Evaluating the Million Hearts Learning Collaborative. Measuring and Documenting our Impact Together

The Million Hearts initiative enhances cardiovascular disease prevention activities across the public and private sectors in an unprecedented effort to prevent 1 million heart attacks and strokes by 2017. The Association of State and Territorial Health Officials’ (ASTHO) Million Hearts Learning Collaborative assists state health agencies efforts to achieve these goals. 

Sixteen state health agencies and one freely associated state territory were selected to participate in the Million Hearts Learning Collaborative. States are utilizing a quality improvement process to partner across sectors to implement evidence-based strategies to identify, control, and improve blood pressure. The teams are using the Plan, Do, Study, Act (PDSA) model to test and spread systems-level changes using the following levers: data analysis and sharing, creating community clinical linkages, and financing/reimbursement policy.

Participatory evaluation strategies were used to track the change process and measure impact.  Through an iterative process, an overarching logic model was developed with participating states, the project team and the funding agency.  Within this framework, states self-identified the portions of the logic model that reflected their specific interventions and intended outcomes.  Collaborative efforts were undertaken to standardize measurement and data reporting.  A data entry tool was developed and placed on a shared website.  This facilitated shared ownership of the evaluation as states could see both individual and collective impact. Capacity building assistance was provided with an emphasis on facilitating peer-to-peer TA.  The logic model was used as a framework for discussion and analysis within the team and across participating sites.    

There are early indications of success.  All states adopted the National Quality Forum 18 (NQF-18) blood pressure control performance measure. Participating states report affecting 90,000 patients and potentially reaching 1.5 million. In just 9 months, several clinics demonstrated improvement in the percentage of hypertensive patients under control by as much as 12 percentage points.