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， 大约四分之三的成年高血压患者从未接受过治疗，90%的高血压患者接受过治疗。 对高血压的治疗不能实现充分的血压控制。目前印度公众 卫生保健系统既不适合也不具备处理高血压总病例的能力。这是由于在 部分原因是卫生保健系统各级设施之间协调不力，缺乏机制， 对患者进行有效随访或转诊，导致患者需求与治疗不匹配 可用性以及有限医疗资源的低效使用。为了解决医疗保健中的这些差距， 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 大学将合作开发综合跟踪，转诊，电子决策支持和护理 协调（I-TREC）包侧重于高血压及其最常见的合并症，糖尿病。这 多组件包将改善各级医疗机构之间的护理协调 层次结构，并将包括电子数据采集，电子决策支持和护理协调培训 用于医疗保健专业人员;向患者发送短信以获得预约和疾病管理建议; 医院级检索患者病史和库存需求;以及卫生管理部门监测数据， 程度.我们的目的是：（1）在公共卫生系统内， 地方、国家和国际利益攸关方;（2）在所有15个卫生设施中实施I-TREC 包括旁遮普邦加区（县级行政单位）的政府保健系统 （3）采用准实验设计，通过比较关键指标的性能， 邦加区块的指标与同一地区的另一个非相邻但可比较的区块。的 拟议的T4干预措施有望巩固以前在单一层面上证明有效的战略， 将医疗保健层次结构整合为一个完全依赖现有医疗保健的协调医疗服务系统 劳动力研究结果将有可能彻底改变印度全国致命慢性病的护理， 最脆弱和难以接触的患者，他们严重依赖政府医疗保健系统， 生成一个可扩展的模型，可以应用到其他类似的设置。

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.