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Taking Action on Blood Pressure Control to Prevent Heart Attacks & Strokes
State: Michigan

Key Words
  • Awareness/Media
  • Disease Self-Management
  • Clinical Guidelines
  • Community Health Workers/Lay Health Advisors
  • EHR/Clinical Info Systems
  • Hypertension
  • Policy
  • Quality Improvement
  • Screening
  • Task Force/Coalition/Advisory Group/Network
  • Training/Education
Submitted Date: 2015

Chronic Disease Topic Area
  • Arthritis
  • Health Equity
  • Heart Disease
  • Strokes
Problem Statement
  • One out of three deaths in Michigan is caused by cardiovascular disease, mostly from heart attacks and strokes.  
  • Controlling high blood pressure can reduce the risk of stroke by 40% and heart attack by 27% yet only about half of adults with high blood pressure have it under control.
  • Implementing practices related to the goals of the national Million Hearts® initiative is an important step for helping Michigan residents get their blood pressure under control. These practices include meaningful use of electronic medical records by physicians, using community health workers to assist with blood pressure self-management, and providing team-based care for those with high blood pressure.
Project Objective(s)

The overall goal of the workshop was to prepare the HDSP Unit and its partners to implement a coordinated chronic disease program and integrated work plan to guide Michigan’s contribution to preventing 1 million heart attacks and strokes (the national Million Hearts® goal). The Michigan contribution would require the prevention of 31,300 heart attacks and strokes before 2017, based on Michigan’s population as a proportion of the national population

Workshop objectives included:

  • To familiarize participants with the goals of the federal Million Hearts® initiative
  • To show participants how they can become engaged with Million Hearts® initiative activities

Workshop presenters described how the Affordable Care Act is driving quality improvement in healthcare by changing the payment structure and the use of health information technology. Workshop participants were introduced to two areas of focus for the MDCH State Public Health Actions/1305 grant from CDC. The workshop highlighted the benefits of meaningful use of electronic health records to report and track patient blood pressure to improve blood pressure control and understanding the role of community health workers and other health care extenders in supporting care managers in primary care settings with blood pressure control.

Program Action
  • To prepare the Heart Disease and Stroke Prevention (HDSP) Unit at the Michigan Department of Community Health (MDCH) and its partners for the implementation of a coordinated chronic disease program and integrated work plan, MDCH hosted a Million Hearts® stakeholder workshop in May 2014.
  • The purpose of the workshop was to improve partners’ understanding of the Million Hearts® initiative and assist them in aligning their efforts with the goals of Million Hearts®.  
  • Thirty-one participants representing 15 organizations joined leadership and staff from the MDCH to explore Million Hearts® strategies and those related to the MDCH’s funding for their State Public Health Actions/1305 grant from the Centers for Disease Control and Prevention (CDC). Organizations represented include the Michigan Public Health Institute, National Kidney Foundation of Michigan, Michigan’s Quality Improvement Organization – MPRO, Michigan Center for Effective IT Adoption, the Michigan Community Health Worker Alliance, hospitals, health departments, and agencies participating in the Michigan Primary Care Transformation project.
  • Following the Million Hearts® stakeholder workshop, the Michigan Million Hearts Workgroup was formed to follow up on the common themes identified during the action planning sessions of the workshop.
Data/Other Information Collected

MDCH is tracking the following:

  • the agencies and sectors that are participating members of the workgroup 
  • data on a number of performance measures related to blood pressure control, health systems interventions and community-clinical linkages (as a requirement of the CDC 1305 funding).Data sources include primary care practices that have systems and policies supporting team-based care.
  • self-reported blood pressure (through the Michigan BRFSS)
  • programs that utilize CHWs

Many of the partners who work on the CDC 1305 grant and now the CDC 1422 funding participate in this workgroup.  If they currently do not, we are actively recruiting them to join! 

We know that one way clinicians can help control high blood pressure and cardiovascular disease is to fully use the features of their electronic health records (EHRs).  One way that full utilization is demonstrated is through attestation to Meaningful Use.  In Michigan, there are about 30,000 to 40,000 eligible providers and only about 4,200 of Medicaid eligible providers are attesting.  Based on this and on anecdotal evidence from our Regional Extension Center and Medicaid health information technology department, providers in Michigan have a lot of room for improvement in the use of their EHRs to help patients manage their high blood pressure. 

We’re also aware that the complicated health care system and the influence of the various social determinants of health are significantly affecting how easily Michiganders can take care of their chronic conditions.  Community health workers can assist to overcome barriers to care.  We need to increase the professional recognition and incorporation of CHWs into health and community care systems.

Impact / Accomplishment
  • Over 85% of participants felt that the workshop met three of stated objectives either moderately well or very well; these objectives were: 1) participants will demonstrate an understanding of the Million Hearts initiative, and how their organization’s current activities and the state’s activities can align with and support the goals of Million Hearts; 2) participants will demonstrate an understanding of how the Affordable Care Act is changing the health care landscape, especially in the use of health information technology and payment structure, as drivers of quality improvement; and 3) participants will demonstrate an understanding of the benefits of the meaningful use of electronic health records to report and track patient blood pressure, to improve hypertension control. A total of 93.3% of participants reported the workshop met the fourth and final objective - participants will demonstrate an understanding of the role of Community Health Workers and other health care extenders in hypertension control and how their efforts link to and support care managers in primary care settings.
  • One Federally Qualified Health Center that is located in one of Michigan’s most disparate regions incorporated the Million Hearts treatment protocol and informational posters into their high blood pressure projects.  After testing these materials at one clinic, they have expanded to an additional, sister clinic.  They are working with their information technology staff to embed this algorithm into the electronic health system at the clinic, though it is taking longer than expected.  During an upcoming workgroup meeting, this process will be shared with attendees with the hope of spreading to other health centers.
  • We capitalized on the new focus created by the Workshop and invited attendees to form the Michigan Million Hearts Workgroup. 
  • MDCH received an ASTHO Million Hearts Learning Collaborative grant in which we applied the identified common themes to the competitive application.  Subsequently, several statewide stakeholders who participated in the workshop and remain in the workgroup are also involved in this Learning Collaborative.
Challenges/Lessons Learned

All members of the Michigan Million Hearts Workgroup have time commitments that distract from the focus of meeting for the purpose of Million Hearts® efforts.  In addition, most of the stakeholders see the state as the leader for this initiative in Michigan yet there is only one staff member at the MDCH to work on Million Hearts efforts.  Many members are interested in sharing what they were already doing and incorporating Million Hearts concepts into their current work.  Members were interested in meeting quarterly and a few of the members were interested in taking on assignments. 

Next Steps

The Michigan Million Hearts Workgroup continues to meet via conference call quarterly.  We are planning to host an in-person meeting of all current stakeholders as well as new invitees before August 30, 2015.  We are investigating how to support the use of a hypertension treatment protocol by having it listed as a resource on Michigan’s Quality Improvement Consortium website. 

The strategies we are advancing now related to EHRs include:

  • Increasing EHR adoption and the use of health IT to improve performance
  • Development of a protocol policy
  • Education of providers, physicians, and others on the importance of EHRs and team-based care

The strategies we are advancing now related to community health workers include:

  • Promotion and support of Michigan Community Health Worker Alliance
  • Education of physicians on success and ROI of CHWs in current Michigan communities; increasing awareness of CHWs by physicians and providers
  • Standardization of CHW education and training, as well as certification and credentials for the state of Michigan

Kristina Dawkins
Michigan Department of Health and Human Services