Key result
Community health worker outreach raises clinic follow-up by ~16 percentage points in a quality initiative.
Why the study?
In India, achieving a 25% relative reduction in raised BP prevalence by 2025 requires effectively treating approximately 4.5 crore additional individuals, prompting a QI initiative to improve follow-up and reduce missed visits.
Does a Quality Improvement initiative involving ASHA home visits and data triangulation improve follow-up visits and reduce missed visits in individuals with hypertension?
Does a Quality Improvement initiative involving ASHA home visits and data triangulation improve follow-up visits and reduce missed visits in individuals with hypertension?
Absolute Event Rate: 37% vs 21%
Leveraging community health workers (ASHAs) for home visits and triangulating pharmacy data significantly improved routine follow-up care and blood pressure monitoring for hypertension patients in a district hospital setting.
May support ASHA-led QI for hypertension follow-up in district hospitals; hypothesis-generating pending randomized confirmation.
BACKGROUND: In India, to achieve a 25% relative reduction in the prevalence of raised blood pressure (BP) by 2025, approximately 4.5 crore additional people with hypertension will need to have their BP effectively treated. We conducted a Quality Improvement (QI) initiative to improve follow-up and reduce missed visits among individuals with hypertension registered under India Hypertension Control Initiative, District Hospital, Seoni, Madhya Pradesh, India, in 2022. METHODS: We conducted a quasiexperimental study from January to September 2022 in the District Hospital in Seoni, Madhya Pradesh. Following the Ishikawa diagram, the major root causes for missed visits were identified, and countermeasures were developed. The packages under Plan-Do-Study-Act (PDSA) included (i) training urban Accredited Social Health Activists to conduct house visits for individuals with missed visits and (ii) triangulating the follow-up records from various information systems. The review meetings for QI initiatives were conducted fortnightly to follow-up PDSAs. We calculated the proportion of individuals who were followed-up monthly, and the proportion of missed visits among those registered quarterly. RESULTS: Cumulatively, 2850 individuals were registered with hypertension till September 2022. Following the intervention, the monthly follow-up proportion increased from 21% in January to 37% in September 2022. Missed visit proportion decreased from 66% (228/345) in quarter four, 2021, to 22% (40/180) in quarter three, 2022. Of the 1438 individuals counselled by ASHA home visits, 74.9% returned for follow-up. CONCLUSION: In our setting, QI initiatives suggested that missed visits decreased during the intervention period. However, the interventions must be implemented continuously for better monitoring and use in similar settings.
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Bharadwaj et al. (2025) studied Hypertension (n=2,850). Quality Improvement initiative (ASHA home visits and data triangulation) vs. Pre-intervention baseline care was evaluated on Monthly follow-up proportion. A quality improvement initiative utilizing community health worker home visits and data triangulation increased the monthly follow-up proportion from 21% to 37% and reduced missed visits.
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