The Architecture of Rural Healthcare: Supporting access to health in remote and rural areas

Many remote and rural areas in the United States lack adequate access to basic healthcare services such as primary, urgent, and emergency care typically provided by healthcare systems and hospitals. In addition, many rural communities are comprised of an increasingly aging population, a growing number of patients with chronic illnesses, and in some communities a high volume of tourists that need urgent care. Remote communities struggle with providing access to these basic but essential healthcare services taken for granted in more populated areas. Changing reimbursement, evolving patterns of care delivery and advances in technology are all altering how access to medical care can be delivered in geographically isolated locations. At the same time, increasing healthcare provider shortages place a particular strain on access to medical care in rural communities. This evolving context for care in rural America increases the pressures to provide greater access to better care with limited physical and human resources. As a result, an even greater need exists today for rural healthcare providers to deliver care in an appropriately designed environment that can enable the highest possible level of care that is delivered more effectively with limited resources over time. This thesis investigation identifies best practices on how to design of rural and remote community healthcare facilities that supports high quality and sustainable healthcare services. Healthcare settings in remote areas must support standardized care delivery by providers who may be remote or rotating between multiple communities while enhancing access to the highest level of care possible. Also, they must be sustainable and relatively self-sufficient front-line outposts that are physically distant from major medical resources. A comprehensive literature and case study review was employed to identify background issues in healthcare and best practices for rural health care architecture. Databases searched include Academic Search Complete, Academic Search Premier, Alt Health Watch, Avery Index to Architectural Periodicals, CINAHL Plus with text, Health source, and Medline. From the literature review, over 83 articles were reviewed with 70 of these articles directly or indirectly applicable to topics related to rural healthcare objectives. Primary research was gathered through site visits and formal observations of selected best practice case studies in a cross section of rural and remote communities in the US and Canada along with interviews of design professionals and health providers associated with the identified projects. The literature and case study research along with site visits was used to identify and develop a series of architectural design guidelines for rural medical facilities and a prototype program. The design guidelines generated include optimizing user accessibility, operating off the grid, constructing modular units, standardizing clinical spaces, creating adaptable spaces, and maximizing staff connectivity