Healthy Hearts for Michigan (HH4M): Providing support to improve the heart health and help reduce CVD disparities by engagement with primary care practices.

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Project Abstract. Heart attack and stroke are two of the leading causes of death in the United States, accounting for approximately 800,000 deaths, and over $300 billion in healthcare and disability costs each year. To reduce this burden, in 2011, the U.S. Department of Health and Human Services launched the Million Hearts campaign to prevent one million heart attacks and strokes by promoting the "ABCS" of clinical prevention (aspirin therapy, blood pressure control, cholesterol management, and smoking cessation). Michigan is among the top 10 states with the highest cardiovascular disease (CVD) burden in the US. The CDC estimates a CVD rate of 1,379 per 100K people in Michigan (MI). Approximately 35% of MI adults have hypertension (HTN), with 77% taking high blood pressure medication, and 20% reporting they were smoking. Rural populations experience a higher than average prevalence of HTN and are more likely to be physically inactive, use tobacco, and have diabetes, when compared with urban counties. Almost 25% of MI's population live in rural communities where individuals often face extended drive times to their primary care provider and provider shortages. Each of Michigan's 57 nonmetropolitan counties have a shortage of PC practices. Work within the AHRQ-funded EvidenceNOW program suggests that some evidence-based QI strategies to improve CVD care can be adapted and implemented in small PC practices with limited resources. The Healthy Hearts for Michigan (HH4M) project will build on EvidenceNOW by establishing a statewide cooperative and network of practice facilitators in MI who will support small rural practices to implement clinical interventions to improve HTN and tobacco cessation and provide education on ABCS evidence. These efforts will be coupled with optimization of health IT and remote monitoring and management through telehealth to address barriers to access and healthcare shortages in rural MI. We have convened a multi-disciplinary collaborative that includes Altarum Institute, Michigan Center for Rural Health, Upper Peninsula Healthcare Solutions, the American Medical Association, Michigan Department of Health and Human Services, Northwestern University and physician advisors. Our collaborative builds on the prior work of Altarum and our MI-based partners, delivering quality improvement support to small primary practices, with the learnings from a successful EvidenceNOW program to spread evidenced-based best practices and build a sustainable primary care extension service in Michigan. Specific Aims of HH4M are to: (1) convene and evaluate the development of a statewide cooperative to support the in-clinic implementation of the HH4M model for patients with HTN and patients who use tobacco; and (2) evaluate the ability of rural practices to implement the elements of the HH4M model by identifying facilitators and barriers to sustainable implementation, and test whether the model improves (a) blood pressure control and (b) tobacco use screening and cessation in a stepped-wedge trial with a pilot and three waves.