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. 2023 Jun 5:1-12.
doi: 10.1007/s43477-023-00087-2. Online ahead of print.

A Delphi Study to Prioritize Evidence-Based Strategies for Cardiovascular Disease Care in India

Kavita Singh  1   2   3 , Awantika Joshi  2 , Nikhil Srinivasapura Venkateshmurthy  1   2 , Rahul Rahul  4 , Mark D Huffman  5   6   7 , Nikhil Tandon  8 , Dorairaj Prabhakaran  1   2
Affiliations

A Delphi Study to Prioritize Evidence-Based Strategies for Cardiovascular Disease Care in India

Kavita Singh et al. Glob Implement Res Appl. .

Abstract

Providing quality cardiovascular disease (CVD) care in low resource setting requires understanding of priority and effective interventions. This study aimed to identify and prioritize evidence-based quality improvement strategies for CVD care in India using a modified two-round Delphi process in which, we asked 46 experts (clinicians, researchers, program implementers and policy makers) to rate 25 proven CVD care strategies grouped into: (1) patient support, (2) information communication technology (ICT) for health, (3) group problem solving, (4) training, and (5) multicomponent strategy on a scale of 1 (highest/best)-5 (lowest/worst) on priority, relative advantage, and feasibility. Subsequently, we convened an expert consensus panel of 32 members to deliberate and achieve consensus regarding the prioritized set of strategies for CVD care. The Delphi study found that group problem solving strategies achieved the best score for priority (1.80) but fared poorly on feasibility (2.88). Compared to others, multicomponent strategies were rated favorably across all domains (priority = 1.84, relative advantage = 1.94, and feasibility = 2.40). The ICT for health strategies achieved the worst scores for priority = 2.01, relative advantage = 2.31, and feasibility = 2.85. Training and patient support strategies scored moderately across all domains. The expert panel narrowed the selection of a multicomponent strategy consisting of (1) electronic health records with clinical decision-support system, (2) non-physician health worker facilitated care, (3) patient education materials, (4) text-message based reminders for healthy lifestyle, and (5) audit and feedback report for providers. Future research will evaluate the real-world feasibility and effectiveness of the multicomponent strategy in patients with CVD in a low- and middle-income country setting.

Supplementary information: The online version contains supplementary material available at 10.1007/s43477-023-00087-2.

Keywords: Cardiovascular disease care; Delphi study; India; Quality improvement.

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Conflict of interest statement

Conflict of interestIn the last 3 years, MDH has received support from the World Heart Federation through unrestricted education grants from Boehringer Ingelheim, Novartis, and Bupa and from the American Heart Association, Verily, and AstraZeneca for work unrelated to this research. MDH has also received salary support from the American Medical Association for his role as an associate editor for JAMA Cardiology. MDH has planned patents for combination therapy for the treatment of heart failure. The George Institute for Global Health has a patent, license, and has received investment funding with the intent to commercialize fixed-dose combination therapy through its social enterprise business, George Medicines. All other co-authors declare no conflict of interests.

Figures

Fig. 1
Fig. 1
Delphi process diagram. QI quality improvements, CVD cardiovascular disease. Likert scale 1–5, 1 = highest priority/feasibility or best strategy, 5 = lowest priority/feasibility or worst strategy
Fig. 2
Fig. 2
Mean scores of strategy groups for priority, relative advantage, and feasibility criteria. (1 = Best; 5 = Worst). *Mean scores for five quality improvement strategy groups: (1) patient support, (2) information communication and technology (ICT) for health, (3) group problem solving, (4) high/low intensity training, and (5) multicomponent strategies. These strategies were rated by experts across three domains on a scale of 1–5 (1 = best, 5 = worst): priority, relative advantage (compared to usual care scenario), and feasibility criteria (reach, technical complexity, capital intensity and cultural acceptability)
Fig. 3
Fig. 3
Strategy groups represented on a graph based on high and low rankings for feasibility and priority. *Mean scores for relative advantage are represented by the size of the bubble, i.e., high, medium, low
See this image and copyright information in PMC

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