Project Extension For Community Healthcare Outcomes Research Articles

Implementation of Project ECHO in a university health network: contrasting and comparing experiences across health conditions through a qualitative approach in a Canadian tertiary care centre

ObjectivesThe objective of this study was to compare and contrast the experiences of interdisciplinary attendees (spokes) and experts (hub members) from three Extension for Community Healthcare Outcomes (ECHO) programmes: hepatitis...

Telementoring to Strengthen Child and Youth Mental Health Care Capacity in Primary Care Providers: Session Duration and Learning Outcomes.

Primary care providers (PCPs) report insufficient capacity for child and youth mental health care (CYMH). The telementoring program Project ECHO (Extension for Community Healthcare Outcomes) can build capacity, but 75- to 120-minute sessions are a participation barrier. Using a Lean health care paradigm, we designed a 60-minute session, and compared self-reported CYMH capacity strengthening (10 constructs) and satisfaction between 60- and 90-minute sessions. Pre-post (n = 139) and post-cycle (n = 146) survey data were analyzed using generalized linear mixed-effects logistic regression. Capacity strengthening was demonstrated when analyzing both groups together (all Ps ≤ .002). Session duration did not affect capacity strengthening for 9/10 constructs (all Ps > .05), but medication management development was higher with 90-minute sessions (P = .002). Satisfaction was high in both groups. The 60-minute ECHO CYMH sessions can be used without negative learning outcomes, but more mentoring may be needed to build capacity for psychopharmacologic treatment.

“Moving beyond silos”: focus groups to understand the impact of an adapted project ECHO model for a multidisciplinary statewide forum of substance use disorder care leaders

BackgroundAlthough clinical substance use disorder (SUD) care is multidisciplinary there are few opportunities to collaborate for quality improvement or systems change. In Oregon, the Project ECHO (Extension for Community Healthcare Outcomes) model was adapted to create a novel multidisciplinary SUD Leadership ECHO. The objective of this study was to understand the unique effects of the adapted ECHO model, determine if the SUD Leadership ECHO could promote systems change, and identify elements that enabled participant-leaders to make changes.MethodsFour focus groups were conducted between August and September of 2022 with a purposive sample of participants from the second cohort of the Oregon ECHO Network’s SUD Leadership ECHO that ran January to June 2022. Focus group domains addressed the benefits of the adapted ECHO model, whether and why participants were able to make systems change following participation in the ECHO, and recommendations for improvement. Thematic analysis developed emergent themes.Results16 of the 53 ECHO participants participated in the focus groups. We found that the SUD Leadership ECHO built a multi-disciplinary community of practice among leaders and reduced isolation and burnout. Three participants reported making organizational changes following participation in the ECHO. Those who successfully made changes heard best practices and how other organizations approached problems. Barriers to initiating practice and policy changes included lack of formal leadership authority, time constraints, and higher-level systemic issues. Participants desired for future iterations of the ECHO more focused presentations on a singular topic, and asked for a greater focus on solutions, advocacy, and next steps.ConclusionsThe adapted ECHO model was well received by focus group participants, with mixed reports on whether participation equipped them to initiate organizational or policy changes. Our findings suggest that the SUD Leadership ECHO model, with fine-tuning, is a promising avenue to support SUD leaders in promoting systems change and reducing isolation among SUD leaders.

Integration through education: utilizing project ECHO to mitigate fragmentation and support adaptive expert care in HIV Psychiatry

PurposeCare of complex patients requires collaboration across hospital and community settings. Yet there is little recognition of the capabilities that healthcare workers need to effectively implement integrated care. An adaptive expertise theoretical framework can inform educational efforts that aim to give providers the abilities to navigate complexity and ambiguity in the healthcare system, including across hospital and community settings. Prior education research in the HIV sector has demonstrated that adaptive expert skills can be cultivated through education that emphasizes perspective exchange, inviting uncertainty in practice and integration of diverse perspectives on care.Design/methodology/approachThese principles informed the creation of an Extension for Community Healthcare Outcomes (ECHO) in HIV Psychiatry – the first ECHO directed at a non-clinical, community health worker (CHW) audience. The goal was to improve informal collaborations across hospitals and communities.FindingsParticipation in the ECHO was robust, with significant on-camera engagement. Participants attributed success of the ECHO to key themes: explicit value placed on all kinds of knowledge (not simply clinical knowledge), emphasis on approaches for navigating ambiguity and complexity and engagement in perspective exchange for provision of integrated, team-based care. Future cycles of ECHO HIV Psychiatry are being pursued, with a focus on the development of adaptive expert capabilities and the impact on integration of care between community and hospital services.Originality/valueTo our knowledge, this is the only ECHO that is specifically aimed at frontline CHWs.

Leveraging Project ECHO to Implement a Suite of Substance Use Learning Communities for Statewide Impact.

Overdoses and alcohol consumption rose during the pandemic. However, uptake of practices which reduce mortality (eg, medications for opioid use disorder, harm reduction practices) remains insufficient. Provider training and telementoring is needed to ensure sufficient capacity for treating substance use disorders (SUDs) with evidence-based practices. The Project ECHO (Extension for Community Healthcare Outcomes) model involves the use of web technologies to deliver didactic and case-based learning through a panel of experts to build such competency in a community of learners. Project ECHO was leveraged to implement a statewide telementoring center of addictions-focused ECHO programs, including programming in prescribing, harm reduction, recovery support services, collaborations with first responders, and systems-level challenges. Participants represented health and behavioral health disciplines practicing across the state of Texas in metropolitan and rural areas. Learners were administered: (1) an online registration form that inquired about basic demographics, (2) a post-session survey at the conclusion of each session capturing satisfaction and likelihood to implement, and (3) annual surveys measuring changes in knowledge and self-efficacy. Attendance and other learner data were stored and extracted from the partner relationship management database: iECHO. Training programs were attended by 968 learners, with an average of 48 learners per session. Geographic reach included 47 Texas cities. Post-training survey results indicated high rates of learner satisfaction, with an average rating of 4.68 on a 5-point Likert-like scale. Annual surveys indicated improvements in provider knowledge and self-confidence across all programs. Early results indicate robust uptake, wide geographic reach, high learner satisfaction, and provider knowledge and confidence gains. This preliminary evidence supports the use of the ECHO model as a potential tool for scaling comprehensive SUD telementoring centers to meet workforce development needs over large geographic areas.

Using Project ECHO to deliver a tele-mentoring and teaching program on palliative care in South Asia: Interpretive description of participants' experiences with a community of practice for learning.

To explore the learning experiences of participants (learners and teachers), in a yearlong tele-teaching and mentoring program on pediatric palliative care, which was conducted using the Project ECHO (Extension for Community Healthcare Outcomes) model and consisted of 27 teaching and clinical case discussion sessions for palliative medicine residents in India and Bangladesh. The goal of the study is to explore how participation and learning is motivated and sustained for both residents and teachers, including the motivators and challenges to participation and learning in a novel online format. Qualitative interviews with ECHO participants, including learners and teachers were conducted. Interviews were recorded and transcribed. Thematic analysis of interview data was conducted within an interpretive description approach. Eleven physicians (6 residents, 5 teachers) participated in interviews. Key elements of the ECHO program which participants identified as supporting learning and participation include small group discussions, a flipped classroom, and asynchronous interactions through social media. Individual learner characteristics including effective self-reflection and personal circumstances impact learning. Providing opportunities for a diverse group of learners and teachers, to interact in communities of practice (COP) enhances learning. Three major themes and 6 subthemes describing learning processes were identified. Themes included (1) ECHO program structure, (2) learner characteristics, and (3) COP. Subthemes included flipped classroom, breakout rooms, learning resources, personal circumstances, self-awareness of learning needs, and community interactions. Project ECHO suggests a novel model to train health providers, which is effective in low- and middle-income countries. Online learning programs can lead to learning through community of practice when learners and teachers are able to interact and engage in peer support and reflective practice. Educators should consider incorporating small group discussions, a flipped classroom design, and opportunities for asynchronous interactions to enhance learning for participants in online learning programs.

Is Project ECHO the transformational silver lining for interprofessional and interorganizational collaboration?

ABSTRACT The globally disruptive impact of the COVID-19 pandemic on both healthcare systems and health profession education has created an opportunity for a reassessment of methods for delivering interprofessional practice education (IPE). A good candidate for consideration is Project ECHO (Extension for Community Healthcare Outcomes). Its unique combination of structural design in connecting specialist and community-based clinical sites, foundational education theories, and didactic and case-based learning methods present an innovative and promising new method of promoting both interprofessional and interorganizational collaboration. This paper first provides a description of Project ECHO, its major features, recent expansion during the pandemic, and IPE-related research history. Second, the educational concepts and theories underlying its use and their implications for interprofessional and interorganizational collaboration are reviewed. These include community of practice and single and double-loop learning. Third, the expression of these concepts in how key elements of ECHO are utilized – including the didactic presentation; the case study presentation, discussion, and tele-mentoring; and the power of community and tele-networking – will be explored. Finally, implications and applications for the expansion of ECHO into promoting competency-based education and innovative interprofessional and interorganizational collaboration will be presented.

Using Project Extension for Community Healthcare Outcomes to Enhance Substance Use Disorder Care in Primary Care: Mixed Methods Study.

Substance use and overdose deaths make up a substantial portion of injury-related deaths in the United States, with the state of Ohio leading the nation in rates of diagnosed substance use disorder (SUD). Ohio's growing epidemic has indicated a need to improve SUD care in a primary care setting through the engagement of multidisciplinary providers and the use of a comprehensive approach to care. The purpose of this study was to assess the ability of the Weitzman Extension for Community Healthcare Outcomes (ECHO): Comprehensive Substance Use Disorder Care program to both address and meet 7 series learning objectives and address substances by analyzing (1) the frequency of exposure to the learning objective topics and substance types during case discussions and (2) participants' change in knowledge, self-efficacy, attitudes, and skills related to the treatment of SUDs pre- to postseries. The 7 series learning objective themes included harm reduction, team-based care, behavioral techniques, medication-assisted treatment, trauma-informed care, co-occurring conditions, and social determinants of health. We used a mixed methods approach using a conceptual content analysis based on series learning objectives and substances and a 2-tailed paired-samples t test of participants' self-reported learner outcomes. The content analysis gauged the frequency and dose of learning objective themes and illicit and nonillicit substances mentioned in participant case presentations and discussions, and the paired-samples t test compared participants' knowledge, self-efficacy, attitudes, and skills associated with learning objectives and medication management of substances from pre- to postseries. The results of the content analysis indicated that 3 learning objective themes-team-based care, harm reduction, and social determinants of health-resulted in the highest frequencies and dose, appearing in 100% (n=22) of case presentations and discussions. Alcohol had the highest frequency and dose among the illicit and nonillicit substances, appearing in 81% (n=18) of case presentations and discussions. The results of the paired-samples t test indicated statistically significant increases in knowledge domain statements related to polysubstance use (P=.02), understanding the approach other disciplines use in SUD care (P=.02), and medication management strategies for nicotine (P=.03) and opioid use disorder (P=.003). Statistically significant increases were observed for 2 self-efficacy domain statements regarding medication management for nicotine (P=.002) and alcohol use disorder (P=.02). Further, 1 statistically significant increase in the skill domain was observed regarding using the stages of change theory in interventions (P=.03). These findings indicate that the ECHO program's content aligned with its stated learning objectives; met its learning objectives for the 3 themes where significant improvements were measured; and met its intent to address multiple substances in case presentations and discussions. These results demonstrate that Project ECHO is a potential tool to educate multidisciplinary providers in a comprehensive approach to SUD care.

Abstract TP272: Project Echo’s Beneficial Effect on Stroke Prevention Education for Healthcare Professionals

Introduction/Background: Project ECHO (Extension for Community Healthcare Outcomes) is a telehealth initiative that connects specialists with healthcare providers (HCPs) through videoconferencing, enabling knowledge-sharing and skill-building to improve preventative patient care in underserved areas This program was implemented in a study in Western Michigan concerning primary stroke prevention in vulnerable populations including women, African Americans, and Latinx patients. Research Questions/Hypothesis: We hypothesized that the program would effectively increase understanding among HCPs of effective risk-factor modifications in these populations. Goals/Aims: The study aimed to implement ECHO to increase access to stroke-preventative education for HCPs who serve vulnerable populations. These populations usually lack primary stroke prevention knowledge tailored to their individual risk factors. Methods/Approach: Cornwell Health conducted 5 didactic sessions with these goals in focus. We used participant surveys conducted before/after the program to assess the program’s efficacy. The curriculum focused on lifestyle modifications and covered 2013/2014 AHA stroke prevention guidelines and 2013 AHA/ACC guidelines to reduce cardiovascular risk. Results/Data: A 40% response rate was achieved from HCP participants. The average number of correct answers on the surveys out to 10 increased from 6 ± 1.2 questions on the pre-survey to 6.5 ± 1.0 on the post-survey. Confidence in counseling patients on risk-factor modification increased from 18.8% to 40.6%. Additionally, 87.5% of participants expressed interest in future Project ECHO programs on primary stroke prevention. Conclusion: The ECHO platform was beneficial concerning HCP understanding of risk-factor modifications in primary stroke prevention, confidence in counseling patients, and evaluation of the program’s educational value. The ECHO platform proved to be instrumental in reaching these outcomes and can be implemented in various capacities relating to community outreach and education.

COVID-19 Pivoted Virtual Skills Teaching Model: Project ECHO Ontario Skin and Wound Care Boot Camp.

To describe a virtual, competency-based skin and wound care (SWC) skills training model. The ECHO (Extension for Community Healthcare Outcomes) Ontario SWC pivoted from an in-person boot camp to a virtual format because of the COVID-19 pandemic. An outcome-based program evaluation was conducted. Participants first watched guided commentary and videos of experts performing in nine SWC multiskills videos, then practiced and video-recorded themselves performing those skills; these recordings were assessed by facilitators. Data were collected using pre-post surveys and rubric-based assessments. Descriptive statistics and thematic analysis were applied to data analysis. Fifty-five healthcare professionals participated in the virtual boot camp, measured by the submission of at least one video. A total of 216 videos were submitted and 215 assessment rubrics were completed. Twenty-nine participants completed the pre-boot camp survey (53% response rate) and 26 responded to the post-boot camp survey (47% response rate). The strengths of the boot camp included the applicability of virtual learning to clinical settings, boot camp supplies, tool kits, and teaching strategies. The analysis of survey responses indicated that average proficiency scores were greater than 80% for three videos, 50% to 70% for three of the videos, and less than 50% for three of the videos. Participants received lower scores in local wound care and hand washing points of contact. The barriers of the boot camp included technical issues, time, level of knowledge required at times, and lack of equipment and access to interprofessional teams. This virtual ECHO SWC model expanded access to practical skills acquisition. The professional development model presented here is generalizable to other healthcare domains.

"Keep trying": a qualitative investigation into what patients with chronic pain gain from Project ECHO.

The study aims to investigate the patient perspective on the pathway from healthcare practitioners' presentations of their cases at a Project ECHO (Extension for Community Healthcare Outcomes) tele-clinic to the management of those patients' chronic pain. Managing patients with chronic and complex pain constitutes a prevalent, stressful challenge in the primary care setting. Primary care physicians typically have received little training in treating such patients and, until recently, have relied heavily on opioid and other pharmaceutical therapies as part of their regimen. Project ECHO Ontario Chronic Pain and Opioid Stewardship is an interprofessional telementoring program connecting pain specialists to primary care practitioners with the aim of supporting them in managing their patients with chronic pain, although the patients concerned do not generally participate in the telementoring sessions. While a number of papers have described the benefits accruing to healthcare professionals through participating in Project ECHO, there has been little exploration concerning patients' perceptions of their care subsequent to case presentation. Using data from in-depth interviews with 20 patients along with their associated case presentation forms and the recommendations following the presentation, we look at the alignment of patient and practitioner views and inquire about the patient's perceptions of how Project ECHO affects them. Results suggest that the impact on patients is indirect but positive: most respondents express pleasure in contributing to research around chronic pain management, though only two of them identified a direct impact on their own treatment. They also appreciated their practitioner's efforts to bring expert attention to the patient's situation. Patients whose cases are presented to Project ECHO sessions experience positive emotions at being part of the process of research and quality improvement, regardless of changes in their own conditions. This study highlights the importance to patients of their practitioners' commitment to managing their chronic pain.

Abstract B015: Enhancing knowledge of cancer survivorship care among primary care clinicians serving underserved populations: Lessons from an ECHO project

Abstract Background: Primary care clinicians (PCCs), especially those practicing at Community Health Centers (CHCs) serving underserved populations, provide medical care for a substantial number of patients with cancer. PCCs often lack formal medical training in cancer survivorship care in the context of their various chronic conditions, creating an opportunity for knowledge sharing through Project ECHO (Extension for Community Healthcare Outcomes). This is a critical gap because of the growing number of cancer survivors in the United States (US) needing high-quality and comprehensive care. This study partnered with CHC PCCs to enhance cancer survivorship knowledge through a Cancer Survivorship ECHO Project – a peer-to-peer telementoring approach. Methods: Nine ECHO sessions were conducted from Oct 2022 - June 2023 in partnership with two CHCs covering cancer survivorship topics, such as breast and prostate cancer survivorship, late and long-term effects of cancer and its treatments, and psychosocial distress. Each session featured a case-based presentation by a PCC followed by a didactic presentation from oncology and primary care content experts. An online pre-ECHO project survey was distributed to evaluate PCCs' cancer survivorship knowledge and training. Qualitative in-depth interviews were conducted to assess PCCs' barriers and facilitators in providing survivorship care and experiences with participating in the ECHO sessions with eight PCCs. Results: Out of the 12 eligible PCCs from two CHCs, the response rate for the pre-ECHO project survey was 58.3% (n=7). Preliminary findings revealed that 83.3% of the PCCs reported a lack of training in cancer survivorship. Qualitative analysis of the eight PCC interviews identified specific barriers to providing high-quality care, such as the lack of accessible survivorship resources in the electronic medical records and means to quickly communicate with oncologists and the need for survivorship training to assist with managing their patient's side effects from late and long term effects of cancer. In this context, PCCs reported the positive impact of ECHO sessions on enhancing survivorship knowledge and training to deliver high-quality cancer survivorship care. Conclusion: Enhancing knowledge and building capacity among PCCs are important components in improving the delivery of cancer survivorship care in an underserved patient population. ECHO-based telementoring approaches have the potential to engage PCCs collaboratively in addressing the knowledge gap and consequently improving patient outcomes. Citation Format: Maram Museitif, Bijal A. Balasubramanian, Hilary Ma, Rebecca Eary. Enhancing knowledge of cancer survivorship care among primary care clinicians serving underserved populations: Lessons from an ECHO project [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B015.

Beyond knowledge and confidence: a mixed methods evaluation of a Project ECHO course on dementia for primary care

ABSTRACT Primary care clinicians have an important role in the management of dementia and have expressed interest in continuing education. The authors describe a model they used for providing dementia education in primary care, Project ECHO (Extension for Community Healthcare Outcomes), and an overview of its major features. A partnership including academic institutions and a national healthcare association is then outlined, including the unique features of the ECHO model developed through this partnership. A mixed-methods methodology was used for programmatic evaluation. This use of mixed methods adds vital new knowledge and learner perspectives that are key to planning subsequent ECHO courses related to dementia and primary care. The discussion includes an exploration of the significance of these findings for understanding the motivations of primary care providers for participation in the educational program, as well as the limitations of the current study. A final section explores the next steps in the continued development of the model and its implications for geriatrics education in dementia care, especially the supportive role that ECHO courses can play in meeting the challenges of dementia care.

An examination of an adapted Project ECHO model series during the COVID‐19 pandemic in Idaho

AbstractIntroductionIdaho is a medically underserved and rural state comprised mostly health professional shortage areas for primary and specialty care. Given the state shortages and barriers to access care, the testing and treatment of COVID‐19 may be improved through the implementation of telementoring education programs such as Project Extension for Community Healthcare Outcomes (ECHO). The purpose of this article was to assess session attendance and self‐reported healthcare clinician perceptions of the ECHO Idaho COVID‐19 series (2020 and 2021), a modified Project ECHO model provided during the COVID‐19 pandemic in Idaho.MethodsECHO Idaho developed a COVID‐19 ECHO series for healthcare providers to attend in 2020 and 2021. The sessions included COVID‐19 updates specific to Idaho, didactic presentations on prevention, screening, diagnosis, and evidence‐based treatments for COVID‐19, and case‐based presentations.ResultsA total of 664 individuals attended the 2020 series and 260 individuals attended the 2021 series, with 1752.5 continuing medical education hours being claimed. Participants reported series participation increased overall knowledge of COVID‐19, knowledge of best practices for treatment, and awareness of resources available in Idaho. Further, series participation was perceived to reduce feelings of isolation, enhance access to information, and support healthcare professionals (e.g., provided resources) during the pandemic.ConclusionResults of this evaluation indicate that the ECHO Idaho COVID‐19 series was a useful and valuable program to implement during a pandemic in a rural and frontier state to improve physician knowledge and specialty training.

Multisite Quality Improvement Program Within the Project ECHO Diabetes Remote Network

The telementoring Project ECHO (Extension for Community Healthcare Outcomes) model has been shown to improve disease management in diabetes in many underserved communities. The authors aim to evaluate if ECHO could also be an effective tool for quality improvement (QI) of diabetes care in these communities. Thirteen clinics in underserved communities in California and Florida participating in Project ECHO Diabetes were recruited for a 12-month QI program. The program provided weekly tele-education sessions, including a didactic presentation and case-based discussion. In addition, clinics chose their own set of quality measures to improve and met remotely to discuss their efforts, successes, and setbacks every quarter with mentorship from QI experts. Of the 31 QI initiatives attempted by different clinics, all had either made improvements (25 initiatives, 80.6%) or were in the process of making improvements (6 initiatives, 19.4%) in structural, process, and outcome measures. Examples of these measures include whether clinics have protocols to identify high-risk patients (structure), numbers of continuous glucose monitor prescriptions submitted by the clinics (process), and percentage of patients with diabetes whose most recent HbA1c are > 9% (outcome). For one measure, 40.0% of the clinics had achieved a higher percentage of cumulative HbA1c measurement in the third quarter of the year, compared to the fourth quarter in the previous year. The cost of QI implementation varied widely due to different number of personnel involved across sites. A QI program delivered via Project ECHO Diabetes can facilitate quality improvements in underserved communities.

Applying the Project ECHO Model to Support Implementation and Sustainment of Cognitive Behavioral Therapy for Psychosis.

Project Extension for Community Healthcare Outcomes (ECHO) is a teleconsultation model that leverages technology to sustain specialized interventions in underresourced settings. We present the application of the ECHO model to longitudinal training and consultation for community behavioral health providers learning to deliver cognitive behavioral therapy for psychosis, an evidence-based psychotherapy for individuals with psychotic disorders that has poorly penetrated the US mental health system. We analyzed within-group change over practitioners' 6-month ECHO participation cycle using the Expanded Outcomes Framework. We evaluated outcomes associated with participation, satisfaction, knowledge acquisition, performance, patient symptom severity, and functional impairment. In the first 3 years, the cognitive behavioral therapy for psychosis ECHO Clinics supported 150 providers from 12 community agencies. Forty percent did not complete the 6-month ECHO calendar, most commonly due to separation from their agency. Participants reported high degrees of satisfaction. Declarative and procedural knowledge increased over the 6-month period. Of the 24 providers who received a fidelity review, 87.5% met or exceeded the competency benchmark within the 6-month period. Clinical outcomes reflected reductions in hallucinations, negative symptoms, depression, mania, and functional impairment, but no reductions were detected in delusions, disorganized speech, or abnormal psychomotor behavior. ECHO Clinics offer a mode of providing continuous access to expert instruction, peer-to-peer consultation, and case-based learning that other workforce training models lack. Our evaluation suggests that the ECHO model supports continuous professional development for practitioners, most of whom had indicated inadequate preparation for their role. We observed improved learner and select patient outcomes.

Clinician education on climate change and health: virtual learning community models

Clinician education on climate change and health: virtual learning community models

Using "Big Data" to Provide Insights into Early Adopters of Continuing Professional Development: An Example from Project ECHO.

Mental health care is often managed in primary care with limited specialist support, particularly in rural and remote communities. Continuing professional development programs (CPD) can offer a potential solution to further mental health training; however, engaging primary care organizations (PCOs) can be challenging. The use of "big data" to identify factors influencing engagement in CPD programs has not been well studied. Therefore, the aim of this project was to use administrative health data from Ontario, Canada to identify characteristics of PCOs associated with early engagement in a virtual CPD program, Project Extension for Community Healthcare Outcomes (ECHO) Ontario Mental Health (ECHO ONMH) . Ontario health administrative data for fiscal year 2014 was used to compare the characteristics of ECHO ONMH-adopting PCOs, and their patients, to nonadopter organizations (N = 280 vs. N = 273 physicians). ECHO-adopting PCOs did not differ with respect to physician age or years of practice, although PCOs with more female physicians were somewhat more likely to participate. ECHO ONMH adoption was more likely in regions with lower psychiatrist supply, among PCOs using partial salary payment models, and those with a greater interprofessional complement. Patients of ECHO-adopters did not differ on the basis of gender or health care utilization (physical or mental health); however, ECHO-adopting PCOs tended to have patients with less psychiatric comorbidity. Models such as Project ECHO, which deliver CPD to primary care, are advanced to address lack of access to specialist health care. These findings support the use of administrative health data to assess the implementation, spread, and impact of CPD.

Thematic analyses of participant survey responses following dermatology ECHO programs with dermoscopy: Practical tips and lessons learned.

Skin cancer is a major public health concern in the United States, reflecting approximately one in every three cancer diagnoses. Despite the high incidence of skin cancer, access to dermatologists is limited, especially in rural areas. Primary care physicians play a pivotal role in the evaluation of skin conditions, but dermatology training gaps exist in primary care training programs. This study examines the use of the Project ECHO (Extension for Community Healthcare Outcomes) knowledge-sharing framework to provide dermoscopy and skin cancer detection training to primary care providers (PCPs). Responses to surveys administered to participants in two separate dermoscopy-focused Project ECHO courses were analyzed. Survey responses were collected over a 4-year period for the two courses, which were delivered in Maine and Texas. Thematic analysis of the qualitative data was performed, revealing codes and subcodes that indicated several overall trends. Overall, most respondents indicated the ECHO sessions to be helpful, reporting an increase in confidence and knowledge in dermoscopy. Other codes reflected a positive reception of the learning materials and teaching styles. Furthermore, participant survey analyses highlighted areas of improvement for future ECHO course sessions. This thematic analysis of Project ECHO courses in dermatology with dermoscopy demonstrates the feasibility of using virtual educational platforms to effectively teach PCPs about dermoscopy and skin cancer, with high levels of participant satisfaction. The need to keeping the educational sessions brief, avoid scheduling sessions on high-volume patient care days, and provide a means for participants to obtain hands-on training in the operation of a dermatoscope were among the top lessons learned.

TransECHO: A National Tele-Education Program for Expanding Transgender and Gender Diverse Health Care.

Purpose: Few clinicians have received training to provide comprehensive primary care for transgender and gender diverse (TGD) people. This article describes the program design and evaluation outcomes of TransECHO, a national professional development program for training primary care teams on the provision of affirming integrated medical and behavioral health care for TGD people. TransECHO is based on Project ECHO (Extension for Community Healthcare Outcomes), a tele-education model that aims to reduce health disparities and increase access to specialty care in underserved areas. Methods: Between 2016 and 2020, TransECHO conducted 7 year-long cycles of monthly training sessions facilitated by expert faculty through videoconference technology. Primary care teams of medical and behavioral health providers from federally qualified health centers (HCs) and other community HCs across the United States engaged in didactic, case-based, and peer-to-peer learning. Participants completed monthly postsession satisfaction surveys and pre-post TransECHO surveys. Results: TransECHO trained 464 providers from 129 HCs in 35 U.S. states, Washington DC, and Puerto Rico. On satisfaction surveys, participants provided high scores for all items, including those related to enhanced knowledge, effectiveness of teaching methods, and intentions to apply knowledge and change practice. Compared with pre-ECHO survey responses, post-ECHO responses averaged higher self-efficacy and lower perceived barriers to providing TGD care. Conclusions: As the first Project ECHO on TGD care for U.S. HCs, TransECHO has helped to fill the gap in training on comprehensive primary care for TGD people.