Describing implementation outcomes for a virtual community of practice: The ECHO Ontario Mental Health experience

Eva Serhal,Cheryl Pereira,Rosaria Armata,Sanjeev Sockalingam,Allison Crawford,Jenny Hardy

doi:10.1186/s12961-022-00818-1

Eva Serhal, Cheryl Pereira + Show 4 more

Open Access

https://doi.org/10.1186/s12961-022-00818-1

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Abstract

BackgroundProject ECHO is a virtual education model aimed at building capacity among healthcare providers to support optimal management for a range of health conditions. The expansion of the ECHO model, further amplified by the pandemic, has demonstrated an increased need to evaluate implementation success to ensure that interventions are implemented as planned. This study describes how Proctor et al.’s implementation outcomes (acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability) were adapted and used to assess the implementation of ECHO Ontario Mental Health (ECHO-ONMH), a mental health-focused capacity-building programme.MethodsUsing Proctor et al.’s implementation outcomes, the authors developed an implementation outcomes framework for ECHO-ONMH more generally. Using this, outcome measures and success thresholds were identified for each outcome for the ECHO-ONMH context, and then applied to evaluate the implementation of ECHO-ONMH using data from the first 4 years of the programme.ResultsAn ECHO-ONMH implementation outcomes framework was developed using Proctor’s implementation outcomes. ECHO-ONMH adapted implementation outcomes suggest that ECHO-ONMH was implemented successfully in all domains except for penetration, which only had participation from 13/14 regions. Acceptability, appropriateness and adoption success thresholds were surpassed for all 4 years, showing strong signs of sustainability. The programme was deemed feasible all 4 years and was found to be more cost-effective. ECHO-ONMH also showed high rates of fidelity to the ECHO model, and high rates of penetration.ConclusionsThis is the first study to use Proctor et al.’s implementation outcomes to describe implementation success for a virtual capacity-building model. The proposed ECHO implementation outcomes framework provides a base for similar interventions to evaluate implementation success, which is an important precursor to understanding learning, service or health outcomes related to the model. Additionally, these findings can act as a benchmark for other international ECHOs and educational programmes.

Highlights

Project Extension for Community Healthcare Outcomes (ECHO) is a virtual education model aimed at building capacity among healthcare providers to support optimal management for a range of health conditions
The international spread of the ECHO model was sparked by an influential study published by Project ECHO founder Dr Sanjeev Arora and colleagues in 2011, suggesting that in many cases, Primary care providers (PCP) supported by teleeducation and tele-mentoring via ECHO were able to provide care that led to equivalent or better outcomes when compared to specialist care for patients with hepatitis C [2]
Our study describes how Proctor et al.’s eight implementation outcomes were adapted to assess the implementation of an ECHO project, ECHO-ONMH, a virtual capacity-building programme implemented in Ontario, Canada

Summary

Introduction

Project ECHO is a virtual education model aimed at building capacity among healthcare providers to support optimal management for a range of health conditions. Project Extension for Community Healthcare Outcomes (ECHO®) is a mature and validated model of virtual education and capacity-building that has shown excellent spread and scale globally. It was developed at the University of New Mexico to address regional variances in Serhal et al Health Research Policy and Systems (2022) 20:17 access to specialty care, in particular improving access for people living in rural and remote underserved regions [1, 2]. Numerous studies have shown that ECHO expands PCP knowledge of best practices, increases self-efficacy and behaviour, and improves patient outcomes as well as cost-effectiveness [1, 7,8,9,10] several qualitative studies have suggested that ECHO programmes can serve to reduce providers’ feelings of isolation or help create a community of practice [11, 12]

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