Study Evaluates Methods to Improve Blood Pressure

The MetroHealth System and its partners demonstrated that a statewide, team‑based approach can meaningfully improve blood pressure control, especially for underserved patients, according to a new study published in the Journal of General Internal Medicine.

The study evaluated the impact of Heart Healthy Ohio Initiative (HHOI) – a collaborative program funded by a $4.1 million grant from the Agency for Healthcare Research and Quality to help states strengthen adoption of evidence‑based cardiovascular disease prevention strategies.

“By working together, we created a lasting support system that helped primary care practices use proven methods to reduce cardiovascular risk,” said Shari D. Bolen, MD, MPH, the study’s co-principal investigator and Director of the MetroHealth Population Health Research Institute. “Coordinated and community‑focused approaches like these have the power to improve health on a large scale.”

HHOI included 48 primary care clinics across 21 Ohio counties, serving 293,638 patients – 37% of whom had hypertension. Clinics received structured support to improve blood pressure measurement, timely follow-up, treatment protocols and patient outreach. Monthly quality‑improvement coaching, data feedback and peer‑learning sessions helped drive sustained improvements. The progress included:

• Blood pressure control improved by 3 percentage points overall (67.7% to 70.7%).
• Rural and uninsured patients saw the largest gains, improving by more than 6 percentage points.
• More modest improvements – around 2 percentage points – were observed among Medicaid enrollees, younger patients and women.

The team concluded that HHOI demonstrates the feasibility and early success of a scalable, statewide quality‑improvement infrastructure aimed at better hypertension control – particularly among underserved groups who often face the highest cardiovascular risks. Also, the initiative’s structured coaching, consistent data reporting and peer collaboration model may be replicable for other states seeking to address chronic disease more effectively.

“This was all about strengthening the processes behind good care – making sure patients were followed up with, appointments were scheduled and nothing slipped through the cracks,” said Aleece Caron, PhD, HHOI co-lead investigator and researcher in the MetroHealth Population Health Research Institute. “When teams could see what was working and adjust together, that’s when meaningful change really started to happen.”

In addition to MetroHealth, the HHOI project involved researchers from Case Western Reserve University’s School of Medicine, University of Cincinnati and The Ohio State University Wexner Medical Center. Three community health collaboratives – Better Health Partnership (Cleveland), The Health Collaborative (Cincinnati) and Health Impact Ohio (Columbus) – also participated.

HHOI builds upon the work of the Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH), a statewide initiative designed to improve health outcomes of Medicaid patients and eliminate health disparities throughout Ohio.