The National Association of Chronic Disease Directors funded six organizations from across the US to effectively implement Million Hearts® strategies among priority populations between January – July 2023 as part of The Million Hearts® Health Equity Implementation project. Download the final report summarizing the Health Equity Implementation timeline and each project team’s progress toward advancing cardiovascular health equity and reducing disparities among their selected population. You can also view a snapshot of results in the dropdowns below.

 

Key Findings and Lessons Learned from the 2023 Million Hearts® Health Equity Implementation Project

Key Findings and Lessons Learned from the 2023 Million Hearts® Health Equity Implementation Project

 

On July 26, 2023, NACDD celebrated each of the funding recipients’ project results and facilitated discussion around the sustainability and potential spread of their efforts. The meeting was attended by many representatives from the Centers for Disease Control and Prevention (CDC), NACDD and cardiovascular health staff from State Health Departments. Read a summary of the meeting or watch a recording:

Million Hearts® Health Equity Implementation Project: Celebration and Results-Sharing Meeting Summary – July 26, 2023

Celebration and Results-Sharing Meeting Summary – July 26, 2023

Learn more about each of the funding recipients’ efforts and lessons learned.

UConn Health’s Maternal-Fetal Medicine practice in Farmington, Connecticut supplied 212 pregnant and postpartum women at risk for hypertensive disorders of pregnancy with a Preeclampsia Foundation Cuff Kit and blood pressure monitoring education. 67% of enrollees are from racial/ethnic minority groups. The practice serves many women with low incomes and women from racial/ethnic minority groups were prioritized for services due to their higher risk for preeclampsia.  

  • The project offered providers the option to refer women for a telephone visit with a pharmacist to promote medication adherence.  
  • An engaged team helped make the project successful, including a physician champion, nurses, a Women’s Health Community Health Specialist, electronic health record analysts, and many more dedicated people.  
  • UConn Health aims to sustain this program through approval as a contracted pharmacy vendor for Medicaid and through private support. 

Outcomes and Results:

212 patients enrolled, including 60 inpatients and 152 outpatients, with the following demographics:

Enrolled patient race/ethnicityNumber of enrolled patients
American Indian or Alaskan Native2
Asian7
Black or African American72
Hispanic or Latino55
Other5
UnKnown3
White68

View sample educational materials, protocols and other implementation resources from UConn Health.

Huddle Up Moms, an organization in Roanoke, Virginia founded to bring pregnant and postpartum women together for mutual support, provided blood pressure cuffs and care navigation to underserved pregnant women.  

  • The women engaged in an education and monitoring program with a care coordinator, who also connected them to community resources to address social determinants of health (SDOH)-related needs.  
  • A wide range of other community-based organizations and local clinical partners were encouraged to refer pregnant women to the program, with a total 75 Preeclampsia Foundation Cuff Kits distributed to these partners.  
  • Seventeen women were enrolled to receive care coordination through their pregnancies and immediately after.
  • This project significantly expanded the services Huddle Up Moms can offer to its participants as well as strengthening key professional relationships in the area. 

Outcomes and Results:

Seventeen participants enrolled with the following demographics:

Self-reported race/ethnicityPercent of participants
Black1
White6
Hispanic, non-White6
Jordanian1
Black, American, Indian, White1
White and American1
African American and White1

In the News:

Logo for West Virginia University. There is an interlocked yellow W and V on the left, followed by the words "West Virginia University" in blue.

The West Virginia University (WVU) Medicine Heart Failure clinic in Morgantown, West Virginia expanded a pharmacist-led telemedicine heart failure medication optimization program internally and in select primary care clinics in the West Virginia Practice-Based Research Network (WVPBRN).

  • The project aimed to reduce barriers to specialty care access; improve the percent of heart failure patients receiving appropriate medications; and improve heart failure symptoms, quality of life, cardiac function, and mortality. 
  • One hundred seventy-two blood pressure cuffs and 100 scales were provided to patients in rural Appalachian areas who went on to participate in 144 tele-pharmacy encounters.  
  • WVU plans to use the data gathered in this project to advocate for WV Medicaid to cover the cost of SMBP cuffs for members.  

Outcomes and Results:

Demographics of enrolled patients:

Demographic characteristicPercent of enrolled patients
Sex: 
Male70
Female30
Race: 
White97
Black or African American3
Insurance status: 
Medicaid16.2
Medicare66.7
Commercial14.7
Uninsured2.4
Rural residence:29

Read More From WVU’s Press Release

Logo for St. James Healthcare. On the left is a a Swiss Cross that is half blue, half green with a white heart at the center. To the right are the words St. James in large blue letters, with Healthcare in thin blue letters underneath followed by SCL Health in green letters. St. James Healthcare, a rural hospital in Butte, Montana serving a 7-county region in the southwest of the state-provided blood pressure cuffs and scales to patients admitted with a diagnosis of heart failure, with an emphasis on residents of rural areas.  

  • Participants received education on their diagnosis, medications, and use of the cuff and scale. A pharmacist and a Cardiac Rehab Therapist also followed up with participants after hospital discharge and coordinated with the care team as needed.  
  • Preliminary results show a significant change in hospital readmission for heart failure patients from 34% prior to program launch to 7.9% at its lowest.  
  • Results from the project will help inform the hospital system’s planned implementation of remote patient monitoring. 

Outcomes and Results:

Twenty patients enrolled with an age range of 31-86 and the following additional demographics:

Demographic characteristicPercent of enrolled patients
Sex: 
Male75
Female25
Ethnicity: 
Caucasian95
Hispanic5
Insurance status: 
Medicare70
Medicaid15
Commercial10
VA5

View sample educational materials, protocols and other implementation resources from St. James Healthcare.

Logo for Midvale Community Building Community. There is a large, black bell with CBC written on it in white letters. Across the top of the bell is a crimson ribbon with Midvale written on it in white letters. The bell is circled by a light red border, with the words Community Building Community written across the bottom of the border in white text. Midvale Community Building Community (CBC) in Midvale, Utah is a charitable clinic serving low-income, uninsured Latino patients that implemented a Community Health Worker (CHW)-led program to distribute BP cuffs to patients and conduct tobacco use screens. Midvale CBC also subscribed to the Dispensary of Hope, enabling the clinic to provide free medications to patients at the time of their visit. Implementing this project led Midvale CBC to open a new weekly hypertension clinic to provide ongoing care for enrolled patients, and to become the first charitable clinic in Utah to be licensed as a Charity Clinic.  

  • Midvale CBC supplied blood pressure cuffs to 150 patients at risk for hypertension and screened 341 adults served in their mental health and dental programs for tobacco use.  
  • Community Health Workers (CHWs) provided education, follow-up, and connections to community resources.  
  • Midvale CBC was recently named a 2023 Hypertension Hero by the National Hypertension Control Roundtable for this work. 
Demographics of program participants:
Demographic characteristic Percent of SMBP program participants
Ethnicity:
Hispanic or Latino 100
Sex:
Male 23
Female 78
Age:
20-40 36
40-60 50
60-80 15

Sample educational materials, protocols and other implementation resources from Midvale Community Building Community

University of Pittsburgh School of Pharmacy and the Pennsylvania Pharmacists Care Network (PPCN) supported teams serving low-income patients with hypertension at 5 pharmacies in underserved areas of the state.  

  • A pharmacist champion and intern at each site identified Medicaid patients to receive services including, but not limited to, 1) BP screenings and follow up; 2) medication adherence support; 3) BP medication therapy management; 4) care coordination; 5) lifestyle modification counseling; 6) SDOH screening and linkages to resources.  
  • One hundred ten unique patients received hypertension services at participating pharmacies, engaging in a total of 162 patient encounters. Pharmacies also screened 73 patients for SDOH-related needs.  
  • Results and lessons learned from this project will be shared throughout PPCN’s statewide network of over 180 pharmacies.

Demographics of the patients receiving services:

Demographic characteristicNumber of patients
Race: 
Black or African American16
White124
Other1
Unknown21
Ethnicity: 
Hispanic or Latino3
non-Hispanic or Latino107
Unknown52
Insurance status: 
Medicaid153
Underinsured5
Uninsured1
Other3

View sample educational materials, protocols and other implementation resources from University of Pittsburgh School of Pharmacy.

In the News

NACDD’s The Heart of the Matter podcast released “The Power and Possibilities of Pharmacy Partnerships” featuring Drs. Stephanie McGrath and Kelsey Hake from the University of Pittsburgh School of Pharmacy, and Troy Trygstad from the Community Pharmacy Enhanced Services Network.

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