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Background <p>Ohio ranks among the highest US states for cardiovascular disease (CVD) morbidity and mortality. Although interventions exist for managing CVD risk factors, adoption in primary care is often limited. The Agency for Healthcare Research and Quality funded four states to develop scalable, statewide models for implementing evidence-based practices to address these gaps.</p> Objective <p>To evaluate the effectiveness of the Heart Healthy Ohio Initiative (HHOI), a statewide quality improvement (QI) initiative focused primarily on improving blood pressure (BP) control</p> Design <p>Pre-post, repeated cross-sectional QI study using electronic health record (EHR) data to compare patient outcomes 6 months pre- and post-intervention</p> Participants <p>A total of 293,638 adult patients (aged ≥ 18&#xa0;years) from 48 primary care clinics across 21 counties, of whom 107,216 (37%) had hypertension.</p> Interventions <p>Practices received structured QI support to implement evidence-based strategies for hypertension management, including BP measurement, timely follow-up, treatment protocols, and outreach. Monthly QI coaching, peer learning, and data feedback supported implementation. Smoking cessation strategies were also encouraged.</p> Main Measures <p>The primary outcome was BP control, defined as &lt; 140/90&#xa0;mmHg. Process measures included repeat BP measurement, timely follow-up, and medication intensification. Regression analyses evaluated the impact of process measures on BP control improvement. Secondary measures on smoking cessation included screening, quit advice, resource referrals, and medications prescribed.</p> Key Results <p>BP control improved from 67.7% to 70.7% post-intervention. Greater improvements were observed among rural and uninsured patients (&gt; 6%) compared to smaller gains among Medicaid enrollees, younger patients, and women (~ 2%). All three process measures were significantly associated with better BP control in multivariable models. Smoking cessation measures were maintained or declined by ~ 2%, although only five sites actively addressed smoking cessation.</p> Conclusions <p>HHOI demonstrates the feasibility and early success of a statewide, cooperative QI infrastructure to improve BP control. This model may be replicable in other states and offers insights for addressing hypertension control through targeted, scalable strategies.</p>

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Heart Healthy Ohio Initiative: A Statewide Cooperative to Improve Cardiovascular Risk

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月26日

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  • Shari D. Bolen,
  • Douglas Einstadter,
  • Jordan Fiegl,
  • Thomas E. Love,
  • Jackson T. Wright Jr,
  • Aleece Caron,
  • Eileen Seeholzer,
  • Adam T. Perzynski,
  • Chris Taylor,
  • Leon McDougle,
  • Stephanie Kanuch,
  • Catherine Sullivan,
  • Susan A. Flocke,
  • Kurt C. Stange,
  • Randy Wexler,
  • Saundra Regan

摘要

Background

Ohio ranks among the highest US states for cardiovascular disease (CVD) morbidity and mortality. Although interventions exist for managing CVD risk factors, adoption in primary care is often limited. The Agency for Healthcare Research and Quality funded four states to develop scalable, statewide models for implementing evidence-based practices to address these gaps.

Objective

To evaluate the effectiveness of the Heart Healthy Ohio Initiative (HHOI), a statewide quality improvement (QI) initiative focused primarily on improving blood pressure (BP) control

Design

Pre-post, repeated cross-sectional QI study using electronic health record (EHR) data to compare patient outcomes 6 months pre- and post-intervention

Participants

A total of 293,638 adult patients (aged ≥ 18 years) from 48 primary care clinics across 21 counties, of whom 107,216 (37%) had hypertension.

Interventions

Practices received structured QI support to implement evidence-based strategies for hypertension management, including BP measurement, timely follow-up, treatment protocols, and outreach. Monthly QI coaching, peer learning, and data feedback supported implementation. Smoking cessation strategies were also encouraged.

Main Measures

The primary outcome was BP control, defined as < 140/90 mmHg. Process measures included repeat BP measurement, timely follow-up, and medication intensification. Regression analyses evaluated the impact of process measures on BP control improvement. Secondary measures on smoking cessation included screening, quit advice, resource referrals, and medications prescribed.

Key Results

BP control improved from 67.7% to 70.7% post-intervention. Greater improvements were observed among rural and uninsured patients (> 6%) compared to smaller gains among Medicaid enrollees, younger patients, and women (~ 2%). All three process measures were significantly associated with better BP control in multivariable models. Smoking cessation measures were maintained or declined by ~ 2%, although only five sites actively addressed smoking cessation.

Conclusions

HHOI demonstrates the feasibility and early success of a statewide, cooperative QI infrastructure to improve BP control. This model may be replicable in other states and offers insights for addressing hypertension control through targeted, scalable strategies.