HEARTS in the Americas: Evaluation framework for continuous quality improvement in primary care centers

Abstract

This document has been designed to support primary healthcare (PHC) teams, particularly primary care institutions serving a defined population or territory, within the context of PAHO’s HEARTS in the Americas program. It aims to facilitate understanding of the evaluation methodology and to provide standardized, practical tools for its implementation. The primary users of this publication are the quality committees or quality groups within primary care centers (PCCs) that have adopted HEARTS. Additionally, it targets local health teams responsible for the clinical and administrative management of PCCs, enabling them to conduct quality self-evaluations. National or subnational entities within each country's health system can also utilize this document for external evaluations.

The slowing decline in cardiovascular disease mortality, coupled with suboptimal hypertension control levels across populations, indicates that the current health service model is no longer sufficient. In this context, HEARTS in the Americas emerges as the regional adaptation of the World Health Organization's Global HEARTS Initiative. The program focuses on continuous quality improvement for the comprehensive and integrated management of hypertension and cardiovascular risk within primary healthcare services. Furthermore, it extends its applicability to other prevalent chronic conditions—including cerebrovascular, kidney, and metabolic diseases—that represent significant disease burdens in every country across the Region.

The HEARTS quality improvement evaluation emphasizes the systematic and standardized assessment of fidelity, feasibility, acceptability, and effectiveness of the interventions promoted by the program. HEARTS in the Americas views quality assessment as a non-punitive process centered on self-evaluation, learning, and organizational commitment. This process aims to identify barriers to implementation and foster innovative, effective, and sustainable local solutions to improve both process quality and health outcomes.