Million Hearts and Hypertension control, Using a Multi-State Learning Collaborative Model to address systems approach to change

Million Hearts™ (MH) is a national initiative to prevent 1 million heart attacks and strokes in the U.S by 2017. The Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services (CMS), co-leaders of Million Hearts™ within HHS, are working in collaboration with other federal agencies and private-sector organizations to make a long-term impact on cardiovascular disease. In July 2013, CDC funded the Association of Territorial Health Officials (ASTHO) to deploy a community improvement process to implement best practices and evidence based policies to identify, control, and improve blood pressure. ASTHO lead an effort in 9 states and the District of Columbia to improve performance of the ABCS (Aspirin when appropriate • Blood pressure control • Cholesterol management •Smoking cessation). Performance improvement of the ABCs focused on a multi-sector team approach using health information technology (HIT). Participating states identified populations of individuals with uncontrolled hypertension and established quality improvement processes to achieve the following objectives and interventions: 1. Increase reporting and monitoring of National Quality Forum (NQF 18). 2. Improve identification of undiagnosed persons with high blood pressure. 3. Improve diagnosis, treatment, and follow-up of persons with high blood pressure (i.e. avoiding missed opportunities while patient is in the office). This ASTHO MH project serves as an opportunity to demonstrate how quickly system changes can affect hypertension control rates. States utilize partnerships across state sectors including hospital systems, quality improvement organizations, payors. These state level partners collaborated with partners at the local level including in FQHC's, clinics, local public health agencies, and other key partners. This multi-level approach allowed for rapid pilots and tests at the local level to inform a core set of state-level actions with high impact improvements in hypertension control to support Million Hearts®.