A comparison of four Nebraska rural health care delivery networks to an interorganizational relationship model of service delivery networks

Interorganizational health care delivery networks have potential for sustaining health services delivery in rural areas faced with economic and demographic challenges. Continuing devolution of centralized federal programs to local administration fuels interest in such networks.^ This study compares Nebraska rural health care delivery networks (Albion-Ord, Blue River Valley, Rural Partners, Inc., and Western Nebraska) to an interorganizational model. The model is based on theories of interorganizational relations, exchange, population ecology, and synthesized collaboration. It assumes that outcomes are influenced by external and internal factors, operationalized through external control, technology, structure, operational processes, and outcomes.^ Data were collected by a non-random, two-level cluster mail survey to network members (45/59 = 76.3% response rate). All networks received assistance from the Nebraska Office of Rural Health to organize, mainly to prepare for managed care delivery.^ Networks show formal organization, including coordinators, budgets supported primarily by grants, strategic plans, and boards of directors. Hospital administrators hold most leadership positions, with few physicians or citizens involved. Members value their network which they believe anticipates and acts on environmental changes.^ Correlation and regression analysis show partial fit between the research model and study networks as evidenced by significance in internal (organizational) factors, but not external (environmental) factors. Effectiveness, measured by the gap between best possible and actual practice, increased with network connectivity (r = $-$.36, p $\u3c$.05), group methods of administrative decision making (r = $-$.52, p $\u3c$.001), and sequential pattern of service delivery (r = $-$.39, p $\u3c$.05).^ Greater dependence on vertical funding corresponds to greater external control (r =.43, p $\u3c$.01). The prediction that as scope of work narrows, task intensity (r = $-$.56, p $\u3c$.001), duration (r = $-$.41, p $\u3c$.01), and task volume (r = $-$.50, p $\u3c$.01) increase is upheld. Centrality and size of networks decrease together (r =.43, p $\u3c$.01) when there is little reliance on vertical sources of funds (r = $-$.36, p $\u3c$.05).^ The integrated interorganizational model demonstrates some efficacy for testing potential effectiveness of rural health care networks.