Miller Nancy Houston BSN FAACVPR; Warren, Deidre BSN, RN, FAACVPR; Myers, Denise MPH, RNThe Journal of Cardiovascular Nursing: October 1996 Economic Forces Affecting the Columnn of Care: PDF Only Abstract Managed care has changed the way health care is delivered in the United States. Simultaneously, major changes in the management of patients with coronary heart disease has led to dramatic shifts in cardiac rehabilitation. Exercise training, education, and counseling to modify coronary risk factors has clearly been shown to benefit patients with coronary disease. Moreover, intensive risk factor modification has been shown to prevent progression of coronary atherosclerosis and to lower morbidity and mortality. Newer delivery models of rehabilitation are needed to improve health outcomes in a cost-effective way. A nursing case management model (MULTIFIT), illustrates one such innovative delivery model that meets the needs of a managed care plan for comprehensive cardiovascular risk reduction and surveillance of patients. © 1996 Aspen Publishers, Inc.