The goal? Everyone working at the top of their game to find and treat patients before a cardiovascular event occurs, and ensure they get the best care. A team approach, with primary care providers supported by trained experts in care, can get you there.

Department of Health has resources and partners to help you assess and enhance your organization's use of team-based care. Please contact us.

Here are some tools and resources suggested by partners to use team-based care to improve cardiovascular health of your patients:

Team-Based Care White Paper from the Cardiovascular Disease and Diabetes Network Leadership Team (CDNLT)

Team Effort: Supporting Diabetes Care with a Team-Based Approach is a white paper developed between 2020 – 2022 by the Cardiovascular Disease and Diabetes Network Leadership Team (CDNLT), CDNLT members collaborated to interview seven professionals and one patient to collect information in an effort to share that information with those that are looking to understand more about the various roles in the health care system and how they are all a part of the diabetes management team. Interdisciplinary teamwork is an important model for delivering appropriate and effective health care to individuals with diabetes and other chronic conditions, such as hypertension. Working as a cohesive team in healthcare enables the practice of collaboration and effective communication to expand beyond the traditional roles within each discipline, allowing decisions to be made towards a common goal.

Surgeon General Issues Call to Action to Control Hypertension

High levels of hypertension control can be achieved in clinical settings and communities. However, recently analyzed data show hypertension control rates worsening, not improving. Released October 2020, the Surgeon General’s Call to Action to Control Hypertension (Call to Action) seeks to avert the negative health effects of hypertension by identifying evidence-based interventions that can be implemented, adapted, and expanded in diverse settings across the United States. Additional resources, including a Partner Toolkit, can be found on the CDC's High Blood Pressure website.


Revised 2020 Million Hearts Hypertension Control Change Package

CDC’s Division for Heart Disease and Stroke Prevention recently released of the second edition of the Million Hearts® Hypertension Control Change Package (HCCP). This update was prompted by the release of updated clinical guidelines, development of new resources, and advances in quality improvement, and emphasizes Team-Based Care strategies.


Great 8

The Great 8 is a visual-based tool created to improve communications around cardiovascular health between health professionals and patients, especially patients with low health literacy and limited English proficiency. Healthcare team members can help patient set self-management goals, and stay connected to patients, by using this versatile tool. For more information visit our Great 8 page.


AMA Team-Based Care - Equip Direct Care Staff to Facilitate Patient Self-Management

Improve Patient Care and Team Engagement Through Collaboration and Streamlined Processes


Centers for Disease Control and Prevention: Promoting Team-Based Care to Improve High Blood Pressure Control


The Community Guide: Team-Based Care to Improve Blood Pressure Control


Self-Measured Blood Pressure Monitoring at Home Policy Statement

Self-measured blood pressure (SMBP) offers clinical benefits and the potential for being cost-effective over blood pressure (BP) monitoring conducted in a medical office. Still, improvements in patient education, provider training and insurance coverage are needed for the broader adoption of the practice. Of the millions of Americans with hypertension, less than half have the condition under control, with many cases going undiagnosed.

Barriers to the widespread use of SMBP monitoring deter its wider implementation in the US. The Self-Measured Blood Pressure Monitoring at Home Policy Statement from the American Health Association and the American Medical Association offers recommendations to address these barriers. The policy statement reviews the effectiveness of SMBP monitoring in diagnosing and managing hypertension, which is critical to narrowing disparities and improving blood pressure control in low-income, and medically underserved communities, rural communities and communities of color that experience significant disparities in hypertension rates.