Project ECHO Research Articles

Diabetes On Track: Redesigning Diabetes Management in Rural Primary Care

OBJECTIVE Diabetes remains an intractable public health problem, particularly in rural communities. The Diabetes On Track initiative returns control of designing and implementing strategies to improve diabetes care delivery systems to the local clinics and community partners. This article reports on protocol development and the first 18 months of the Diabetes On Track project within the health care setting. RESEARCH DESIGN AND METHODS Using a rapid-cycling quality improvement approach, the research team partnered with two rural clinics. Clinics completed a strengths and needs assessment before being offered a menu of possible strategies to implement. Clinics worked with the research team to implement, refine, and adapt these initial interventions and develop further strategies based on local data that were continually collected and shared. Six core indicators were established as primary outcome measures. Process measures were established based on the strategies chosen. RESULTS Both clinics decided to create a registered nurse health coach position to provide diabetes education to individuals with or at risk for developing diabetes. Both clinics also chose to implement a physician dashboard highlighting diabetes-related indicators so clinicians could track panel improvement over time. Other interventions included using a prediabetes outreach list and taking advantage of professional development opportunities, including a diabetes-focused Project ECHO series. CONCLUSION Improving diabetes care in rural communities is a challenge, and novel solutions are needed, with a focus on sustainability. The Diabetes On Track initiative is showing promising results, allowing primary care clinics to use community knowledge and data to redesign effective diabetes care delivery systems.

Exploring Suggestions from Educational Leaders and ChatGPT for Addressing Problems of Practice in TeleED

Educational leaders are faced with multi-faceted dilemmas that place decision-making at the heart of their day-to-day work. For support, they often turn to collaborative networks of experienced educators, such as Project ECHO, for solutions to address challenges they encounter while working in the field. The availability of generative AI technology, however, may have potential for informing the solutions to complex educational dilemmas as well, saving time and offering efficiency for problem solving. This study compares solutions for three problems of practice (PoP) that were generated through ChatGPT software and those proposed by the educational leaders in TeleED, an online professional development platform. The problem of practice in this study refers to complex, real-world challenges or problems shared by educational leaders. Findings indicate that solutions to these PoPs showed similarities, suggesting that both ChatGPT and the educational leaders in TeleED highlight ideas such as documentation and peer mentoring to address challenges. This reflects ChatGPT’s ability to generate applicable solutions to complex problems that somewhat mirror solutions posed by leaders. However, educational leaders offered solutions that were nuanced, context specific, and contained explanations of resources and experiences that enhanced discussions. Findings suggest that ChatGPT may have utility for enhancing decision-making but not replacing the human element.

Six years of Project ECHO: Implementation and evaluation of a hospice-led multiprofessional education programme.

Objectives: This article reports on the implementation and evaluation of an established technology-enabled collaborative learning programme (Project ECHO) at an independent UK hospice in the North of England over a 6-year period. Methods: An independent audit of collated, anonymised data from the programme is used to report attendance patterns and session evaluations. Results: The results show a gradual increase in attendances, programmes, sessions and hours of education, coupled with consistently positive evaluation reports. Conclusion: This supports existing evidence that Project ECHO is an effective method of delivering remote healthcare education, demonstrating impact on the first three levels of Moore's education framework; participation, satisfaction and learning. Future expansion in terms of geography and topics covered is proposed, alongside enhanced evaluation methods to demonstrate impact at the higher levels of Moore's framework.

The Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program implementation strategy for expanding treatment for hospitalized adults with opioid use disorder

IntroductionIn 2017, we launched the “B-Team” (buprenorphine team), the first hospitalist-led opioid use disorder (OUD) treatment program in Texas. Based on initial success, we obtained funding from Texas Health & Human Services to expand the model to other hospitals in Texas through the Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program. MethodsThis is a mixed methods study of the implementation of the SHOUT program, which is an OUD treatment intervention, in different hospitals in Texas. Our implementation approach combined training, tailoring, and technical assistance following the Replicating Effective Programs (REP) strategy with statewide telementoring delivered via Project ECHO. To evaluate the reach, adoption, and impact of SHOUT Texas, we assessed: 1) participating hospitals (adoption); 2) patients screened for OUD (impact); 3) patients started on medications for OUD (impact); 4) patients discharged with coordinated outpatient care (impact); 5) providers and staff trained via ECHO (reach); and 6) satisfaction with ECHO training (impact). Additionally, semi-structured interviews were conducted with key stakeholders at expansion sites to identify strengths and weaknesses of the implementation strategy and supports and barriers to successful implementation. Rapid qualitative analysis was completed by a team of analysts who transcribed and summarized interviews to identify key domains of interest and emergent themes. ResultsBetween 2020 and 2023, the SHOUT Texas program expanded to three additional Texas hospital sites, resulting in 3065 hospitalized adult patients starting treatment for OUD. More than 2500 interprofessional clinicians (physicians, nurses, physician assistants, social workers) received SHOUT training regarding inpatient initiation of OUD treatment, with 241 attending at least one hour-long Project ECHO session. Eight key stakeholders at expansion sites were interviewed. Successful components of the SHOUT program included training resources, in-person launches, and collaboration with specialized addiction treatment subject matter experts. Challenges included identifying outpatient follow-up, pharmacy and medication constraints, and nursing education barriers. Interviews also identified lessons learned, advice to other hospitals, and next steps to build capacity. ConclusionsImplementation of the SHOUT Texas model across diverse hospital settings using REP and Project ECHO resulted in significant provider engagement and rapid increase in the number of patients initiating OUD treatment during hospitalization. Lessons learned from this novel approach may be applicable in other states, particularly those that have not expanded Medicaid.

Conducting Physician Engagement Research in a Pandemic: Persevering when Burnout Mitigation Is Needed Most.

Background: We planned a pilot study on a physician engagement intervention, termed ECHO-MDA, using the Project ECHO framework. The study was approved and launched just as the COVID pandemic reached Texas. We pivoted to accommodate the realities of research in pandemic times. Objectives: The primary outcome was feasibility assessed by the proportion of participants attending at least 9 out of 13 ECHO-MDA sessions. Design: The study was envisioned as a randomized, wait-list pilot study exploring the impact ECHO-MDA with a planned enrollment of 50 physicians (25 per arm). Results: Due to pandemic-related challenges, 35 physicians were enrolled. Ten attended nine or more sessions. Participants indicated that the program was beneficial. Conclusion: Pandemic-related work and personal conditions likely had adverse impacts on enrollment and attendance. Launching professional wellness programs during a global crisis is challenging but can still yield benefits for participants. We offer suggestions for researchers launching professional engagement studies in unexpectedly challenging times.

Call to Address Diabetes and CKD Disparities Leveraging the Project ECHO Model

Call to Address Diabetes and CKD Disparities Leveraging the Project ECHO Model

Evaluation of Caru Programme: A National Programme Supporting Palliative, End of Life and Bereavement Care in Nursing Homes in Ireland

Abstract Background The aim of the interim evaluation report is to provide the Caru Programme team with information on the impact of the Programme to date and to highlight the outcomes and challenges, whilst reiterating the key aims and objectives of the Programme and the overall evaluation. Methods The evaluation utilities’ a combination of quantitative and qualitative methodologies. A pre-post design of baseline, mid-line and end-line primary data collection is used to measure the overall impact of the programme. Secondary data analysis of participant feedback, workshop evaluations and attendance was completed under the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Results The education sessions provided were highly valued, with the majority of participants indicating an increase in baseline knowledge after attending a session. There were very high levels of positive experience with 80-99% of participants strongly endorsing the activities and recommending the programme. Participants who attended the Project ECHO and the QI workshops, indicated an intention to change practice; however, at this stage of the evaluation, there is a lack of specific details on what practice or change would be introduced, or indeed, its timeline. This will be measured in the next phase of the evaluation. Conclusion Caru is an innovative continuous learning programme supporting nursing home staff in the delivery of palliative, end-of-life, and bereavement care to residents. The learning components are delivered using a range of approaches, Webinars, Project ECHO online learning, Regional Networks, Quality Improvement Workshops. The interim evaluation report outlines the outcomes from Phase I and the first year of the programme’s delivery. It provides insights into its impact, outcomes, and challenges as well as providing a basis for the next phase of the evaluation. This interim evaluation lays the groundwork for a comprehensive understanding of the Caru Programme model and impact and provides valuable insights into its effectiveness.

Leveraging telementoring platforms to enhance PA capacity and education.

Telementoring is a valuable workforce development resource that connects subject matter experts with healthcare providers via videoconferencing. This technology can deliver training, education, and ongoing technical support to build workforce capacity. Arizona State University (ASU) has leveraged a widely used telementoring platform, Project ECHO, to disseminate best practices in palliative medicine. The model has increased clinician knowledge and confidence, and the learning network may provide protective factors for clinician wellness. The replicable and inclusive nature of telementoring platforms creates educational opportunities to align learners across the didactic and clinical years of medical training, as well as into early- and midcareer for physician associates/assistants (PAs). Telementoring programs can be used across the PA learning continuum, including in PA training programs.

A novel Project ECHO curriculum on older adult pain management and opioid use disorder for outpatient clinicians

ABSTRACT Chronic pain, opioid use, and opioid use disorder (OUD) are increasingly common in older adults. Outpatient clinician education may improve outcomes. Our aim was to create and evaluate a novel curriculum for outpatient clinicians on older adult pain management, opioid prescribing, and OUD leveraging Project ECHO®, a model for delivering subspecialized medical knowledge to community outpatient clinicians via videoconferencing. The series is comprised of 8-hour-long sessions, each with an expert-led interactive lectures followed by participant-led case discussions. Topics include pain assessment & treatment, considerations in older adults (e.g. cognition, caregiver support), shared decision-making, behavioral health, and OUD diagnosis and treatment. Sixty-nine clinicians attended the series and completed the pre-series survey; 78% (n = 54) completed the post-series survey. Clinicians reported a significant increase in self-efficacy in 14/14 queried competencies and greater frequency of performing 7/10 practice behaviors regarding older adult pain management, opioid prescribing, and OUD management. The most liked curricular components were opportunities to learn with subspecialists and discussions with other community clinicians. Qualitative analysis suggests that clinicians may benefit from education on specific geriatrics-related content areas. This novel curriculum has potential to improve management of older adult chronic pain, opioid prescribing, and OUD in a virtual and scalable format.

Design and Pilot Implementation of an ECHO Module on Hepatitis C Virus Infection During Pregnancy.

We developed a Project ECHO® module to offer prenatal providers training on engaging in shared decision-making about hepatitis C virus (HCV) treatment during pregnancy. In this pilot program, the ECHO module addressing HCV during pregnancy and the potential benefits of treatment was associated with increases in self-efficacy scores among participants.

Increasing pediatric primary care providers’ confidence and use of in-office interventions for anxiety: an application of the project ECHO model

PurposeThe prevalence of pediatric anxiety disorders is on the rise but youth have challenges in accessing specialty evidence-based mental health care. As a result, families turn to their pediatric primary care provider (PCP) for assessment and management of anxiety. To increase PCPs’ abilities to manage anxiety, the Extension for Community Healthcare Outcomes (“Project ECHO”) was used. The purpose of this study is to explore the impact of Project ECHO on participating PCPs’ knowledge, self-efficacy and interventions surrounding the assessment and management of anxiety.Design/methodology/approachData were collected pre- and post-course across five cohorts. Participants completed a clinical knowledge test, ratings of self-efficacy and self-reported frequencies of in-office interventions. Satisfaction was also measured.FindingsAttendance remained strong, and participants rated high satisfaction. From pre- to post-course, participants demonstrated increased knowledge on almost all objective questions. Participants reported increased self-efficacy across all domains. Finally, participants endorsed increased use of several in-office interventions.Practical implicationsThis study highlights the importance of Project ECHO as a continuing education model to enhance PCPs’ abilities and confidence in the assessment and management of anxiety. Future continuing education endeavors should consider Project ECHO as a means of increasing PCPs’ capacity to manage mental health conditions.Originality/valueTo the best of the authors’ knowledge, this is the first study that applied the Project ECHO model to pediatric anxiety as a mechanism of increasing knowledge, self-efficacy and in-office interventions with PCPs.

“Nothing about Us without Us” Meets the “All Teach, All Learn” Model: Autistic Self-Advocates as Leaders and Collaborators in Project ECHO

Those with intellectual and developmental disabilities (I/DD), especially autism, represent an often misunderstood and underserved population. In order to address health disparities faced by those with I/DD in Washington state, the Extension for Community Healthcare Outcomes (Project ECHO) model was implemented to build capacity to serve these individuals and their families in their home communities. Through this year-long telementorship and learning community, expert teams lead clinics based on interdisciplinary case-based discussion and knowledge sharing with medical, behavioral, and mental healthcare providers. A cornerstone of these expert teams are autistic self-advocates, who provide insight into lived experience. In this paper, we will discuss how the inclusion of six autistic self-advocates across four different ECHO programs has allowed ECHO participants to broaden their horizons and gain new insight into supports for their I/DD clients across multiple aspects of care. In addition to the unique knowledge provided by self-advocates, their participation illustrates the potential for all people with I/DD to live rich and fulfilling lives. The initial implementation and on-going success of including lived experience within the ECHO model can be used as an example of how to create partnerships that meaningfully inform decisions and improve equitable outcomes in service provision.

A health equity ECHO for clinicians of individuals with SCD

Abstract SCD is the most common genetic disorder in the United States, affecting nearly 100 000 Americans, with the majority of affected individuals identifying as Black. Studies have shown that both children and adults with SCD face stigmatization resulting in low-quality care stemming from institutional racism and implicit bias by clinicians. Clinician biases often result from a lack of awareness of their own racial identity, failure to develop an anti-racist or social justice lens, and absence of skills to mitigate racist practices and policies. The Sickle Treatment and Outcomes Research in the Midwest (STORM) multi-state regional learning network developed a health equity training curriculum that was delivered as a continuing education learning series using the Project ECHO® virtual telementoring framework supplemented with an online learning management system. The curriculum addressed foundations of race, racism, and whiteness along with social justice strategies for the individual and institutional level and was piloted with 2 clinician cohorts to assess its feasibility, acceptability, and the potential impact on clinician self-efficacy. Feasibility and acceptability data, including qualitative feedback, suggest that this is a promising method for multidisciplinary clinicians and trainees for raising self-awareness about racism and bias, providing a safe community for self-reflection, and building skills to address inequities within healthcare settings.

Expanding Hepatitis C Virus Treatment in the New Mexico State Prison System: Using the ECHO Model for Provider and Prison Peer Education.

It is critical to address hepatitis C virus (HCV) in carceral settings to achieve worldwide elimination of the virus. We describe New Mexico's (NM) experience expanding HCV treatment in state prisons, supplemented with Project ECHO (ECHO; virtual mentorship through guided practice) and the NM Peer Education Program (NMPEP). We describe how using these programs may be a model for expanding treatment in prisons globally. ECHO, NM Corrections Department (NMCD) and Wexford Health Services (WHS) collaborate to treat HCV in state prisons and increase HCV knowledge among incarcerated persons using NMPEP. Each person arriving in prison is tested for HCV and those with active infection receive baseline labs, which are reviewed. Patients not meeting criteria for simplified treatment are presented to ECHO for expert guidance. Otherwise, patients are treated by WHS without consultation. NMPEP provides patient-to-patient education in prisons, addressing HCV myths and exploring treatment refusals. From December 2020 to June 2023, 3603 people had HCV viremia. In this study, 1685 people started treatment: 1280 were treated using the simplified algorithm and 405 were presented to ECHO. Of the 988 people who completed treatment and had sustained virologic response (SVR) labs drawn, 89.2% achieved SVR (i.e., cure). Most of the 107 people who did not achieve SVR had presumed reinfection. NMPEP trained 148 peer educators who educated 3832 peers about HCV prevention and treatment. HCV treatment in prisons can be expanded by implementing simplified treatment algorithms, use of the ECHO model for patients with advanced disease and peer education.

"That Was an Eye Opener for Me": Mixed-Methods Outcomes Educating Texas Community Health Workers on HPV Vaccination Using Project ECHO®.

Human papillomavirus (HPV) is known to cause six different types of cancer. HPV vaccination can prevent over 90% of these cancers. Community health workers (CHWs) have the potential to drive HPV vaccination demand through education and navigation by addressing vaccine hesitancy and dis/misinformation and by reaching non-English speaking, vulnerable, or rural populations. Despite their possible reach, there is limited research on HPV vaccination education programs for CHWs. In 2020-2021, the American Cancer Society (ACS) HPV Cancer Free Texas (HPVCFT) Project implemented the eight-session Mission: HPVCFT Vaccination ECHO-CHW Program ten times. This manuscript details the program's implementation processes and outcomes. The program used the Project ECHO model and was offered in both English and Spanish. One hundred and forty-six Texan CHWs completed pre- and post-training surveys. The participants demonstrated significant HPV vaccination knowledge increases and desirable shifts in their foundational HPV vaccination beliefs, including the belief that the HPV vaccine is for cancer prevention. The participants also reported increased confidence in communicating about the HPV vaccine in the community. Improving knowledge, beliefs, and confidence in HPV vaccination is the first step in addressing concerns and increasing uptake. Future research and interventions are needed to better understand how CHWs can be more systematically linked to vaccination opportunities or provided with clearer paths for directing patients to providers that vaccinate.

Clinical Outcomes of Rural Patients with Diabetes Treated by ECHO-Trained Providers Versus an Academic Medical Center.

Despite clinical practice guidelines prioritizing cardiorenal risk reduction, national trends in diabetes outcomes, particularly in rural communities, do not mirror the benefits seen in clinical trials with emerging therapeutics and technologies. Project ECHO supports implementation of guidelines in under-resourced areas through virtual communities of practice, sharing of best practices, and case-based learning. We hypothesized that diabetes outcomes of patients treated by ECHO-trained primary care providers (PCPs) would be similar to those of patients treated by specialists at an academic medical center. Specialists from the University of New Mexico (UNM) launched a weekly diabetes ECHO program to mentor dyads consisting of a PCP and community health worker at ten rural clinics. We compared cardiorenal risk factor changes in patients with diabetes treated by ECHO-trained dyads to patients treated by specialists at the UNM Diabetes Comprehensive Care Center (DCCC). Eligible participants included adults with type 1 diabetes, type 2 diabetes on insulin, or diabetes of either type with A1c > 9%. The primary outcome was change from baseline in A1c in the ECHO and DCCC cohorts. Secondary outcomes included changes in body mass index (BMI), blood pressure, cholesterol, and urine albumin to creatinine ratio (UACR). Compared to the DCCC cohort (n = 151), patients in the ECHO cohort (n = 856) experienced greater A1c reduction (-1.2% vs -0.6%; p = 0.02 for difference in difference). BMI decreased in the Endo ECHO cohort and increased in the DCCC cohort (-0.2 vs. +1.3 kg/m2; p = 0.003 for difference in difference). Diastolic blood pressure declined in the Endo ECHO cohort only. Improvements of similar magnitude were observed in low-density lipoprotein cholesterol in both groups. UACR remained stable in both groups. ECHO may be a suitable intervention for improving diabetes outcomes in rural, under-resourced communities with limited access to a specialist.

An Overview of the Project ECHO—Cervical Cancer Prevention in Mozambique

PURPOSE Cervical cancer is the most common cancer among women in Mozambique, a Portuguese-speaking country in sub-Saharan Africa. There is a shortage of health care providers to diagnose and treat preinvasive cervical disease. Therefore, training and mentoring to perform colposcopy, cervical biopsy, ablation and loop electrosurgical excision procedure (LEEP) is imperative. The purpose of this study is to describe our program to date. METHODS Our team of physicians, nurses and other health professionals from the United States (US) and Brazil provides in-person training for clinicians in Mozambique supplemented with Project ECHO® (Extension for Community Healthcare Outcomes), a telementoring program to provide virtual support and reinforce and amplify knowledge and skills to build capacity. In-person trainings are held 2-4 times per year. ECHO videoconferences are held monthly with Mozambican clinicians presenting de-identified patient cases for discussion with specialists from the US and Brazil and their peers. Training, lectures and discussions are held in Portuguese. In 2023 we launched a survey to assess the impact of Project ECHO to the participants. The survey covered the applicability of the content discussed in their practice and the content learned during case presentations. Data from the survey were stored in REDcap. RESULTS Since February 2019, we have held nine in-person and 16 virtual trainings supplemented with 59 ECHO telementoring sessions, with an average of 53 participants per session. Forty-eight cases were presented and discussed. Respondents included 182 participants. Of the 139 who answered their profession, the majority were nurses (83, 59.8%), followed by doctors (33, 23.7%) and others (23, 16.5%). When asked about applicability of the content discussed in ECHO, the majority agreed/strongly agreed that the content was applicable to their practice (78/79, 98.7%) and that they learned something new during the case presentations (114/116, 98.3%). Lastly, 93.2% (68/73) of responders said that they would make changes to their practice as a result of the Project ECHO participation. CONCLUSION Well-trained clinicians for the management of women with abnormal screening tests is critical for improving cervical cancer prevention. The ECHO project model facilitates and extends mentoring and training of healthcare professionals and keeps providers engaged in learning.

A Quality Improvement Approach to Elevate Clinicians’ Use of Evidenced-Based Practice

ABSTRACT Mental and behavioral health needs amongst youth are on the rise, increasing the demand for community clinicians to treat increasingly complex cases. Extensive, complex caseloads contribute to burnout particularly when clinicians do not have the training to deliver effective treatment. Case conceptualization is a crucial component of effective treatment, as this guides intervention selection. Case conceptualization is vital within the evidence-based practice model, but this clinical skill is complex and challenging to implement effectively. A quality improvement (QI) approach was used by psychologists to develop and implement an eight-session training series with three cohorts of master’s prepared clinicians to increase their utilization of evidence-based treatments (EBTs) in clinical practice using the Project ECHO model. This QI project was accomplished via an iterative process where feedback was incorporated throughout the series. Participants’ knowledge, self-efficacy, and clinical practice were assessed pre- and post- completion of the series. Iterations in programming to improve the quality of the course are covered in detail. Participants demonstrated significant improvements in self-efficacy and reported positive changes in their clinical practice. There was no statistical change in knowledge, which was high on the pretest. Participants reported increased utilization and self-efficacy using EBTs in their clinical practice following participation in the course. Ongoing QI efforts and data collection are needed to continue to improve programming and demonstrate effectiveness of the series. Future efforts targeting specific EBT approaches for masters-prepared clinicians would be worthwhile.

Development and implementation of a geriatric oncology interprofessional case-based educational intervention for cancer care providers.

9020 Background: Geriatric assessment (GA) is recommended as part of the standard of care for older adults with cancer. However, the GA has not been fully adopted as part of routine practice in oncology in Mexico, mainly due to lack of qualified personnel and limited knowledge. We designed an interprofessional case-based educational intervention to address the main barriers for implementation of GA in oncology. Methods: We followed Kern’s six-step approach to design a continuing professional development (CPD) activity. Our targeted learners consisted of teams comprised of one oncologist and one geriatrician who practiced at the same site in Mexico. By the end of the intervention, participants would be able to perform GA in older adults with cancer, and to integrate information obtained through a GA in a cancer treatment plan through adequate interventions. We used Project ECHO’s model to create a CPD activity consisting of 12 weekly 75-minute online sessions via Zoom, with content selected from international geriatric oncology guidelines. At baseline, and at the end of the course, participants answered a 36-item multiple choice knowledge assessment (scale 0-100), a survey on self-perceived competence in GA skills (scale 0-10), and an adaptation of the Association for Community Cancer Centers Geriatric Oncology Gap Assessment Tool, which assesses subjective performance of the GA (scale 0-4). Participants also completed a satisfaction questionnaire. We compared baseline and post-intervention scores through paired t tests; results from the satisfaction questionnaire are reported descriptively. Results: We included 56 participants (28 geriatricians and 28 oncologists). Median participant attendance was 10 sessions (IQR 9-11). Thirty-eight participants completed the satisfaction questionnaire: median satisfaction was 10/10 (range 8-10). There was no difference in satisfaction scores between oncologists and geriatricians. Mean baseline knowledge score was 59.5±12.8 and mean post-intervention knowledge score was 74.4±9.7 (p<0.001, effect size 1.14). Mean baseline competence score was 6.42±2.5 and mean post-intervention competence score was 9.02±0.78 (p<0.001, effect size 1.03). Mean baseline performance score was 2.58±0.65 and mean post-intervention knowledge score was 3.29±0.5 (p<0.001, effect size 1.64). Increases in knowledge, competence, and performance scores were observed both in oncologists and in geriatricians separately. Conclusions: This interprofessional curriculum on GA in oncology was feasible and acceptable, and led to significant increases in knowledge, competence, and performance among participants. Project ECHO’s case-based learning model is adequate to provide interprofessional education, which is crucial in multidisciplinary areas such as geriatric oncology.

KANSURVIVE: Testing a telementoring model for improving cancer survivorship care in rural practice.

e13791 Background: Cancer survivors require long-term, coordinated care to address the physical, emotional, and psychosocial effects of cancer and its treatment. KanSurvive, a single arm feasibility trial, evaluated the effectiveness of the KanSurvive ECHO intervention combined with practice facilitation (PF) to promote better adoption of evidence-based practice (EBP) survivorship care guidelines for breast, colorectal, lung, and prostate cancer among rural survivors. Methods: Fifteen primary care clinics in Kansas (80% in RUCA codes 4-10), including 62 healthcare professionals, were invited to participate in four, 1-hour Project ECHO telementoring program held in 2021. Real-time videoconferencing sessions covered EBP survivorship guidelines for breast, colorectal, lung, and prostate cancer. Clinics used brief plan-do-study-act cycles with PF supporting implementation of the quality improvement process. Utilizing the National Quality Forum framework, a performance indicator booklet with established measures in preventive health and cancer survivorship was developed as a data collection and quality improvement resource. Performance indicators included EBP screening actions related to cancer surveillance, lifestyle factors, distress, evidence of a review of family history of cancer, and the patient’s cancer diagnosis documented in the EHR. Results: Three clinics (7 = healthcare professionals) withdrew from the project citing competing demands and a provider leaving the practice. The COVID-19 pandemic delayed project initiation and prevented clinic visits. Recruitment and study procedures were implemented remotely. Clinic staff identified 138 cancer survivors (M = 13, IQR [6-16] per practice) seen in the year pre-intervention, and 129 survivors in the year prior to post-intervention. Pre-intervention, overall tumor surveillance was 91%, but lung cancer surveillance was lower than other tumor types at 70%. Other than surveillance, measures of baseline performance were similar across tumor types: screening for distress 84%, assessment of BMI 97%, screening for tobacco use 83% and documentation of family history 70%. Post-intervention performance indicators were similar except for documentation of family history which increased to 89% (p < 0.01). Conclusions: Standardized survivorship metrics can facilitate quality assessment as part of an ECHO-based cancer survivorship program. Although there are modest opportunities for improvement, PCPs in this study caring for rural patients perform reasonably well across a variety of cancer survivorship performance metrics comparable to national primary care quality measures. Documented assessment of family history of cancer lags other metrics and improved after participation in the KanSurvive telementoring program.