Heat a skillet over medium heat and add olive oil
Brown the ground beef breaking it apart with a spoon until fully cooked then drain excess fat
Transfer the cooked beef to the slow cooker
Add chopped onions minced garlic crushed tomatoes tomato paste Worcestershire sauce Italian seasoning salt and black pepper
Pour in the beef broth and stir well to combine all ingredients
Cover and cook on low for six to seven hours or high for three to four hours
Thirty minutes before serving add the uncooked pasta to the slow cooker
Stir well and add an extra half to one cup of water or broth if needed
Cover and cook on low for another thirty to forty minutes until the pasta is tender
Stir in Parmesan cheese and let it melt into the sauce
If making the creamy version add heavy cream at this stage and mix well
Let the pasta sit for five minutes before serving
Serve hot garnished with fresh parsley or additional cheese