<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03296280</url>
  </required_header>
  <id_info>
    <org_study_id>PEX 16-003</org_study_id>
    <secondary_id>I50HX002263-01A1</secondary_id>
    <nct_id>NCT03296280</nct_id>
  </id_info>
  <brief_title>Evaluation of Implementation of a National Point-of-Care Ultrasound Training Program</brief_title>
  <official_title>Evaluation of Implementation of a National Point-of-Care Ultrasound Training Program</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>VA Office of Research and Development</agency>
      <agency_class>U.S. Fed</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>US Department of Veterans Affairs</agency>
      <agency_class>U.S. Fed</agency_class>
    </collaborator>
  </sponsors>
  <source>VA Office of Research and Development</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
    <is_us_export>No</is_us_export>
  </oversight_info>
  <brief_summary>
    <textblock>
      This VA QUERI Partnered Evaluation Initiative will evaluate the impact of an immersive&#xD;
      Point-of-care Ultrasound (POCUS) Training Course on provider skill acquisition and retention;&#xD;
      the frequency of POCUS use by trained providers; and the barriers/facilitators to POCUS in&#xD;
      the VHA. Data sources include pre- and post-course assessment tools, medical coding data, and&#xD;
      course evaluations. Providers that participate in the POCUS Training Course will be compared&#xD;
      to control providers from wait-listed facilities. Additionally, participating facilities vs.&#xD;
      wait-listed facilities for the POCUS Training Course will be compared. Findings from this&#xD;
      project will guide ongoing efforts of the investigators' operating partners, VA Specialty&#xD;
      Care Centers of Innovation (SCCI) and the VA Simulation Learning and Research Network&#xD;
      (SimLEARN), to develop a national POCUS training program and facilitate implementation of&#xD;
      POCUS use system-wide in the VA healthcare system.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Background: Point-of-care ultrasonography (POCUS) has been shown to reduce procedure-related&#xD;
      complications from invasive bedside procedures, reduce time to diagnosis, and reduce&#xD;
      ancillary testing, which ultimately reduces patient radiation exposure and healthcare costs.&#xD;
      Despite its potential advantages, POCUS has not been universally adopted in healthcare due to&#xD;
      limited numbers of providers trained in use of POCUS. The VA's Simulation Learning, Education&#xD;
      and Research Network (SimLEARN) and Specialty Care Centers of Innovation (SCCI) have launched&#xD;
      a collaborative initiative to develop a national POCUS training program. The goal of this&#xD;
      collaborative training program is to teach VA providers basic diagnostic and procedural&#xD;
      applications of POCUS. The proposed project will evaluate the effectiveness of an immersive&#xD;
      POCUS training course developed by SimLEARN on provider skill acquisition and retention,&#xD;
      frequency of use, and identify barriers/facilitators to POCUS use at participating VHA&#xD;
      facilities.&#xD;
&#xD;
      Methods: Approximately 120 participants from a convenience sample of 20 diverse VA facilities&#xD;
      will participate in a 2.5-day immersive POCUS training course at the SimLEARN National&#xD;
      Simulation Center in Orlando during fiscal year 2017. The investigators' evaluation plan will&#xD;
      collect data from facility Chiefs of Staff, providers from facilities participating in POCUS&#xD;
      training, and providers from wait-listed facilities at different time points using different&#xD;
      assessment tools: VA Facility POCUS Survey, Provider POCUS Survey, Brief Provider POCUS&#xD;
      Survey, Pre-/Post-course Knowledge and Skills Test, and Coding Data.&#xD;
&#xD;
      Objective 1: Evaluate provider skill acquisition and retention, and frequency of POCUS use&#xD;
      after participation in the POCUS Training Course. Pre- and post-course testing will be used&#xD;
      to assess acquisition of knowledge and technical skills to perform POCUS exams. Post-course&#xD;
      testing for knowledge and skill retention, and frequency of use, will be performed 6-9 months&#xD;
      after the training course.&#xD;
&#xD;
      Objective 2: Determine the effect of the POCUS Training Course and implementation&#xD;
      facilitation on facility-level frequency of POCUS use. Facilities with providers that&#xD;
      infrequently use POCUS will be eligible to participate in the POCUS Training Course. However,&#xD;
      not all facilities will be able to be accommodated in the 1st year of the training program,&#xD;
      requiring a facility waiting list. Facilities with providers participating in the POCUS&#xD;
      Training Course will be compared to wait-listed facilities with regard to frequency of POCUS&#xD;
      use. Using the Brief Provider POCUS Survey, frequency of POCUS use by providers in both&#xD;
      participating and waitlisted facilities will be compared. Additionally, coding data will be&#xD;
      reviewed to assess frequency of procedures performed with and without imaging guidance and&#xD;
      procedural complication rates comparing the two groups of facilities.&#xD;
&#xD;
      Objective 3: Determine provider and facility-level barriers and facilitators to POCUS use.&#xD;
      Provider and facility-level barriers will be assessed using 3 tools: Provider POCUS Survey&#xD;
      (trained providers), Brief Provider POCUS Survey (wait-listed and participating facilities),&#xD;
      and Facility POCUS Survey (all facilities). Differences in barriers reported and their&#xD;
      relationship to frequency of POCUS use will be compared.&#xD;
&#xD;
      Objective 4: Development of POCUS Champions course to facilitate local implementation by&#xD;
      addressing facility-level barriers. The POCUS Champions course will address several&#xD;
      facility-level barriers to implementation that have been identified by the PEI: lack of image&#xD;
      archiving, limited access to ultrasound machines, undefined credentialing/privileging&#xD;
      processes, need for a quality assurance process, and lack of trained providers. The POCUS&#xD;
      Champions course will include an annual 3-day boot camp, bi-monthly conference calls, and&#xD;
      ongoing mentorship. The goal of the 3-day boot camp will be for Champions to prepare a local&#xD;
      implementation plan that can be presented to their facility's leadership. During the&#xD;
      bimonthly conference calls, a brief didactic on a focused topic will be presented followed by&#xD;
      an update on local progress from each site. The initial goal of the POCUS Champions course is&#xD;
      to facilitate implementation of POCUS use in VA facilities, starting with 4-6 facilities that&#xD;
      can serve as models for other facilities. The research to date has identified these elements&#xD;
      as core components of a successful POCUS program. The POCUS Champions course will support&#xD;
      progress on intermediate milestones towards ensuring these core components are in place, to&#xD;
      facilitate adoption, reach, and sustainment. This provides a roadmap to sustainable POCUS&#xD;
      use.&#xD;
&#xD;
      Deliverables: The primary deliverable will be report that will summarize the effect of&#xD;
      training on provider skill acquisition and retention, frequency of use of POCUS, and barriers&#xD;
      and facilitators to POCUS implementation. This project will guide SimLEARN's and SCCI's&#xD;
      efforts to develop a National POCUS Training Program and implement POCUS use nationally in&#xD;
      the VA healthcare system. Additionally, this report may serve as a roadmap for the VHA for&#xD;
      implementation of similar simulation-based educational innovations.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">October 3, 2016</start_date>
  <completion_date type="Actual">September 30, 2020</completion_date>
  <primary_completion_date type="Actual">June 29, 2018</primary_completion_date>
  <study_type>Observational</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Cohort</observational_model>
    <time_perspective>Prospective</time_perspective>
  </study_design_info>
  <primary_outcome>
    <measure>Change in Frequency of Point-of-care Ultrasound Use for Diagnostic and Procedural Applications at Baseline and 6-9 Months</measure>
    <time_frame>Baseline compared to 6-9 months later.</time_frame>
    <description>Provider self-reported data pre- and post-intervention on frequency of point-of-care ultrasound use, based on number of exams per week.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Change in Point-of-care Ultrasound Knowledge From Baseline to 6-9 Months</measure>
    <time_frame>Baseline compared to 6-9 months later.</time_frame>
    <description>Provider knowledge will be tested pre- and post-intervention (at baseline [pre-course] and 6-9 months post-course). Knowledge Exam has a minimum of 0 points and a maximum of 30 points (1 pt per question). A higher score indicates more knowledge about POCUS. A positive change in score means a better outcome post-course (net increase in knowledge) compared to baseline.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Point-of-care Ultrasound Cardiac Skills From Baseline to 6-9 Months</measure>
    <time_frame>Baseline compared to 6-9 months later.</time_frame>
    <description>Provider hands-on cardiac skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Cardiac Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Point-of-care Ultrasound Lung Skills From Baseline to 6-9 Months</measure>
    <time_frame>Baseline compared to 6-9 months later.</time_frame>
    <description>Provider hands-on lung skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Lung Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Point-of-care Ultrasound Peripheral IV Skills From Baseline to 6-9 Months</measure>
    <time_frame>Baseline compared to 6-9 months later.</time_frame>
    <description>Provider hands-on peripheral IV skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Peripheral IV Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Point-of-care Ultrasound Abdominal Skills From Baseline to 6-9 Months</measure>
    <time_frame>Baseline compared to 6-9 months later.</time_frame>
    <description>Provider hands-on abdominal skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Abdominal Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Barrier to Point-of-care Ultrasound Use (Ability to Operate) From Baseline to 6-9 Months Post-Course</measure>
    <time_frame>Baseline compared to 6-9 months later.</time_frame>
    <description>Change in percentage of providers who reported not knowing how to operate POCUS 6-9 months post-course compared to pre-course. A positive percentage indicates a better outcome post-course.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Barriers to Point-of-care Ultrasound Use (Skill Maintenance) From Baseline to 6-9 Months Post-Course</measure>
    <time_frame>Baseline compared to 6-9 months later.</time_frame>
    <description>Change in percentage of providers who reported experiencing difficulty with maintaining POCUS skills pre-course compared to 6-9 months post-course. A positive percentage indicates more providers are experiencing this barrier post-course, which is not unexpected as more providers acquire POCUS skills.</description>
  </secondary_outcome>
  <number_of_groups>2</number_of_groups>
  <enrollment type="Actual">116</enrollment>
  <condition>Other Acute Illnesses Presenting to the Hospital</condition>
  <condition>Heart Failure</condition>
  <condition>Pneumonia</condition>
  <condition>Deep Venous Thrombosis</condition>
  <condition>Cellulitis</condition>
  <condition>Abdominal Aortic Aneurysm</condition>
  <condition>Acute Cholecystitis</condition>
  <condition>Peritoneal Free Fluid</condition>
  <condition>Hydronephrosis</condition>
  <condition>Pleural Effusion</condition>
  <condition>Urinary Retention</condition>
  <arm_group>
    <arm_group_label>Early Intervention</arm_group_label>
    <description>This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Late Intervention</arm_group_label>
    <description>This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17.</description>
  </arm_group>
  <eligibility>
    <study_pop>
      <textblock>
        VA physicians&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Non-Probability Sample</sampling_method>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
        Selection of VA facilities invited to participate in the national POCUS training course was&#xD;
        based on data from a national needs assessment conducted by the VA's Health Analysis and&#xD;
        Information Group. VA facilities that meet all of the following inclusion criteria are&#xD;
        eligible to send physicians to participate in the POCUS training course:&#xD;
&#xD;
          1. Chief of staff desires POCUS training for his/her facility&#xD;
&#xD;
          2. &gt;=2 Service Chiefs from emergency medicine, critical care medicine, or hospital&#xD;
             medicine desire training for his/her physicians, AND&#xD;
&#xD;
          3. &gt;=1 portable ultrasound machine(s) available to physicians within these services&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          1. Chief of staff does not desire POCUS training for his/her facility&#xD;
&#xD;
          2. &lt;2 Service Chiefs from emergency medicine, critical care medicine, or hospital&#xD;
             medicine desire training for his/her physicians, OR&#xD;
&#xD;
          3. No portable ultrasound machine(s) available to physicians within these services&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>N/A</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Nilam Jayant Soni, MD MSc</last_name>
    <role>Principal Investigator</role>
    <affiliation>South Texas Health Care System, San Antonio, TX</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>South Texas Health Care System, San Antonio, TX</name>
      <address>
        <city>San Antonio</city>
        <state>Texas</state>
        <zip>78229</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <link>
    <url>https://www.queri.research.va.gov/national_partnered_evaluations/ultrasound.cfm</url>
    <description>VA Quality Enhancemen Research Initiative (QUERI)</description>
  </link>
  <verification_date>November 2020</verification_date>
  <study_first_submitted>September 19, 2017</study_first_submitted>
  <study_first_submitted_qc>September 22, 2017</study_first_submitted_qc>
  <study_first_posted type="Actual">September 28, 2017</study_first_posted>
  <results_first_submitted>August 13, 2019</results_first_submitted>
  <results_first_submitted_qc>March 5, 2020</results_first_submitted_qc>
  <results_first_posted type="Actual">March 11, 2020</results_first_posted>
  <last_update_submitted>November 5, 2020</last_update_submitted>
  <last_update_submitted_qc>November 5, 2020</last_update_submitted_qc>
  <last_update_posted type="Actual">November 23, 2020</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>ultrasound</keyword>
  <keyword>ultrasonography</keyword>
  <keyword>point of care</keyword>
  <keyword>Doppler ultrasound</keyword>
  <keyword>ultrasound imaging</keyword>
  <keyword>diagnostic ultrasound</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Cellulitis</mesh_term>
    <mesh_term>Cholecystitis</mesh_term>
    <mesh_term>Cholecystitis, Acute</mesh_term>
    <mesh_term>Pleural Effusion</mesh_term>
    <mesh_term>Urinary Retention</mesh_term>
    <mesh_term>Hydronephrosis</mesh_term>
    <mesh_term>Thrombosis</mesh_term>
    <mesh_term>Aortic Aneurysm</mesh_term>
    <mesh_term>Aortic Aneurysm, Abdominal</mesh_term>
    <mesh_term>Venous Thrombosis</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <provided_document_section>
    <provided_document>
      <document_type>Study Protocol and Statistical Analysis Plan</document_type>
      <document_has_protocol>Yes</document_has_protocol>
      <document_has_icf>No</document_has_icf>
      <document_has_sap>Yes</document_has_sap>
      <document_date>September 9, 2016</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/80/NCT03296280/Prot_SAP_000.pdf</document_url>
    </provided_document>
  </provided_document_section>

  <clinical_results>

    <participant_flow>
      <recruitment_details>10 facilities were to participate in the first 6 POCUS course session during FY17. 10 facilities were to participate in the last 6 POCUS course sessions during FY17. Participants, rather than facilities, were recruited and assigned to to the early or late intervention arms.</recruitment_details>
      <group_list>
        <group group_id="P1">
          <title>Early Intervention</title>
          <description>This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17. Although facilities are being recruited the intervention is taking place at the individual level. All reporting will be at the individual level.</description>
        </group>
        <group group_id="P2">
          <title>Late Intervention</title>
          <description>This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17. Although facilities are being recruited the intervention is taking place at the individual level. All reporting will be at the individual level.</description>
        </group>
      </group_list>
      <period_list>
        <period>
          <title>Overall Study</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="73"/>
                <participants group_id="P2" count="43"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="67"/>
                <participants group_id="P2" count="36"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="6"/>
                <participants group_id="P2" count="7"/>
              </participants_list>
            </milestone>
          </milestone_list>
        </period>
      </period_list>
    </participant_flow>

    <baseline>
      <group_list>
        <group group_id="B1">
          <title>Early Intervention</title>
          <description>This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17</description>
        </group>
        <group group_id="B2">
          <title>Late Intervention</title>
          <description>This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17.</description>
        </group>
        <group group_id="B3">
          <title>Total</title>
          <description>Total of all reporting groups</description>
        </group>
      </group_list>
      <analyzed_list>
        <analyzed>
          <units>Participants</units>
          <scope>Overall</scope>
          <count_list>
            <count group_id="B1" value="73"/>
            <count group_id="B2" value="43"/>
            <count group_id="B3" value="116"/>
          </count_list>
        </analyzed>
      </analyzed_list>
      <measure_list>
        <measure>
          <title>Age</title>
          <population>Row populations differs from Overall because age was self-reported through an online survey and was not answered by all participants.</population>
          <units>years</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <class_list>
            <class>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="70"/>
                    <count group_id="B2" value="39"/>
                    <count group_id="B3" value="109"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="45.7" spread="10.6"/>
                    <measurement group_id="B2" value="43.5" spread="7.7"/>
                    <measurement group_id="B3" value="44.9" spread="9.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Sex: Female, Male</title>
          <population>Row populations differs from Overall because sex was self-reported through an online survey and was not answered by all participants.</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="70"/>
                    <count group_id="B2" value="39"/>
                    <count group_id="B3" value="109"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <title>Female</title>
                  <measurement_list>
                    <measurement group_id="B1" value="27"/>
                    <measurement group_id="B2" value="18"/>
                    <measurement group_id="B3" value="45"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Male</title>
                  <measurement_list>
                    <measurement group_id="B1" value="43"/>
                    <measurement group_id="B2" value="21"/>
                    <measurement group_id="B3" value="64"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Race and Ethnicity Not Collected</title>
          <population>Race and Ethnicity were not collected from any participant.</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="0"/>
                    <count group_id="B2" value="0"/>
                    <count group_id="B3" value="0"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B3" value="0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Provider Specialty</title>
          <population>Row populations differs from Overall because provider specialty was self-reported through an online survey and was not answered by all participants.</population>
          <units>participants</units>
          <param>Number</param>
          <class_list>
            <class>
              <title>Anesthesiology</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="70"/>
                    <count group_id="B2" value="39"/>
                    <count group_id="B3" value="109"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="6"/>
                    <measurement group_id="B2" value="7"/>
                    <measurement group_id="B3" value="13"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Critical Care</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="70"/>
                    <count group_id="B2" value="39"/>
                    <count group_id="B3" value="109"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="10"/>
                    <measurement group_id="B2" value="8"/>
                    <measurement group_id="B3" value="18"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Emergency Medicine</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="70"/>
                    <count group_id="B2" value="39"/>
                    <count group_id="B3" value="109"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="13"/>
                    <measurement group_id="B2" value="9"/>
                    <measurement group_id="B3" value="22"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Endocrinology</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="70"/>
                    <count group_id="B2" value="39"/>
                    <count group_id="B3" value="109"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="1"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>General Surgery</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="70"/>
                    <count group_id="B2" value="39"/>
                    <count group_id="B3" value="109"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="3"/>
                    <measurement group_id="B3" value="3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Internal Medicine</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="70"/>
                    <count group_id="B2" value="39"/>
                    <count group_id="B3" value="109"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="31"/>
                    <measurement group_id="B2" value="10"/>
                    <measurement group_id="B3" value="41"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Pulmonary</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="70"/>
                    <count group_id="B2" value="39"/>
                    <count group_id="B3" value="109"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="8"/>
                    <measurement group_id="B2" value="2"/>
                    <measurement group_id="B3" value="10"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Other</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="70"/>
                    <count group_id="B2" value="39"/>
                    <count group_id="B3" value="109"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="1"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Facility Location</title>
          <units>participants</units>
          <param>Number</param>
          <class_list>
            <class>
              <title>Continental</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="73"/>
                    <count group_id="B2" value="43"/>
                    <count group_id="B3" value="116"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="13"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="13"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Midwest</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="73"/>
                    <count group_id="B2" value="43"/>
                    <count group_id="B3" value="116"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="11"/>
                    <measurement group_id="B2" value="4"/>
                    <measurement group_id="B3" value="15"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Northeast</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="73"/>
                    <count group_id="B2" value="43"/>
                    <count group_id="B3" value="116"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="8"/>
                    <measurement group_id="B2" value="12"/>
                    <measurement group_id="B3" value="20"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Pacific</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="73"/>
                    <count group_id="B2" value="43"/>
                    <count group_id="B3" value="116"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="11"/>
                    <measurement group_id="B2" value="11"/>
                    <measurement group_id="B3" value="22"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Southeast</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="73"/>
                    <count group_id="B2" value="43"/>
                    <count group_id="B3" value="116"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="30"/>
                    <measurement group_id="B2" value="16"/>
                    <measurement group_id="B3" value="46"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Years of practice since residency</title>
          <population>Row populations differs from Overall because years since residency was self-reported through an online survey and was not answered by all participants.</population>
          <units>years</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <class_list>
            <class>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="70"/>
                    <count group_id="B2" value="39"/>
                    <count group_id="B3" value="109"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="14.8" spread="10.4"/>
                    <measurement group_id="B2" value="11.5" spread="6.9"/>
                    <measurement group_id="B3" value="13.6" spread="9.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Percent of time performing direct patient care</title>
          <population>Row populations differs from Overall because percent of time performing direct patient care was self-reported through an online survey and was not answered by all participants.</population>
          <units>% of time performing direct pt care</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <class_list>
            <class>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="B1" value="70"/>
                    <count group_id="B2" value="39"/>
                    <count group_id="B3" value="109"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="57" spread="30"/>
                    <measurement group_id="B2" value="58" spread="23"/>
                    <measurement group_id="B3" value="57" spread="28"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </measure_list>
    </baseline>

    <outcome_list>
      <outcome>
        <type>Primary</type>
        <title>Change in Frequency of Point-of-care Ultrasound Use for Diagnostic and Procedural Applications at Baseline and 6-9 Months</title>
        <description>Provider self-reported data pre- and post-intervention on frequency of point-of-care ultrasound use, based on number of exams per week.</description>
        <time_frame>Baseline compared to 6-9 months later.</time_frame>
        <population>Participants who completed a provider survey both at the start and about 6-9 months later</population>
        <group_list>
          <group group_id="O1">
            <title>Early Intervention</title>
            <description>This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17</description>
          </group>
          <group group_id="O2">
            <title>Late Intervention</title>
            <description>This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17.</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Frequency of Point-of-care Ultrasound Use for Diagnostic and Procedural Applications at Baseline and 6-9 Months</title>
          <description>Provider self-reported data pre- and post-intervention on frequency of point-of-care ultrasound use, based on number of exams per week.</description>
          <population>Participants who completed a provider survey both at the start and about 6-9 months later</population>
          <units>Number of POCUS Exams/week</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="62"/>
                <count group_id="O2" value="33"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="12.9" lower_limit="4.5" upper_limit="21.3"/>
                    <measurement group_id="O2" value="4.0" lower_limit="1" upper_limit="7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Point-of-care Ultrasound Knowledge From Baseline to 6-9 Months</title>
        <description>Provider knowledge will be tested pre- and post-intervention (at baseline [pre-course] and 6-9 months post-course). Knowledge Exam has a minimum of 0 points and a maximum of 30 points (1 pt per question). A higher score indicates more knowledge about POCUS. A positive change in score means a better outcome post-course (net increase in knowledge) compared to baseline.</description>
        <time_frame>Baseline compared to 6-9 months later.</time_frame>
        <population>Participants who completed a knowledge survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts.</population>
        <group_list>
          <group group_id="O1">
            <title>Early Intervention</title>
            <description>This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17</description>
          </group>
          <group group_id="O2">
            <title>Late Intervention</title>
            <description>This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17.</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Point-of-care Ultrasound Knowledge From Baseline to 6-9 Months</title>
          <description>Provider knowledge will be tested pre- and post-intervention (at baseline [pre-course] and 6-9 months post-course). Knowledge Exam has a minimum of 0 points and a maximum of 30 points (1 pt per question). A higher score indicates more knowledge about POCUS. A positive change in score means a better outcome post-course (net increase in knowledge) compared to baseline.</description>
          <population>Participants who completed a knowledge survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts.</population>
          <units>change in score on POCUS Knowledge scale</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="57"/>
                <count group_id="O2" value="27"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5.3" lower_limit="4.4" upper_limit="6.2"/>
                    <measurement group_id="O2" value="6.5" lower_limit="4.4" upper_limit="8.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Point-of-care Ultrasound Cardiac Skills From Baseline to 6-9 Months</title>
        <description>Provider hands-on cardiac skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Cardiac Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.</description>
        <time_frame>Baseline compared to 6-9 months later.</time_frame>
        <population>Participants who completed a skills survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts.</population>
        <group_list>
          <group group_id="O1">
            <title>Early Intervention</title>
            <description>This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17</description>
          </group>
          <group group_id="O2">
            <title>Late Intervention</title>
            <description>This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17.</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Point-of-care Ultrasound Cardiac Skills From Baseline to 6-9 Months</title>
          <description>Provider hands-on cardiac skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Cardiac Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.</description>
          <population>Participants who completed a skills survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts.</population>
          <units>change in score on Cardiac Skills scale</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="58"/>
                <count group_id="O2" value="23"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="41.6" lower_limit="35.2" upper_limit="48.0"/>
                    <measurement group_id="O2" value="46.1" lower_limit="35.6" upper_limit="56.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Point-of-care Ultrasound Lung Skills From Baseline to 6-9 Months</title>
        <description>Provider hands-on lung skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Lung Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.</description>
        <time_frame>Baseline compared to 6-9 months later.</time_frame>
        <population>Participants who completed a skills survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts.</population>
        <group_list>
          <group group_id="O1">
            <title>Early Intervention</title>
            <description>This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17</description>
          </group>
          <group group_id="O2">
            <title>Late Intervention</title>
            <description>This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17.</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Point-of-care Ultrasound Lung Skills From Baseline to 6-9 Months</title>
          <description>Provider hands-on lung skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Lung Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.</description>
          <population>Participants who completed a skills survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts.</population>
          <units>change in score on Lung Skills scale</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="58"/>
                <count group_id="O2" value="24"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="49.2" lower_limit="43.4" upper_limit="55.0"/>
                    <measurement group_id="O2" value="60.5" lower_limit="50.8" upper_limit="70.3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Point-of-care Ultrasound Peripheral IV Skills From Baseline to 6-9 Months</title>
        <description>Provider hands-on peripheral IV skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Peripheral IV Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.</description>
        <time_frame>Baseline compared to 6-9 months later.</time_frame>
        <population>Participants who completed a skills survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts.</population>
        <group_list>
          <group group_id="O1">
            <title>Early Intervention</title>
            <description>This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17</description>
          </group>
          <group group_id="O2">
            <title>Late Intervention</title>
            <description>This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17.</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Point-of-care Ultrasound Peripheral IV Skills From Baseline to 6-9 Months</title>
          <description>Provider hands-on peripheral IV skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Peripheral IV Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.</description>
          <population>Participants who completed a skills survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts.</population>
          <units>change in score on Peri-IV Skills scale</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="54"/>
                <count group_id="O2" value="21"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="31.6" lower_limit="24.7" upper_limit="38.6"/>
                    <measurement group_id="O2" value="40.5" lower_limit="26.1" upper_limit="54.9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Point-of-care Ultrasound Abdominal Skills From Baseline to 6-9 Months</title>
        <description>Provider hands-on abdominal skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Abdominal Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.</description>
        <time_frame>Baseline compared to 6-9 months later.</time_frame>
        <population>Participants who completed a skills survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts.</population>
        <group_list>
          <group group_id="O1">
            <title>Early Intervention</title>
            <description>This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17</description>
          </group>
          <group group_id="O2">
            <title>Late Intervention</title>
            <description>This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17.</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Point-of-care Ultrasound Abdominal Skills From Baseline to 6-9 Months</title>
          <description>Provider hands-on abdominal skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Abdominal Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.</description>
          <population>Participants who completed a skills survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts.</population>
          <units>change in score on Abdom Skills scale</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="58"/>
                <count group_id="O2" value="24"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="40.8" lower_limit="34.1" upper_limit="47.5"/>
                    <measurement group_id="O2" value="54.8" lower_limit="44.7" upper_limit="65.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Barrier to Point-of-care Ultrasound Use (Ability to Operate) From Baseline to 6-9 Months Post-Course</title>
        <description>Change in percentage of providers who reported not knowing how to operate POCUS 6-9 months post-course compared to pre-course. A positive percentage indicates a better outcome post-course.</description>
        <time_frame>Baseline compared to 6-9 months later.</time_frame>
        <population>Participants who reported not knowing how to use POCUS machine in survey at the beginning of the course</population>
        <group_list>
          <group group_id="O1">
            <title>Early Intervention</title>
            <description>This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17</description>
          </group>
          <group group_id="O2">
            <title>Late Intervention</title>
            <description>This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17.</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Barrier to Point-of-care Ultrasound Use (Ability to Operate) From Baseline to 6-9 Months Post-Course</title>
          <description>Change in percentage of providers who reported not knowing how to operate POCUS 6-9 months post-course compared to pre-course. A positive percentage indicates a better outcome post-course.</description>
          <population>Participants who reported not knowing how to use POCUS machine in survey at the beginning of the course</population>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="22"/>
                <count group_id="O2" value="9"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="68"/>
                    <measurement group_id="O2" value="67"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Barriers to Point-of-care Ultrasound Use (Skill Maintenance) From Baseline to 6-9 Months Post-Course</title>
        <description>Change in percentage of providers who reported experiencing difficulty with maintaining POCUS skills pre-course compared to 6-9 months post-course. A positive percentage indicates more providers are experiencing this barrier post-course, which is not unexpected as more providers acquire POCUS skills.</description>
        <time_frame>Baseline compared to 6-9 months later.</time_frame>
        <population>Participants who reported at least one barrier 6-9 months after course</population>
        <group_list>
          <group group_id="O1">
            <title>Early Intervention</title>
            <description>This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17</description>
          </group>
          <group group_id="O2">
            <title>Late Intervention</title>
            <description>This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17.</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Barriers to Point-of-care Ultrasound Use (Skill Maintenance) From Baseline to 6-9 Months Post-Course</title>
          <description>Change in percentage of providers who reported experiencing difficulty with maintaining POCUS skills pre-course compared to 6-9 months post-course. A positive percentage indicates more providers are experiencing this barrier post-course, which is not unexpected as more providers acquire POCUS skills.</description>
          <population>Participants who reported at least one barrier 6-9 months after course</population>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="19"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="23"/>
                    <measurement group_id="O2" value="37"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
    </outcome_list>

    <reported_events>
      <time_frame>Adverse events were not monitored. Not applicable.</time_frame>
      <desc>Adverse events were not monitored. Not applicable.</desc>
      <group_list>
        <group group_id="E1">
          <title>Early Intervention</title>
          <description>This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17</description>
        </group>
        <group group_id="E2">
          <title>Late Intervention</title>
          <description>This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17.</description>
        </group>
      </group_list>
      <serious_events>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, all-cause mortality</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="0"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="0"/>
              </event>
              <event>
                <sub_title>Total, serious adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="0"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="0"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </serious_events>
      <other_events>
        <frequency_threshold>0</frequency_threshold>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, other adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="0"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="0"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </other_events>
    </reported_events>

    <certain_agreements>
      <pi_employee>All Principal Investigators ARE employed by the organization sponsoring the study.</pi_employee>
      <restrictive_agreement>There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed. </restrictive_agreement>
    </certain_agreements>
    <limitations_and_caveats>Maintaining early or late intervention groups due to schedules/space limitations.&#xD;
Equipment not readily available and inability to receive IT approvals limited follow-up scheduling.&#xD;
Participants with limited clinical time may skew scores.</limitations_and_caveats>
    <point_of_contact>
      <name_or_title>Nilam Soni</name_or_title>
      <organization>South Texas Veterans Health Care System / UT Health San Antonio</organization>
      <phone>210-949-9454</phone>
      <email>sonin@uthscsa.edu</email>
    </point_of_contact>
  </clinical_results>
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03296280
org study id: PEX 16-003
secondary id: I50HX002263-01A1
nct id: NCT03296280
lead sponsor: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
is us export: No
This VA QUERI Partnered Evaluation Initiative will evaluate the impact of an immersive
      Point-of-care Ultrasound (POCUS) Training Course on provider skill acquisition and retention;
      the frequency of POCUS use by trained providers; and the barriers/facilitators to POCUS in
      the VHA. Data sources include pre- and post-course assessment tools, medical coding data, and
      course evaluations. Providers that participate in the POCUS Training Course will be compared
      to control providers from wait-listed facilities. Additionally, participating facilities vs.
      wait-listed facilities for the POCUS Training Course will be compared. Findings from this
      project will guide ongoing efforts of the investigators' operating partners, VA Specialty
      Care Centers of Innovation (SCCI) and the VA Simulation Learning and Research Network
      (SimLEARN), to develop a national POCUS training program and facilitate implementation of
      POCUS use system-wide in the VA healthcare system.
Background: Point-of-care ultrasonography (POCUS) has been shown to reduce procedure-related
      complications from invasive bedside procedures, reduce time to diagnosis, and reduce
      ancillary testing, which ultimately reduces patient radiation exposure and healthcare costs.
      Despite its potential advantages, POCUS has not been universally adopted in healthcare due to
      limited numbers of providers trained in use of POCUS. The VA's Simulation Learning, Education
      and Research Network (SimLEARN) and Specialty Care Centers of Innovation (SCCI) have launched
      a collaborative initiative to develop a national POCUS training program. The goal of this
      collaborative training program is to teach VA providers basic diagnostic and procedural
      applications of POCUS. The proposed project will evaluate the effectiveness of an immersive
      POCUS training course developed by SimLEARN on provider skill acquisition and retention,
      frequency of use, and identify barriers/facilitators to POCUS use at participating VHA
      facilities.

      Methods: Approximately 120 participants from a convenience sample of 20 diverse VA facilities
      will participate in a 2.5-day immersive POCUS training course at the SimLEARN National
      Simulation Center in Orlando during fiscal year 2017. The investigators' evaluation plan will
      collect data from facility Chiefs of Staff, providers from facilities participating in POCUS
      training, and providers from wait-listed facilities at different time points using different
      assessment tools: VA Facility POCUS Survey, Provider POCUS Survey, Brief Provider POCUS
      Survey, Pre-/Post-course Knowledge and Skills Test, and Coding Data.

      Objective 1: Evaluate provider skill acquisition and retention, and frequency of POCUS use
      after participation in the POCUS Training Course. Pre- and post-course testing will be used
      to assess acquisition of knowledge and technical skills to perform POCUS exams. Post-course
      testing for knowledge and skill retention, and frequency of use, will be performed 6-9 months
      after the training course.

      Objective 2: Determine the effect of the POCUS Training Course and implementation
      facilitation on facility-level frequency of POCUS use. Facilities with providers that
      infrequently use POCUS will be eligible to participate in the POCUS Training Course. However,
      not all facilities will be able to be accommodated in the 1st year of the training program,
      requiring a facility waiting list. Facilities with providers participating in the POCUS
      Training Course will be compared to wait-listed facilities with regard to frequency of POCUS
      use. Using the Brief Provider POCUS Survey, frequency of POCUS use by providers in both
      participating and waitlisted facilities will be compared. Additionally, coding data will be
      reviewed to assess frequency of procedures performed with and without imaging guidance and
      procedural complication rates comparing the two groups of facilities.

      Objective 3: Determine provider and facility-level barriers and facilitators to POCUS use.
      Provider and facility-level barriers will be assessed using 3 tools: Provider POCUS Survey
      (trained providers), Brief Provider POCUS Survey (wait-listed and participating facilities),
      and Facility POCUS Survey (all facilities). Differences in barriers reported and their
      relationship to frequency of POCUS use will be compared.

      Objective 4: Development of POCUS Champions course to facilitate local implementation by
      addressing facility-level barriers. The POCUS Champions course will address several
      facility-level barriers to implementation that have been identified by the PEI: lack of image
      archiving, limited access to ultrasound machines, undefined credentialing/privileging
      processes, need for a quality assurance process, and lack of trained providers. The POCUS
      Champions course will include an annual 3-day boot camp, bi-monthly conference calls, and
      ongoing mentorship. The goal of the 3-day boot camp will be for Champions to prepare a local
      implementation plan that can be presented to their facility's leadership. During the
      bimonthly conference calls, a brief didactic on a focused topic will be presented followed by
      an update on local progress from each site. The initial goal of the POCUS Champions course is
      to facilitate implementation of POCUS use in VA facilities, starting with 4-6 facilities that
      can serve as models for other facilities. The research to date has identified these elements
      as core components of a successful POCUS program. The POCUS Champions course will support
      progress on intermediate milestones towards ensuring these core components are in place, to
      facilitate adoption, reach, and sustainment. This provides a roadmap to sustainable POCUS
      use.

      Deliverables: The primary deliverable will be report that will summarize the effect of
      training on provider skill acquisition and retention, frequency of use of POCUS, and barriers
      and facilitators to POCUS implementation. This project will guide SimLEARN's and SCCI's
      efforts to develop a National POCUS Training Program and implement POCUS use nationally in
      the VA healthcare system. Additionally, this report may serve as a roadmap for the VHA for
      implementation of similar simulation-based educational innovations.
observational model: Cohort
time perspective: Prospective
measure: Change in Frequency of Point-of-care Ultrasound Use for Diagnostic and Procedural Applications at Baseline and 6-9 Months
time frame: Baseline compared to 6-9 months later.
description: Provider self-reported data pre- and post-intervention on frequency of point-of-care ultrasound use, based on number of exams per week.
measure: Change in Point-of-care Ultrasound Knowledge From Baseline to 6-9 Months
time frame: Baseline compared to 6-9 months later.
description: Provider knowledge will be tested pre- and post-intervention (at baseline [pre-course] and 6-9 months post-course). Knowledge Exam has a minimum of 0 points and a maximum of 30 points (1 pt per question). A higher score indicates more knowledge about POCUS. A positive change in score means a better outcome post-course (net increase in knowledge) compared to baseline.
measure: Change in Point-of-care Ultrasound Cardiac Skills From Baseline to 6-9 Months
time frame: Baseline compared to 6-9 months later.
description: Provider hands-on cardiac skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Cardiac Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.
measure: Change in Point-of-care Ultrasound Lung Skills From Baseline to 6-9 Months
time frame: Baseline compared to 6-9 months later.
description: Provider hands-on lung skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Lung Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.
measure: Change in Point-of-care Ultrasound Peripheral IV Skills From Baseline to 6-9 Months
time frame: Baseline compared to 6-9 months later.
description: Provider hands-on peripheral IV skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Peripheral IV Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.
measure: Change in Point-of-care Ultrasound Abdominal Skills From Baseline to 6-9 Months
time frame: Baseline compared to 6-9 months later.
description: Provider hands-on abdominal skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Abdominal Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline.
measure: Change in Barrier to Point-of-care Ultrasound Use (Ability to Operate) From Baseline to 6-9 Months Post-Course
time frame: Baseline compared to 6-9 months later.
description: Change in percentage of providers who reported not knowing how to operate POCUS 6-9 months post-course compared to pre-course. A positive percentage indicates a better outcome post-course.
measure: Change in Barriers to Point-of-care Ultrasound Use (Skill Maintenance) From Baseline to 6-9 Months Post-Course
time frame: Baseline compared to 6-9 months later.
description: Change in percentage of providers who reported experiencing difficulty with maintaining POCUS skills pre-course compared to 6-9 months post-course. A positive percentage indicates more providers are experiencing this barrier post-course, which is not unexpected as more providers acquire POCUS skills.
arm group label: Early Intervention
description: This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17
arm group label: Late Intervention
description: This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17.
study pop: 
sampling method: Non-Probability Sample
criteria: 
gender: All
minimum age: N/A
maximum age: N/A
healthy volunteers: Accepts Healthy Volunteers
last name: Nilam Jayant Soni, MD MSc
role: Principal Investigator
affiliation: South Texas Health Care System, San Antonio, TX
facility: 
country: United States
url: https://www.queri.research.va.gov/national_partnered_evaluations/ultrasound.cfm
description: VA Quality Enhancemen Research Initiative (QUERI)
responsible party type: Sponsor
mesh term: Cellulitis
mesh term: Cholecystitis
mesh term: Cholecystitis, Acute
mesh term: Pleural Effusion
mesh term: Urinary Retention
mesh term: Hydronephrosis
mesh term: Thrombosis
mesh term: Aortic Aneurysm
mesh term: Aortic Aneurysm, Abdominal
mesh term: Venous Thrombosis
sharing ipd: No
provided document: 
participant flow: 
baseline: 
outcome list: 
reported events: 
certain agreements: 
limitations and caveats: Maintaining early or late intervention groups due to schedules/space limitations.
Equipment not readily available and inability to receive IT approvals limited follow-up scheduling.
Participants with limited clinical time may skew scores.
point of contact: 