Assessing a multicomponent quality improvement strategy for chronic care of cardiovascular diseases in India: The C-QIP randomized feasibility trial
12 affiliations
- 1Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- 2Public Health Foundation of India, New Delhi, India
- 3Centre for Chronic Disease Control, New Delhi, India
- 4All India Institute of Medical Sciences, New Delhi, India
- 5SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India
- 6GB Pant Hospital, New Delhi, India
- 7Sir Ganga Ram Hospital, New Delhi, India
- 8Georgetown University, Washington, District of Columbia, United States of America
- 9Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, United States of America
- 10Washington University School of Medicine, St. Louis, Missouri, United States of America
- 11The George Institute for Global Health, University of New South Wales, Sydney, Australia
- 12University of Abuja, Abuja, Nigeria
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.
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BibTeX
@article{singh2026assessing,
title = {{Assessing a multicomponent quality improvement strategy for chronic care of cardiovascular diseases in India: The C-QIP randomized feasibility trial}},
author = {Kavita Singh and Ambuj Roy and Dimple Kondal and Kalyani Nikhare and Mareesha Gandral and Satish G. Patil and Kiran Aithal and Meenahalli Palleda Girish and Mohit Gupta and Kushal Madan and Jitendra P. S. Sawhney and Kamar Ali and Meetushi Jain and Savitesh Kushwaha and Devraj Jindal and Emily Mendenhall and Shivani A. Patel and Kabayam M. Venkat Narayan and Nikhil Tandon and Mark D. Huffman and Dorairaj Prabhakaran},
journal = {PLOS Medicine},
year = {2026},
month = sep,
doi = {10.1371/journal.pmed.1004932},
url = {https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004932},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Assessing a multicomponent quality improvement strategy for chronic care of cardiovascular diseases in India: The C-QIP randomized feasibility trial
AU - Kavita Singh
AU - Ambuj Roy
AU - Dimple Kondal
AU - Kalyani Nikhare
AU - Mareesha Gandral
AU - Satish G. Patil
AU - Kiran Aithal
AU - Meenahalli Palleda Girish
AU - Mohit Gupta
AU - Kushal Madan
AU - Jitendra P. S. Sawhney
AU - Kamar Ali
AU - Meetushi Jain
AU - Savitesh Kushwaha
AU - Devraj Jindal
AU - Emily Mendenhall
AU - Shivani A. Patel
AU - Kabayam M. Venkat Narayan
AU - Nikhil Tandon
AU - Mark D. Huffman
AU - Dorairaj Prabhakaran
PY - 2026
DA - 2026/09/29
JO - PLOS Medicine
DO - 10.1371/journal.pmed.1004932
UR - https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004932
AB - 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.
SN - 1549-1676
ER -