Integrated Tracking, Referral, and Algorithmic Management (I-TREC) System for Hypertension and Diabetes

项目摘要 近三分之一的印度成年人患有高血压，更多的人患有高血压前期。在印度农村， 大约四分之三的成人高血压患者从未接受过治疗，90%的人接受过治疗 对高血压的治疗未能实现充分的血压控制。当前的印度公众 医疗保健系统既不面向也不具备处理全部高血压病例的能力。这是应该在 部分原因是医疗系统不同级别的设施之间协调不力，以及缺乏机制来 有效地跟踪或转介患者，导致患者需求和治疗之间不匹配 可获得性以及对有限的医疗资源的低效利用。为了解决医疗保健领域的这些差距 交付模式、全印度医学科学研究所、印度公共卫生基金会和埃默里 大学将合作开发综合跟踪、推荐、电子决策支持和护理 协调方案(I-TREC)侧重于高血压及其最常见的合并症--糖尿病。这 多组分一揽子计划将改善医疗机构各个级别之间的护理协调 它将包括电子数据采集、电子决策支持和护理协调培训 对于医疗保健专业人员；向患者发送短信以获取预约和疾病管理建议； 设施级别的患者历史记录和库存需求检索；以及健康管理数据监控 级别。我们的目标是(1)调整i-TREC，以便在公共医疗系统内实施，并提供投入 地方、国家和国际利益攸关方；(2)在所有15个卫生设施实施I-TREC 组成旁遮普邦邦加区(分区行政单位)的政府医疗保健系统 (3)使用准实验设计通过比较密钥的性能来评估I-TREC Banga街区的指标与同一地区另一个不相邻但可比较的街区的指标。这个 拟议的T4干预承诺在单一层面巩固以前证明有效的战略 医疗保健层次结构到完全依赖于现有医疗保健的协调护理提供系统 劳动力。这一发现将有可能彻底改变印度各地对致命慢性病的护理 最脆弱和难以接触的患者，他们严重依赖政府医疗体系和 生成可应用于其他类似设置的可扩展模型。

PROJECT ABSTRACT Nearly one in three Indian adults has hypertension and many more have pre-hypertension. In rural India, roughly three-quarters of adults with hypertension never receive treatment, and 90% of individuals receiving treatment for hypertension fail to achieve adequate blood pressure control. The current Indian public healthcare system is neither oriented nor equipped to process the total caseload of hypertension. This is due in part to poor coordination across facilities at different levels of the healthcare system and lack of mechanisms to efficiently follow-up with or refer patients, resulting in a mismatch between patient needs and treatment availability as well as inefficient use of limited healthcare resources. To address these gaps in the healthcare delivery model, the All India Institute of Medical Sciences, Public Health Foundation of India, and Emory University will partner to develop an Integrated Tracking, Referral, Electronic Decision Support and Care Coordination (I-TREC) package focused on hypertension and its most frequent comorbidity, diabetes. This multi-component package will improve coordination of care across various levels of the healthcare facility hierarchy and will include electronic data capture, electronic decision support, and care coordination training for healthcare professionals; text messaging to patients for appointments and disease management advice; facility level retrieval of patient history and inventory needs; and health administration monitoring of data across levels. Our objectives are to (1) adapt I-TREC for implementation within the public healthcare system with input of local, national, and international stakeholders; (2) implement I-TREC across all 15 health facilities comprising the government healthcare system in Banga Block (sub-district level administrative unit) of Punjab state, India; and (3) evaluate I-TREC using a quasi-experimental design by comparing performance of key indicators in Banga Block with another non-neighboring but comparable block in the same district. The proposed T4 intervention promises to consolidate previously proven strategies at single-levels of the healthcare hierarchy into a coordinated system of care delivery that relies entirely on the existing healthcare workforce. Findings will have the potential to revolutionize care for deadly chronic diseases across India in the most vulnerable and hard-to-reach patients who rely heavily on the government healthcare system and generate a scalable model that can be applied to other similar settings.