Heart Healthy Ohio Initiative Improves Blood Pressure Control, Especially for Underserved Communities

A statewide quality improvement initiative in Ohio has demonstrated significant success in improving blood pressure control, particularly among rural and uninsured patients, according to a study published in the Journal of General Internal Medicine. The Heart Healthy Ohio Initiative (HHOI), funded by a $4.1 million grant from the Agency for Healthcare Research and Quality (AHRQ), is a collaborative effort to strengthen the adoption of evidence-based cardiovascular disease prevention strategies across the state.

Addressing a Critical Health Need in Ohio

Ohio faces a substantial burden of cardiovascular disease (CVD), ranking among the highest states in the U.S. For CVD-related morbidity and mortality. Recognizing this need, the HHOI was launched to address gaps in primary care adoption of effective CVD risk management interventions.

How the Heart Healthy Ohio Initiative Works

The HHOI involved 48 primary care clinics across 21 Ohio counties, serving a total of 293,638 adult patients, with 37% having hypertension. Participating clinics received structured support focused on key areas of hypertension management, including:

• Accurate blood pressure measurement
• Timely patient follow-up
• Standardized treatment protocols
• Proactive patient outreach

This support included monthly quality improvement coaching, data feedback to track progress, and peer-learning sessions to foster collaboration and shared best practices. Smoking cessation strategies were also encouraged as part of the initiative.

Key Findings and Improvements

The study revealed a 3 percentage point overall improvement in blood pressure control, increasing from 67.7% to 70.7% post-intervention. However, the benefits were not evenly distributed:

• Rural and Uninsured Patients: Experienced the most significant gains, with improvements exceeding 6 percentage points.
• Medicaid Enrollees, Younger Patients, and Women: Showed more modest improvements, around 2 percentage points.

A Scalable Model for Quality Improvement

Researchers concluded that the HHOI demonstrates the feasibility and early success of a scalable, statewide quality improvement infrastructure for better hypertension control. The initiative’s structured coaching, consistent data reporting, and collaborative model could be replicated by other states aiming to improve chronic disease management.

“This was all about strengthening the processes behind good care – making sure patients were followed up with, appointments were scheduled and nothing slipped through the cracks,” said Aleece Caron, PhD, HHOI co-lead investigator and researcher in the MetroHealth Population Health Research Institute.

Collaboration and Building on Existing Initiatives

The HHOI project involved collaboration between researchers from MetroHealth, Case Western Reserve University’s School of Medicine, University of Cincinnati, and The Ohio State University Wexner Medical Center. Three community health collaboratives – Better Health Partnership (Cleveland), The Health Collaborative (Cincinnati), and Health Impact Ohio (Columbus) – also played a key role.

The initiative builds upon the perform of the Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH), a statewide effort focused on improving health outcomes for Medicaid patients and reducing health disparities throughout Ohio.

Looking Ahead

The Heart Healthy Ohio Initiative provides a promising model for improving cardiovascular health outcomes through collaborative, data-driven quality improvement. Continued efforts to expand and refine this approach could lead to further reductions in CVD morbidity and mortality across Ohio and beyond.