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.
Cardiovascular disease (CVD) is the leading cause of death and disability in India and typically afflicts people at ages 6-10 years younger than in high-income countries. Simple, inexpensive out-patient care innovations at the healthcare providers and health system level have improved outcomes in patients with existing CVD considerably in high-income countries such as the United States and Europe, but these have not been widely developed, implemented, nor studied in India, despite the variability of care, rising burden of disease, and potential for improved clinical outcomes. We believe that the local development, adaptation, feasibility testing and evaluation of such a collaborative (team-based care) quality improvement intervention (consisting of non-physician health worker, text messages for lifestyle advise and clinical decision support system) delivered at the CVD clinics (mix of government and private) will not only create new knowledge and improve clinical outcomes in patients with CVD in India but will also lead to innovative solutions that may ultimately be applicable to patients in the United States.