Outcomes
The Project ECHO Model® is a proven tele-mentoring model that is designed to explicitly target PCPs, address health disparities, and improve patient outcomes. The model is also replacing traditional forms of continuing medical education and revolutionizing the approach to addressing diabetes disparities in the primary care setting. Over 500 peer-reviewed articles validating the model with data demonstrate that patients who received care from clinicians mentored using the ECHO methodology had outcomes as good or better than those treated at specialized referral hospitals, which has largely been credited to leveraging the patient‐centered medical home model.
Learn how the ECHO model is being used for diabetes to improve patient outcomes, develop clinic level quality improvement programs, change clinician practice in the primary care setting, and reduce healthcare costs in the Medicaid population:
PATIENT OUTCOMES
Improvements in Diabetes Care Outcome and Glycemic Assessment Status:
Targeting Rural Patients (New Mexico). Data from New Mexico demonstrate people with diabetes being treated with insulin and managed by primary care professionals participating in ECHO (N=856) show significant improvements in A1c (1.2% decrease) and were more likely than counterparts at the university diabetes specialty clinic (N=151) to transition from “uncontrolled” (A1c > 9%) to “controlled” (A1c < 8%) in glycemic assessment status.
CLINIC IMPROVEMENTS
Quality Improvement Program for Diabetes:
Project ECHO Diabetes programs in the states of California (Stanford University) and Florida (University of Florida Diabetes Institute) leveraged the ECHO model to demonstrate feasibility of how the ECHO model can be leveraged for diabetes quality improvement (QI) by aligning with the local priorities of community health centers. The 12-month QI program within Project ECHO Diabetes resulted in clinics making improvements in structural, process, and outcome measures. With collective knowledge from primary care clinics, professionals specialized in diabetes care, and experts in innovative and practical QI, strategies were developed and implemented in clinics serving under-resourced communities. Of the 31 QI initiatives attempted by different clinics, all were described as having either made improvements (25 initiatives, 80.6%) or in process of making improvements (6 initiatives, 19.4%) in structural, process, and outcome measures. Implementing QI initiatives under the ECHO model provides a less burdensome, inexpensive, and individualized approach for each clinic to achieve quality care based on their needs and priorities while allowing them to learn from other clinics at the same time.
CLINICIAN CHANGE
Improvements in Clinician Knowledge and Confidence in Managing Complex Diabetes in Primary Care:
Many ECHO program in the US have published reports describing the impact of the ECHO model on improving clinician knowledge and confidence in managing complex diabetes in the primary care setting. Findings from New Mexico demonstrated significant increases in self-efficacy around complex diabetes management in rural settings, increases in uptake of best practices, reduction in the need for referrals to specialists, and recognition of participating PCPs as local content experts.
Diabetes ECHOs in Washington, DC (George Washington University) and Chicago (ECHO Chicago), which targeted the urban population, similarly showed PCP increases in self-efficacy and knowledge. In DC, physician assistant students also demonstrated increased knowledge and confidence.
A collaborative led by Stanford University and the University of Florida Diabetes Institute demonstrated proof of concept that the ECHO model can attract interest from PCPs in a 6-month weekly program for T1D. Pre- and post-surveys demonstrated participants had significant improvement in diabetes knowledge (P ≤ .01) and diabetes confidence (P ≤ .01), with diabetes technology being the most cited change in practice.
Three unique diabetes ECHOs representing 4 regions (Chicago, Washington DC, New Mexico, and Washington State) evaluated comfort or perception of prescribing practice changes for community primary care clinicians. Self-reported prescription use for newer diabetes medications with cardiovascular indications increased significantly, as did the perceived likelihood of prescribing intensive insulin therapy. Primary care clinicians also were more likely to prescribe newer diabetes technology such as continuous glucose monitoring (CGM).
HEALTH PLAN OUTCOMES
Reduced Healthcare Spending and Lower Diabetes-Related Hospital Admissions:
Data from a diabetes-related Project ECHO program in New Jersey run by Rutgers University demonstrated the impact of primary care professional (PCP) participation in Project ECHO on the care of Medicaid enrollees with diabetes. Rutgers enrolled and trained over 50 PCPs (physicians, advanced practitioners, and pharmacists) in their “RWJMS EndoECHO Program,” which involved weekly 1-hour telementoring sessions between February 2017 and July 2018. Comparing utilization and spending between Medicaid patients seen by PCPs participating in a Project ECHO program to those of matched nonparticipating PCPs, participation in the Project ECHO was associated with decreases of 44% in inpatient admissions (P=0.001) and 62% in inpatient treatment spending (P= 0.021) relative to comparison patients.
PUBLICATIONS RELATED TO DIABETES ECHO PROGRAMMING
Bouchonville MF, Erhardt EB, Leyva YL, LARISSA Myaskovsky, Unruh ML, Arora S. 1029-P: Building Diabetes Care Capacity in Rural Underserved Communities—A Comparison of Cardiorenal Risk Factor Outcomes in Patients Treated by ECHO-Trained Providers vs. an Academic Medical Center. Diabetes. 20 June 2023; 72 (Supplement_1): 1029–P. https://doi.org/10.2337/db23-1029-P
Berry CA, Dávila Saad A, Blecker S, Billings J, Bouchonville MF, Arora S, Paul MM. Comparison of Care Provided to Underserved Patients With Diabetes by a Telementoring Model of Care to Care Provided by a Specialty Clinic: Endo ECHO Versus an Academic Specialty Clinic. Sci Diabetes Self Manag Care. 2023;49(3):239-246.
Bouchonville MF, Hager BW, Kirk JB, Qualls CR, Arora S. Endo ECHO Improves Primary Care Provider and Community Health Worker Self-Efficacy in Complex Diabetes Management in Medically Underserved Communities. Endocr Pract. 2018;24(1):40-46.
Paul MM, Saad AD, Billings J, Blecker S, Bouchonville MF, Chavez C, Hager BW, Arora S, Berry CA. A Telementoring Intervention Leads to Improvements in Self-Reported Measures of Health Care Access and Quality among Patients with Complex Diabetes. J Health Care Poor Underserved. 2020;31(3):1124-1133.
Wang CJ, Lewit EM, Clark CL, Lee FW, Maahs DM, Haller MJ, Addala A, Lal RA, Cuttriss N, Baer LG, Figg LE, Añez-Zabala C, Sheehan EP, Westen SC, Bernier AV, Donahoo WT, Walker AF. Multisite Quality Improvement Program Within the Project ECHO Diabetes Remote Network. Jt Comm J Qual Patient Saf. 2024;50(1):66-74.
Phelps M, Aldous A, Ehrhardt NM. 506-P: Project ECHO for diabetes improves physician assistant students’ knowledge and confidence for complex diabetes care. Diabetes. 2022;71(suppl 1):506-P.
Cuttriss N, Anez-Zabala C, Baer LG, Bernier A, Basina M, Filipp SL, Hood KK, Gurka MJ, Lal R, Haller MJ, Maahs DM, Hu H, Town M, Sheehan E, Wang CJ, Yabut K, Walker AF. 338-OR: Leveraging the Project ECHO Model for Type 1 Diabetes (T1D) in California and Florida: Democratizing Knowledge in Underserved T1D Communities. Diabetes. 2019;68(suppl 1):338-OR.
Walker AF, Cuttriss N, Haller MJ, Hood KK, Gurka MJ, Filipp SL, Anez-Zabala C, Yabut K, Roque X, Wong JJ, Baer L, Figg L, Bernier A, Westen S, Lewit E, Sheehan E, Basina M, Lal R, Maizel J, Maahs DM. Democratizing Type 1 Diabetes Specialty Care in the Primary Care Setting to Reduce Health Disparities: Project Extension for Community Healthcare Outcomes (ECHO) T1D. BMJ Open Diabetes Res Care. 2021;9(1):e002262.
Ehrhardt N, Thomas C, Zou T, Vasconcelos AG, Bouchonville M (2024). Project ECHO for Diabetes Improves Primary Care Providers’ Comfort With and Use of Diabetes Medications and Technology. American Diabetes Association. Figure. https://doi.org/10.2337/figshare.24945009.v1
Ehrhardt N, Thomas CC, Zou T, Vasconcelos AG, Bouchonville M. Project ECHO for Diabetes Improves Primary Care Providers’ Comfort With and Use of Diabetes Medications and Technology. Diabetes Spectr. 2024; ds230050. https://doi-org.ezproxy.bu.edu/10.2337/ds23-0050
Cantor JC, Chakravarty S, Farnham J, Nova J, Ahmad S, Flory JH. Impact of a Provider Tele-mentoring Learning Model on the Care of Medicaid-enrolled Patients With Diabetes. Med Care. 2022;60(7):481-487.