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

项目摘要/摘要 建议的K43应用程序旨在开发、实施和评估 协作质量改进(C-QIP)干预(非医生卫生工作者，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心血管疾病患者的措施和临床结果 医学研究理事会(MRC)开发和评估复杂干预措施的框架。一个 越来越多的研究表明，在患者、提供者和健康水平上有几个因素 系统可能有效地降低CVD在印度的影响，如识字，增加与 患者，以及综合医疗保健。在印度最大限度地提高心血管疾病治疗水平必须涉及一系列 从适当的处方到更长期的坚持以及低(ER)成本的健康 服务交付创新，例如非医生医护人员和基于Web的交互式或 面向提供者和患者的基于移动健康的临床决策支持系统。多面性 改善干预(包括但不限于非医生卫生工作者/病例管理人员， 基于团队的护理、短信提醒、为患者和提供者提供的交互式决策辅助、审计和 反馈机制)在高收入国家取得了成功，改善了 现有心血管疾病患者，但在印度尚未得到广泛评估。这些干预措施 可通过实施成为心血管疾病预防、治疗和控制的创新来源 科学研究。 在该奖项的职业发展期间，我将选修研究课程 道德、项目评估和健康服务研究，以补充我之前的培训。这就做 参加世界卫生组织SEARO(东南部)组织的培训或讲习班 亚洲区域办事处)，以了解循证临床标准的发展和 适用于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。 建议和未来的职业发展，作为一名独立、创新的调查员和领导者 全球心血管疾病研究。10年后，我设想自己将成为一名驻印度的全球临床研究人员 心血管疾病流行病学和预防，重点放在南亚。我现在和未来的训练， 机构和指导团队为我提供了极好的平台，让我发现关于改进的新想法 并最终在包括美国在内的全球范围内传播和传播。这个 NIH K43基金可以为我提供指导临床研究的培训和研究机会 追求我的职业目标。 相关性 由印度从业者开发改善心血管疾病护理的当地解决方案可能会 提供与美国相关并适用于美国的创新想法。因此，这项提议旨在 改善印度心血管疾病患者的慢性护理服务，挖掘创新潜力 全球健康，这是美国国立卫生研究院的主题目标，也是福格蒂的战略使命的一部分 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.