Study protocol for evaluating the effectiveness of the ECHO tele-mentoring program for primary care physicians in india on the management of Cardio-Metabolic Syndrome

The burden of Cardio-Metabolic Syndrome (CMS) is surging globally and in LMICs like India. Despite several efforts to address this burden, significant challenges for managing CMS remain, especially in the management of such cases in primary care. ECHO India plans to address this gap by training 1700 primary care physicians (PCPs) across six states through a tele-mentoring process. The goal of the program is to improve the skills of PCPs in managing patients with CMS. To evaluate the effectiveness of the training of PCPs for management of CMS in primary care, to evaluate the benefit of the training program vis-à-vis the system costs incurred (cost-benefit analysis), to examine intended and unintended benefits at the system level as a result of the mentoring program. A Type II hybrid quasi-experimental design will be used, adapting the RE-AIM-QuEST framework with a mixed-methods approach. Effectiveness will be evaluated through a controlled before–after study with patients conducted in two states, Tamil Nadu and West Bengal. A difference-in-difference design will be used to assess patient satisfaction and cost–benefit outcomes across the two states. Program performance data from ECHO India will be analyzed quantitatively, alongside qualitative key informant interviews to explore system-level changes in CMS management. Quantitative analysis will be conducted using R, and qualitative analysis using NVivo. Quantitative and qualitative findings will be integrated and reported using an adapted RE-AIM QuEST framework. This study will provide a comprehensive evaluation of the ECHO tele-mentoring model for PCPs’ training on the management of CMS in India.