| Course | MHA 599 Capstone: Leading the Organization Through Change (MHA/599) |
|---|---|
| Week | 1 |
| Paper type | Capstone opportunity proposal |
| Length | about 1,150 words, 4 double-spaced pages plus title page and references |
| Format | APA 7 student paper |
| School | University of Phoenix |
| Program | MHA |
| Updated | September 2026 |
Free sample paper for MHA 599 Week 1
Blood Pressure Across Three Hundred Miles: Identifying a Strategic Opportunity for Change in a Montana Regional Health System's Rural Clinics
[Student Name]
University of Phoenix
MHA/599: Capstone: Leading the Organization Through Change
Week 1 Assignment
[Instructor Name]
[Date]
The health system, its clinics, patient figures and the proposal are composites written for a model paper; county estimates come from the CDC data set cited, retrieved in September 2026, and research findings from the sources listed.
The chief executive of a composite regional health system based in Billings, Montana, asked the director of population health a question during the system's strategic planning: if you could make one change that would matter most to our rural patients over the next three years, what would it be? This capstone begins with her answer. This first paper identifies the opportunity, the evidence behind it and its scope.
The Organization
The system operates a 180-bed regional medical center in Billings and 14 primary care clinics in towns across south-central and eastern Montana, some more than 150 miles from Billings. It serves ranching and farming communities, two American Indian reservations and small towns where the clinic is often the only source of primary care for fifty miles or more. Its strategy emphasizes keeping care close to home and reducing avoidable hospitalizations.
Looking for the Right Opportunity
The director reviewed several candidates: expanding telehealth visits, a heart failure remote monitoring program, behavioral health integration and hypertension control. She asked which opportunity was common, harmful if neglected, poorly controlled now, supported by strong evidence and feasible across long distances.
The Local Data
County estimates show the scale of the problem. CDC's 2025 county estimates put age-adjusted high blood pressure among adults at 28.3% in Yellowstone County, which includes Billings, 29.8% in Musselshell County, 33.5% in Big Horn County and 35.2% in Rosebud County. In Big Horn County, 14.5% of adults aged 18 to 64 lacked health insurance and 18.7% of adults lacked reliable transportation (Centers for Disease Control and Prevention, 2025).
The System's Own Data
The system's records showed about 11,800 patients with a diagnosis of hypertension in its rural clinics. Only 46% had blood pressure below 140/90 at their last visit, compared with 61% at the Billings clinics. Many rural patients saw a clinician only once or twice a year, and a single office reading often did not reflect their usual pressure, so medicines were rarely adjusted between visits.
Why Blood Pressure
Uncontrolled high blood pressure causes strokes, heart attacks, heart failure and kidney disease, conditions that bring rural patients on long ambulance rides to Billings. It is common, often silent and treatable with medicines that are inexpensive. The gap between what is possible and what is achieved is large.
Evidence for a Model That Works
The strongest evidence supports home monitoring combined with active medication management. A Minnesota trial randomized whole clinics: patients in the intervention clinics sent home readings electronically to pharmacists, who changed doses and drugs as needed. Over a year, well over half of those patients reached and held their targets, roughly twice the rate in comparison clinics, and the gap was still visible six months after the program stopped (Margolis et al., 2013). The trial's success came from pharmacists acting on the readings, not from the monitors alone.
Evidence From a Model That Did Not Work
Not every remote monitoring program succeeds. In a randomized trial of 1,437 patients hospitalized for heart failure, combined health coaching calls and telemonitoring after discharge did not reduce readmissions within 180 days, which occurred in 50.8% of the intervention group and 49.2% of the usual care group, although quality of life improved (Ong et al., 2016).
Lessons From the Two Trials
The contrast suggests that monitoring helps when someone acts on the data quickly and the condition responds to adjustments that can be made remotely. Blood pressure fits that description well; heart failure after hospitalization is more complex. The director chose hypertension as the focus of the capstone.
Comparing the Alternatives
Expanding telehealth visits would help access but not necessarily control. Heart failure monitoring had weaker evidence. Behavioral health integration was important but required scarce clinicians. Hypertension control with home monitoring and pharmacist management was common, harmful, poorly controlled, strongly evidenced and feasible at a distance.
What Patients Said
The director spoke with patients at two rural clinics. A rancher in his sixties said he checked his pressure at the feed store's machine when he remembered, but the clinic was an hour away and he went only when his prescriptions ran out. A woman caring for her grandchildren said she could not take a day off to drive for a blood pressure check. Both said they would use a home monitor if someone actually looked at the numbers and called them.
What Clinicians Said
Rural clinicians described the frustration of adjusting medicines based on one reading every six months. Several had tried asking patients to keep logs, which rarely came back. A nurse practitioner said she would welcome a pharmacist partner who could make adjustments between visits under an agreed protocol.
Equity Considerations
The rural counties with the highest estimates of high blood pressure include reservation communities, where historical mistrust of health systems runs deep. Any program must be designed with tribal health leaders, respect community preferences and ensure that devices work where cellular coverage is weak.
Strategic Alignment
The opportunity fits the system's strategy of keeping care close to home, its participation in a Medicare shared savings arrangement that rewards avoiding hospitalizations and its commitment to reducing disparities for rural and American Indian patients.
Scope
The capstone will design and plan a pharmacist-led home blood pressure program, starting with four rural clinics and 800 patients with uncontrolled hypertension, with a plan to expand to all 14 clinics in the second year.
Stakeholders
Key stakeholders include rural clinic physicians and nurse practitioners, clinical pharmacists, clinic nurses and medical assistants, patients and families, tribal health leaders, the information technology team, finance and revenue cycle, the chief medical officer and the board's quality committee.
Risks to Note Early
Three risks were visible from the start: weak cellular coverage in parts of the service area, which could prevent devices from transmitting; the time needed to write pharmacist protocols and win clinician trust; and the need for a sustainable way to pay for pharmacist time after any initial funding. Each will be addressed in later papers.
Early Stakeholder Reactions
Initial conversations were encouraging but cautious. Clinicians worried about more data to review; pharmacists welcomed the role; tribal health leaders asked that the program be designed with them, not for them. These reactions will shape later papers.
What Comes Next
Later capstone papers will develop the innovation and business model, the change and communication plan, the implementation plan, the financial and risk analysis and a final presentation to leadership.
Conclusion
The chief executive asked for one change that would matter most to rural patients. County estimates and the system's own data show high blood pressure is common and poorly controlled in rural communities, and research shows that home monitoring with pharmacist management works while monitoring without active management may not. A scoped pharmacist-led program in four rural clinics is the strategic opportunity this capstone will develop.
References
Centers for Disease Control and Prevention. (2025). PLACES: Local data for better health, county data, 2025 release [Data set]. data.cdc.gov. https://data.cdc.gov/d/swc5-untb
Margolis, K. L., Asche, S. E., Bergdall, A. R., Dehmer, S. P., Groen, S. E., Kadrmas, H. M., Kerby, T. J., Klotzle, K. J., Maciosek, M. V., Michels, R. D., O'Connor, P. J., Pritchard, R. A., Sekenski, J. L., Sperl-Hillen, J. M., & Trower, N. K. (2013). Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: A cluster randomized clinical trial. JAMA, 310(1), 46-56. https://doi.org/10.1001/jama.2013.6549
Ong, M. K., Romano, P. S., Edgington, S., Aronow, H. U., Auerbach, A. D., Black, J. T., De Marco, T., Escarce, J. J., Evangelista, L. S., Hanna, B., Ganiats, T. G., Greenberg, B. H., Greenfield, S., Kaplan, S. H., Kimchi, A., Liu, H., Lombardo, D., Mangione, C. M., Sadeghi, B., ... Fonarow, G. C. (2016). Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure: The Better Effectiveness After Transition-Heart Failure (BEAT-HF) randomized clinical trial. JAMA Internal Medicine, 176(3), 310-318. https://doi.org/10.1001/jamainternmed.2015.7712
What the MHA 599 Week 1 instructions ask
MHA 599 Week 1 usually asks students to identify a strategic opportunity for change or innovation in a health care organization as the foundation of a capstone project. Prompts may ask students to describe the organization, define a problem or opportunity, explain its strategic importance, summarize evidence and data and outline scope, stakeholders and next steps. Capstone formats vary, so check your version's milestones and which organization you may use. Strong proposals choose an opportunity that matters to the organization's strategy and patients, support it with local data and research, compare it with alternatives, define a realistic scope and identify the stakeholders whose support the change will need.
How this MHA 599 Week 1 example is built
The chief executive's request for one change that would matter most to rural patients over the next three years opens the paper. The organization and its rural clinics are described. County estimates show high blood pressure is common and rural residents face barriers to care. The system's own data show that fewer than half of its hypertension patients in rural clinics are controlled. Two telemonitoring trials, one successful and one not, show which model to choose. Alternatives are compared. The opportunity is scoped as a pharmacist-led home blood pressure program in four clinics, with stakeholders, their first reactions and next steps.
MHA 599 Week 1 grading rubric: where the points go
The capstone opportunity week is typically graded on strategic relevance, use of evidence and a feasible scope. Graders expect an accurate picture of the organization, a well-defined opportunity, local data and research showing its importance, comparison with alternatives, alignment with organizational strategy, a realistic scope and identification of stakeholders. Honest use of evidence, including studies that did not work, earns credit, as does listening to patients and clinicians early. The proposal should set up the rest of the capstone, naming the papers that will follow. APA formatting and structure complete the grade. Proposals that choose an opportunity too large to accomplish, or rely on enthusiasm without data, commonly lose points; so do proposals that ignore evidence against the chosen model.
MHA 599 Week 1 help: mistakes to avoid
A common weakness in MHA 599 Week 1 is choosing an opportunity that is fashionable rather than important to the organization. Start with the organization's strategy and patients' needs, then look at data. Use local data, such as county estimates and your own records, and research on what works, including studies that failed, since they show what to avoid. Compare a few alternatives against the same criteria and explain why you chose one. Keep the scope small enough to accomplish in the capstone timeframe but meaningful enough to matter to patients and leaders. Finally, name the stakeholders whose support you need, since leading change starts with them, and note how each first reacted.
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MHA 599 Week 1 questions, answered
What does MHA/599 Week 1 usually ask for?
The first capstone paper typically asks students to identify a strategic opportunity for change or innovation in a health care organization, with data, evidence, scope and stakeholders.
Where can I find a free MHA 599 Week 1 sample paper?
The Montana blood pressure capstone proposal above can be read free, with notes on each element. Describe your capstone organization, and your first paper is on us.
Does home blood pressure telemonitoring work?
In one clinic-randomized trial, it roughly doubled the share of patients who reached and held their blood pressure targets over a year.
Does remote monitoring reduce heart failure readmissions?
A randomized trial of 1,437 patients found that telemonitoring with health coaching calls after heart failure hospitalization did not reduce 180-day readmissions compared with usual care.
How common is high blood pressure in rural Montana counties?
CDC county estimates from the 2025 release show age-adjusted adult high blood pressure of 33.5% in Big Horn County and 35.2% in Rosebud County, compared with 28.3% in Yellowstone County.
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