Quality Improvement and NCD Control: A Three-Year Primary Care Sustainability Assessment

Authors

  • Baridalyne Nongkynrih Centre for Community Medicine, All India Institute of Medical Sciences, Delhi, India
  • Ravneet Kaur Centre for Community Medicine, All India Institute of Medical Sciences, Delhi, India
  • Anam Anil Alwani Centre for Community Medicine, All India Institute of Medical Sciences, Delhi, India
  • Ankit Chandra Department of Community Medicine, All India Institute of Medical Sciences, Central Armed Police Forces Institute of Medical Sciences, New Delhi, India

DOI:

https://doi.org/10.55489/njcm.170120265939

Keywords:

Blood Pressure Control, Glycaemic Control, Non-Communicable Disease, Quality Improvement, Sustainability, Primary Care

Abstract

Objectives: This study aimed to evaluate the three-year sustainability of a quality improvement (QI) initiative designed to improve health records of individuals with hypertension and diabetes at a primary health facility in Delhi, India. Additionally, we used data from the records to calculate outcome indicators.

Methods: This mixed methods study assessed sustainability using the National Health Service Sustainability Model and Guide. The World Health Organization’s cohort monitoring approach was used to calculate annual control rates, loss-to-follow-up rates and missed visits.

Findings: The overall score for the sustainability assessment was 96.2%. Factors contributing to sustainability included the transition to digital health records, stakeholder engagement, process adaptation, improved clinical decision making, and strong senior leadership support.

In all, 953 individuals living with hypertension and/or diabetes registered at the centre. Annual blood pressure and glycaemic control rates fluctuated from baseline to 2024. Records showed high loss-to-follow-up rates, and a large proportion of missed visits and missing data.

Conclusion: The QI initiative of improved record keeping achieved a high sustainability score after three years. While digital records enabled calculating outcome indicators, these fell short of desired levels because of external factors, patients’ behaviour and poor availability of drugs and diagnostics.

References

GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024 May 18;403(10440):2100-2132. DOI: https://doi.org/10.1016/S0140-6736(24)00367-2. Erratum in: Lancet. 2024 May 18;403(10440):1988. DOI: https://doi.org/10.1016/S0140-6736(24)00824-9. PMID: 38582094; PMCID: PMC11126520.

Mensah GA, Fuster V, Murray CJL, Roth GA; Global Burden of Cardiovascular Diseases and Risks Collaborators. Global Burden of Cardiovascular Diseases and Risks, 1990-2022. J Am Coll Cardiol. 2023 Dec 19;82(25):2350-2473. DOI: https://doi.org/10.1016/j.jacc.2023.11.007 PMid:38092509 PMCid:PMC7615984

World Health Organization. Hearts: technical package for cardiovascular disease management in primary health care [Internet]. Geneva: World Health Organization; 2016 [cited 2025 Jan 6]. 73 p. Available from: https://iris.who.int/handle/10665/252661

Frieden TR, Varghese CV, Kishore SP, Campbell NRC, et al. Scaling up effective treatment of hypertension-A pathfinder for universal health coverage. J Clin Hypertens (Greenwich). 2019 Oct;21(10):1442-1449. DOI: https://doi.org/10.1111/jch.13655 PMid:31544349 PMCid:PMC8030517

Foo C, Logan K, Eu E, Erlangga D, et al. Starfield's 4Cs of NCD management in primary healthcare: a conceptual framework development from a case study of 19 countries. BMJ Glob Health. 2025 Jan 29;10(1):e017578. DOI: https://doi.org/10.1136/bmjgh-2024-017578 PMid:39880416 PMCid:PMC11781094

Chandra A, Kaur R, Bairwa M, Rai S, Nongkynrih B. Monitoring of Non-communicable Diseases in a Primary Healthcare Setting in India: A Quality Improvement Initiative. Cureus. 2023 Apr 25;15(4):e38132. DOI: https://doi.org/10.7759/cureus.38132. Erratum in: Cureus. 2023 Apr 28;15(4):c112. DOI: https://doi.org/10.7759/cureus.c112. PMID: 37252596; PMCID: PMC10224714.

Atkinson S, Ingham J, Cheshire M, Went S. Defining quality and quality improvement. Clin Med (Lond). 2010 Dec;10(6):537-539. DOI: https://doi.org/10.7861/clinmedicine.10-6-537 PMid:21413472 PMCid:PMC4951855

Mortimer F, Isherwood J, Wilkinson A, Vaux E. Sustainability in quality improvement: redefining value. Future Healthc J. 2018 Jun;5(2):88-93. DOI: https://doi.org/10.7861/futurehosp.5-2-88 PMid:31098540 PMCid:PMC6502556

Palepu S, Yadav K, Ahamed F, Goswami AK, Nongkynrih B, Pandav CS. Acute morbidity profile and treatment seeking behaviour among people residing in an urban resettlement colony in Delhi, India. Nepal J Epidemiol. 2018 Mar 31;8(1):716-724. DOI: https://doi.org/10.3126/nje.v8i1.21140 PMid:30867975 PMCid:PMC6204064

World Health Organization. WHO technical specifications for automated non-invasive blood pressure measuring devices with cuff [Internet]. Geneva: World Health Organization; 2020 [cited 2025 Jun 22]. (WHO medical device technical series;). Available from: https://iris.who.int/handle/10665/331749

Singh RS. Delhi govt to provide 450 types of medical tests free of cost from January 1 [Internet]. Hindustan Times. 2022 [cited 2025 Jun 22]. Available from: https://www.hindustantimes.com/cities/delhi-news/delhi-govt-to-provide-450-types-of-medical-tests-free-of-cost-from-january-1-101670937209363.html

Chandra A, Rai SK, Nongkynrih B. Planning and setting up of a patient health record system for patients with non-communicable diseases in a primary healthcare setting. The Journal of Community Health Management. 2022;9(4):216-222. DOI: https://doi.org/10.18231/j.jchm.2022.040

Noncommunicable Disease Facility-Based Monitoring Guidance: framework, indicators and application. Geneva: World Health Organization; 2022. [cited 2025 Jun 23] Available from: https://www.who.int/publications/i/item/9789240057067

HEARTS of NCD: An integrated approach to management of noncommunicable diseases (NCD) in primary health care (Online Course). WHO Academy [Internet]. Learning Experience Platform. [cited 2025 Jun 22]. Available from: https://www.knowledge-action-portal.com/en/content/hearts-ncd-integrated-approach-management-noncommunicable-diseases-primary-health-care

Maher L, Gustafson D, Evans A. Sustainability Model and Guide [Internet]. NHS Institute for Innovation and Improvement; [cited 2025 Jan 13]. Available from: https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/NHS-Sustainability-Model-2010.pdf

Ministry of Health and Family Welfare, Indian Council of Medical Research. Standard treatment workflow for diabetes mellitus type 2 [Internet]. [cited 2025 Jun 15]. Available from: https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567245_diabetes_mellitus_type_2.pdf

Boguslavsky V, Gutierrez R, Holschneider S. Effective leadership for quality improvement in health care: A practical guide [Internet]. USAID ASSIST Project. Chevy Chase, MD: University Research Co., LLC (URC; 2019 [cited 2025 Jan 15]. Available from: https://www.urc-chs.com/wp-content/uploads/urc-assist-qi-leadership-guide.pdf

Saiod AK, van Greunen D, Veldsman A. Electronic health records: benefits and challenges for data quality. In: Khan SU, Zomaya AY, Abbas A, editors. Handbook of Large-Scale Distributed Computing in Smart Healthcare. Cham: Springer International Publishing; 2017, p.123-156. DOI: https://doi.org/10.1007/978-3-319-58280-1_6

Update on Ayushman Bharat Digital Mission: Press release [Internet]. [cited 2025 Jun 14]. Available from: https://mohfw.gov.in/?q=pressrelease-147

Ministry of Health and Family Welfare. Operational guidelines- National Programme for Prevention and Control of Non-Communicable Diseases (2023-2030) [Internet]. 2023. [cited 2025 Jun 16] Available from: https://www.mohfw.gov.in/sites/default/files/NP-NCD%20Operational%20Guidelines_0.pdf

Pressure on mohalla clinic docs to reduce tests [Internet]. The Times of India. 2024 [cited 2025 Jun 23]. Available from: https://timesofindia.indiatimes.com/city/delhi/pressure-on-mohalla-clinic-doctors-to-reduce-tests/articleshow/110062801.cms

Shukla P. AAP's flagship mohalla clinics face closure [Internet]. The New Indian Express. 2024 [cited 2025 Jun 23]. Available from: https://www.newindianexpress.com/cities/delhi/2024/Oct/01/aaps-flagship-mohalla-clinics-face-closure

Lall D, Engel N, Srinivasan PN, et al. Improving primary care for diabetes and hypertension: findings from implementation research in rural South India. BMJ Open. 2020 Dec 15;10(12):e040271. DOI: https://doi.org/10.1136/bmjopen-2020-040271 PMid:33323433 PMCid:PMC7745330

Hegde A, Patel H, Laxmeshwar C, et al. Delivering hypertension care in private-sector clinics of urban slum areas of India: the Mumbai Hypertension Project. J Hum Hypertens. 2023 Sep;37(9):767-774. DOI: https://doi.org/10.1038/s41371-022-00754-1 PMid:36153383 PMCid:PMC9510164

Seth AK, Kansal S, Salve HR, Gupta S, Kumar R, Misra P. The Role of Noncommunicable Disease Clinics in Improving Control of Hypertension and Diabetes Among Adults Residing in Rural Ballabgarh, Haryana. Cureus. 2023 Apr 8;15(4):e37283. DOI: https://doi.org/10.7759/cureus.37283 PMID: 37038380; PMCID: PMC10082560

Narendiran V, Ramasamy N, Sarkar S. Relationship between proxy behavior in clinic attendance and disease control among persons with hypertension and diabetes at a rural primary health center: A cohort analysis in South India. J Family Med Prim Care. 2024 Nov;13(11):5220-5224. DOI: https://doi.org/10.4103/jfmpc.jfmpc_873_24 PMid:39722976 PMCid:PMC11668391

Yahaya JJ, Doya IF, Morgan ED, et al. Poor glycemic control and associated factors among patients with type 2 diabetes mellitus: a cross-sectional study. Sci Rep. 2023 Jun 14;13(1):9673. DOI: https://doi.org/10.1038/s41598-023-36675-3 PMid:37316565 PMCid:PMC10267215

Delhi's mohalla clinics see 28% drop in visits amid drug shortages in 2024 [Internet]. The Financial Express. 2025 [cited 2025 Jun 23]. Available from: https://www.financialexpress.com/india-news/delhis-mohalla-clinics-see-28-percent-drop-in-visits-amid-drug-shortages-in-2024/3713423/

Delhi health department clears Rs 90 crore dues, resolving essential medicine shortage in government hospitals [Internet]. The New Indian Express. 2024 [cited 2025 Jun 23]. Available from: https://www.newindianexpress.com/cities/delhi/2024/Dec/28/delhi-health-department-clears-rs-90-crore-dues-resolving-essential-medicine-shortage-in-government-hospitals

Singh MM, Basu S, Lalwani H, et al. Hypertension care cascade in an urban resettlement colony and slum in Delhi, India: a cross-sectional survey. BMC Public Health. 2023 Oct 27;23(1):2116. DOI: https://doi.org/10.1186/s12889-023-17021-8 PMid:37891517 PMCid:PMC10612386

Alwani AA, Kaur R, Bairwa M, Misra P, Nongkynrih B. Diabetes distress and associated factors among adults with diabetes mellitus residing in a metropolitan city of India: a community-based study. Clin Diabetes Endocrinol. 2024 Dec 9;10(1):40. DOI: https://doi.org/10.1186/s40842-024-00203-7 PMid:39648218 PMCid:PMC11626746

Ministry of Health and Family Welfare, World Health Organization, ICMR. Indian Hypertension Control Initiative 2021 Progress Report [Internet]. 2021 Dec [cited 2025 Jun 6]. Available from: https://cdn.who.int/media/docs/default-source/india-news/india-hypertension-control-initiative/ihci-annual-progress-report.pdf?sfvrsn=bc13f528_2&utm_medium=email&utm_source=transaction

Published

2026-01-01

How to Cite

1.
Nongkynrih B, Kaur R, Alwani AA, Chandra A. Quality Improvement and NCD Control: A Three-Year Primary Care Sustainability Assessment. Natl J Community Med [Internet]. 2026 Jan. 1 [cited 2026 Jan. 1];17(01):52-6. Available from: https://njcmindia.com/index.php/file/article/view/5939

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Original Research Articles

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