other’s strengths to address their communities’ needs, a task that may have been more difficult and less efficient on their own. To learn more about these collaborations, please follow this LINK to review the case studies in their entirety.

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Rachel Dean, MPH, is a Graduate Research Assistant at the East Tennessee State University Center for Rural Health and Research. She is currently earning her Doctor of Public Health with a focus on Community and Behavioral Health from the College of Public Health at East Tennessee State University with research interests in rural health disparities and aging.

Stephanie Mathis, DrPH, MPH, is a Research Associate Professor in the East Tennessee State University Center for Rural Health and Research and the Department of Community and Behavioral Health. She is also affiliated with the ETSU Addiction Science Center. Her research focuses on rural health and substance use disorder. Additionally, Dr. Mathis has experience with local, state, and regional evaluations of health initiatives. She serves as study staff for the Consortium for Workforce Research in Public Health (CWORPH), focused on public health systems and workforce research, and as core research staff for the ETSU/NORC Rural Health Research Center, focused on conducting policy-relevant rural health research.

Kayla Alvis, PhD, MS, BCBA, is a Research Assistant Professor at East Tennessee State University’s Center for Rural Health and Research. She holds a Ph.D. in Rural Sociology with an interdisciplinary specialization in Demography from The Ohio State University. Dr. Alvis has contributed to federally funded research through HRSA, CDC, and ARC, as well as projects supported by Dogwood Health Trust, the Tennessee Department of Health, and the Commonwealth Fund. She is a member of the Consortium for WOrkforce Research in Public Health (CWORPH), the ETSU/NORC Rural Health Research Center, and the Vanderbilt Consortium Leadership Education in Neurodevelopmental and Related Disabilities (LEND).

Benjamin Pelton, MPH, RT(R) is a research project manager at the East Tennessee State University Center for Rural Health and Research overseeing studies funded by governmental and philanthropic organizations. He manages administrative tasks for projects focused on area-level indices, disaster recovery, and the public health workforce.

Haleigh Leslie, DrPH, MPH, MBA, was a graduate research assistant at the East Tennessee State University Center for Rural Health and Research at the time of the study. She now serves as the health officer for the Ionia County Health Department in Michigan.

Michael Meit, MA, MPH; is a Research Associate Professor and the Director of the East Tennessee State University Center for Rural Health and Research. Meit has been actively involved in public health systems and services research for many years, particularly as it relates to rural, local public health. He is also a site PI for the Consortium for WOrkforce Research in Public Health (CWORPH), focused on public health systems and workforce research, and a member of the ETSU/NORC Rural Health Research Center, focused on conducting policy-relevant rural health research.

Casey Balio, PhD, is a Research Assistant Professor at the East Tennessee State University Center for Rural Health and Research and the Department of Health Services Management and Policy. Her research focuses on the intersection of rural health, health policy, and public health. She is also a member of the Consortium for WOrkforce Research in Public Health (CWORPH), focused on public health systems and workforce research, and the ETSU/NORC Rural Health Research Center, focused on conducting policy-relevant rural health research.