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
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.