Study concept and design: N. B. Record, Onion, Dixon, S. S. Record, Fowler, Pearson.
Acquisition, analysis, or interpretation of data: N. B. Record, Onion, Prior, S. S. Record, Cayer, Amos, Pearson.
Drafting of the manuscript: N. B. Record, Onion, Prior, Dixon, S. S. Record, Fowler, Amos, Pearson.
Critical revision of the manuscript for important intellectual content: N. B. Record, Onion, Prior, Dixon, S. S. Record, Cayer, Amos, Pearson.
Statistical analysis: N. B. Record, Prior, Amos.
Administrative, technical, or material support: Prior, Dixon, S. S. Record, Fowler, Cayer, Pearson.
Study supervision: Onion, Pearson.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr N. B. Record and Ms S. S. Record reported that they and Franklin Memorial Hospital hold minority interests in Franklin ScoreKeeper, a company formed to develop and market the software developed by the FCHP. No other disclosures were reported.
Funding/Support: Logistical and financial support was provided by Franklin Memorial Hospital. Federal support beginning in 1972 until the mid-1980s came from the Office of Economic Opportunity and the Rural Health Care Service Outreach grant program; multiple small grants of $10 000 to $80 000 over the past 40 years, mostly during the initial 2 decades came from the Federal Health Underserved Rural Area grant program, the Bingham Program, the Regional Medical Program, Maine Bureau of Health, Maine Department of Human Services 314(d) grants, Western Maine Community Partnership, the Healthy Communities Coalition, Franklin Memorial Hospital, the United Way, and others, the details for which are no longer available.
Role of the Sponsors: There was no sponsor and no direct financial support for this report beyond the participation in the study group, from which this article eventually emerged, of some present (G.R.C,) and past (N.B.R., S.S.R., D.C.D., R.E.P.) Franklin Memorial Hospital employees. The hospital and ScoreHealth System provided some administrative support, such as meeting space and clerical services. Neither the hospital nor other partial funders over the decades listed here had any controlling role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Additional Contributions: We gratefully acknowledge the vital contributions of Clinton C. Conant, BS, MS, and Paul A. Judkins Jr, BA, both now deceased, for their original leadership in the community and the formation of Rural Health Associates. We also thank Richard Batt, BS, MBA, then president of the local hospital, for recognizing the potential of the Franklin Cardiovascular Health Program (FCHP) to advance area community health; John W. Whittington, MD (Institute for Healthcare Improvement [IHI]) for sharing his outcome vs income adjustment methodology, publishing the IHI internal study of outlier US counties online for public access, and general encouragement; David Harris, RN, PhD (University of Southern Maine), and Sheena Bunnell, PhD, MBA (University of Maine at Farmington), for their advice in study concept and design; Michael Rowland, MD, MPH, and Jay Naliboff, MD (Franklin Memorial Hospital), for study group participation and current Franklin Community Health Network information; Jane Arcari, LPN (FCHP), for more than 20 years of diligent FCHP information system development and support, and who, along with Dwight Payne, BS (ScoreHealth System), and Nicole Ditata, MCHES (Healthy Community Coalition of Greater Franklin County), provided data for this article; Kim E. Haggan (Maine Center for Disease Control’s Office of Data, Research, and Vital Statistics) for her provision of Maine vital statistics records; and W. Gregory Feero, MD (Maine-Dartmouth Family Medicine Residency), James L Glazer, MD (North Conway, New Hampshire, Memorial Hospital/Tufts University School of Medicine), Susan Thomas, MD (ScoreHealth System), and Daniel L. Meyer, PhD (DEWN Associates, Readfield, Maine), for their critical manuscript reviews. None of the authors or contributors received personal compensation for their assistance.
Correction: This article was corrected online April 28, 2015, for errors in the age data in Table 2.