Target: BP™: A National Initiative to Improve Blood Pressure Control

Abstract

Target: BP™ is a national initiative launched by the American Heart Association and the American Medical Association in 2017 in response to the high prevalence of uncontrolled blood pressure (BP) in the United States. Target: BP™ provides support to health care organizations and health care teams, with no user fees, to improve the quality of care for adults with hypertension by providing education and resources and recognizing organizations committed to prioritizing and reporting their rate of BP control. Through Target: BP™, the American Heart Association and the American Medical Association also collaborate to align policy with evidence through federal, state, and institutional policy advocacy and raise public awareness through media campaigns. In 2022, Target: BP™ recognized 1309 health care organizations serving 8.4 million patients with hypertension for prioritizing BP control, 675 of which affirmed performance of evidence-based BP measurement activities and 551 of which reported BP control rates ≥70%. With the proportion of US adults with controlled BP falling to 48.2% from 2017 to 2020, Target: BP™ remains focused on regaining lost ground in national BP control rates by emphasizing accurate BP measurement, rapid treatment intensification, healthful lifestyle changes, and evidence-based use of self-measured BP monitoring. Target: BP™ also emphasizes adoption of team-based care models and prioritizing equitable health outcomes. More than 1.37 million unique users have visited https://targetbp.org/ and downloaded 98 341 Target: BP™ resources from 2017 to 2022.

High blood pressure (BP) is a major risk factor for coronary heart disease, heart failure, and stroke and among the leading causes of death and disability.¹ BP has been identified as 1 of 8 key components of cardiovascular health by the American Heart Association (AHA).² Despite the availability and low cost, effective pharmacological and nonpharmacological treatment, BP control (defined by the national controlling high BP measure, Centers for Medicare and Medicaid Services (CMS) 165 as systolic BP <140 mm Hg and diastolic BP <90 mm Hg) among US adults with hypertension continues to be suboptimal, having reached 53.8% in 2013 to 2014 and most recently standing at 48.2% in 2017 to 2022 with ongoing inequitable control rates by race, ethnicity, insurance status, household income, and other factors.^3,4 That said, some health care organizations (HCOs) have reported BP control rates of ≥70% and even ≥80%, including Federally Qualified Health Centers serving historically marginalized patient populations.^5,6

The purpose of this review is to describe the origins, objectives, scope, and accomplishments of Target: BP™ to date, raise awareness and understanding of available evidence-based, best practice resources, and highlight opportunities to engage in efforts to improve BP control through practice improvement and policy change. To help HCOs implement best practices, Target: BP™ offers HCOs support within ambulatory practice sites and communities to help translate evidence into everyday clinical practice and provide recognition for best practices and outcomes. More recently, Target: BP™ has addressed the broader hypertension ecosystem by helping to align policy with evidence through federal state and institutional policy advocacy and to raise public awareness and action through media campaigns.

BACKGROUND AND OVERVIEW

In 2015, the AHA and the American Medical Association (AMA) brought together shared goals, complementary resources, and expertise to help focus the Nation’s attention on improving BP control among US adults. In 2017, that collaboration launched Target: BP™, a national initiative offering quality improvement (QI) tools and resources to HCOs and care teams, with no user fees, to improve the diagnosis, treatment, and management of hypertension and recognize HCOs committed to prioritizing and reporting BP control rates.⁷

Engaging the Primary Audience

The primary audience for Target: BP™ is health care professionals and care teams who manage patients with hypertension, focusing mostly on primary care and some specialty providers and practices. To engage in Target: BP™, HCOs register to participate and can submit their aggregate BP control rate data based on CMS 165 through a self-service data platform, enabling them to track annual progress, benchmark against peer groups, and receive national recognition. Participating HCOs receive monthly newsletters, access to free continuing medical education/continuing education credit opportunities, and QI tools translating the latest evidence into practice. Although there are no user fees associated with the Target: BP™ initiative, HCO costs to champion and lead QI efforts, use initiative tools and resources, and participate in the annual recognition program depend on the unique engagement and cost structure of each HCO. Among actively engaged HCOs who submitted recognition data in 2022, 44% are Federally Qualified Health Centers or community health centers. Other participants are a mix of primary care and multi-specialty practices including a range of small independent practices, large health systems, and academic medical centers in rural, suburban, and urban settings. HCOs have been engaged to participate in Target: BP™ primarily through outreach efforts conducted by AHA’s Community Impact and Quality, Outcomes Research, and Analytics teams, who serve locally and nationally. As AHA and AMA have prioritized health equity and the elimination of health disparities, Federally Qualified Health Centers represent a significant and growing segment of participating HCOs.

Initiative Assets

The elements of Target: BP™ include clinical education and practice tools, recognition program resources, policy efforts, and public awareness campaigns—all fueled by AHA’s and AMA’s human and financial resources coordinated both nationally and locally with relationships in communities and HCOs across the country. The work of Target: BP™ is rooted in the 2017 AHA/American College of Cardiology Hypertension Guideline, scientific statements, and peer-reviewed publications and is continuously updated with emerging research on clinical care, QI methods, performance measures, and models of care. A national advisory group of diverse, multidisciplinary thought leaders including physicians, nurse practitioners, nurses, pharmacists, and physician assistants provides ongoing guidance to the evolution of the program.

BRINGING EVIDENCE INTO CLINICAL PRACTICE

Target: BP™ offers many assets that support HCOs in assessing their practice, strengthening the knowledge and skills of their care teams, improving their quality of care, and educating patients. These materials are downloadable for free, including an increasing number of patient-facing resources available in Spanish, Chinese, and other languages.⁷

AMA MAP™ framework

Many Target: BP™ QI tools are based on AMA’s MAP™ framework (Figure 1) and assets that were developed as part of AMA MAP BP, an evidence-based QI program shown to demonstrate sustained improvement in BP control. MAP stands for measure accurately, act rapidly, and partner with patients. The MAP framework addresses 3 key clinical care processes that drive hypertension control: obtaining accurate and representative BP measurements; diagnosing and managing hypertension with timely and effective treatment; and promoting self-management of hypertension through positive lifestyle changes, adherence to treatment, and use of self-measured BP (SMBP). This framework was designed to address some of the most common barriers to BP control, diagnostic uncertainty, therapeutic inertia, and treatment nonadherence.^8–10

Figure 1.

American Medical Association (AMA) MAP™ framework.

Target: BP™ Practice Tools and Resources

As such, Target: BP™ assets address each part of the MAP framework, providing resources for each component to assess the current state of clinical practice, strengthen the knowledge and skill of providers, and care team members, implement practice changes with job aids, and support patients with high quality, accessible education, and self-care tools. HCOs can walk through the self-guided website and reference the Combined Quick Start Guide to embark on a QI journey.¹¹

Of note, Target: BP™ has a suite of tools that support SMBP monitoring. SMBP tools mirror key MAP concepts emphasizing the importance of preparing patients to measure accurately at home, guiding providers in using SMBP data to inform prompt diagnostic and treatment decisions, and leveraging the tool of SMBP to enhance treatment adherence. The SMBP Quick Start Guide was developed in response to the increased interest in home BP monitoring. The SMBP Infographic for patients has been downloaded 7939 times.¹²

The most frequently requested Target: BP™ practice resource is the In-office Position Graphic (Figure 2) that reinforces key aspects of measurement accuracy and the potential error (in mm Hg) caused by each of several deviations from evidence-based technique.¹³ Downloaded 8725 times, this poster was initially developed as a reminder for care team members to use evidence-based measurement technique. Anecdotal feedback revealed that the poster engaged patients to more readily participate or even remind care team members of accurate technique. The Technique Quick Check Tool is another popular QI tool that serves as a competency checklist for training and maintaining consistent BP measurement practice among care team members, downloaded 3487 times.¹⁴

Figure 2.

Target: BP™ American Medical Association (AMA) MAP™ BP in-office positioning graphic.

Educational Events

From 2017 to 2022, 16 live and on-demand webinars have accumulated 12 673 hours viewed on topics related to MAP, SMBP, team-based care, and health equity. Webinars on the accuracy of BP measurement remain the most watched, accounting for 8141 hours viewed from 2017 to 2022. HCOs often use this resource to provide orientation and refresher training every 6 to 12 months in accordance with guideline recommendations and staff can earn free, enduring continuing medical education/continuing education credit.⁷

RECOGNIZING BEST PRACTICES AND OUTCOMES

In addition to supporting professional education, practice, and QI efforts, Target: BP™ also offers an annual recognition program that incentivizes and celebrates HCOs that have demonstrated their commitment to prioritizing BP control and submitted data about their practices and outcomes.

Award Levels and Criteria

From 2017 to 2020, the recognition program offered 2 award levels, Participant and Gold. The Participant award acknowledges organizational commitment and completion of data submission whereas the Gold award also acknowledges HCOs reporting BP control rates ≥70%, per CMS 165, defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg. CMS 165 has been used since the inception of Target: BP™ because it continues to be the reporting requirement for various CMS programs, that is, Merit-Based Incentive Payment System (MIPS), Medicare Shared Savings Program (MSSP), and Accountable Care Organizations, and for the Health Resources and Services Administration (HRSA) Health Center Program Uniform Data System Data reporting. Recognition awards are based on prior year data, for example, 2020 awards are based on 2019 data.

In 2021, the award criteria were expanded to include Silver and Gold+ awards. The criteria to earn either of these awards include attesting to the completion of at least 4 of 6 evidence-based BP measurement activities emphasizing device validation and calibration, team training and testing, and systems of care to support accurate BP measurement (Figure 3). The addition of evidence-based practice attestation questions and related awards was designed to create focus and additional opportunities for improvement.

Figure 3.

2021 to 2023 Target: BP™ Annual Recognition Program Award Criteria. BP indicates blood pressure.

Award Achievement

From 2017 to 2022, a cumulative total of 3100 HCOs have been engaged in the Target: BP™ Recognition Program. Of those, 1419 submitted recognition data in 2022, an increase from 1167 in 2021 and a nearly 4-fold increase from 330 HCOs in 2017. These HCOs represented 48 states and 2 US territories. Those 1419 HCOs reported caring for about 8.4 million adult patients with a diagnosis of hypertension. On average, the BP control rate of data submitting HCOs (1309) was 65.6%, an increase from 63.5% in 2021. In addition, 551 HCOs, 42% (551/1309), reported BP control rates ≥70% with an average control rate of 77%. Four hundred HCOs submitted data for the first time in 2022, with 180 HCOs reporting control rates of ≥70%.

Among 871 HCOs who submitted data in the Target: BP™ Recognition Program in 2021 and 2022, 568 HCOs reported increases in control rates between 2020 and 2021, whereas 294 HCOs had negatively trending control rates. There were 164 HCOs reporting control rates in 2019, 2020, and 2021 of ≥70%. Recognizing HCOs that attested to at least 4 of 6 evidence-based BP measurement activities with control rates <70%, Silver awards were given to 567 HCOs in 2021 and 675 in 2022.

Figure 4 illustrates the trends in the patient population served, retention, and award achievements of participating HCOs from 2017 to 2022. The temporary decline in participation in 2020 and number of HCOs achieving control rates of ≥70% in 2020 and 2021 is possibly attributable to the challenges of the COVID-19 pandemic. In 2022, Target: BP™ realized the highest level of participation, attestation of evidence-based BP measurement activities, and reported BP control rates of ≥70%. From 2017 to 2022, 33 HCOs participated every year, retaining 10% of 2017 participants. From 2020 to 2022, 1081 HCOs have participated every year, retaining 42% of 2020 participants, indicating an increase in participation and retention.

Figure 4.

Target: BP™ Annual Recognition Program Growth.

With 2 years of BP measurement attestation data from 2021 to 2022, Figure 5 illustrates the percentage of organizations attesting to these activities increased in each criterion, except for checking to see if devices were validated for clinical accuracy due to a change in the manner in which the question was asked, so this does not provide an equal comparison.

Figure 5.

Target: BP™ Annual Recognition Program evidence-based measurement activity attestation rates. *Changes to this question from 2021 to 2022 limit comparison and do not necessarily indicate a reduction in the rate of checking device validation. **Total number of health care organizations (HCOs) submitting data during the year.

Data Platform and Submission

To participate in the Recognition Program, HCOs register, consent, and gain access to the Target: BP™ data platform, where they enter or upload their aggregate control rate data and respond to attestation questions. In addition, HCOs are asked to report practice characteristics, including the number of clinicians and the race/ethnicity and payor mix of their total adult patient population served, indicators of the complexity of the patient population being reached. By submitting data, HCOs set a baseline and then can self-assess, consider available educational programs and QI resources to improve, and then resubmit annually. The annual recognition program provides a timeframe and incentive for continuous QI. The annual window for data submission from the prior year’s performance typically runs from January through May. Following data review and verification procedures, Target: BP™ announces awardees in September.

The benefits to HCOs for participating in the annual Target: BP™ Recognition program include access to the data platform to which they submit their data (Figure 6). This tool includes functionality to examine performance over time and in comparison to aggregated data of other participating HCOs, as a whole or by subgroups based on HCO size of the patient population served or type of organization (federally qualified health center or community health center; primary care or specialty; residency site; urban, suburban, or rural geography, or state). For health systems or HCOs with multiple locations, data can be visualized as 1 entity or in a side-by-side comparison of individual sites within the entity. HCOs can also request customized aggregate comparator groups, such as regional cohorts.

Figure 6.

Outpatient Recognition Program Data Platform. This dashboard illustration contains demonstration data. BP indicates blood pressure; FQHC, Federally Qualified Health Center; HTN, hypertension; MIPS, Merit-based Incentive Payment System; and NQF, National Quality Forum.

Recognition Benefits

HCOs are publicly recognized by Target: BP™ through a national press release by the AHA and AMA, through national and state professional meeting events such as AHA’s Scientific Sessions, and a national health care trade publication. HCOs also receive a Recognition Award toolkit with resources for a local press release and digital award medallion icons for use in printed or electronic form such as banners or institutional website and email footers. HCOs have used these assets creatively to celebrate their achievement internally with their teams and promote their level of excellence and commitment to BP control in their communities.⁷

Based on an increasing number of HCOs participating, attesting to improved BP measurement practices, and reporting higher control rates, the Recognition Program serves as an effective engagement strategy. Furthermore, it has become a tool to help focus attention on evidence-based practices, such as accurate BP measurement. The recurring nature of the recognition program encourages HCOs to sustain and improve BP control rates and supporting practices, such as regular BP measurement device calibration or team training.

ALIGNING POLICY WITH THE EVIDENCE

AHA and AMA have expanded from their initial focus on clinical care in HCOs to include efforts to affect health care policies. These efforts are primarily focused on aligning patient insurance coverage and provider reimbursement with guideline recommendations. Ongoing collaborative efforts aim to address federal and state-level policy change and other national and institutional standards to support evidence-based practices.¹⁵

The AMA developed 2 SMBP CPT^® codes (99473 and 99474) to code and bill for training patients in the use of SMBP and for clinicians to monitor monthly readings. These codes came into effect in 2020. Through Target: BP™, education and practice tools were created to disseminate information about the new codes to support SMBP program sustainability.¹⁶

AHA and AMA submitted a joint national coverage determination request to the Centers for Medicare and Medicaid Services seeking Medicare coverage for SMBP devices for diagnosing and treating patients with suspected or confirmed hypertension. This request is pending review and represents a significant opportunity to expand patient access to SMBP devices and practice sustainability for evidence-based care.

At the state level, AHA and AMA have focused on Medicaid coverage for SMBP devices and reimbursement for SMBP care. A 50-state analysis in 2023 revealed 76% of state Medicaid plans covered SMBP devices and 36% reimbursed for ongoing SMBP monitoring.¹⁷ AHA and AMA are working together to support policy implementation to help patients and HCOs make use of new benefits and promote evidence-based adoption and practice of SMBP. Policy change efforts are ongoing in other states to expand benefits, promoting the use of oscillometric, validated devices, and coverage of an XL BP cuff, when indicated.

AMA and AHA have also collaborated to promote a national standard for BP measurement device accuracy. Using devices that have been validated for clinical accuracy has been identified as a critical factor for BP control. The AMA enlisted the National Opinion Research Center at the University of Chicago to assist in the design, independent management, and launch of the US Blood Pressure Validated Device Listing (VDL™) in April 2020. Similar resources existed previously in Europe and Canada, but none in the US market. Since the VDL™ launched the list includes an increasing number of in-office, home, ambulatory, kiosk, and wrist devices.¹⁸

In addition, AHA and AMA collaborated to include data elements defined by the Office of the National Coordinator in the US Core Data for Interoperability standards that align with best practices in BP management. Each organization submitted testimony and comments to the Health Information Technology Advisory Committee to include a Level 2 average BP data element, a dedicated field that is distinct from a singular BP reading. In July 2023, the Office of the National Coordinator announced a final determination of US Core Data for Interoperability Version 4 recognizing average BP as a new data element for use in contexts such as in-office confirmatory, self-, or 24-ambulatory measurements.¹⁹

Promoting private sector policy change is another potential approach to drive best practices in hypertension control. Target: BP™ offers a model template for HCOs to adopt a validated BP device procurement policy.²⁰ The policy is designed to help ensure the expenditure of HCO resources for guideline-recommended BP devices and equitable patient access to accurate devices.

RAISING PUBLIC AWARENESS

Public awareness and patient engagement remain essential parts of Target: BP™’s hypertension improvement strategy. AHA, AMA, and the Advertising Council produced a series of public awareness campaigns emphasizing the risk of heart attack and stroke associated with high BP, encouraging BP care and control, and normalizing the practice of home BP monitoring. The campaign, Get Down with Your Blood Pressure, was developed and partially federally funded as part of the National Hypertension Control Initiative, in response to persisting health inequities and the exacerbation of high BP impacting communities of color, particularly for Black, Hispanic/Latino, and Native American adults. This multimedia campaign teaches adults how to self-measure BP and emphasizes the importance of talking to your health care provider about a BP management plan. From 2017 to 2022, these campaigns amassed 3.3 billion impressions and 1.24 million campaign site sessions through donated social and print media.²¹

Release the Pressure is another public-facing initiative focusing on self-care and heart health among Black women. Website resources and events encourage individuals to Take the Pledge to prioritize heart health, promote accurate home BP measurement and tracking, and offer other wellness resources. The Release the Pressure Heart Health Squad, a coalition of national health care professional organizations and experts, guides the initiative and includes the AMA, AHA, AMA Foundation, Association of Black Cardiologists, Minority Health Institute Inc., and the National Medical Association. To date, the initiative has generated 72 000 pledges, 140 000 views of an SMBP training video, and 206 000 in-person and live event participants.²²

FUTURE DIRECTIONS

AHA and AMA continue to expand QI resources and recognition and policy incentives to improve and sustain BP control. Target: BP™ is investing in patient-level data tools that can provide more timely process and outcome information to drive QI. Target: BP™ is pilot-testing a hypertension data registry that extracts patient-level encounter data using the HL7^® FHIR^® standard into a data platform featuring the AMA MAP™ metrics including Confirmatory BP Measurements, Medication Intensification, Average Systolic BP Reduction after Medication Intensification, Systolic BP Terminal Digit Preference, Use of Fixed-Dose Combo Product, along with Controlling High BP and Improvement in BP measures. The registry functionality includes numerous standardized and custom reporting tools with patient-level data and the ability to stratify data by race and ethnicity, provider, practice site, and other data elements as well as to view patient-level detail.

In 2024, the Target: BP™ Recognition Program will field test additional attestation questions about the use of hypertension algorithms with a BP treatment goal of <130/<80 mm Hg, treatment intensification, and timely follow-up; assessment and intervention for modifiable lifestyle risk factors; SMBP patient training, data relay, and data use in hypertension management; and the accurate collection and use of race and ethnicity and social determinants of health data for assessing and addressing equitable health outcomes. The new criteria will be used to determine 2025 Recognition Program awards.⁷

COMPLEMENTARY EFFORTS TO IMPROVE BP CONTROL

In addition to collaborative work through Target: BP™, AHA, and AMA, as well as several other national organizations, have engaged in complementary efforts in support of improved hypertension control. The 2017 High Blood Pressure Guideline remains the scientific cornerstone to guide BP control.²³ Subsequent scientific statements about BP measurement, medication adherence, and weight-loss have added to the evidence-base to inform practice.^24–26 The 2019 AHA/ACC Clinical Performance and Quality Measures for Adults with High Blood Pressure include measures with lower BP thresholds that align with the recommendation in the 2017 Guideline and offers additional guidance to HCOs for improving patient outcomes.²⁷ These measures, however, have not been integrated into national reporting requirements to date.

The AHA leverages its local Community Impact staff across the country to engage HCOs in hypertension control through participation in Target: BP™, National Hypertension Control Initiative , and other BP control activities made possible by national and local philanthropic support. The activities include providing validated BP devices, educational resources, and consultation, for example, to create clinical-community linkages.

In 2018, the AHA launched the Hypertension Center Certification program to improve the outcomes of patients with complex or difficult-to-treat hypertension, through partnering with medical practices, incorporating best practices, and implementing evidence-based treatment guidelines. Since the Certification program’s inception, over 25 centers have been certified as Comprehensive or Practice Hypertension Centers and nearly 20 centers aim to become certified and recertify within the next year.²⁸

The AMA offers AMA MAP BP, an evidence-based QI program that can lead to significant, sustained improvements in BP control. AMA MAP BP has demonstrated a 10% point increase in BP control in 6 months with sustained results at 1 year.⁹ The program includes the use of a dashboard with process and intermediate outcome metrics that drive the BP control coupled with the support of hypertension and QI experts providing practice facilitation at no charge. AMA works with federally qualified health centers, academic medical centers, and some of the largest multi-state health systems in the United States.²⁹

Numerous other national, state, and local initiatives add to the landscape of hypertension control efforts, including the Centers for Disease Control and Prevention (CDC) Million Hearts, the National Association of Community Health Centers, the National Hypertension Control Roundtable, and the 2020 Surgeon General’s Call to Action to Control Hypertension.^30–33

CHALLENGES AND OPPORTUNITIES

Many factors pose challenges to improving BP control, despite having a deep understanding of the disease, relatively inexpensive, and readily accessible sources for diagnosis and treatment, and many evidence-based tools, resources, and methods for improving care. Factors often noted by HCOs participating in Target: BP™ include issues, such as divergent guideline-recommended BP treatment targets, staffing shortages, financial performance pressure, and infrastructure gaps in outpatient care with respect to QI, clinical leadership, information technology, and organizational capacity.⁶

• The convergence of treatment targets among international and US guidelines (such as recent updates by the American Diabetes Association and American Academy of Family Practice recommendations toward the 2017 AHA/ACC Hypertension Guideline) can be expected to further align hypertension control efforts.^34,35

• The performance and financial pressure on primary care practices persist with high burn-out and workforce shortages. Growing evidence about the effectiveness of team-based care models reducing the hours per day that physicians need to implement guideline-directed primary care from 26.7 to 9.3 hours per day offers hope in improving the health of patients and the well-being of the workforce.³⁶

• Compared with hospital environments, the regulatory, quality, and clinical leadership infrastructure are often less robust in outpatient settings, even in large health systems. Accountable Care Organizations may be a more powerful driver of outpatient quality with incentives linked to population outcomes.

• The health information technology environment in outpatient care remains challenging with less consistently advanced electronic health records, fewer Information Technology staff, and limitations with interoperability with remote monitoring devices. The rapid uptake of telehealth and remote monitoring during the COVID-19 pandemic and resumed implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions may serve to close these gaps more rapidly than expected.³⁷

• Fully leveraging the organizational capacity of the US Department of Health and Human Services agencies—particularly the Health Resources and Services Administration to optimally support 1400 community health centers serving 30 million patients—through systematization, standardization, and protocolization for BP control is an opportunity to pursue.

For Target: BP™, these scientific, human, financial, regulatory, technical, and organizational factors have the power to concentrate or dilute attention and action on hypertension control, with the potential to accelerate or decelerate progress toward promoting health; preventing heart attacks, strokes, and other medical consequences; and eliminating health disparities. Target: BP™ aims to increase the number of HCOs taking steps to improve hypertension control and deepen engagement in the initiative to drive performance improvement and better health for people with hypertension.

CONCLUSIONS

Target: BP™ and the related work of the AHA and AMA remain focused on improving the nation’s BP control to ≥70%. HCOs are encouraged to do the following:

• Prioritize BP control as an institutional goal.

• Use evidence-based tools and resources to improve performance.

• Track progress and examine data for equitable health outcomes.

• Celebrate successes through annual recognition.

• Champion evidence and policy alignment at the institution, state, and national levels.

Target: BP™ offers tools and resources to support engagement through these means to improve the nation’s health.⁷

ARTICLE INFORMATION

Acknowledgments

The authors thank all of the current and past team members who have made significant contributions to the Target: BP™ especially, Angela Agens, Tyler Baier, Allie Bateman, Jo-Lynne Carter, Una Charley, Katelyn Dean, Brian Eaggleston, Amy Featherston, Sinead Forkan-Kelly, Julie Grabarkewitz, Shannon Haffey, Rupi Hayer, Debbie Hornor, Alyson Joyner, Brady Lever, Kate Kirley, Brooke McSwain, Linda Murakami, Liz Montgomery, Sara O’Kane, Nar Ramkissoon, Neha Sachdev, Lisa Sanders, Taylor Turner, Kirstin Siemering, Laurie Whitsel, Janet Williams, Jianing Yang, and AHA’s Community Impact and Quality, Outcomes Research, and Analytics staff. The authors also thank the past and current Target: BP™ Advisory Group volunteers for their expertise and guidance as well as Michele Bolles, Juliana Crawford, Delane Heldt, and Karen Kmetik for their executive leadership.

Sources of Funding

None.

Disclosures

All authors have read and approved the submission of the article; the article has not been published and is not being considered for publication elsewhere, in whole or in part, in any language, except as an abstract. The findings and conclusions are those of the authors and do not necessarily represent the official position the American Medical Association.