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.
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.
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DOI：
10.1186/s12913-020-05851-w
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发表时间：
2020-11-09
影响因子：
2.8
通讯作者：
Tandon N
中科院分区：
文献类型：
--
作者：
Patel SA;Sharma H;Mohan S;Weber MB;Jindal D;Jarhyan P;Gupta P;Sharma R;Ali M;Ali MK;Narayan KMV;Prabhakaran D;Gupta Y;Roy A;Tandon N
高血压和糖尿病是全球最常见和最致命的慢性疾病之一。在印度，大多数患有这些疾病的成年人仍然没有得到诊断、治疗或治疗不当和不受控制。需要创新和可扩展的方法，为这些疾病的医疗和生活方式管理提供经证明有效的策略。这项实施科学研究的总体目标是评估综合跟踪、转诊、电子决策支持和护理协调（I-TREC）计划。I-TREC利用信息技术（IT）来管理印度公共医疗机构中年龄≥30岁的成年人的高血压和糖尿病。I-TREC计划结合了多种循证干预措施：电子病例记录表（eCRF），以整合和跟踪公共资助的医疗保健系统中的患者信息和转诊;电子临床决策支持系统（CDSS），以帮助临床医生为患者提供量身定制的基于指南的护理;修订工作流程，以确保设施内和设施间的协调护理;加强对医生和护士关于非传染性疾病医疗内容和生活方式管理的培训。该计划将在印度旁遮普的一个主要农村地区实施和评估。评价将采用混合方法数据收集的准实验设计。评估指标评估了高血压和糖尿病连续护理的变化，并以达到，有效性，采用实施和维护（RE-AIM）框架为基础。数据将从多个来源进行三角测量，包括社区调查、卫生设施评估、利益相关者访谈和来自I-TREC项目电子数据库的患者水平数据。I-TREC整合了以前经过验证的策略，以改善医疗保健系统单级高血压和糖尿病的管理，并将其整合为一个可扩展的模型，用于在医疗保健系统层次结构的所有级别上提供协调的护理。研究结果有可能为最佳实践提供信息，最终在印度提供优质的公共部门高血压和糖尿病护理。该研究已在印度临床试验注册中心注册（注册号CTRI/2020/01/022723）。该研究于2020年1月13日启动干预措施前注册。当前版本的方案为第2版，日期为2018年6月6日。
Hypertension 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. The 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. I-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. The 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.
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