Dartmouth Clinical and Translational Science Institute

Health and healthcare delivery for individuals living in rural areas face many health challenges—the compounded needs of an aging population, geographic dispersion, inadequate public transportation, spotty internet service, and spikes in substance use. These factors—like most public health problems—reflect a complex interplay of biological, environmental, psychological, social, and systems-level drivers. At the same time, recent years have seen a wealth of research in healthcare delivery science in rural areas. Much of this work was conducted by scientists affiliated with SYNERGY, Dartmouth’s Clinical and Translational Science Institute, founded in 2013. SYNERGY faculty reported the expanded use of telehealth, digital health, machine learning; strengthened partnerships between healthcare systems and community health centers; and developed a decision aid to guide policymaking. Our work in this area, centered in SYNERGY’s earliest years, has deepened our commitment to translational science that centers rural healthcare delivery and health, while exploring the full spectrum of translational science and workforce development. Hence, we propose to return SYNERGY to the national CTSA consortium. The overarching goal of this application is to continue to spur innovation in clinical and translational science with a focus on rural healthcare, in collaboration with other CTSA hubs, and to study a new model to catalyze T3 translational science in healthcare settings. SYNERGY reflects a close partnership between Dartmouth Health (DH) and Dartmouth College (DC). DH is the largest healthcare system in New Hampshire, with its flagship hospital in a rurally designated area. DC brings the resources of a research- intensive college, including schools of medicine, engineering, business, and graduate studies. SYNERGY includes our new Center for Rural Healthcare Delivery Science and key regional collaborators, including the Northern New England Clinical Translational Research Network (a partnership between MaineHealth and the University of Vermont), a Veterans Affairs hospital, community groups, and a “pipeline” program to grow the scientific workforce. SYNERGY’s goals are to (1) Accelerate the delivery of evidence-based diagnostics, therapeutics, and processes to address the healthcare needs of rural communities; (2) Assure the availability of timely, actionable patient- and population-level data to mitigate the translational block of “siloing” between translational scientists and healthcare system leadership by deploying a novel coproduction learning health system (LHS); (3) Train the next generation of translational scientists, with a particular focus on identifying future leaders in healthcare delivery science and rural health; (4) Disseminate these practices and lessons learned within the CTSA community through engagement with subnetworks addressing rural health, implementation science, and learning health systems science; and (5) Involve local communities in the design, conduct, analysis, and dissemination of our work, while engaging in studies of stakeholder engagement.