Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in the Americas Innovation Group.

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.
Competing Interests: GG, MH, TM, VP and PO are staff members of the Pan American Health Organization. JB, AG, JM, GR, AR and EZ are consultants to PAHO/HEARTS in the Americas. NRCC reports personal fees from Resolve to Save Lives (RTSL), the Pan American Health Organization and the World Bank outside the submitted work; and an unpaid consultant on dietary sodium and hypertension control to numerous governmental and non-governmental organizations. MJD reports personal fees from the Ministry of Economy, Planning and Development of Dominican Republic outside the submitted work, and works as independent consultant on gender and public health to governmental and non-governmental organizations. Authors alone are responsible for the views expressed in this publication, and they do not necessarily represent those of the Pan American Health Organization. Ethics approval was not required for this study as this qualitative study reviewed existing published documents, convened a group of practitioners who participated in the Innovation Group voluntarily to select hypertension drivers and design the scorecards.
(© 2022 Pan American Health Organization.)