This proposed study focuses on newborn screening for Critical Congenital Heart Disease (CCHD) using Pulse
Oximetry, which was added to the recommended uniform screening panel (RUSP) in 2011. Challenges often
face implementation of new medical screenings into the patient environment, in spite of proven effectiveness in
research. Low implementation levels of screening can greatly diminish outcomes for infants, as undiagnosed
CCHD can lead to greater mortality and morbidities, including developmental problems. Infants without CCHD
will also be affected by low implementation because incorrect screening procedures can lead to false positive
results, causing families to face anxiety and unnecessary costs for transport and further examination.
Currently, over 99% of U.S. newborns are born in states that have individually mandated CCHD screening in
the last 3 years, yet implementation levels in many states are low or unknown.
In the study’s first aim, barriers and facilitators in the current CCHD screening implementation will be assessed
through: (1) observation of CCHD screening practices at hospitals in the local area, (2) nationwide one-on-one
interviews among nurse managers in nursery units, and (3) nationwide surveys of nursery nurses. A systematic
assessment of multilevel implementation will be guided by the Consolidated Framework for Implementation
Research (CFIR), serving as an organizational construct. Results will help tailor interventions to improve
implementation. In order to estimate future implementation levels, the nurses’ survey will be conducted at two
time points (years three and five). For our second aim, we will use cost-effectiveness analysis (CEA). With
CEA, the difference in cost-effectiveness between current and future years will be calculated. Results will
determine whether diffusion (natural adoption of a technique over time) is enough to bring about desired levels
of implementation, or if investment is needed to accomplish desired levels of cost-effective interventions.
The Parent K01 is an important mechanism for reaching my career goal to become an independent
investigator in health services research. Support will allow me to extend my research acumen into my primary
focus of implementation science, from both a qualitative and quantitative approach. Up until this point, my
focus and practice has been clinical and quantitative. K01 provides me with training in skills I have not had time
or the opportunity to develop, including qualitative research interview methodologies, survey design and
administration, and cost-effectiveness analysis. I hold an Assistant Professor position at Los Angeles
Biomedical Research Institute, Harbor-UCLA Medical Center, with access to many resources at UCLA
Westwood, Charles R. Drew University, and RAND. Moreover, I have the support of an incredible team of
outstanding mentors from these UCLA-associated institutions. Research in implementation science and cost-
effectiveness analysis will drive my future career direction when I seek funding through an R01 mechanism.
