Chronic Disease in Rural America – Models and Innovations
These stories feature model programs and successful rural projects that can serve as a source of ideas and provide lessons others have learned. Some of the projects or programs may no longer be active. Read about the criteria and evidence-base for programs included.
Other Project Examples
Medical Home Plus
Updated/reviewed February 2020
- Need: To help reduce diabetes, depression, and stroke risk in rural residents.
- Intervention: A collaborative care model was implemented in the Idaho counties of Clearwater, Idaho, and Lewis.
- Results: Increased number of patients with controlled blood sugar, controlled blood pressure, and higher depression screening rates.
University of Mississippi Medical Center's Center for Telehealth
Updated/reviewed January 2020
- Need: Rural areas in Mississippi often lack adequate access to specialty healthcare services such as emergency medicine, stroke neurology, pediatric specialists and psychiatrists.
- Intervention: The University of Mississippi Medical Center created the Center for Telehealth to deliver quality specialty services through telehealth video conferencing and remote monitoring tools to the underserved areas of Mississippi.
- Results: The program has been successfully implemented throughout many of the state's rural hospitals and has reduced transfers and geographic barriers for patients.
COPD Readmission Prevention Program
Updated/reviewed December 2019
- Need: Organized effort targeting COPD patients' medical needs in order to prevent hospital readmission in Zanesville, Ohio.
- Intervention: Creation of an integrated system model using nurse navigators that incorporates evidence-based chronic disease care management approaches to COPD care.
- Results: Improved readmission rates and overall improved acute and chronic care for the area's COPD patients.
The Adolescent Pre-Diabetes Prevention Program
Added October 2018
- Need: Prevention of type 2 diabetes in adolescents living in rural parts of Louisiana.
- Intervention: Through screenings, the Adolescent Pre-Diabetes Prevention Program detects the onset of prediabetes. Through nutrition and physical activity education, the program teaches high school students and staff how to adopt healthy lifestyles.
- Results: The program has seen an increase in enrollment and continues to see decreases in body weight, body mass index, and A1C levels among participants.
Last Updated: 2/27/2020