Quality Improvement Module for Cardiovascular Health Program

PROBLEMS:

According to the Global Burden of Disease Report (2019), cardiovascular diseases (CVD) were responsible for 393 million DALYs in 2019 and 18·6 million deaths. Additionally, 80% of these deaths occurred in low and middle-income countries (LMIC), and at least half of these deaths are preventable. 

BACKGROUND :

The Lown Scholars Program strives to change this global picture by training a cadre of mid-career professionals who would serve as agents of change in their communities and countries by designing, implementing, and evaluating cardiovascular disease prevention programs. Over 100 Lown Scholars have been trained, and each year, a new batch is hosted in Boston for a month-long session. A Quality Improvement module is not offered in the present curriculum.

Quality improvement (QI) in healthcare is a systematic approach that uses data to improve the quality and safety of healthcare delivery. It aims to improve outcomes for patients, healthcare systems, and organizations by reducing variation, achieving predictable results, and improving processes and structure. The Institute of Medicine (IOM) has identified six domains of healthcare quality: Patient safety, Effectiveness, Patient-centeredness, Timeliness, Efficiency, and Equity.

QI, with the tool of PDSA (Plan-Do-Study-Act), can address the problem of inconsistent application of guideline-directed care and unnecessary variation in practice, contributing to high costs, suboptimal patient outcomes, and low-value care. Furthermore, health care remains inefficient and inadequately responsive to the preferences and needs of clinicians or patients. Accordingly, there is a need for new approaches to deliver high-quality cardiovascular care, especially in low and middle-income countries.

A systematic review of quality improvement efforts for cardiovascular disease care in low and middle-income countries shows the conclusion “that CVD care quality improvement can be successfully implemented in LMICs. Most studies focused on chronic CVD conditions; more acute CVD care quality improvement studies are needed. Longer term interventions and follow-up will be needed in order to assess the sustainability of quality improvement efforts in LMICs.”

CETI is an NGO based in India, a country that is making leaps in improving cardiovascular care. Over the past 10 years, CETI has worked on QI training in the area of infectious diseases, especially TB. In the course, District TB Officers (DTOs) have conducted PDSA Plan-Do-Study-Act cycles and significantly improved the quality of care. For example, in May 2021, DTOs in three states, Gujarat, Madhya Pradesh, and Rajasthan, were involved in a PDSA cycle to increase the uptake of the Aarogya Sathi App at the suggestion of the Central TB Division. A focused effort found that over the next 4 months, the uptake in these states increased from 0.47% to 13.70% without using any additional resources, while in the rest of India, it went up from 1.79% to 5.86% only. Now, CETI is focusing on non-communicable diseases for training.

Lown Scholars would benefit from learning the quality improvement and PDSA approach to change since this is an evidence-based strategy for intervention. As leaders in cardiovascular health, Lown Scholars can mentor others in their countries. The PDSA based Quality Improvement curriculum would broadly focus upon (1) How LMICs can mitigate the challenges of limited healthcare budgets as well as constrained professional health workforce capacity (2) How to get the most out of known effective interventions within the limitations of available resources (3) How standards and interventions should be dictated by context and community capacity (4) How at the patient/provider level, regardless of the specific intervention, intensified team-based care generally can lead to improved medication adherence and hypertension control.

OBJECTIVE:

We propose to develop and deploy a hybrid QI module for the present and previous Lown scholars in person and in 3 months. 

1. Engage 25-30 Lown fellows for 10 hours of intensive (in-person 10 new fellows)  and virtual (20 previous fellows) followed by 1 hour of weekly session for 3 months.  Total of 20 hours of training. 
2. Each Lown Fellow would conduct a capstone PDSA project on the cardiovascular topic of their interest using the electronic PDSA tool. In addition, fellows will have the option of doing an additional personal (self-improvement) PDSA.
3. Each Lown Fellow will acquire skills to be a trainer in PDSA to share with their staff and teams in their designated country. 

PROCESS:

1. Develop a QI curriculum on PDSA by CETI Faculty in collaboration with Lown Faculty.
2. Share QI-Module for Cardiovascular Health QIM-CVH with Fellows and begin recruitment.
3. In June 2024, Prepare Fellows for the program one month before the session.
4. In June 2024, train and prepare two Quality Improvement Counselors ( QIC) who will work with 15 scholars for a period of 4 months (a brief period before and after the teaching sessions)
5. In July 2024, In-Person – Online training for 5 hours each day for 2 days where core QI teaching occurs.
6. From July to September, online each Saturday morning EST from 8 am to 9 am- For a total of 10 hours. In total, 20 hours of direct teaching with senior faculty.
7. During 3 months, QIC will be in touch and assist fellows for PDSA and other sessions for 3 hours per week.
8. Fellows will present their PDSA to the group in the last two sessions.
9. Evaluation of course and faculty by fellows will be done.

COURSE CONTENT:

EXPECTED OUTCOME:

Fellows will learn the fundamentals of quality improvement and learn how to use a tool of e-PDSA which can be used for personal and professional purposes. The fellows will be able to train others

BUDGET :

QIC faculty, staff cost and travel cost. Total cost ranges from $5,000 to $7,500 over 4 months.
Supplemental funding from Soni-Jain Charitable Trust.

KEY PERSONS:

Manoj Jain MD MPH QI Faculty Lead
Rakesh Suseela MD MPH – Fellows Engagement sessions lead
Raman Arora – Team Building and QIC Lead
Pratibha Kohli – QI Consultant
Sharvari Ubale – CETI Staff
Salil Bhargava – Dean Gandhi Medical College, Bhopal
Quality Improvement Consultants – 2 QIC