The Integrated Tracking, Referral, and Electronic Decision Support, and Care Coordination (I-TREC) program: scalable strategies for the management of hypertension and diabetes within the government healthcare system of India

• Type of Material: Article
• Authors: Shivani Patel, Emory University; Hanspria Sharma, All India Institute of Medical Sciences; Sailesh Mohan, Centre for Chronic Disease Control; Mary Weber, Emory University; Devraj Jindal, Centre for Chronic Disease Control; Prashant Jarhyan, Centre for Chronic Disease Control; Priti Gupta, Centre for Chronic Disease Control; Rakshit Sharma, All India Institute of Medical Sciences; Mumtaj Ali, Centre for Chronic Disease Control; Mohammed Ali, Emory University; K.M. Venkat Narayan, Emory University; Dorairaj Prabhakaran, Emory University; Yashdeep Gupta, All India Institute of Medical Sciences; Ambuj Roy, All India Institute of Medical Sciences; Nikhil Tandon, All India Institute of Medical Sciences
• Language: English
• Date: 2020-12-01
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © 2020, The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12913-020-05851-w
• Title of Journal or Parent Work: BMC Health Services Research
• Volume: 20
• Issue: 1
• Start Page: 1022
• End Page: 1022
• Grant/Funding Information: SAP, KMVN, MKA, and MBW were supported in part by funding from NIDDK (P30DK111024).; PG was supported by funding from the NIH Fogarty International Center (VUMC67452 under D43TW009337).; This study is supported in part by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), award number 5U01HL138635 under the Hypertension Outcomes for T4 Research within Lower Middle-Income Countries (Hy-TREC) program.
• Keywords: mHealth; Health system; Diabetes; Hypertension; Information technology; Continuum of care; Quality improvement; Implementation science
• Research Categories: Health Sciences, Public Health; Health Sciences, Health Care Management

Abstract

Background: Hypertension and diabetes are among the most common and deadly chronic conditions globally. In India, most adults with these conditions remain undiagnosed, untreated, or poorly treated and uncontrolled. Innovative and scalable approaches to deliver proven-effective strategies for medical and lifestyle management of these conditions are needed. Methods: The overall goal of this implementation science study is to evaluate the Integrated Tracking, Referral, Electronic decision support, and Care coordination (I-TREC) program. I-TREC leverages information technology (IT) to manage hypertension and diabetes in adults aged ≥30 years across the hierarchy of Indian public healthcare facilities. The I-TREC program combines multiple evidence-based interventions: an electronic case record form (eCRF) to consolidate and track patient information and referrals across the publicly-funded healthcare system; an electronic clinical decision support system (CDSS) to assist clinicians to provide tailored guideline-based care to patients; a revised workflow to ensure coordinated care within and across facilities; and enhanced training for physicians and nurses regarding non-communicable disease (NCD) medical content and lifestyle management. The program will be implemented and evaluated in a predominantly rural district of Punjab, India. The evaluation will employ a quasi-experimental design with mixed methods data collection. Evaluation indicators assess changes in the continuum of care for hypertension and diabetes and are grounded in the Reach, Effectiveness, Adoption Implementation, and Maintenance (RE-AIM) framework. Data will be triangulated from multiple sources, including community surveys, health facility assessments, stakeholder interviews, and patient-level data from the I-TREC program’s electronic database. Discussion: I-TREC consolidates previously proven strategies for improved management of hypertension and diabetes at single-levels of the healthcare system into a scalable model for coordinated care delivery across all levels of the healthcare system hierarchy. Findings have the potential to inform best practices to ultimately deliver quality public-sector hypertension and diabetes care across India. Trial registration: The study is registered with Clinical Trials Registry of India (registration number CTRI/2020/01/022723). The study was registered prior to the launch of the intervention on 13 January 2020. The current version of protocol is version 2 dated 6 June 2018.