Rural Clinical Models for Health Promotion and Disease Prevention
Healthcare providers and facilities play an instrumental role in improving the health of rural residents.
Healthcare providers and hospital staff can use many of the strategies and theories included in this module to
improve the health outcomes of their patients. Healthcare settings in rural areas have also adopted clinical
models that support systems change and the way that care is delivered to patients managing and preventing
chronic conditions and disease. These models include:
Disease Management: The
Chronic Disease Self-Management Program is a workshop given for two and a half hours, once a week, for six
community settings such as senior centers, churches, libraries, and hospitals. People with different chronic
health problems attend together. Workshops are facilitated by two trained leaders, one or both of whom are
non-health professionals with chronic diseases themselves. Subjects covered include:
- Techniques to deal with problems such as frustration, fatigue, pain, and isolation
- Appropriate exercise for maintaining and improving strength, flexibility, and endurance
- Appropriate use of medications
- Communicating effectively with family, friends, and health professionals
- Decision making
- How to evaluate new treatments
Community Health Worker/Promotoras de
model uses community members with a shared cultural background to
assist individuals with health issues and disease management. Community Health Workers (CHWs) assist people with
information, provide care coordination services, and provide support to adopt healthy behaviors and lifestyles.
Medical Home: A
patient-centered medical home focuses on strengthening the clinician-patient relationship. This is achieved
through improved access, managed and coordinated care, increased support, and is designed to help prevent,
manage, and decrease the impact of various chronic diseases.
Resources to Learn More
Promoting Preventive Services for
Adults 50-64: Community and Clinical Partnerships
Promotes lifesaving clinical preventive services for adults aged 50 to 64. Includes health prevention
statistics, and identifies recommended practices for implementing community and clinical prevention
Organization(s): Centers for Disease Control and Prevention, American Medical Association,
Community Health Workers
Addressing Chronic Disease through Community Health
Workers: A Policy and Systems-Level Approach
Provides guidance and resources for implementing recommendations to integrate community health
workers (CHWs) into community-based efforts to prevent chronic disease.
Organization(s): Centers for Disease Control and Prevention
Health Workers Evidence-Based Models Toolbox
Identifies promising practice models and evidence-based models for developing CHW programs in rural communities.
Includes literature reviews on CHW program models as well as training approaches, implementation of programs,
and program planning.
Organization(s): Health Resources and Services Administration (HRSA)
Community Health Workers to Reduce Health Disparities in Minnesota
Discusses the impacts and outcomes from a CHW education program in Minnesota, and summarizes past projects
relating to CHWs, program results, and lessons learned.
Organization(s): Robert Wood Johnson Foundation
Community Health Worker Programs
Presents examples of CHW programs in numerous states, and information gathered assisting in establishment of a
CHW program in North Dakota, Minnesota, Massachusetts, New Mexico, New York, Colorado, Washington, and
Author(s): Dickson, L. & Yahna, R.M.
Organization(s): University of North Dakota Center for Rural Health
Patient Centered Medical Homes
Defining the PCMH
Defines the patient-centered medical home (PCMH) as encompassing five key attributes: 1)
comprehensive care, 2) patient-centered; 3) coordinated care; 4) accessible services; and 5) quality and safety.
Organization(s): Agency for Healthcare Research and Quality (AHRQ)