Ohio is in the top quartile of states for high cardiovascular disease (CVD) event rates (combined stroke and heart attacks, highlighting the need for the Heart Healthy Ohio Initiative (HHOI) Quality Improvement Project (QIP). HHIO QIP is funded by the Agency for Healthcare Research and Quality and led by several of the medical schools and the three Regional Health Collaboratives across the state. This QI initiative is partnering with the Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) and the Ohio Academy of Family Physicians and is focused on adapting and testing a Heart Healthy Quality Improvement (QI) process designed to improve cardiovascular health and reduce disparities in CVD.