Implementation and Scale-up of the American Indian Structural Heart Disease Partnership (IN-STEP)
Description: Across almost every indicator, American Indians face massive disparities in health outcomes. Cardiovascular diseases drive a large proportion of this disparity, with American Indian adults twice as likely to have the cardiac disease as compared to the general US population. In our preliminary work with a Tribe in Eastern Arizona, one in 14 American Indian adults who underwent screening were found to have undiagnosed SHD. Improving early detection for American Indians living with SHD holds the potential to rapidly achieve greater equity in health outcomes. Our team has developed evidenced-based interventions and implementation strategies for decentralized SHD services in low-income countries, which can be adapted for use in the American Indian Community Health Representative (CHR) program through reciprocal innovation. The CHR Program is designed to extend culturally sensitive health promotion and interventions within Tribal communities and could provide a transformative approach to improve SHD outcomes. The overall objective of the American Indian Structural Heart Disease Partnership (IN-STEP) is to co-develop an implementation model for improving SHD diagnosis and care. IN-STEP will utilize community-based participatory research to adapt and integrate an evidence-based intervention – point of care echocardiography supported by automated intelligence diagnostics - into an existing community health representative (CHR) program. The specific aims of IN-STEP are to: 1) Co-design a cardiovascular disease extender program using a CBPR approach to ensure that IN-STEP meets the needs of the community and has the greatest impact on improving SHD outcomes, 2) Utilize rapid interrupted time series experiments to refine and test implementation models of the IN-STEP program, within a single Tribal CHR Program in Eastern Arizona, and 3) Evaluate the IN-STEP program across multiple CHR programs within the Phoenix Area IHS Region and evaluate the impact of the program using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). IN-STEP will build workforce capacity and create a scalable unit for translation across CHR programs nationally. Further, IN-STEP will create a novel community-centered template for improving health equity for American Indians that can be validated and scaled and will be an innovative adaptation of CHRs to provide sub-specialty care extension with relevance to other non-communicable diseases among Ame
Funder: American Heart Association
Amount: $3,545,000
Funding type: research
Funder scheme: Health Equity Research Network
Start date: 2023-07-01
End date: 2027-06-30
Investigators: Sarah De Loizaga, Sarah De Loizaga
Institution: Cincinnati Children's Hospital Medical Center
Funded outputs count: 1
Funder award ID: 23HERNPRH1150359
OpenAlex ID: G5178488950