Rural Health
Resources by Topic: Chronic disease management
Evaluation of the ACO REACH Model: Evaluation Report 3
Presents key findings from an evaluation of the Accountable Care Organization (ACO) REACH Model's first performance year, as well as the two years of the preceding Global and Professional Direct Contracting (GPDC) Model. Examines model participants' implementation experiences and the model's impact on cost, utilization, and quality outcomes. Includes information on the participation of Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Critical Access Hospitals (CAHs) in the model.
Additional links: Appendices, CMS Perspective Report, Executive Summary, Findings at a Glance
Date: 07/2026
Sponsoring organizations: Centers for Medicare & Medicaid Services, NORC at the University of Chicago
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Presents key findings from an evaluation of the Accountable Care Organization (ACO) REACH Model's first performance year, as well as the two years of the preceding Global and Professional Direct Contracting (GPDC) Model. Examines model participants' implementation experiences and the model's impact on cost, utilization, and quality outcomes. Includes information on the participation of Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Critical Access Hospitals (CAHs) in the model.
Additional links: Appendices, CMS Perspective Report, Executive Summary, Findings at a Glance
Date: 07/2026
Sponsoring organizations: Centers for Medicare & Medicaid Services, NORC at the University of Chicago
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Rural Health and Health Disparities in Hypertension Management: A Scientific Statement From the American Heart Association
Discusses factors influencing the high rural prevalence of hypertension and highlights approaches for improving rural hypertension management. Covers topics including nonmedical drivers of health, access to services, medication access and use, nutrition and food insecurity, telehealth, and culturally-tailored service delivery.
Author(s): Cassandra D. Ford, Natalie A. Cameron, Donald Clark, et al.
Citation: Hypertension
Date: 06/2026
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Discusses factors influencing the high rural prevalence of hypertension and highlights approaches for improving rural hypertension management. Covers topics including nonmedical drivers of health, access to services, medication access and use, nutrition and food insecurity, telehealth, and culturally-tailored service delivery.
Author(s): Cassandra D. Ford, Natalie A. Cameron, Donald Clark, et al.
Citation: Hypertension
Date: 06/2026
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Effect of Health Literacy on use of a Virtual Coach to Promote Home Blood Pressure Monitoring
Examines health literacy and utilization of a virtual coaching agent to support hypertension management in rural residents. Utilizes data from 59 participants in rural Pennsylvania to monitor frequency of home blood pressure monitoring (HBPM) readings and the impact of virtual coaching for HPBM in patients with low health literacy.
Author(s): Chinenye C. Odo, Andrew Mrkva, Erin Shepherd, et al.
Citation: Journal of Clinical Hypertension, 28(6), e70320
Date: 06/2026
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Examines health literacy and utilization of a virtual coaching agent to support hypertension management in rural residents. Utilizes data from 59 participants in rural Pennsylvania to monitor frequency of home blood pressure monitoring (HBPM) readings and the impact of virtual coaching for HPBM in patients with low health literacy.
Author(s): Chinenye C. Odo, Andrew Mrkva, Erin Shepherd, et al.
Citation: Journal of Clinical Hypertension, 28(6), e70320
Date: 06/2026
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Transforming Diabetes Management in Rural America: A Qualitative Exploration of a Diabetes Coaching Program Delivered via Telehealth
Details the experiences of 27 rural participants in a telehealth-based Diabetes Self-Management Education and Support Services (DSMES) intervention which took place in 2023 and 2024. Covers topics including program structure, impacts on quality of life, program engagement, lifestyle changes, participant motivations, and more.
Author(s): Catherine Moring, Caroline Brock, Katharine L. Brown, Allison Ford-Wade
Citation: International Journal of Environmental Research and Public Health, 23(6), 696
Date: 05/2026
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Details the experiences of 27 rural participants in a telehealth-based Diabetes Self-Management Education and Support Services (DSMES) intervention which took place in 2023 and 2024. Covers topics including program structure, impacts on quality of life, program engagement, lifestyle changes, participant motivations, and more.
Author(s): Catherine Moring, Caroline Brock, Katharine L. Brown, Allison Ford-Wade
Citation: International Journal of Environmental Research and Public Health, 23(6), 696
Date: 05/2026
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Where Primary Care and Clinical Pharmacy Services 'Intersect': Louisiana Program Helps Patients Understand and Manage Medications
Features a program at Arbor Family Health in Louisiana that connects chronic disease patients with nurse health coaches and clinical pharmacists. Shares how pharmacy faculty and students from the Xavier University of Louisiana's College of Pharmacy conduct annual comprehensive medication reviews by phone.
Author(s): Gretel Kauffman
Citation: Rural Monitor
Date: 05/2026
Sponsoring organization: Rural Health Information Hub
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Features a program at Arbor Family Health in Louisiana that connects chronic disease patients with nurse health coaches and clinical pharmacists. Shares how pharmacy faculty and students from the Xavier University of Louisiana's College of Pharmacy conduct annual comprehensive medication reviews by phone.
Author(s): Gretel Kauffman
Citation: Rural Monitor
Date: 05/2026
Sponsoring organization: Rural Health Information Hub
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Promoting Access to Chronic Illness Management and Nursing Education in a Rural Illinois Nurse-Led Mobile Health Unit
Examines the impact of nurse-led mobile health units (MHUs) to provide point-of-care (POC) screening and management of chronic disease in rural and hard-to-reach areas. Discusses MHU clinical experiences in nursing programs and expanding access to POC healthcare in rural areas.
Author(s): Carol Sieck, Kelly D. Rosenberger, Summer Roeschley-Park, Carolyn Dickens
Citation: Journal of the American Association of Nurse Practitioners, 38(6), 393-397
Date: 03/2026
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Examines the impact of nurse-led mobile health units (MHUs) to provide point-of-care (POC) screening and management of chronic disease in rural and hard-to-reach areas. Discusses MHU clinical experiences in nursing programs and expanding access to POC healthcare in rural areas.
Author(s): Carol Sieck, Kelly D. Rosenberger, Summer Roeschley-Park, Carolyn Dickens
Citation: Journal of the American Association of Nurse Practitioners, 38(6), 393-397
Date: 03/2026
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Unapologetically Built Backwards: ONU HealthWise, Pharmacist-Driven Healthcare Access in Rural Ohio
Features a university pharmacy department in rural Ohio that prepares pharmacy students for rural practice while also providing mobile services in nearby rural counties. Describes how the program has expanded to offer interprofessional education experiences and serve a larger region.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 03/2026
Sponsoring organization: Rural Health Information Hub
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Features a university pharmacy department in rural Ohio that prepares pharmacy students for rural practice while also providing mobile services in nearby rural counties. Describes how the program has expanded to offer interprofessional education experiences and serve a larger region.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 03/2026
Sponsoring organization: Rural Health Information Hub
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Rural Health Transformation Program: State Focus on Maternal and Child Health
Describes maternal and child healthcare initiatives addressed in state Rural Health Transformation Program applications. Covers access to maternity care, the maternal health workforce, community-based behavioral health programs, technology-enabled strategies for maternal health, and more.
Author(s): Anoosha Hasan, Elliot Hill, Zack Gould
Date: 03/2026
Sponsoring organization: National Academy for State Health Policy
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Describes maternal and child healthcare initiatives addressed in state Rural Health Transformation Program applications. Covers access to maternity care, the maternal health workforce, community-based behavioral health programs, technology-enabled strategies for maternal health, and more.
Author(s): Anoosha Hasan, Elliot Hill, Zack Gould
Date: 03/2026
Sponsoring organization: National Academy for State Health Policy
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Increasing Uptake of Diabetes Self-Management Education and Support (DSMES) in Rural Kentucky Primary Care Clinics: Findings From a Pilot Pragmatic Cluster-Randomized Trial
Provides findings from a quality improvement pilot study focused on increasing diabetes self-management education and support (DSMES) uptake via coaching and technical assistance in rural Kentucky primary care clinics.
Author(s): Mary E. Lacy, Jessica Elliott, Vance Drakeford, et al.
Citation: Journal of Primary Care & Community Health, 17
Date: 03/2026
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Provides findings from a quality improvement pilot study focused on increasing diabetes self-management education and support (DSMES) uptake via coaching and technical assistance in rural Kentucky primary care clinics.
Author(s): Mary E. Lacy, Jessica Elliott, Vance Drakeford, et al.
Citation: Journal of Primary Care & Community Health, 17
Date: 03/2026
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Factors Associated with High vs. Low Implementation of Medicare's Chronic Care Management Programme in Wyoming Primary Care Practices
Identifies factors associated with rural primary care practices' participation in the Medicare Chronic Care Management (CCM) program, using interview data of 13 healthcare professionals at 6 sites in Wyoming. Compares characteristics of high and low implementation sites, including discussion of healthcare team communication, evaluation, leadership, and more.
Author(s): Elizabeth Punke, Lucas A. Wall, Christine L. McKibbin, et al.
Citation: Primary Health Care Research & Development, 27, e19
Date: 02/2026
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Identifies factors associated with rural primary care practices' participation in the Medicare Chronic Care Management (CCM) program, using interview data of 13 healthcare professionals at 6 sites in Wyoming. Compares characteristics of high and low implementation sites, including discussion of healthcare team communication, evaluation, leadership, and more.
Author(s): Elizabeth Punke, Lucas A. Wall, Christine L. McKibbin, et al.
Citation: Primary Health Care Research & Development, 27, e19
Date: 02/2026
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