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Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in
Jeffrey W Brettler1,2, Gloria P Giraldo Arcila3, Teresa Aumala4
1Southern California Permanente Medical Group, Los Angeles, CA, USA.
Insights
Improving hypertension control is crucial for reducing cardiovascular disease (CVD) in the Americas. The HEARTS in the Americas Initiative developed key drivers and scorecards to enhance hypertension management in primary care settings.
Area of Science:
- Public Health
- Cardiology
- Health Services Research
Background:
- Cardiovascular disease (CVD) remains a leading cause of death in the Americas, with hypertension as a primary modifiable risk factor.
- Despite efforts, hypertension control rates are low, and CVD mortality is not declining as expected.
- The World Health Organization's HEARTS technical package and the Pan American Health Organization's HEARTS in the Americas Initiative aim to improve CVD risk management, particularly hypertension control.
Purpose of the Study:
- To identify key evidence-based drivers for effective hypertension control.
- To develop a comprehensive scorecard for monitoring the implementation of these drivers in primary care.
- To support quality improvement processes within the HEARTS in the Americas Initiative.
Main Methods:
- An interdisciplinary group of practitioners identified essential hypertension control drivers.
- High-performing health systems were studied to understand successful quality improvement strategies.
- Drivers were translated into process measures and integrated into scorecards for the HEARTS in the Americas monitoring system.
Main Results:
- Eight key drivers were selected, categorized into five domains: diagnosis, treatment, continuity of care, delivery system, and performance evaluation.
- Two interconnected scorecards were developed to monitor these drivers.
- The scorecards are integrated into the HEARTS in the Americas monitoring and evaluation system.
Conclusions:
- Focusing on these selected hypertension drivers and utilizing the developed scorecards will guide quality improvement efforts.
- This approach aims to achieve population-level hypertension control goals in participating countries.
- The initiative supports health centers in implementing effective hypertension management strategies.
Background:
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the Americas, and hypertension is the most significant modifiable risk factor. However, hypertension control rates remain low, and CVD mortality is stagnant or rising after decades of continuing reduction. In 2016, the World Health Organization (WHO) launched the HEARTS technical package to improve hypertension control. The Pan American Health Organization (PAHO) designed the HEARTS in the Americas Initiative to improve CVD risk management, emphasizing hypertension control, to date implemented in 21 countries.
Methods:
To advance implementation, an interdisciplinary group of practitioners was engaged to select the key evidence-based drivers of hypertension control and to design a comprehensive scorecard to monitor their implementation at primary care health facilities (PHC). The group studied high-performing health systems that achieve high hypertension control through quality improvement programs focusing on specific process measures, with regular feedback to providers at health facilities.
Findings:
The final selected eight drivers were categorized into five main domains: (1) diagnosis (blood pressure measurement accuracy and CVD risk evaluation); (2) treatment (standardized treatment protocol and treatment intensification); (3) continuity of care and follow-up; (4) delivery system (team-based care, medication refill), and (5) system for performance evaluation. The drivers and recommendations were then translated into process measures, resulting in two interconnected scorecards integrated into the HEARTS in the Americas monitoring and evaluation system.
Interpretation:
Focus on these key hypertension drivers and resulting scorecards, will guide the quality improvement process to achieve population control goals at the participating health centers in HEARTS implementing countries.
Funding:
No funding to declare.
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