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Prado P, Gamarra Á, Rodríguez L, Brettler J, Farrell M, Girola ME, Malcolm T, Martínez R, Molina V, Moran AE, Neupane D, Rosende A, Valdés González Y, Mukhtar Q, Ordunez P. [Monitoring and evaluation platform for HEARTS in the Americas: improving population-based hypertension control programs in primary health carePlataforma de monitoramento e avaliação do programa HEARTS nas Américas: melhoria dos programas de controle da hipertensão de base populacional na atenção primária à saúde]. Rev Panam Salud Publica 2023; 47:e90. [PMID: 37223327 PMCID: PMC10202337 DOI: 10.26633/rpsp.2023.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 05/25/2023] Open
Abstract
HEARTS in the Americas is the Pan American Health Organization flagship program to accelerate the reduction of the cardiovascular disease (CVD) burden by improving hypertension control and CVD secondary prevention in primary health care. A monitoring and evaluation (M&E) platform is needed for program implementation, benchmarking, and informing policy-makers. This paper describes the conceptual bases of the HEARTS M&E platform including software design principles, contextualization of data collection modules, data structure, reporting, and visualization. The District Health Information Software 2 (DHIS2) web-based platform was chosen to implement aggregate data entry of CVD outcome, process, and structural risk factor indicators. In addition, PowerBI was chosen for data visualization and dashboarding for the analysis of performance and trends above the health care facility level. The development of this new information platform was focused on primary health care facility data entry, timely data reporting, visualizations, and ultimately active use of data to drive decision-making for equitable program implementation and improved quality of care. Additionally, lessons learnt and programmatic considerations were assessed through the experience of the M&E software development. Building political will and support is essential to developing and deploying a flexible platform in multiple countries which is contextually specific to the needs of various stakeholders and levels of the health care system. The HEARTS M&E platform supports program implementation and reveals structural and managerial limitations and care gaps. The HEARTS M&E platform will be central to monitoring and driving further population-level improvements in CVD and other noncommunicable disease-related health.
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Affiliation(s)
- Patric Prado
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Ángelo Gamarra
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Libardo Rodríguez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Jeffrey Brettler
- Departamento de Ciencias de Sistemas de SaludFacultad de Medicina Bernard J. Tyson de Kaiser PermanentePasadenaEstados Unidos de AméricaDepartamento de Ciencias de Sistemas de Salud, Facultad de Medicina Bernard J. Tyson de Kaiser Permanente, Pasadena, Estados Unidos de América.
| | - Margaret Farrell
- Resolve to Save LivesNueva YorkEstados Unidos de AméricaResolve to Save Lives, Nueva York, Estados Unidos de América.
| | - María E. Girola
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Taraleen Malcolm
- Organización Panamericana de la SaludPuerto EspañaTrinidad y TobagoOrganización Panamericana de la Salud, Puerto España, Trinidad y Tobago.
| | - Ramón Martínez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Virginia Molina
- Organización Panamericana de la SaludCiudad de MéxicoMéxicoOrganización Panamericana de la Salud, Ciudad de México, México.
| | - Andrew E. Moran
- Resolve to Save LivesNueva YorkEstados Unidos de AméricaResolve to Save Lives, Nueva York, Estados Unidos de América.
| | - Dinesh Neupane
- Departamento de EpidemiologíaEscuela de Salud Pública Bloomberg de la Universidad Johns HopkinsBaltimoreEstados Unidos de AméricaDepartamento de Epidemiología, Escuela de Salud Pública Bloomberg de la Universidad Johns Hopkins, Baltimore, Estados Unidos de América.
| | - Andrés Rosende
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Yamilé Valdés González
- Hospital Universitario General Calixto GarcíaComisión Nacional Técnica Asesora del Programa de Hipertensión ArterialLa HabanaCubaHospital Universitario General Calixto García, Comisión Nacional Técnica Asesora del Programa de Hipertensión Arterial, La Habana, Cuba.
| | - Qaiser Mukhtar
- División de Protección de la Salud MundialCentros para el Control y la Prevención de EnfermedadesAtlantaEstados Unidos de AméricaDivisión de Protección de la Salud Mundial, Centros para el Control y la Prevención de Enfermedades, Atlanta, Estados Unidos de América.
| | - Pedro Ordunez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
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Valdés González Y, Morejón Giraldoni A, Pérez Perea L, Jiménez Chiquet A, López Lima C, Campbell N, Giraldo G. La Iniciativa HEARTS en Cuba: experiencias tras 5 años de implementación. Rev Panam Salud Publica 2022; 46:e176. [PMID: 36284551 PMCID: PMC9578651 DOI: 10.26633/rpsp.2022.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/09/2022] [Indexed: 12/03/2022] Open
Abstract
Con el propósito de describir los cambios en el control de la hipertensión arterial desde 2016 a 2021 y la relación de los progresos con la madurez de implementación de la Iniciativa HEARTS en el primer nivel de atención de Cuba, se diseñó un estudio prospectivo de implementación que promovió la medición correcta de la presión arterial con esfigmomanómetros automáticos validados, la atención basada en riesgo, la introducción de protocolos de tratamiento antihipertensivo estandarizado, la prevención secundaria y el trabajo en equipo. Se fomentó además la educación a pacientes, la búsqueda activa de casos y las actividades comunitarias. Los datos se obtuvieron de los registros de implementación y fueron analizados con el programa estadístico SPSS versión 21, se reportan las medidas de resultados y sus intervalos de confianza del 95%. Se evaluaron los indicadores poblacionales: cobertura de registro, control entre tratados, control poblacional, así como el índice de madurez de procesos de HEARTS en Las Américas. Comparativamente, entre los años 2016 y 2021 aumentaron los centros participantes, desde un centro de demostración hasta 22 policlínicos en 6 provincias y 7 municipios. Se evidenció un incremento significativo en los valores absolutos del total de población atendida, el número de hipertensos registrados, de pacientes controlados entre los tratados e hipertensos controlados entre todos los adultos, aunque con variaciones anuales en los porcentajes de cobertura, control entre tratados y control poblacional. Los mayores progresos ocurrieron en los centros con equipos de salud de alto desempeño. Cinco años después de la implementación de la Iniciativa HEARTS en Cuba se transita hacia la institucionalización de la metodología.
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Affiliation(s)
| | | | | | | | | | | | - Gloria Giraldo
- Organización Panamericana de la Salud, Washington DC, Estados Unidos de América
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Prado P, Gamarra A, Rodriguez L, Brettler J, Farrell M, Girola ME, Malcolm T, Martinez R, Molina V, Moran AE, Neupane D, Rosende A, González YV, Mukhtar Q, Ordunez P. Monitoring and evaluation platform for HEARTS in the Americas: improving population-based hypertension control programs in primary health care. Rev Panam Salud Publica 2022; 46:e161. [PMID: 36133432 PMCID: PMC9484330 DOI: 10.26633/rpsp.2022.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023] Open
Abstract
ABSTRACT
HEARTS in the Americas is the Pan American Health Organization flagship program to accelerate the reduction of the cardiovascular disease (CVD) burden by improving hypertension control and CVD secondary prevention in primary health care. A monitoring and evaluation (M&E) platform is needed for program implementation, benchmarking, and informing policy-makers. This paper describes the conceptual bases of the HEARTS M&E platform including software design principles, contextualization of data collection modules, data structure, reporting, and visualization. The District Health Information Software 2 (DHIS2) web-based platform was chosen to implement aggregate data entry of CVD outcome, process, and structural risk factor indicators. In addition, PowerBI was chosen for data visualization and dashboarding for the analysis of performance and trends above the health care facility level. The development of this new information platform was focused on primary health care facility data entry, timely data reporting, visualizations, and ultimately active use of data to drive decision-making for equitable program implementation and improved quality of care. Additionally, lessons learnt and programmatic considerations were assessed through the experience of the M&E software development. Building political will and support is essential to developing and deploying a flexible platform in multiple countries which is contextually specific to the needs of various stakeholders and levels of the health care system. The HEARTS M&E platform supports program implementation and reveals structural and managerial limitations and care gaps. The HEARTS M&E platform will be central to monitoring and driving further population-level improvements in CVD and other noncommunicable disease-related health.
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Affiliation(s)
- Patric Prado
- Pan American Health Organization. Washington, DC, USA
| | | | | | - Jeffrey Brettler
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, United States of America
| | | | | | - Taraleen Malcolm
- Pan American Health Organization, Port of Spain, Trinidad and Tobago
| | | | | | | | - Dinesh Neupane
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | | | - Yamilé Valdés González
- University Hospital General Calixto García, National Technical Advisory Committee on Hypertension, Havana, Cuba
| | - Qaiser Mukhtar
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Pedro Ordunez
- Pan American Health Organization. Washington, DC, USA
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Brettler JW, Arcila GPG, Aumala T, Best A, Campbell NR, Cyr S, Gamarra A, Jaffe MG, la Rosa MJD, Maldonado J, Ojeda CN, Haughton M, Malcolm T, Perez V, Rodriguez G, Rosende A, González YV, Wood PW, Zúñiga E, Ordunez P. Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in the Americas Innovation Group. Lancet Reg Health Am 2022; 9:None. [PMID: 35711685 PMCID: PMC9121401 DOI: 10.1016/j.lana.2022.100223] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
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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Affiliation(s)
- Jeffrey W Brettler
- Southern California Permanente Medical Group, Los Angeles, CA, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Gloria P Giraldo Arcila
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Teresa Aumala
- Primary Health Care Center, Ministry of Health, Centro de Salud Conocoto, Quito, Ecuador
| | - Allana Best
- Ministry of Health, Park Street, Port of Spain, Trinidad and Tobago
| | - Norm Rc Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Shana Cyr
- Ministry of Health, Wellness & Elderly Affairs, Sir Stanislaus James Building, Waterfront, Castries, Saint Lucia
| | - Angelo Gamarra
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Marc G Jaffe
- Department of Endocrinology, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, CA, USA
| | - Mirna Jimenez De la Rosa
- School of Public Health, Faculty of Health Sciences, Universidad Autónoma de Santo Domingo, Dominican Republic.,Oficina Escuela de Salud Pública, Ciudad Universitaria, Universidad Autónoma de Santo Domingo, Distrito Nacional, Dominican Republic
| | | | - Carolina Neira Ojeda
- Department of Noncommunicable Diseases, Ministry of Health, Santiago de Chile, Chile
| | | | - Taraleen Malcolm
- Pan American Health Organization (PAHO), Port of Spain, Trinidad and Tobago
| | - Vivian Perez
- Pan American Health Organization,(PAHO), Lima, Peru
| | - Gonzalo Rodriguez
- Pan American Health Organization, (PAHO), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Yamilé Valdés González
- National Technical Advisory Committee on Hypertension, University Hospital "General Calixto García", Havana, Cuba
| | - Peter W Wood
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Eric Zúñiga
- Health Services Antofagasta, Servicio de Salud Antofagasta, Universidad de Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
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DiPette DJ, Goughnour K, Zuniga E, Skeete J, Ridley E, Angell S, Brettler J, Campbell NRC, Coca A, Connell K, Doon R, Jaffe M, Lopez-Jaramillo P, Moran A, Orias M, Pineiro DJ, Rosende A, González YV, Ordunez P. Standardized treatment to improve hypertension control in primary health care: The HEARTS in the Americas Initiative. J Clin Hypertens (Greenwich) 2020; 22:2285-2295. [PMID: 33045133 DOI: 10.1111/jch.14072] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/03/2020] [Accepted: 09/13/2020] [Indexed: 01/12/2023]
Abstract
Hypertension is the leading risk factor for cardiovascular disease (CVD) worldwide. Despite the availability of effective antihypertensive medications, the control of hypertension at a global level is dismal, and consequently, the CVD burden continues to increase. In response, countries in Latin America and the Caribbean are implementing the HEARTS in the Americas, a community-based program that focuses on increasing hypertension control and CVD secondary prevention through risk factor mitigation. One key pillar is the implementation of a standardized hypertension treatment protocol supported by a small, high-quality formulary. This manuscript describes the methodology used by the HEARTS in the Americas program to implement a population-based standardized hypertension treatment protocol. It is rooted in a seamless transition from existing treatment practices to best practice using pharmacologic protocols built around a core set of ideal antihypertensive medications. In alignment with recent major hypertension guidelines, the HEARTS in the Americas protocols call for the rapid control of blood pressure, through the use of two antihypertensive medications, preferably in the form of a single pill, fixed-dose combination, in the initial treatment of hypertension. To date, the HEARTS in the Americas program has seen the improvement in antihypertensive medication formularies and the establishment of pharmacologic treatment protocols tailored to individual participating countries. This has translated to significant increases in hypertension control rates post-program implementation in these jurisdictions. Thus, the HEARTS in the Americas program could serve as a model, for not only the Americas Region but globally, and ultimately decrease the burden of CVD.
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Affiliation(s)
- Donald J DiPette
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Kenneth Goughnour
- Women Influencing Health, Education and Rule of Law (WI-HER), Vienna, VA, USA
| | - Eric Zuniga
- Health Service of Antofagasta, University of Antofagasta, Antofagasta, Chile
| | - Jamario Skeete
- Department of Internal Medicine, Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | | | - Sonia Angell
- California Department of Public Health, California, IL, USA
| | | | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Antionio Coca
- Department of Internal Medicine, Hypertension and Vascular Risk Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Kenneth Connell
- Faculty of Medical Sciences, The University of the West Indies, St Michael, Barbados
| | - Rohit Doon
- Ministry of Health, Port of Spain, Trinidad and Tobago
| | - Marc Jaffe
- Division of Endocrinology, Kaiser Permanente, San Francisco, CA, USA
| | | | - Andrew Moran
- Resolve to Save Lives, An initiative of Vital Strategies, New York, NY, USA.,Columbia University Irving Medical Center, New York, NY, USA
| | - Marcelo Orias
- Sanatorio Allende Córdoba, Universidad Nacional de Córdoba, Cordoba, Argentina
| | | | | | - Yamilé Valdés González
- National Technical Advisory Commission on Hypertension, Havana, Cuba.,University Hospital "General Calixto García", Havana, Cuba
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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Valdés González Y, Campbell NRC, Pons Barrera E, Calderón Martínez M, Pérez Carrera A, Morales Rigau JM, Afonso de León JA, Pérez Jiménez V, Landrove Rodríguez O, DiPette DJ, Giraldo G, Orduñez P. Implementation of a community-based hypertension control program in Matanzas, Cuba. J Clin Hypertens (Greenwich) 2020; 22:142-149. [PMID: 31967722 DOI: 10.1111/jch.13814] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 11/30/2022]
Abstract
Increased blood pressure is a leading risk factor for death worldwide, and improving the control of hypertension is a major health goal to reduce non-communicable disease. Thus, in 2016, as part of a regional effort between the Pan American Health Organization and Cuban Ministry of Public Health to reduce cardiovascular risk and disease, a community demonstration project was implemented to enhance hypertension control. The intervention project was in a population of 25 868 people served by the Carlos Verdugo Martínez Polyclinic in Matanzas, Cuba. The project implemented interventions currently recommended in the World Health Organization HEARTS modules, including a standardized clinical training program with certification for blood pressure measurement, routine screening for hypertension in clinics and in the community, a simple directive pharmacologic treatment algorithm, and a registry with performance reporting and feedback. Qualitative and quantitative program monitoring and evaluation was established. In a 2010 national survey, the prevalence of hypertension and the rate of hypertension control were estimated to be 31% and 36%, respectively. Following less than one year of the full implementation of the program, the prevalence of hypertension, proportion of the hypertensive population registered as having hypertension, proportion of those drug-treated who were controlled, and estimated population rate of control were 30%, 90%, 68%, and 58%, respectively. Based on these positive results, the program has been expanded to include another demonstration program initiated in a second region. In addition, preliminary efforts to disseminate and scale-up aspects of the program to the full Cuban population have started.
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Affiliation(s)
- Yamilé Valdés González
- National Technical Advisory Commission on Hypertension, University Hospital "General Calixto García", Havana, Cuba
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | | | | | | | - José Manuel Morales Rigau
- 6Department of Noncommunicable Diseases, Hygiene, Epidemiology and Microbiology Provincial Center, Matanzas, Cuba
| | | | | | | | - Donald J DiPette
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Gloria Giraldo
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Pedro Orduñez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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