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Programs & Initiatives

Diabetes and Heart Disease Prevention and Management Program

The Diabetes and Heart Disease Prevention and Management Program implements and evaluates evidence-based strategies to prevent and manage cardiovascular disease and diabetes in high-burden populations. Program strategies related to heart disease focus on healthcare system quality improvement and linking community resources and clinical services:

  • Electronic Health Records (EHR)/Health Information Technology (HIT): Promote the adoption and use of EHRs and HIT to improve provider outcomes and patient health outcomes related to identification of individuals with undiagnosed hypertension and management of adults with hypertension.

  • Team-based care: Support engagement of non-physician team members (e.g., nurses, nurse practitioners, pharmacists, nutritionists, physical therapists, social workers) in hypertension and cholesterol management in clinical settings.

  • Medication Therapy Management (MTM): Promote the adoption of MTM between pharmacists and physicians for the purpose of managing high blood pressure, high blood cholesterol, and lifestyle modification.

  • Self-Measured Blood Pressure (SMBP): Facilitate use of SMBP monitoring with clinical support among adults with hypertension.

  • Referrals: Implement systems to facilitate systematic referral of adults with hypertension and/or high blood cholesterol to community programs/resources.

Ohio 2017-2019 State Health Improvement Plan (SHIP)

The State Health Improvement Plan (SHIP) is a strategic set of evidence-based strategies at the scale needed to measurably improve population health outcomes and achieve health equity. Chronic disease is one of three priorities in the SHIP.  The SHIP includes outcome objectives to reduce the percent of adults ever diagnosed with coronary heart disease, heart attack and hypertension, in addition to specific outcome objectives to reduce the percent of adults ever diagnosed with hypertension for priority populations (e.g., blacks, people with disabilities, low educational attainment and low income, older adults and people who reside in Appalachian counties). Healthcare system and access strategies include activities that focus on hypertension screening and management, MTM and team-based care (e.g., use of community health workers) to control hypertension.