Grant: CIHR Fellowship

Hypertension is a major cause of premature death worldwide. Two-thirds of adults with hypertension live in low- and middle-income countries (LMICs). Despite this public health crisis, few studies have examined the quality of care for hypertension in LMICs. Evaluating health system performance for hypertension requires an understanding of the care received by patients over time. The overarching objective of this study is to track longitudinal care quality and outcomes for patients with hypertension in LMICs. First, we will develop a flexible measurement tool that uses mobile phones to assess undermeasured dimensions of health system quality for hypertension including: continuity and timeliness of care, patient experience, and patient-reported outcomes such as health, economic impact, and patient trust. This tool will rely on internationally recognized standards of care. Then we will longitudinally assess care quality and outcomes for people with hypertension in two different contexts: Argentina and India. In each country, we will recruit 1,000 patients newly diagnosed with hypertension. Participants will be given a mobile phone to conduct monthly phone surveys with live interviewers. They will be followed for 12 months. At baseline and endline, data collectors will conduct face to face surveys, collect biomarkers, conduct a physical examination, extract data from medical registers, and assess the facility. The results will pinpoint bottlenecks for health system performance and will inform quality improvement reforms for non-communicable diseases. Policy makers will use e-cohorts to monitor performance gaps along the continuum of care. Multiple methods of knowledge translation will be used (publications, conferences, workshops, and policy briefs). In the future, we plan to implement e-cohorts in other countries and to adapt the tool to assess other high priority chronic conditions such as diabetes.