Americares India Foundation (AIF) operates eight Mobile Health Centers (MHCs), providing primary healthcare services to 70,000 patients annually from poor urban communities in Mumbai. About 5,000 patients out of the 70,000 are diagnosed with hypertension. The preliminary analysis of hypertensive patients utilizing services at eight MHCs showed controlled blood pressure in nearly half of the hypertensive patients. Further analysis stratifying blood pressure control revealed an inequity of about 10% between female and male hypertensive patients.

The changes were tested using Shewhart's Cycle for Learning and Improvement: Plan, Do, Study Act (PDSA). The purpose of using a PDSA method lies in exploring and learning how an intervention can work in a particular setting and iteratively make necessary adjustments to increase the chances of achieving the desired improvements, including 1) Increase percentage of hypertensive patients whose blood pressure is controlled and; 2) Uncover and bridge any equity gaps in blood pressure control.

After receiving health equity training and running rapid PDSA cycles, each MHC team was asked to develop and practice changes that would positively influence follow-up visits. The staff also tested patients' blood pressure every fifteen days. According to the Indian guideline for hypertension treatment, the target blood pressure is 130/80 mmHg for those under age 60 and 140/90 mmHg for those aged 60 and above. Treatment targets were consulted by physicians and health professionals and individualized according to the patient's health status.

After removing missing data, we identified 212,466 clinical visits between June 1, 2021, and August 22, 2022. The keyword search results showed 27.5% of the total visits were identified as hypertensive. We recorded that 64.3% of female hypertensive visits were controlled, while only 54.4% of male hypertensive visits were controlled in the baseline. We recorded 92.3% of female hypertensive visits were controlled, and 88.4% of male hypertensive visits were controlled in the endline. The gender gap was reduced from 11.4% to 2.2%.

This improvement project showed that it is possible to apply improvement methods to improve the quality of care for patients with hypertension and bridge any inequity gaps in the care provided.