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

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.