Cardiac Health: TMF QIN-QIO and Partners Improve Access to Blood Pressure Monitoring and Management Tools

The TMF Quality Innovation Network – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Texas, Arkansas, Missouri, Oklahoma and Puerto Rico – has partnered with Greater Grace Church and a large health care provider system in the St. Louis area to reduce hypertension within the community using the American Heart Association’s (AHA) Check.Change.Control blood pressure program. Check.Change.Control focuses on educating participants about blood pressure and how to monitor and manage it.

The TMF QIN’s staff in Missouri works with churches and other faith-based organizations to provide tools and resources to educate their parishioners and others in the community about how to correctly monitor their blood pressure, what constitutes a heart-healthy diet and other tips. The QIN-QIO’s staff coordinates with church volunteers to help conduct blood pressure screenings and works with health care system staff to identify local and AHA resources to help church members live a healthier lifestyle.

Following initial blood pressure screenings, local volunteer health mentors, which TMF QIN staff have trained, follow up with participants and encourage them to continue monitoring their blood pressure and tracking their numbers. As a complement to the screening, the QIN-QIO offers diabetes self-management education through the Health for Life – Everyone with Diabetes Counts initiative, since high blood pressure is a risk factor for developing diabetes. 

During the first phase of the project, starting in August of 2015, 45 church members took advantage of the Check.Change.Control program. The second phase of the project began in the spring of 2016. During the “Spring into Better Health” session the program grew to 67 members, with a majority of the participants coming for more than one visit.

Following this success, Mercy Clinic East, a branch of the Accountable Care Organization representing Missouri, received the Million Hearts “Hypertension Control Champion” award for its activities in surrounding communities, in which Greater Grace and TMF QIN played a big part. The team used proven methods to accomplish these goals, including timely data, quick interventions, involving the patient in communication, and effective tools for comprehensive management of care.

TMF QIN’s staff in Missouri, along with partners under the Million Hearts® campaign, hope to continue improving population health with the launch of a diabetes self-management program in the spring of 2017.

This story is one of 15 that were included in the 2016 QIO Program Progress Report.