Integrated Tracking, Referral, Electronic Decision Support and Care Coordination (I-TREC)

High blood pressure is the leading risk factor for premature death globally, and lack of blood pressure awareness is a critical barrier to adequate control. In India, nearly one in three adults has hypertension. In rural areas, where almost 70% of the population resides, data suggest that only 25% of those with hypertension are aware of their condition, 25% of those aware of their hypertension are treated for their condition, and only 10% of those with hypertension achieve adequate blood pressure control. Alongside hypertension, diabetes is one of the most prevalent and deadly of all chronic conditions in India. Like hypertension, diabetes remains under-treated and poorly controlled, with only 20%-25% of persons with diabetes in Indian cities achieving glucose control.

The Government of India is embarking on a new policy initiative to improve screening and continuity of care for hypertension and diabetes within the public healthcare system hierarchy. In concert with this initiative, The All India Institute of Medical Sciences, Public Health Foundation of India, and Emory University have partnered to adapt proven information technology and care coordination interventions into a package for enhanced chronic disease care that will be adopted by the Indian public healthcare system and implemented by existing healthcare personnel. The intervention is called the Integrated Tracking, Referral, Electronic Decision Support and Care Coordination (I-TREC) package, focused on hypertension and diabetes. This multi-component package will include electronic patient data capture through an electronic health record, electronic decision support for providers, and care coordination training for healthcare professionals; appointment reminders and disease management advice to patients via text messaging; facility level retrieval of patient history and inventory needs; and health administration monitoring of data across levels. The study goals are to (1) adapt our prior suite of quality of care improvement interventions into the I-TREC package for implementation within the public healthcare system; (2) provide technical training and assistance to the Government of Punjab, India to implement I-TREC in all healthcare facilities of a single block (sub-district administrative unit) in the state; and (3) evaluate I-TREC using a quasi-experimental design by comparing relevant health and healthcare outcomes in a community-based sample in the intervention block with outcomes observed in a community-based sample in a comparable block in which no facilities have adopted I-TREC.

Funded by grant number U01HL138635 from the National, Heart, Lung, And Blood Institute of the US National Institutes of Health