The Integrated Tracking, Referral, and Electronic Decision Support, and Care Coordination (I-TREC) program: scalable strategies for the management of hypertension and diabetes within the government healthcare system of India

BMC Health Services Research

Rakshit Sharma¹  Hanspria Sharma¹  Mumtaj Ali²  Prashant Jarhyan²  Devraj Jindal²  Priti Gupta²  Dorairaj Prabhakaran³  Sailesh Mohan³  Ambuj Roy⁴  Yashdeep Gupta⁵  Nikhil Tandon⁵  Shivani A. Patel⁶  Mary Beth Weber⁶  K. M. Venkat Narayan⁶  Mohammed K. Ali⁷ 

[1] All India Institute of Medical Sciences, New Delhi, India;Centre for Chronic Disease Control, New Delhi, India;Centre for Chronic Disease Control, New Delhi, India;Public Health Foundation of India, Gurgaon, India;Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India;Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India;Department of Global Health, Emory University, 1518 Clifton Rd NE / Rm 7037, Atlanta, USA;Department of Global Health, Emory University, 1518 Clifton Rd NE / Rm 7037, Atlanta, USA;Department of Family and Preventive Medicine, Emory University, Atlanta, USA;

关键词: Hypertension;    Diabetes;    Health system;    Information technology;    mHealth;    Implementation science;    Quality improvement;    Continuum of care;   

DOI  :  10.1186/s12913-020-05851-w

来源: Springer

【 摘 要 】

BackgroundHypertension and diabetes are among the most common and deadly chronic conditions globally. In India, most adults with these conditions remain undiagnosed, untreated, or poorly treated and uncontrolled. Innovative and scalable approaches to deliver proven-effective strategies for medical and lifestyle management of these conditions are needed.MethodsThe overall goal of this implementation science study is to evaluate the Integrated Tracking, Referral, Electronic decision support, and Care coordination (I-TREC) program. I-TREC leverages information technology (IT) to manage hypertension and diabetes in adults aged ≥30 years across the hierarchy of Indian public healthcare facilities. The I-TREC program combines multiple evidence-based interventions: an electronic case record form (eCRF) to consolidate and track patient information and referrals across the publicly-funded healthcare system; an electronic clinical decision support system (CDSS) to assist clinicians to provide tailored guideline-based care to patients; a revised workflow to ensure coordinated care within and across facilities; and enhanced training for physicians and nurses regarding non-communicable disease (NCD) medical content and lifestyle management. The program will be implemented and evaluated in a predominantly rural district of Punjab, India. The evaluation will employ a quasi-experimental design with mixed methods data collection. Evaluation indicators assess changes in the continuum of care for hypertension and diabetes and are grounded in the Reach, Effectiveness, Adoption Implementation, and Maintenance (RE-AIM) framework. Data will be triangulated from multiple sources, including community surveys, health facility assessments, stakeholder interviews, and patient-level data from the I-TREC program’s electronic database.DiscussionI-TREC consolidates previously proven strategies for improved management of hypertension and diabetes at single-levels of the healthcare system into a scalable model for coordinated care delivery across all levels of the healthcare system hierarchy. Findings have the potential to inform best practices to ultimately deliver quality public-sector hypertension and diabetes care across India.Trial registrationThe study is registered with Clinical Trials Registry of India (registration number CTRI/2020/01/022723). The study was registered prior to the launch of the intervention on 13 January 2020. The current version of protocol is version 2 dated 6 June 2018.

【 授权许可】

CC BY