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、实施和评估一个 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 在印度使用英国的现有CVD患者中的测量和临床结局 医学研究理事会（MRC）制定和评估复杂干预措施的框架。一 越来越多的研究表明，在病人、提供者和健康水平上有几个因素 系统可以有效地降低CVD在印度的影响，如识字，增加与 患者和综合医疗保健。在印度，最大限度地提高CVD治疗必须涉及一系列的 从适当的处方到长期坚持以及低成本健康的过程 提供服务的创新，如非医生保健工作者和互动式基于网络或 为医疗服务提供者和患者提供基于移动健康的临床决策支持系统。多方面的质量 改善干预措施（包括但不限于非医生卫生工作者/个案管理人员， 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， 反馈机制）在高收入国家取得了成功， 患有CVD的人，但在印度尚未进行广泛评估。这些干预措施 可能是通过实施CVD预防、治疗和控制的创新来源 科学研究 在这个奖项的职业发展期间，我将参加研究课程 伦理学，项目评估和卫生服务研究，以补充我之前的培训。我会 参加世界卫生组织东南亚区域办事处（东南 亚洲区域办事处），了解循证医学临床标准的发展， 根据当地国家环境和医疗保健系统调整的指南。 我独特的背景和训练将作为目前的坚实基础 作为一个独立的，创新的调查员和领导者， 全球CVD研究。10年后，我设想自己成为一名印度临床研究人员， CVD流行病学和预防，重点是南亚。我现在和将来的训练， 机构和指导团队为我提供了一个很好的平台，让我发现关于改进的新想法 心血管健康，并最终在全球传播和提供，包括在美国。的 NIH K43补助金可以为我提供指导临床研究培训和研究机会， 追求我的职业目标。 相关性 发展当地的解决方案，以改善心血管疾病护理的印度从业者， 提供与美国相关并适用于美国的创新想法。因此，这项建议旨在 改善印度心血管疾病患者的慢性病护理服务，并抓住创新潜力 全球健康，NIH的主题目标和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.