Developing and testing Collaborative Quality ImProvement initiative (C-QIP) for prevention of cardiovascular disease in India

项目概要/摘要 拟议的 K43 应用程序旨在开发、实施和评估 协作质量改进 (C-QIP) 干预（非医师卫生工作者，文本 健康生活方式和临床决策支持系统的信息）对护理过程的影响 使用英国对印度现有 CVD 患者采取的措施和临床结果 医学研究委员会 (MRC) 制定和评估复杂干预措施的框架。一个 越来越多的研究表明患者、提供者和健康水平的几个因素 系统可以有效降低印度CVD的影响，例如识字率、增加与人相处的时间 患者和综合医疗保健。最大限度地提高印度的 CVD 治疗水平必须采取一系列措施 从适当处方到长期坚持以及低成本健康的过程 服务提供创新，例如非医生卫生工作者和交互式网络或 为提供者和患者提供基于移动医疗的临床决策支持系统。多方面品质 改善干预（包括但不限于非医师卫生工作者/病例管理者， 基于团队的护理、短信提醒、患者和提供者的交互式决策辅助、审核和 反馈机制）在高收入国家已成功地改善了 患有 CVD 的个体，但在印度尚未得到广泛评估。这些干预措施 通过实施可以成为 CVD 预防、治疗和控制创新的源泉 科学研究。 在该奖项的职业发展期间，我将学习研究课程 道德、项目评估和卫生服务研究，以补充我之前的培训。我会 参加世界卫生组织 SEARO（东南 亚洲区域办事处），了解循证临床标准的制定和 适应当地国家环境和医疗保健系统的指南。 我独特的背景和训练将为现在奠定坚实的基础 作为独立、创新的研究者和领导者的建议和未来的职业发展 全球CVD研究。十年后，我设想自己成为全球的一名印度临床研究员 CVD 流行病学和预防，重点是南亚。我现在和未来的训练， 机构和指导团队为我提供了绝佳的平台，让我发现有关改进的新想法 心血管健康，并最终在全球范围内传播和传播，包括在美国。的 NIH K43 补助金可以为我提供指导性临床研究培训和研究机会 追求我的职业目标。 相关性 印度医生开发本地解决方案以改善心血管疾病护理可能 提供与美国相关并适用的创新想法。因此，该提案旨在 改善印度心血管疾病患者的长期护理服务并抓住创新潜力 全球健康、美国国立卫生研究院 (NIH) 的主题目标以及福格蒂战略使命的一部分 国际中心。

PROJECT SUMMARY/ABSTRACT The proposed K43 application aims to develop, implement, and evaluate a Collaborative Quality ImProvement (C-QIP) intervention (non-physician health worker, text messages for healthy lifestyle and clinical decision-support system) effect on processes of care measures and clinical outcomes among individuals with existing CVD in India using United Kingdom Medical Research Council (MRC) framework for developing and evaluating complex interventions. A growing body of research suggests several factors at the level of the patient, provider, and health system may effectively lower the impact of CVD in India, such as literacy, increased time spent with patients, and integrated health care. Maximizing CVD treatment in India must involve a cascade of processes from appropriate prescribing to longer-term adherence as well as low(er)-cost health service delivery innovations such as non-physician health workers and interactive web-based or mHealth-based clinical decision-support system for providers and patients. Multifaceted quality improvement intervention (including but not limited to non-physician health worker/case managers, team-based care, SMS reminders, interactive decision-aids for patients and providers, audit-and feedback mechanisms) have been successful in high-income countries for improving care among individuals with existing CVD, but have not been extensively evaluated in India. These interventions could be sources of innovation in CVD prevention, treatment, and control through implementation science research. During the career development period of this award, I will take courses in research ethics, program evaluation, and health services research to complement my prior training. I will participate in training, or workshops organized by the World Health Organization SEARO (South-East Asia Regional Office), to learn about the development of evidence-informed clinical standards and guidelines adapted to local country settings and healthcare systems. My unique background and training will serve as a strong foundation for the present proposal and for future career development as an independent, innovative investigator and leader in global CVD research. In 10 years, I envision myself as an India-based clinical researcher in global CVD epidemiology and prevention, with a focus in South Asia. My current and future training, institution, and mentoring team provide me excellent platform to discover novel ideas about improving cardiovascular health and ultimately disseminate and deliver them globally, including in the US. The NIH K43 grant can provide me the mentored clinical research training and research opportunities to pursue my career goals. Relevance Development of local solutions to improving CVD care by Indian practitioners may provide innovative ideas that are relevant to and applicable in the US. As such, this proposal aims to improve the delivery of chronic care for patients with CVD in India and capture the innovative potential of global health, a thematic goal of the NIH and part of the strategic mission of the Fogarty International Centre.