Abstract Body: Sustainability, the continuation of a new program, is an ongoing challenge and a barrier to “sustaining” success. The American Heart Association (AHA) has completed the National Hypertension Control Initiative (NHCI), a 3-year demonstration project jointly funded by the United States Department of Health and Human Services’ Office of Minority Health and the Health Resources Services Administration (HRSA) to improve blood pressure (BP) control in 350 low-performing HRSA-funded community health centers (CHCs) with about 1.5 million persons with hypertension (HTN). Implementation strategies to improve BP control included accurate BP measurement, team-based care, standardized treatment protocols, culturally and linguistically appropriate services, and use of self-measured BP (SMBP) monitoring. Sustainability strategies for NHCI include the standardization and protocolization of care processes; adoption of data-informed performance improvement; and continuation and reinforcement of BP control efforts through Target: BP™, a BP control initiative jointly developed and delivered by AHA and the American Medical Association, serving about 9 million persons with HTN.
Eligibility for NHCI included BP control < 60%. In 2023, year 3, 55.5% of NHCI CHCs reported BP control ≥60%. They experienced a 9.6% improvement (18.8% relative change) in BP control from 2020-2023, compared to a 7.7% improvement (13.2% relative change) for all HRSA CHCs. In 2023, 89% of NHCI CHCs reported using a BP measurement protocol, 93% reported an SMBP protocol, and 77% reported a BP treatment algorithm. Implementation of protocols and BP improvement will be sustained by pursuing participation in Target: BP. In the 1st and 2nd years of NHCI, 33% and 35%, respectively, of 346 NHCI CHCs concurrently participated in Target: BP. Of those submitting data in 2023, 25% reported control rates ≥70% and 67% reported adoption of evidence-based practices. In 2024, 55% of all CHCs participated in Target: BP.
AHA’s NHCI work can be sustained by 1) enrollment of all NHCI CHCs in Target: BP through efforts of AHA staff that supported NHCI activities, 2) leveraging Target: BP tools, resources, and quality improvement support, and 3) seeking extramural funding to support AHA BP control efforts. Sustainability of NHCI through Target: BP could be extended from 346 NHCI CHCs to all 1487 CHCs with over 31 million patients. AHA can ensure sustainability of NHCI efforts beyond the 3-year NHCI period through Target: BP.