Mhealth and mobile clinics for implementation of CARE for cardiac and respiratory multimorbidity (M-CARE) - heart and lung disease are among the leading preventable causes of death for americans

The Fogarty International Center of the Department of Health and Human Services awarded The Trustees of Columbia University in the City of New York $578,452 on August 20, 2026, under the International Research and Research Training program (CFDA 93.989) to develop and validate a mobile clinical decision support tool and community health worker training package for integrated screening and management of hypertension and chronic obstructive pulmonary disease in low-literacy, multilingual settings.

The project, titled "mHealth and Mobile Clinics for Implementation of Care for Cardiac and Respiratory Multimorbidity (M-CARE)," will engineer a simplified, multilingual clinical decision support tool operationalizing WHO protocols for co-occurring cardiopulmonary multimorbidity, co-developed with populations represented both at the study site in northeast India and within the U.S. Burmese American diaspora. The recipient will deliver a community health worker training package designed for direct transfer to American primary care settings serving rural populations and federally qualified health centers with staffing shortages and limited specialty access. Validation occurs in northeast India, where disease burden, existing infrastructure, trained community health workers, and established partnerships enable efficient proof-of-concept before tools are deployed to U.S. rural and tribal clinics and urban health centers serving populations including American Indian, Alaska Native, and Burmese American communities.

Work is performed at Columbia University's Health Sciences Division in New York, New York. The period of performance runs through May 31, 2031.

The GAP in CARE is widest in rural U.S. Communities and in urban federally qualified health centers, some of which serve the chin and burmese american diaspora (>300,000). Staffing shortages, limited specialty access, and communication barriers can prevent screening and treatment for hypertension (HTN) and chronic obstructive pulmonary disease (COPD). The mhealth and mobile clinics for implementation of CARE for cardiac and respiratory multimorbidity (M-CARE) project will deliver a simplified mobile clinical decision support (CDS) tool and community health worker (CHW) training package engineered for direct transfer to american primary CARE. Innovation lies in an integrated multilingual CDS that operationalizes who pen for CO-occurring cardiopulmonary multimorbidity in low-literacy settings, CO-developed with a population shared by the mizoram study site and U.S., so validated tools transfer without RE-engineering. We work in india because the disease burden, infrastructure, trained chws, and partnerships needed to validate this approach already exist. In northeast india, active tobacco use reaches 73% in men and 62% in women, ~90% of HTN cases are undiagnosed or untreated, and COPD prevalence is 15-25% in adults ≥40. These rates parallel the hardest-HIT U.S. Rural populations where the prevalence of HTN is about 40% and the prevalence of COPD is 8%. Current tobacco use among american indian and alaska native adults is 34.9% - the highest of any U.S. Racial/ethnic group. Since the 2021 myanmar coup, 50,000+ burmese persons have entered mizoram; the same populations constitute the burmese american diaspora, now concentrated in U.S. Cities-so validated tools can be usable in federally qualified health centers serving these patients or in rural and tribal clinics facing the same language, workforce, and access barriers. Using prism (practical, robust implementation and sustainability model), we will digitize who pen (package of essential noncommunicable disease interventions) cardiovascular and respiratory protocols into the CDS, train 22 chws, measure fidelity, and complete trial preparation. The trial evaluates the CDS in a hybrid type 2 stepped-wedge cluster-randomized trial across 20 clusters (N=800) with a primary outcome being change in blood pressure among participants with HTN, and secondary outcomes are change in the 10-year who cardiovascular disease risk score and COPD-specialist referral completion among screen-positives. Adoption, fidelity, acceptability, feasibility, cost, and scalability will be assessed through mixed methods.