Table 2 Outcome measures, data source, and data collection timeline

Primary outcomes

• Aspirin: percent of patients aged 18 years and older with ischemic vascular disease (IVD) with documented use of aspirin or other antithrombotic.

• Blood pressure management:

1) Percent of patients aged 18–85 who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90).

2) Percent of patients aged 60–85 without diabetes (DM) or chronic kidney disease (CKD) with controlled BP (<150/90),

3) Percent aged 18–85 with DM or CKD with controlled BP (<140/90)

• Cholesterol management:

1) Percentage of patients aged >21 diagnosed with ASCVD who are on statin therapy.

2) Percentage of patients aged >21 with history of LDL >190 mg/dL without ASCVD who are on statin therapy.

3) Percentage of patients aged 40–75 with diabetes without ASCVD and LDL 70–189 mg/dL who are on statin therapy

• Smoking cessation support: Percentage of patients aged 18 years or older who were screened about tobacco use one or more times within 24 months and who received cessation counseling intervention if identified as a tobacco user.

EHR

Baseline, quarterly during intervention period, at the end of intervention (12 months), and 6 months post intervention

Secondary outcome: practice change capacity

• Organizational change process capacity

• Adaptive reserve

Provider and staff survey

Baseline, at the end of intervention (12 months) and 6 months post intervention