Prevention and Chronic Disease Management

• Steps to Implementing Standing Orders for Immunization in Your Practice Setting (Immunize.org)
• Rise to Immunize™ Campaign Toolkit (AMGA.com)

• MyQI Improving Diabetes Care Quality (AHRQ)
• Obesity Management Materials and Resources (ACP)

ACP = American College of Physicians | AHRQ = Agency for Healthcare Research and Quality

• Diabetes Zone Tool (English/Spanish) (HSAG)
• Find a Diabetes Self-Management Education (DSME) Program (ADA)
• Healthcare Provider Diabetes Prevention Toolkit (AMA)
• Diabetes Self-Management Education and Support (DSMES) Toolkit (CDC)
• Self-Care Behaviors to Manage Diabetes (Association of Diabetes Care & Education Specialists)
• A Toolkit to Engage High-Risk Patients in Safe Transitions Across Ambulatory Settings (AHRQ)
• Neighborhood Navigator (American Academy of Family Physicians)

ADA = American Diabetes Association | AHRQ = Agency for Healthcare Research and Quality | AMA = American Medical Association | CDC = Centers for Disease Control and Prevention | HSAG = Health Services Advisory Group

• Heart Disease Zone Tool (English/Spanish) (HSAG)
• Hypertension Control Change Package for Clinicians (Million Hearts®)
• Self-Measured Blood Pressure Monitoring (SMBP):
  • SMBP Action Steps for Clinicians (Million Hearts®)
  • Reimbursement for Hypertension Self-Management: SMBP CPT® Coding (AMA)
• 2025 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults (American Heart Association Journals)
• Clinician Recognition Programs:
  • Target BP Recognition Program (AMA)
  • Hypertension Control Challenge (Million Hearts®)
• 2025 Quality ID #236: Controlling High Blood Pressure (CMS)
• A Toolkit to Engage High-Risk Patients in Safe Transitions Across Ambulatory Settings (AHRQ)
• Neighborhood Navigator (American Academy of Family Physicians) 

AHRQ = Agency for Healthcare Research and Quality | AMA = American Medical Association | CMS = Centers for Medicare & Medicaid Services | HSAG = Health Services Advisory Group

• Kidney Disease Zone Tool (English/Spanish) (HSAG)
• Chronic Kidney Disease (CKD) Quick Reference Guide for Primary Clinicians (NKF)
• Clinical Practice Guidelines for Cardiovascular Disease and CKD (NKF)
• Clinical Practice Guidelines for Diabetes and CKD (NKF)
• 2025 Explore MIPS Value Pathways (MVPs) – Quality Payment Program (CMS)
• Newly Diagnosed With CKD for Patients (AKF)
• Healthy Eating for Adults With CKD (NIDDK)

AKF = American Kidney Fund | CMS = Centers for Medicare & Medicaid Services | HSAG = Health Services Advisory Group | NIDDK = National Institute of Diabetes and Digestive and Kidney Diseases | NKF = National Kidney Foundation