The COVID-19 pandemic brought into stark relief the many healthcare challenges facing individuals living in
rural areas—the compounded needs of an aging population, geographic dispersion, inadequate public
transportation, spotty internet service, spikes in substance use, vaccine hesitancy. These disparities—like most
public health problems—reflect a complex interplay of biological, environmental, psychological, social, and
systems-level factors. At the same time, the pandemic highlighted potential solutions and spurred 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 “COVID compass” 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 equity, 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.