Skip to main content


Implementation and Scale-up of the American Indian Structural Heart Disease Partnership (IN-STEP)

Principal Investigators

Cincinnati Children’s Hospital Medical Center

  • Associate Professor, UC Department of Pediatrics

Cincinnati Children’s Hospital Medical Center

  • Assistant Professor, UC Department of Pediatrics

IN-STEP Project Aims

Aim 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 structural heart disease (SHD) outcomes.

Aim 1A: Utilize group-level assessment (GLA) to identify essential implementation elements of the IN-STEP program.

Aim 1B: Co-create the testable elements of IN-STEP to ensure the program is contextually and culturally relevant and tailored to the American Indian experience.

Aim 2: Utilize rapid interrupted time series experiments to refine and test implementation models of the IN-STEP program, within the WMA Tribal Division of Health Programs.

Hypothesis: The optimized implementation model delivered by CHR will improve SHD detection by at least 50% compared to facility-level detection and be acceptable, appropriate, and feasible.

Aim 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).

Hypothesis: The optimized IN-STEP CHR implementation model will increase SHD detection (new cases/10,000 per month) by at least 50% over the existing diagnosis models.