{ "abstract": "Background: Chronic cardiovascular diseases (CVD) care quality remains suboptimal, globally. We assessed the feasibility, acceptability, fidelity, and preliminary effect of a multicomponent, collaborative quality improvement (C-QIP) strategy among patients with CVD attending outpatient clinics in India. Methods and findings: In this pragmatic feasibility randomized controlled trial, 410 adults with ischemic heart disease, ischemic stroke, or heart failure attending four public and private hospitals were randomized to C-QIP (electronic decision support for providers, non-physician care coordination, patient education, text-message reminders, and audit-feedback) or usual care. Primary outcomes were feasibility, fidelity, adoption, and acceptability; secondary outcomes included guideline-directed medical therapy (GDMT), self-reported adherence, care processes, and risk factors. At end of study (median follow-up 15 months), retention was 192/206 (93.2%) in C-QIP and 187/204 (91.7%) in usual care. Fidelity was high: 187/198 (94.4%) C-QIP participants received lifestyle counseling at end of study. C-QIP increased GDMT use for ischemic heart disease (58.3% versus 32.4%; relative risk [RR] 1.45, 95% CI [1.18, 1.78]) and ischemic stroke (76.7% versus 31.8%; RR 2.41, 95% CI [1.52, 3.81]), but not heart failure. Self-reported adherence was higher for medications (90.9% versus 82.3%; RR 1.08, 95% CI [1.04, 1.12]), diet (91.9% versus 82.3%; RR 1.07, 95% CI [1.02, 1.13]), and physical activity (91.4% versus 70.4%; RR 1.23, 95% CI [1.16, 1.30]). Limitations include feasibility design, individual randomization within shared clinics, and limited power for clinical outcomes and subgroup analysis. Conclusions: The C-QIP trial demonstrated that a multicomponent strategy is feasible, acceptable, and improved chronic CVD care processes in India. Future large, confirmatory hybrid trials are needed to establish whether such quality improvement strategies can reduce cardiovascular morbidity and mortality. Trial Registrations: NCT05196659; CTRI/2022/04/041847 Why was this study done?: What did the researchers do and find?: What do these findings mean?: Kavita Singh and colleagues evaluated a multicomponent quality improvement strategy for chronic cardiovascular disease care in India and found it was feasible to implement, well accepted by patients and providers, and delivered with high fidelity across diverse outpatient settings.", "abstract_shown": true, "affiliations": [ "Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany", "Public Health Foundation of India, New Delhi, India", "Centre for Chronic Disease Control, New Delhi, India", "All India Institute of Medical Sciences, New Delhi, India", "SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India", "GB Pant Hospital, New Delhi, India", "Sir Ganga Ram Hospital, New Delhi, India", "Georgetown University, Washington, District of Columbia, United States of America", "Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, United States of America", "Washington University School of Medicine, St. Louis, Missouri, United States of America", "The George Institute for Global Health, University of New South Wales, Sydney, Australia", "University of Abuja, Abuja, Nigeria" ], "article_type": "Research Article", "arxiv": null, "author_total": 21, "authors": [ { "affs": [ 0 ], "name": "Kavita Singh" }, { "affs": [ 1 ], "name": "Ambuj Roy" }, { "affs": [ 2 ], "name": "Dimple Kondal" }, { "affs": [ 3 ], "name": "Kalyani Nikhare" }, { "affs": [ 4 ], "name": "Mareesha Gandral" }, { "affs": [ 5 ], "name": "Satish G. Patil" }, { "affs": [ 6 ], "name": "Kiran Aithal" }, { "affs": [ 7 ], "name": "Meenahalli Palleda Girish" }, { "affs": [ 8 ], "name": "Mohit Gupta" }, { "affs": [ 9 ], "name": "Kushal Madan" }, { "affs": [ 10 ], "name": "Jitendra P. S. Sawhney" }, { "affs": [ 11 ], "name": "Kamar Ali" }, { "name": "Meetushi Jain" }, { "name": "Savitesh Kushwaha" }, { "name": "Devraj Jindal" }, { "name": "Emily Mendenhall" }, { "name": "Shivani A. Patel" }, { "name": "Kabayam M. Venkat Narayan" }, { "name": "Nikhil Tandon" }, { "name": "Mark D. Huffman" }, { "name": "Dorairaj Prabhakaran" } ], "bibtex": "https://research.draconitic.com/paper/2en6zm2e0sjwe.bib", "cited_by": 0, "doi": "10.1371/journal.pmed.1004932", "fulltext_url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004932", "id": "2en6zm2e0sjwe", "issns": [ "1549-1676" ], "landing_url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004932", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2739|Clinical practice guidelines implementation" ], [ "plos", "/Medicine and health sciences/Cardiology/Cardiovascular medicine/Cardiovascular diseases" ], [ "plos", "/Medicine and health sciences/Cardiology/Cardiovascular medicine/Cardiovascular diseases/Coronary heart disease" ], [ "plos", "/Medicine and health sciences/Cardiology/Heart failure" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Health care/Patients" ], [ "plos", "/Medicine and health sciences/Medical conditions/Cardiovascular diseases" ], [ "plos", "/Medicine and health sciences/Medical conditions/Cardiovascular diseases/Coronary heart disease" ], [ "plos", "/Medicine and health sciences/Medical conditions/Cerebrovascular diseases/Stroke/Ischemic stroke" ], [ "plos", "/Medicine and health sciences/Neurology/Cerebrovascular diseases/Stroke/Ischemic stroke" ], [ "plos", "/Medicine and health sciences/Pharmaceutics/Drug therapy/Antiplatelet therapy" ], [ "plos", "/Medicine and health sciences/Vascular medicine/Coronary heart disease" ], [ "plos", "/Medicine and health sciences/Vascular medicine/Stroke/Ischemic stroke" ], [ "plos", "/People and places/Geographical locations/Asia/India" ] ], "openalex": "W7214733440", "pdf_url": "https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1004932&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-29", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/2en6zm2e0sjwe.ris", "sources": [ { "first_seen": "2026-10-30T12:17:37Z", "native_id": "10.1371/journal.pmed.1004932", "source": "plos", "url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004932" } ], "subjects": [ { "field": "medicine", "origin": "plos:cardiovascular diseases", "subfield": "cardiovascular" } ], "title": "Assessing a multicomponent quality improvement strategy for chronic care of cardiovascular diseases in India: The C-QIP randomized feasibility trial", "title_text": "Assessing a multicomponent quality improvement strategy for chronic care of cardiovascular diseases in India: The C-QIP randomized feasibility trial", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:37Z", "url": "https://research.draconitic.com/paper/2en6zm2e0sjwe", "venue": "PLOS Medicine", "versions": [] }