Information Technology for Hypertension and Diabetes Care in Government Health System

Not yet recruiting

Conditions: Diabetes mellitus, (2) ICD-10 Condition: I10-I16||Hypertensive diseases,

Registration Number: CTRI/2020/01/022723

Lead Sponsor: All India Institute of Medical Sciences AIIMS

Brief Summary: This is an observation trialstudy to develop and implement an Integrated Tracking, Referral, ElectronicDecision Support and Care Coordination (I-TREC) package focused on hypertensionand diabetes management in India. We will use information technology (IT) tocreate an integrated platform that (1) helps in universal screening forhypertension and diabetes; (2) **tracksindividual patient progress through the various levels of the healthcare system**and monitors community-level screening and treatment outcomes; (3) uses **mobile text messaging for referral andappointment reminders** to promote patient retention in care and betteradherence to lifestyle and medication recommendations; (4) provides an **electronic decision support** **system** (DSS) to assist providers withtailoring guideline-based care to individual patient needs; and (5) trainsdesignated individuals at each level of healthcare in **care coordination** strategies to **improve continuity of hypertension and diabetes care in the Indianpopulation**. Moreover, we will design this platform for implementationwithin the existing public healthcare system, in collaboration with theDepartment of Health in Punjab, a state in Northern India, in order to assurecost-efficiency, scalability and longevity beyond this program.

AIM 1. (a) Establish an AdvisoryCommittee of local, national, and international stakeholders and experts toprovide inputs into developing a scalable and generalizable model ofcoordinated healthcare delivery for hypertension and diabetes. This committeewill also advise on formulating best practices for technical capacity buildingto ensure program sustainability. (b) Adapt our existing evidence-based toolsinto an Integrated Tracking, Referral, and Electronic Decision Support, andCare Coordination (I-TREC) package in collaboration with the Punjab StateDepartment of Health. Our goal is to contextually tailor proven single-levelinterventions into a coordinated package within the healthcare system to trackand enhance hypertension and diabetes screening and care per the nationalrecommendations. We will conduct a mixed-methods gap analysis with stakeholders(e.g., patients and providers) to (1) describe baseline health and healthcaredelivery indicators and (2) understand barriers to seeking and providingeffective hypertension and diabetes care.

AIM 2. Implement I-TREC in adistrict of Punjab State, India. I-TREC will consist of an IT-enabled,multi-component package to improve coordination of care across various levelsof the healthcare facility hierarchy and will include electronic data capture,electronic DSS, and care coordination training for selected healthcareprofessionals at each level of care; text messaging to patients forappointments and disease management advice; facility level retrieval of patienthistory and inventory needs, and health administration monitoring of dataacross levels. We will implement the intervention in all 30 health facilitieswithin the healthcare system of a single block (sub-district administrativeunit) in Punjab covering a catchment area of ~1,00,000 lakh population.

AIM3. Evaluate I-TREC using amixed-methods, quasi-experimental design. We will estimate health andhealthcare changes in the intervention block with changes in a non-adjacentcomparison block (i.e., â€œdifference-in-differenceâ€ measures). Community survey,patient focus group discussion, provider interview, and the I-TREC platformdata will be used to evaluate RE-AIM indicators: Reach (e.g., %â€™s screened inthe community, tracked over time, and referred), Effectiveness (e.g., % withcontrolled hypertension in the community), Adoption (e.g., % of facilitiesusing the I-TREC; provider reception to I-TREC), Implementation outcomes (e.g.,concordance between facility paper registry I-TREC database; routineoperational costs per patient), and Maintenance (e.g., % providers using I-TREC6 months after the active intervention).

The proposed T4 intervention promises toconsolidate previously proven strategies at single-levels of the healthcarehierarchy into a scalable model for coordinated care delivery. Expert groupguidance and support from state and central government institutions assureintegration with existing local and national efforts, and great potential torevolutionize care for deadly chronic diseases in the most vulnerablehard-to-reach patients who rely primarily on the government healthcare systemin India and other similar settings.

Detailed Description: Not available

Recruitment & Eligibility

Status: Not Yet Recruiting

Sex: All

Target Recruitment: 2544

Inclusion Criteria

This is not a traditional trial in which we will enroll patients.
Instead, investigators will be provided with de-identified data of all patients who seek care for hypertension and/or diabetes in a government health facility within the intervention block.
Because the data are collected in the course of providing routine care to patients, no additional criteria apply.1)All adults seeking diagnosis of, or care for, hypertension or diabetes at a public health facilities in the intervention block.

Exclusion Criteria

Not provided

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Difference in the mean change in systolic blood pressure from baseline and at 3 year after intervention initiation at the community-level between the I-TREC and comparison block among patient with hypertension. Please note that these data will come from a strictly observational survey conducted in the community.	2 i.e at baseline and at 3 years

Secondary Outcome Measures

Name	Time	Method
Difference between I-TREC and comparison block at baseline and at 3 years after intervention initiation:	1.In the mean change in fasting plasma glucose at the community-level among patient with type-2 diabetes

Trial Locations

Locations (2): CHC, Mukandpur Block
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Nawanshahr, PUNJAB, India
PHC Sujjon Block
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Nawanshahr, PUNJAB, India
CHC, Mukandpur Block
🇮🇳Nawanshahr, PUNJAB, India
Dr Mohinder Singh
Principal investigator
9815241406
nrhmmkdr.nsr518@gmail.com