Enhanced Domain 3 Health Systems Intervention includes Strategy 1 and
Strategy 2

(Note on Supplemental Funding: Provided to enhanced states to expand/increase activities in selected strategies. No additional performance measures but targets should reflect expanded reach and outcomes.)

Strategy 1

Increase implementation of quality improvement process in health systems

Interventions
Increase electronic health records (EHR) adoption and the use of health information technology (HIT) to improve performance

Increase the institutionalization and monitoring of aggregated/standardized quality measures at the provider and systems level

Performance Measure 3.1.01

Proportion of health care systems with electronic health records (EHRs) appropriate for treating patients with high blood pressure

Performance Measure 3.1.02

Proportion of health care systems with electronic health records (EHRs) appropriate for treating patients with diabetes

Performance Measure 3.1.03

Proportion of patients that are in health care systems that have electronic health records (EHRs) appropriate for treating patients with high blood pressure

Performance Measure 3.1.04

Proportion of patients that are in health care systems that have electronic health records (EHRs) appropriate for treating patients with diabetes

Performance Measure 3.1.05

Proportion of health care systems reporting on National Quality Forum (NQF) Measure 0018

Performance Measure 3.1.06

Proportion of health care systems reporting on National Quality Forum (NQF) Measure 59

Performance Measure 3.1.07 (Domain 4 - 4.3.05)

Proportion of patients with high blood pressure in adherence to medication regimens

Performance Measure 3.1.08 (Domain 4 - 4.3.06)

Proportion of patients with diabetes in adherence to medication regimens

Performance Measure 3.1.09 (Domain 4 - 4.3.08)

Proportion of patients with high blood pressure that have a self-management plan (may include medication adherence, self-monitoring of blood pressure levels, increased consumption of nutritious food and beverages, increased physical activity, maintaining medical appointments)

Performance Measure 3.1.10 (Domain 4 - 4.3.10)

Proportion of adults with known high blood pressure who have achieved blood pressure control

Performance Measure 3.1.11

Decreased proportion of PWD with A1C >9%

Performance Measure 3.1.12

Age-adjusted hospital discharge rate for diabetes as any-listed diagnosis per 1,000 persons with diabetes

Strategy 2

Increase use of team-based care in health systems

Interventions
Increase engagement of non-physician team members (i.e., nurses, pharmacists, and patient navigators) in hypertension (HTN) and diabetes management in health care systems

Increase use of self-measured blood pressure monitoring tied with clinical support

Performance Measure 3.2.01

Proportion of health care systems with policies or systems to encourage a multi-disciplinary team approach to blood pressure control

Performance Measure 3.2.02

Proportion of health care systems with policies or systems to encourage a multi-disciplinary team approach to A1C control

Performance Measure 3.2.03

Proportion of patients that are in health care systems that have policies or systems to encourage a multi-disciplinary team approach to blood pressure control

Performance Measure 3.2.04

Proportion of patients that are in health care systems that have policies or systems to encourage a multi-disciplinary approach to A1C control

Performance Measure 3.2.05

Proportion of health care systems with policies or systems to encourage patient self-management of high blood pressure

Performance Measure 3.2.06

Proportion of patients that are in health care systems that have policies or systems to encourage patient self-management of high blood pressure

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