Modifiable cardiovascular disease (CVD) risk factors such as hypertension, cholesterol and
smoking contribute strongly to CVD morbidity, mortality, and health care cost. Ohio is in the
highest quartile for CVD morbidity and mortality and has significant disparities in CVD risk
factors by geographic region, race/ethnicity, and insurance type demonstrating substantial
opportunity for improvement. We propose using a unique facilitated co-design approach to
develop a heart healthy QI intervention based on patient-centered outcomes research (PCOR)
in the context of an expanded statewide Ohio cardiovascular health collaborative (Cardi-OH) to
accelerate statewide CVD improvement and reductions in disparities. This proposal builds on
pockets of regional QI strengths to develop a larger, more extensive and sustainable external QI
support infrastructure by linking the 3 Regional Health Improvement Collaboratives and 7
medical schools with greater reach and extension within primary care and linked to our
statewide collaborative, the Ohio Cardiovascular Health Collaborative.
This 3-year project has 3 aims. For Aim 1, we propose to expand a nascent statewide
cardiovascular health collaborative and establish a sustainable external QI support
infrastructure. For Aim 2 we will co-design, implement and evaluate the effectiveness, adoption,
implementation, and maintenance of the heart healthy QI intervention overall and by subgroup
(e.g., geography, insurance, race/ethnicity) using a group randomized stepped wedge design.
And for Aim 3, we will determine patient, provider, clinic, and other contextual factors associated
with greater improvements in cardiovascular care and outcomes at the heart healthy QIP clinics
We will conduct a robust mixed methods evaluation of: 1) Cardi-OH’s evolution, network
development, dissemination, and sustainability; 2) the co-design, adoption, implementation,
maintenance and effectiveness of the heart healthy QIP overall and by subgroup ; and 3) the
factors associated with better clinical performance on CVD risk factor process improvement.
Project findings will be useful to policymakers, health insurers, practice managers, health
care providers, and patients. This project could provide a transformative and sustainable
statewide model for cardiovascular health improvement and disparity reduction which, through
our mixed methods evaluation, can be shared broadly for replication.