title: Cardiovascular disease prevention in rural Nigeria in the context of a community based health insurance scheme: QUality Improvement Cardiovascular care Kwara-I (QUICK-I).
abstract: BACKGROUND
  Cardiovascular diseases (CVD) are a leading contributor to the burden of disease in low- and middle-income countries. Guidelines for CVD prevention care in low resource settings have been developed but little information is available on strategies to implement this care. A community health insurance program might be used to improve patients' access to care. The operational research project "QUality Improvement Cardiovascular care Kwara - I (QUICK-I)" aims to assess the feasibility of CVD prevention care in rural Nigeria, according to international guidelines, in the context of a community based health insurance scheme.
  
  
  METHODS
  
  
  
  METHODS
  prospective observational hospital based cohort study.
  
  
  METHODS
  a primary health care centre in rural Nigeria.
  
  
  METHODS
  300 patients at risk for development of CVD (patients with hypertension, diabetes, renal disease or established CVD) who are enrolled in the Hygeia Community Health Plan.
  
  
  METHODS
  demographic and socio- economic data, physical and laboratory examination, CVD risk profile including screening for target organ damage. MEASUREMENTS will be done at 3 month intervals during 1 year. Direct and indirect costs of CVD prevention care will be estimated.
  
  
  RESULTS
  1) The adjusted cardiovascular quality of care indicator scores based on the "United Kingdom National Health Services Quality and Outcome Framework". 2) The average costs of CVD prevention and treatment per patient per year for patients, the clinic and the insurance company. 3) The estimated net health care costs of standard CVD prevention care per quality-adjusted life year gained.
  
  
  METHODS
  The primary outcomes, the score on CVD quality indicators and cost data will be descriptive. The quality scores and cost data will be used to describe the feasibility of CVD prevention care according to international guidelines. A cost-effectiveness analysis will be done using a Markov model.
  
  
  CONCLUSIONS
  Results of QUICK-I can be used by policy makers and professionals who aim to implement CVD prevention programs in settings with limited resources. The context of the insurance program will provide insight in the opportunities community health insurance may offer to attain sustainable chronic disease management programs in low resource settings.
  
  
  BACKGROUND
  This protocol has been registered at ISRCTN, ID number: ISRCTN47894401.
authors: Dept of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.hendriks@amc-cpcd.org
authors: Marleen
authors: M
authors: Hendriks
authors: Lizzy
authors: L
authors: Brewster
authors: Ferdinand
authors: F
authors: Wit
authors: Oladimeji Akeem
authors: OA
authors: Bolarinwa
authors: Aina Olufemi
authors: AO
authors: Odusola
authors: William
authors: W
authors: Redekop
authors: Navin
authors: N
authors: Bindraban
authors: Albert
authors: A
authors: Vollaard
authors: Shade
authors: S
authors: Alli
authors: Peju
authors: P
authors: Adenusi
authors: Kayode
authors: K
authors: Agbede
authors: Tanimola
authors: T
authors: Akande
authors: Joep
authors: J
authors: Lange
authors: Constance
authors: C
authors: Schultsz
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D019058:Community Networks; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D009549:Nigeria; D011320:Primary Health Care / Q000191:economics*; D015397:Program Evaluation; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D019035:Rural Health Services / Q000191:economics*; D012959:Socioeconomic Factors