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Million Hearts® Partnerships 2012–2016: Key Evaluation Findings and Successes

This evaluation summary presents selected key findings from an evaluation of the Million Hearts® 2012–2016 partnership network.

The national Million Hearts® initiative made meaningful progress [PDF-1.4 MB] in its first 5 years, including helping prevent about half a million heart attacks and strokes across the United States.1,2 To achieve its goals, the initiative established a broad network of partners to support the dissemination and use of evidence-based strategies to prevent heart disease and stroke. Given the important role that partnerships played in delivering Million Hearts® goals and messages, there was a corresponding need to evaluate the partnership network to assess the activities that developed because of the partnerships and how the network intensified partners’ efforts to prevent heart attacks and strokes.

The findings of this evaluation demonstrate the importance of partnerships to the success of the Million Hearts® initiative. As it moves forward with a new Million Hearts® 2022 [PDF-156 KB] framework, Million Hearts® will continue to focus on maintaining existing partnerships and creating new ones.

Evaluation Purpose and Methods

In consultation with CDC, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services (HHS) contracted with RAND and the University of Colorado Denver to evaluate the Million Hearts® 2012–2016 partnership network.

The purposes of the evaluation were to:

  • Describe the partnerships developed through the Million Hearts® initiative.
  • Define the partners’ activities related to heart disease and stroke prevention.
  • Identify facilitators and barriers to partnerships.

The evaluation used a mixed-methods approach that included an environmental scan, key informant interviews, and a social network analysis. This evaluation summary includes selected key findings identified across the three methods.

Description of Methods Used in the Evaluation of the Million Hearts® Network

Environmental Scan

  • Review of 74 documents representing unique Million Hearts® partnerships at local, state, regional, and national levels through literature and web-based searches.
  • Summary of the development of partnerships, facilitators and barriers to partners’ engagement, and self-reported outcomes of these efforts.

Key Informant Interviews

  • Interviews with subject matter experts from 51 state, regional, and national organizations identified as key players in Million Hearts® (89% response rate). Organizations were identified through the environmental scan and expert consultation with a technical working group that included staff from ASPE, CDC, and the Centers for Medicare & Medicaid Services.
  • Summary of how partners worked together to address the goals of the Million Hearts® initiative, how their work changed as a result of their participation, and how they get and sustain adequate resources to participate.

Social Network Analysis

  • A validated survey tool (PARTNER) used to assess a core group of public and private partners from state, regional, and national levels that participated in Million Hearts® (58 organizations, 74% response rate).
  • Summary of the content and quality of Million Hearts® partnerships, perceptions of trust and value among members, and barriers to participation.

Summary of Selected Evaluation Findings

Million Hearts® Network

Image of the Million Hearts® network showing reported connections (black lines) between different types of partners (colored circles) participating in the Million Hearts® initiative. Partners represented in this social network analysis include – Federal public health programs and services, federal public health research and regulation, private health plans, systems or practices, private professional organizations, and other private groups.

A social network analysis of the Million Hearts® partnership network identified 58 public and private partners, with many more organizations participating at local, state, or regional levels. Partners identified 304 interactions within the network and reported that 77% of interactions resulted in an exchange of information or subject matter expertise.

The evaluation concluded that the Million Hearts® network effectively brought together a diverse group of public and private partners to address issues related to heart disease and stroke prevention. Million Hearts® succeeded in sharing information broadly and supporting partners’ activities to accelerate the nationwide spread of effective strategies to prevent heart attacks and strokes. Findings from the evaluation demonstrate opportunities to further leverage the strengths of the partner network, support broader resource sharing among partners, and reinforce activities implemented by partners.

Million Hearts® Promoted the Development of Partnerships and Activities

Organizations reported that they were able to form new partnerships and strengthen existing ones by participating in the Million Hearts® initiative. For example, out of the 304 total partnership interactions (287 of which described how those relationship began), a majority (59%) directly attributed these relationships to Million Hearts®, either as a new partnership that was initiated through participation in Million Hearts® or as an existing relationship that was strengthened through Million Hearts®. Partners in the Million Hearts® network came from multiple sectors, including federal public-sector organizations (like public health research or regulatory organizations), public health programs or service organizations, and private-sector organizations (like professional associations and private health plans, systems, or practices). Organizations also reported that they trusted and valued these partnerships and viewed the relationships as positive. Organizations reported that partners primarily engaged in information sharing, which represented 77% of all interactions.

Partners’ activities focused on promoting, measuring, and reporting the ABCS (Aspirin when appropriate, Blood pressure control, Cholesterol management, and Smoking cessation) of heart health. Activities included developing, contributing, and sharing information and resources, including educational materials, data, tools, referral sheets, and innovative ideas on best practices. Local programs reported using Million Hearts® branding, tools, and resources developed by the national partnership to support their work. At the national level, partners exchanged information, put new heart disease and stroke prevention programs or strategies into practice, and provided training and technical assistance for using new heart disease and stroke standards of care and practice guidelines.

Select Examples of Partner Strategies and Activities

  • Addressing an Unmet Community Health Need. In partnership with the Million Hearts® initiative, the American Pharmacy Association supported the Ohio State University College of Pharmacy and a partner clinic to improve patient knowledge and skills to support heart health.
  • The Million Hearts™ Initiative: How Nurse Practitioners Can Help Lead. In partnership with the Million Hearts® initiative, the American Academy of Nurse Practitioners encouraged its members to adopt Million Hearts® strategies, including identifying undiagnosed high blood pressure, treating high blood pressure, and using health information technology to improve quality of care and use of the ABCS for heart health.
  • Million Hearts Case Study: Iowa’s Million Hearts Initiative. This state-led initiative in Iowa leveraged partnerships across public health and health care sectors to support components of the Million Hearts® initiative, focused on improving quality of care and use of the ABCS for heart health.
  • The Million Hearts™ Initiative: Progress in Preventing Heart Attacks and Strokes. In alignment with Million Hearts® goals, the Virginia Pharmacists Association and the Virginia Commonwealth University School of Pharmacy worked with employers to help screen 1 million state residents for high blood pressure.

As a result of participating in Million Hearts®, partners adopted new heart disease and stroke prevention activities. Respondents identified changes in their heart disease and stroke prevention activities focusing on raising awareness around the ABCS, providing resources for sharing among stakeholders, developing new heart health–focused programs, facilitating communication between sectors and agencies, and working to reduce heart health disparities. Partners identified several factors that served as key facilitators for adopting and implementing Million Hearts® partnerships and activities, including goal alignment among partners, buy-in from the leadership of participating organizations, good communication between partners, diverse partner sets, trust, recognizing and leveraging resources of other members, and funding.

Million Hearts® Partnership Network Demonstrated Key Successes

The results of this evaluation indicate that Million Hearts® successfully brought partners together and aligned their efforts around a set of national goals. The partners agreed that the initiative was most successful in disseminating information and convening partners.

Select Examples of Disseminating Information and Convening Partners

  • Million Hearts® Self-Measured Blood Pressure Monitoring. The Million Hearts® initiative provided action steps to help public health practitioners teach patients how to measure their own blood pressure.
  • Engaging Partners for Million Hearts® Success. A Million Hearts® stakeholder workshop convened state-level partners to share goals for reducing heart attacks and strokes and strategies for achieving these goals, as well as success stories from groups that used the strategies. Participating states included Colorado, Illinois, Iowa, Missouri, Texas, and Wisconsin.

Million Hearts® cultivated connections between practitioners, policy makers, and even heart disease and stroke patients—which in turn created a greater sense of shared experience, shared purpose, and shared responsibility. Partners reported that their participation in the Million Hearts® initiative led to improved high blood pressure control, improved processes for cardiovascular care, and increased heart health knowledge and awareness among the populations they served.

The Million Hearts® initiative proved to be a credible platform for heart disease and stroke prevention that partners trusted, valued, and participated in. It brought together partners from every level, thus “flattening” the playing field and downplaying any potential hierarchy among organizations. Partners also praised Million Hearts® for recognizing both outstanding efforts and smaller contributions of partner organizations. This recognition on every level helped to motivate partners and keep them engaged. Million Hearts® also helped partners achieve positive heart disease and stroke outcomes among the populations they serve by recognizing the unique resources that partners can contribute and then designing approaches to leverage those resources.

Limitations

The evaluation included data from an environmental scan, key informant interviews, and social network analysis to draw conclusions about the Million Hearts® partner network. Although the social network analysis focused on a core group of 58 partner organizations, the number of organizations involved in Million Hearts® is likely much larger, and these results may not be representative of all Million Hearts® partners. However, this evaluation provides valuable new information on the Million Hearts® network.

References

  1. Frieden TR, Wright JS, Conway PH. Is rapid health improvement possible? Lessons from the Million Hearts initiative. 2017;135(18):1677–1680.
  2. Ritchey MD, Loustalot F, Wall HK, et al. Million Hearts: Description of the national surveillance and modeling methodology used to monitor the number of cardiovascular events prevented during 2012–2016. J Am Heart Assoc. 2017;6(5):e006021.
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