The Office of Rural Health Policy, Department of Health and Human Services requested that the Institute of Medicine establish a committee to provide an independent, unbiased assessment of the quality of health care in rural America.

The committee developed a conceptual framework for a core set of services and the essential infrastructure necessary to deliver those services to rural communities. The committee also recommended priority objectives, identified the changes in policies and programs including, but not limited to, payment policies and the necessary information and communication technology infrastructure needed to advance the identified objectives. In the entire analysis, the committee considered implications for federal programs and policy. The study recommended an agenda for quality improvement in rural settings and identified the performance characteristics that model 21st century community rural health systems should meet.

As a major part of the study the committee convened a large day-and-a-half workshop in addition to three committee meetings. The discussions at the workshop focused on the key characteristics that are unique to rural environments and mapped out the characteristics that a model rural community health system should meet in terms of care delivery, payment, quality monitoring, reporting, IT infrastructure, and other relevant areas.