Brettler Jeffrey W, Giraldo Arcila Gloria P, Aumala Teresa, Best Allana, Campbell Norm Rc, Cyr Shana, Gamarra Angelo, Jaffe Marc G, De la Rosa Mirna Jimenez, Maldonado Javier, Neira Ojeda Carolina, Haughton Modesta, Malcolm Taraleen, Perez Vivian, Rodriguez Gonzalo, Rosende Andres, Valdes Gonzalez Yamile, Wood Peter W, Zuniga Eric, Ordunez Pedro
Southern California Permanente Medical Group Los Angeles EUA Southern California Permanente Medical Group, Los Angeles, EUA.
Departamento de Ciências de Sistemas de Saúde Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena EUA Departamento de Ciências de Sistemas de Saúde, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, EUA.
Rev Panam Salud Publica. 2022 May 10;46:e68. doi: 10.26633/RPSP.2022.68. eCollection 2022.
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.
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.
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.
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.
心血管疾病（CVD）是美洲地区发病和死亡的主要原因，而高血压是最主要的可改变风险因素。然而，高血压控制率仍然很低，并且在经过数十年持续下降后，心血管疾病死亡率停滞不前或有所上升。2016年，世界卫生组织（WHO）推出了HEARTS技术包以改善高血压控制情况。泛美卫生组织（PAHO）设计了美洲地区HEARTS倡议，以改善心血管疾病风险管理，强调高血压控制，迄今为止已在21个国家实施。
为推进实施，一个跨学科的从业者团队参与选择基于证据的高血压控制关键驱动因素，并设计一个综合记分卡，以监测其在初级保健卫生设施（PHC）中的实施情况。该团队研究了通过专注于特定过程指标的质量改进计划实现高高血压控制率的高效卫生系统，并定期向卫生设施的提供者反馈。
最终选定的八个驱动因素分为五个主要领域：（1）诊断（血压测量准确性和心血管疾病风险评估）；（2）治疗（标准化治疗方案和强化治疗）；（3）连续护理和随访；（4）提供系统（团队式护理、药物 refill），以及（5）绩效评估系统。然后将这些驱动因素和建议转化为过程指标，形成两个相互关联的记分卡，纳入美洲地区HEARTS监测和评估系统。
关注这些关键的高血压驱动因素和由此产生的记分卡，将指导质量改进过程，以在HEARTS实施国家的参与卫生中心实现人群控制目标。
