JMIR Publications

ABSTRACT

Background:

Alabama has the second highest rate of cardiovascular disease (CVD) mortality of any US state. Alabama also has a high prevalence of CVD risk factors such as hypertension, diabetes, obesity, and smoking. Within the state, there are disparities in CVD risk factors by race/ethnicity and geography. Many primary care practices do not have the capacity for full-scale quality improvement (QI) initiatives. The Alabama Cardiovascular Cooperative (ALCC), which includes both academic and community stakeholders, was formed to support primary care practices across the state to implement QI initiatives to improve cardiovascular health. The ALCC is implementing a Heart Health Improvement Project (HHIP) in primary care practices with suboptimal rates of blood pressure (BP) control and tobacco use intervention.

Objective:

The goal of the HHIP is to support primary care practices to improve the assessment and management of cardiovascular risk factors, specifically hypertension and tobacco use. The primary objectives are to increase BP control among adults with hypertension and increase rates of tobacco use screening and counseling.

Methods:

The HHIP is utilizing a pre-post design to examine the effect of the HHIP on measures of BP control and tobacco use intervention. To ensure participation from a broad range of clinics, the HHIP required at least 50% of practices to be Federally Qualified Health Centers (FQHCs) or have look-alike status and to include representation from practices located in rural areas. The HHIP uses a multi-pronged approach to QI, including practice facilitation and technical assistance, onsite and eLearning, and improvement through data transparency. In addition to clinical outcomes, information on implementation outcomes is also being collected.

Results:

After contacting 417 primary care practices, 51 were enrolled in the study, including 28 FQHCs or look-alikes; 47 practices implemented the HHIP. Among the 46 practices that completed the baseline survey, 24.4% were solo practices, while 62.2% had 1 to 5 clinicians, and 13.2% had 6 or more clinicians. The median number of patient visits per year was 5,819. Practices had been in operation for a mean of 19.2 years. At baseline, the mean blood pressure control rate was 49.6%. The mean tobacco use screening rate was 81.8% and the tobacco use cessation intervention rate was 71.4%; the rate of tobacco screening and cessation counseling was 67.4%.

Conclusions:

If successful, the ALCC and HHIP may improve the implementation of evidence-based guidelines in primary care and subsequently, cardiovascular health and health equity in the state of Alabama.