Quality Improvement in Cardiovascular Disease Care
Authors: Edward Lee, Rajesh Vedanthan, Panniyammakal Jeemon, Jemima Kamano, Preeti Kudesia, Vikram Rajan, Michael Engelgau, Andrew Moran
Reviews the diagnosis and treatment of cardiovascular disease in low- and middle-income countries (LMICs) with a view to improving the quality of care. In keeping with the Institute of Medicine’s definition of quality as the “degree to which health services for individuals and population increase the likelihood of desired health outcomes and are consistent with current professional knowledge,” the focus rests on studies of specific interventions and measurable health outcomes. Because the resources available to support health care delivery in LMICs prove scarce, clinical quality improvement depends upon getting the most out of known effective interventions within the limits of available resources rather than unproven interventions that require early-phase studies or substantial investment to scale up. The innovative approaches taken by the LMIC programs studied demonstrate that successful improvement does not mean simply adapting high-income country (HIC) programs to LMICs; innovations to improve the quality of clinical care may likewise originate in low-resource environments.