| CVD risk factor-specific care processes | Cross-cutting care processes |
|---|---|
| Hypertension: ensure repeat blood pressure check every 3 months if blood pressure is > 120/80 |
- Use database to track and prioritize screening, monitoring, and treatment of hypertension, diabetes, and dyslipidemia - Use primary care visit communication form to facilitate communication between primary care provider and behavioral health home team - Use motivational interviewing to engage consumers in their CVD risk factor care (e.g. resolving ambivalence around starting medication to treat blood pressure, self-management strategies for diabetes) |
| Dyslipidemia: obtain lipid panel every 12 months | |
| Diabetes mellitus: obtain HbA1c every 6 months if HbA1c < 7% |