The purpose of the ODH Cardiovascular Health (CVH) Program is to support the implementation and evaluation of evidence-based and evidence-informed strategies to prevent and manage cardiovascular disease (CVD) in populations disproportionately at risk of CVD, exacerbated by health inequities and disparities, and social determinants of health. Specific emphasis will be placed on the prevention and control of hypertension and high cholesterol.
Successful implementation of program strategies, both statewide and among priority populations, will lead to an increase in the number/proportion of the following short and intermediate outcomes:
• Strategy 1 short-term outcomes: Increased use of EHRs or HIT to report, monitor, and track clinical and social services and support needs data to improve detection of health care disparities and the identification, management, and treatment of patients at highest risk of cardiovascular disease, with a focus on hypertension and high cholesterol; and, increased use of standardized processes or tools to identify, assess, track, and address the social services and support needs of patient populations at highest risk of CVD.
• Strategy 2 short-term outcomes: Increased use of EHRs or HIT to support communication and coordination among care team members to monitor and address patients’ hypertension and high cholesterol; increased use of multidisciplinary care teams adhering to evidence-based guidelines to address patients' social services and support needs and improve the management and treatment of hypertension and high cholesterol; and, increased multidisciplinary partnerships that address identified barriers to social services and support needs within populations at highest risk of CVD.
• Strategy 3 short-term outcomes: Increased community clinical links to identify and respond to social services and support needs of populations at highest risk of CVD with a focus on hypertension and high cholesterol; increased engagement of CHWs (or their equivalents) to provide a continuum of care extending clinical interventions and addressing social services and support needs; and, increased use of SMBP with clinical support within populations at highest risk of hypertension.
• Intermediate outcomes: Improved blood pressure control among populations within partner health care and community settings; reduced disparities in hypertension control among populations within partner health care and community settings; and, increased utilization of social services and support among populations at highest risk of CVD, with a focus on hypertension and high cholesterol.