Intervention without Infrastructure: The Challenge of Managing Chronic Disease in Rural America

In this session, Dr. Cheng examines the systemic barriers to managing chronic disease through the lens of evidence-based guidelines. Drawing on his experience in clinical practice, rural health education, and digital health leadership, he will explore how geographic isolation, workforce shortages, and socio-economic factors intersect to create the "Rural Health Paradox." Participants will analyze the transition from traditional "volume-based" care to innovative, tech-enabled transformation models—such as the hub-and-spoke and Project ECHO and eConsults—to bridge the gap between urban standards and rural realities. Attendees will leave with actionable strategies for implementing high-level medical consensus in resource-constrained settings to improve health equity.

CME/CE Information

1.00 AMA PRA Category 1 Credits™, 1.00 ABIM MOC or 1.00 AANP

Release Date: 3/25/2026

Expiration Date: 1/15/2027

Topics

Faculty

Anthony M. Cheng, MD

Learning Objectives

Analyze the systemic drivers of the "Rural Health Paradox," including the intersection of geographic isolation, socioeconomic deprivation, and chronic disease prevalence
Evaluate current consensus statements from medical societies such as ACOG, AHA, and AAFP to identify specific challenges in applying "gold-standard" clinical guidelines within resource-constrained rural environments
Identify high-impact digital health and "care transformation" strategies—such as Project ECHO and hub-and-spoke telehealth models—that bridge the gap between urban specialty care and rural primary care
Implement evidence-based frameworks for managing multi-morbidity in rural populations by leveraging community-based resources and innovative clinical workflows

Faculty

Anthony M. Cheng, MD

Associate Professor of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR

Medical Director, Office of Digital Health, Oregon Health & Science University, Portland, OR

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Disclosures

The following relevant financial relationships have been disclosed by those in a position to influence the content of this activity. All have been mitigated by Pri-Med Institute

Faculty Name: Faculty Disclosure here

CME/CE Information

AMA PRA Category 1 Credits™

Accreditation Statement

Pri-Med Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement

Pri-Med Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP

Accreditation Statement

Pri-Med Institute is accredited by the American Association of Nurse Practitioners^® as an approved provider of nurse practitioner continuing education. Provider number: 040308.

Designation Statement

This activity is approved for X.XX contact hour of continuing education, which includes X.XX hours of pharmacology.

MOC Credit Information

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 Medical Knowledge MOC point in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Instructions for Obtaining Credit

Once you have completed the activity, please click the "next" button to advance to the post-activity assessment. To complete this activity and claim credit, you must answer X out of the Y questions correctly. If you are not successful after your first attempt, you will be given an opportunity to reflect upon the answer rationales and have the opportunity to review the educational content before proceeding. Once you have selected your answers, click the "submit" button to complete the evaluation questions and proceed to the claim credit screen. For PAs, the NCCPA accepts for Category 1 CME credit activities designated for AMA PRA Category 1 Credit.

Fine Print

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Disclaimer

The opinions, ideas, and recommendations expressed in this educational activity are those of the faculty only and are not necessarily endorsed by, nor do they necessarily reflect, those of their affiliated institutions, Pri-Med Institute, Pri-Med Institute Advisory Boards and Consultants, DBC Pri-Med, LLC.

Clinical judgment must guide each clinician in weighing the possible risks, benefits, or contraindications of any diagnostics, interventions or treatments discussed. Clinicians should review manufacturers’ product information and consider these with the recommendations of other authorities when applying the assessment and/or clinical management strategies discussed in this activity to the care of their patients.

Statement of Independence

Pri-Med Institute educational activities are developed and conducted in accordance with the ACCME's Standards for Integrity and Independence in Accredited Continuing Education. It is the mission of Pri-Med Institute to develop and present educational activities that are timely, fair-balanced, scientifically rigorous, and that serve to improve patient outcomes. To that end, we welcome your comments about how to better serve your needs.

Disclosure Policies and Contacting Pri-Med Institute

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Pri-Med programs are owned and operated by DBC Pri-Med, LLC, a division of Diversified Communications, Inc. Pri-Med Institute, the accredited division of Pri-Med, is accredited with commendation by the ACCME and approved as a provider of continuing education by the AANP.

Disclosures and Conflict of Interest
Pri-Med Institute requires all individuals in a position to influence educational content for Pri-Med Institute-certified CME/CE activities to disclose personal financial relationships with commercial interests or ineligible companies prior to contributing to its educational activities. Pri-Med Institute assesses disclosed relationships and follows a defined process to mitigate real or implied conflicts to ensure, to the best of its ability, that all educational content is free of commercial bias. All relevant financial relationships have been mitigated Financial disclosures for everyone in control of educational content are provided before the start of each CME/CE activity.

Discussion of Off-Label Uses and Investigational Products
During the course of their presentations, the faculty may mention uses of products that have not been approved in the United States for the indication(s) being discussed. All presenters are instructed to notify participants when they are discussing unapproved uses or investigational agents. In addition, specific slides will include notation of the off-label use or investigational agent being discussed. Views presented related to unapproved uses of products are solely those of the presenter(s) and are not endorsed by Pri-Med Institute or DBC Pri-Med, LLC.

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