Table 1.
Assessment Tools Utilized For Each Step of IN‐STEP
| Organizational Readiness for Implementing Change | Modified Technology Acceptance model | Health Care Access Survey | Semistructured Interviews | |
|---|---|---|---|---|
| Step 1: Characterization of the system where IN‐STEP would be deployed | ||||
| Acronym | ORIC Survey 10 | Modified TAM 11 , 12 | N/A | N/A |
| Brief description | 12 Likert scale (5‐point) items measuring readiness for change at the collective level within the domains of change commitment (5 questions) and change efficacy (7 items) | 8 Likert scale (7‐point) items designed to explain and predict system use along the domains of perceived usefulness (4 questions) and perceived ease of use (4 questions) | De novo survey on health care access and acceptability of echocardiography | Informed by the modified TAM to explore perceptions of usefulness and ease of using POC echo, patient and community‐level responsiveness to using echo for screening |
| Interpretation | Higher score indicates increased readiness | Higher score indicates greater likelihood of use | N/A | N/A |
| Target | Wide range of IHS employees including administrators, providers, nurses, pharmacists, and health techs (goal n=35) | IHS providers who participated in POC echo training (goal n=10) | General community members (goal n=50) | Sampled providers, administrators, and patients (goal n=40) |
| Administration | E‐mail distribution to employees of the participating IHS unit | In‐person during 2‐day intensive training | In‐person, time of study enrollment and POC echo | In‐person |
| Step 2: Build POC echo capacity | ||||
| American College of Emergency Physicians Quality Assessment 13 | Rapid Competency Assessment | Echocardiography Training Evaluation | Small Group Feedback | |
| Acronym | ACEP grade | N/A | N/A | N/A |
| Brief description | 5Level grading scale used for quality assessment of image quality | Binary assessment of 8 skills related to performing echo with acquiring quality images | De novo short survey composed of 4 Likert‐scale questions and 2‐open‐ended questions to assess feedback on training | Small group discussion with 5–6 IHS providers and facilitated by research staff to elicit feedback on echo training process |
| Interpretation | Higher score indicates improved image quality | Skills/images assessed as competent or not competent | N/A | N/A |
| Target | IHS providers who participated in POC echo training (goal n=10) | IHS providers who participated in POC echo training (goal n=10) | IHS providers who participated in POC echo training (goal n=10) | IHS providers who participated in POC echo training (goal n=10) |
| Administration | In‐person at end of 2‐day intensive training | In‐person at end of 2‐day intensive training | In‐person at end of 2‐day intensive training | In‐person at end of 2‐day intensive training |
| Step 3: Deploy active case finding | ||||
| Total number of Screening Studies | Normal vs Abnormal Scans | IHS Provider Interpretation vs Expert Interpretation | SemistructuredIinterviews (for details, see above) | |
| Step 4: Evaluate the approach | ||||
| Patient Echo Acceptability Survey | Provider Integration Survey | Semistructured Interviews | ||
| Acronym | N/A | N/A | ||
| Brief description | De novo survey of 9 Likert‐scale questions (6 points) and 3 open‐ended questions to assess patient acceptance of echo screening | De novo short 3‐question survey (2 Likert‐scale questions | See above for details | |
| Interpretation | Higher score indicated increased acceptance | |||
| Target | Patients receiving a POC screening echo (n=50) | |||
| Administration | In‐person, time of study enrollment following POC echo | 6 Months following echo integration into clinical practice | ||
ACEP indicates American College of Emergency Physicians; echo, echocardiography; IHS, Indian Health Service; IN‐STEP, American Indian Structural Heart Disease Partnership; N/A, not applicable; ORIC, Organizational Readiness for Implementing Change; POC, point‐of‐care; and TAM, Technology Acceptability Model.