Cincinnati Children's Hospital Medical Center Cincinnati OH.
University of Cincinnati Cincinnati OH.
J Am Heart Assoc. 2024 Jan 16;13(2):e031231. doi: 10.1161/JAHA.123.031231.
American Indians face significant barriers to diagnosis and management of cardiovascular disease. We sought to develop a real-world implementation model for improving access to echocardiography within the Indian Health Service, the American Indian Structural Heart Disease Partnership.
The American Indian Structural Heart Disease Partnership was implemented and evaluated via a 4-step process of characterizing the system where it would be instituted, building point-of-care echocardiography capacity, deploying active case finding for structural heart disease, and evaluating the approach from the perspective of the clinician and patient. Data were collected and analyzed using a parallel convergent mixed methods approach. Twelve health care providers successfully completed training in point-of-care echocardiography. While there was perceived usefulness of echocardiography, providers found it difficult to integrate screening point-of-care echocardiography into their workday given competing demands. By the end of 12 months, 6 providers continued to actively utilize point-of-care echocardiography. Patients who participated in the study felt it was an acceptable and effective approach. They also identified access to transportation as a notable challenge to accessing echocardiograms. Over the 12-month period, a total of 639 patients were screened, of which 36 (5.6%) had a new clinically significant abnormal finding.
The American Indian Structural Heart Disease Partnership model exhibited several promising strategies to improve access to screening echocardiography for American Indian populations. However, competing priorities for Indian Health Service providers' time limited the amount of integration of screening echocardiography into outpatient practice. Future endeavors should explore community-based solutions to develop a more sustainable model with greater impact on case detection, disease management, and improved outcomes.
美洲印第安人在心血管疾病的诊断和管理方面面临着重大障碍。我们试图为印第安人健康服务（Indian Health Service，IHS）开发一种现实世界的实施模型，以改善结构性心脏病的超声心动图检查的可及性，该模型即为美国印第安结构性心脏病伙伴关系（American Indian Structural Heart Disease Partnership）。
美国印第安结构性心脏病伙伴关系通过四个步骤实施和评估：描述将实施的系统特征、建立即时护理超声心动图能力、主动寻找结构性心脏病病例、从临床医生和患者的角度评估该方法。使用平行汇聚混合方法收集和分析数据。12 名医疗保健提供者成功完成了即时护理超声心动图培训。虽然超声心动图被认为是有用的，但由于竞争需求，提供者发现很难将筛查即时护理超声心动图融入他们的工作日。在 12 个月结束时，有 6 名提供者继续积极使用即时护理超声心动图。参与研究的患者认为这是一种可接受且有效的方法。他们还确定获得交通工具是获得超声心动图的一个显著挑战。在 12 个月的时间里，共有 639 名患者接受了筛查，其中 36 名（5.6%）有新的临床显著异常发现。
美国印第安结构性心脏病伙伴关系模型展示了一些有前途的策略，可以改善美国印第安人群的筛查超声心动图可及性。然而，印第安人健康服务提供者的时间竞争优先事项限制了将筛查超声心动图纳入门诊实践的程度。未来的努力应该探索基于社区的解决方案，以开发出更可持续、对病例检出、疾病管理和改善结果产生更大影响的模式。
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