Study Reveals Proactive Chronic Care Management Can Improve Rural Patient Cardiovascular Health

October 5, 2022

Health equity becomes a major underlying goal associated with health outcomes with rural populations, who struggle with a higher number of proportional deaths associated with cardiovascular events such as heart disease than urban centers. With only polarizing disparities, a group of academic researchers represented by corresponding author Patrik Johansson, MD  an associate professor at Washington State University and colleagues points out in Journal of Cardiovascular Nursing that 43% of heart disease deaths among persons under the age of 80 years in rural areas were preventable; this compares to just 28% in urban areas for example. IN a 2-group investigational, repeated-measures design the study team randomized participants to one of either A) standard primary care group (n = 30) or B) an intervention group (n = 30) with the latter inclusive of a registered nurse/community health worker-based team delivering care management services. These teams provided this more proactive care services via phone or videoconferencing and the authors designed the study to measure outcomes at baseline and thereafter at 3 and 6 months later.   The study led to the following conclusion: those elderly participants that were randomized to the nurse/community health worker-delivered intervention improved their cardiovascular risk-based profiles, total cholesterol, and low-density lipoprotein levels at 3 months.

The team led by Professor Johansson and funded by the Center for Patient, Family and Community Engagement in Chronic Care Management Center at the University of Nebraska Medical Center found that patients preferred that the care coordination teams conducted their encounters with patients via in person (46.3%) and telephone (42.3%) most over video conferencing app (9%).

Real Disparities

Rural communities face graver cardiovascular risk, particularly as patients get older. CrossTx offers a Chronic Care Management platform for rural health clinics across America with the largest concentration of clients in the western part of the nation.

These authors report in the seven years between 2010 and 2017:

“Preventable deaths from heart disease increased the most in micropolitan counties (age period cohort, 2.5%) and decreased most in large fringe metropolitan counties (age period cohort, −1.1%). Demographic, behavioral, environmental, economic, and social factors put rural residents at a higher risk of death from heart disease and other cardiovascular disease (CVD)-related conditions.In comparison with their urban counterparts, rural residents tend to be older, sicker, and less educated; have higher poverty rates; and are more likely to report limited access to healthcare and lower quality of healthcare.”

But there’s more as the study team reports rural areas face higher risks associated with smoking rates, hypertension, obesity, and generally less healthy sedentary lifestyles.

The Study

In this 2-group investigational, repeated-measures design the study the investigators reports that mean change at 3 months varied by intervention and control groups for cardiovascular risk (-1.0[95% confidence interval (CI), -3.1 to 1.1] vs 1.4 4 [95% CI, −0.4 to 3.3], respectively), total cholesterol (−13.2 [95% CI, −32.1 to 5.7.] vs +21.0 [95% CI, 4.1–38.1], respectively), and low-density lipoprotein (−11.5 [95% CI, −30.8 to 7.7] vs +19.6 [95% CI, 1.9–37.2], respectively) as reported in the Journal of Cardiovascular Nursing. 

When it came to results in high-density lipoprotein, blood pressure or triglycerides there weren’t any group differences.


Care coordination services involving nurses and community health workers can make a material difference in the healthcare of rural patients. CrossTx has observed general trends based on the accumulation of data across 20 states, managing Medicare and Medicaid CCM programs for rural health clinics.

In this study the participants in the nurse/community health worker group fared better when measuring their risk cardiovascular profiles, total cholesterol, and low-density lipoprotein levels by three months

The study authors do acknowledge among other things a small study sample size, suggesting further research involving a larger study should be explored to better assess the data points generated in this study.

Importantly some chronic care management companies have employed an outsourcing call center model for Centers for Medicare and Medicaid Services (CMS) chronic care management programs. This is a mistake as its vitally important to provide localized health care professionals to the care coordination team.  This study showcases the potential of bringing on board a nurse or community health care professional as the leads for chronic care management and coordination.

Check out the study results here.


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