To examine what changes occurred in the acute health care delivery systems of rural Texas energy impact communities from 1978 to 1983, a retrospective survey was used to acquire data from which a database could be generated that could provide information for community and state policy decisions. From a pool of communities chosen by a panel of experts, five communities were selected for study. Three survey tools were used to collect data about health manpower resources, operational status, physical infrastructures, and health care clients. Two interview questionnaires for agency representatives and community residents were also utilized. Using descriptive statistics methods for data analysis disclosed that during impact and/or post-impact periods manpower increased, costs rose, services became more varied, and building expansion occurred. Overall, there were more problems in the acute health care delivery system during the impact and post-impact than during pre-impact, causing agencies to expand and upgrade much sooner than they would have if the communities had remained pre-impact. Regardless of the problems associated with energy impact, acute health care delivery systems improved. Graphic and tabular information is presented in the data analysis section and conclusions are broken down into specific subheadings reflecting impact period, problems, and changes. (PM)