The challenge of community cardiovascular disease: the Dan River Region Cardiovascular Health Initiative Program--DRchip.

The Dan River Region (DRR) is located in southern Virginia, with the city of Danville in the geographical center. The DRR includes Pittsylvania County, Va., the northern half of Caswell County, N.C., a southeastern portion of Henry County, Va., and the western portion of Halifax County, Va. The area’s economy is predominantly agricultural, with some manufacturing and healthcare services also adding to the economic health of the area. One hospital, the Danville Regional Medical Center (DRMC), a tertiary-level medical center, serves the DRR with 350 beds and approximately 150 physicians, including 25 primary care/internal medicine physicians and 5 cardiologists. Approximately 10% of the DRR population utilizes managed care. All physicians are in private practices with many in solo or 2-person groups. The DRR has a population of 150,000, comprised of 64% Caucasians, 35% African Americans, .05% Hispanic Americans, .1% Native Americans, and .04% Asian Americans. The population of the DRR ranks within the top 15% of US counties for annual coronary heart disease mortality. It also has twice the annual state and national rate for stroke mortality and new dialysis starts for end stage renal disease. Forty percent of the population has an income below the 200% poverty level as defined by the US Census. Low educational levels and low per capita income, compared to average state levels, make the DRR population at increased risk for poor health outcomes. This large DRR population is unequally distributed throughout the region and has an unequal distribution of healthcare resources. Many reside in rural settings, with the nearest health care located 30 miles away in Danville, Va. Pittsylvania County, Va. is within one of the federally designated Health Professional Shortage areas and Medically Underserved areas.