Background Individuals living with complex diabetes experience limited access to endocrine care due to a nationwide shortage of endocrinologists. Project ECHO (Extension for Community Healthcare Outcomes) is an innovative, scalable model of health care that extends specialty care to medically underserved areas through ongoing telementorship of community primary care providers (PCPs). The purpose of this study was to assess whether participation in the first iteration of the Endocrine ECHO (Endo ECHO) program resulted in changes to patient well-being, health behaviors and quality of care. Methods PCPs from 10 federally qualified health centers in NM participated in Endo ECHO, facilitated by a team of specialists at the University of New Mexico Health Sciences Center. Endo ECHO patients were eligible for the study if they were 18 years or older with “complex” diabetes: type 1 diabetes or type 2 diabetes and insulin dependent, and/or with an HbA1c of 9% or higher. Patients took a comprehensive survey during enrollment and again after one year. The Diabetes Comprehensive Care Clinic (DCCC) at UNM was included as a means of benchmarking specialized diabetes care, and a sample of DCCC patients completed surveys during the post-test time frame. We assessed ECHO patients for pre/post change using McNemar’s tests for paired data and then compared intervention group post-test scores to the DCCC patient scores. Results Five hundred thirty-three ECHO patients and completed pre and post surveys (62% response rate) and 139 DCCC patients completed surveys during the post survey period. At follow-up, 42% of ECHO patients reported their health status as excellent, very good or good at compared to 30% before program participation ( p <0.0001), and 43% reported five or more days of physical activity per week, compared to 29% at baseline ( p <0.0001). Endo ECHO patients reported more frequent provider-initiated tests for A1C (81% to 91%; p <0.0001), foot examinations (68% to 87%; p <0.0001), and eye exams (63% to 69%; p =0.0266), and 84% of patients felt confident in managing their blood sugar levels at follow-up compared to 62% at baseline ( p <0.0001). Although Endo ECHO patients exhibited statistically significant improvements across all key measures at follow-up, they lagged behind DCCC patients in some areas, including positive health status (42% Endo ECHO post vs 68% DCCC), daily physical activity (43% ECHO post vs 50% DCCC) and daily blood sugar testing (70% ECHO post vs. 83% DCCC). Conclusions Endo ECHO appears to be effective means of improving the health and quality of life for patients with complex diabetes, although opportunities exist to further improve care as compared to care delivered at a university based specialty clinic. Endo ECHO may be a suitable alternative for patients in medically underserved communities where access to an endocrinology referral ce...
Background: Patients receiving diabetes specialty care experience higher quality care, fewer complications and improved survival; however, access to specialists is limited in medically underserved areas. The Endo ECHO program connects specialists at academic medical centers with PCPs through virtual clinics. We report the comparability of quality measures between Endo ECHO patients and those receiving diabetes specialty care. Methods: Patients with complex diabetes from 10 Endo ECHO clinics in NM completed surveys assessing healthcare quality one year after program enrollment. Patients at the University of New Mexico Diabetes Comprehensive Care Center (DCCC) served as a comparison group and completed the same survey. Results: Five hundred thirty-three ECHO patients and 139 DCCC patients completed surveys. ECHO patients were much less likely to identify English as their primary language (69% ECHO vs. 91% DCCC, p<0.0001) and reported lower levels of educational attainment (40% ECHO with at least some college vs. 60% DCCC, p<0.0001). DCCC patients were more likely to report a positive overall health status (42% ECHO vs. 68% DCCC, p<0.0001), yet there was no difference in overall concern about health across groups. ECHO patients reported more frequent visits to their usual source of diabetes care (72% ECHO with 4 or more annual visits vs. 58% DCCC, p<0.0001). There were no differences in the frequency of A1C testing or feet checks by a provider; however, more DCCC patients reported regular eye exams (69% ECHO vs. 87% DCCC, p<0.0001) and that their provider had assessed smoking status (70% ECHO vs. 82% DCCC, p<0.0001). Conclusions: Endo ECHO patients faced greater medical literacy barriers yet reported similar outcomes for several, but not all, diabetes care quality measures as compared to those reported by patients at the DCCC. Endo ECHO may be a suitable alternative to specialty care for patients in medically underserved areas; ongoing evaluation will determine its impact on clinical outcomes. Disclosure M.M. Paul: None. A. Davila Saad: None. J. Billings: None. S. Blecker: Advisory Panel; Self; Medtronic. M.F. Bouchonville: None. B. Hager: None. S. Arora: None. C. Berry: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust
Background Endocrine ECHO (Extension for Community Healthcare Outcomes) is a scalable model of healthcare education that extends enhanced training through ongoing telementoring of community primary care providers (PCPs) by a team of specialists. The purpose of this study was to assess whether patients of providers engaged in the Endocrine ECHO program (Endo ECHO) exhibited improvements in lifestyle, and self-management behaviors. Methods A sample of 533 adult Endo ECHO patients diagnosed with type 1 or complex type 2 diabetes (insulin dependent and/or with an HbA1c of 9% or higher) took a comprehensive survey during Endo ECHO study enrollment (pre-test) and again after at least one year past their first exposure to the intervention (post-test). We assessed pre/post changes in patient-reported outcomes on well-being, lifestyle, and self-management behaviors using McNemar’s tests for paired data. Results A broad array of patients’ self-reported well-being, lifestyle, and self-management behaviors improved over the course of their engagement in the Endo ECHO program. Despite relatively low average health literacy and numeracy, patients’ confidence and self-efficacy to manage their disease also improved significantly from pre-test to post-test. Discussion Endo ECHO may be an effective means of enhancing primary care for individuals with type 1 and complex type 2 diabetes and improving patient capacity to perform the extensive array of lifestyle and self-care behaviors necessary to effectively manage their diabetes outside of the clinical setting. Conclusions The ECHO model of care has been shown to improve provider and satisfaction, quality of care, and in some cases clinical outcomes across various program areas. This study indicates that endocrinology-focused ECHO programs may also lead to behavior changes among patients in between visits to their provider. Further research should examine the impact of the ECHO model on patient behavior.
Purpose: The purpose of the study was to examine differences among adult patients with diabetes who receive care through a telementoring model versus care at an academic specialty clinic on guideline-recommended diabetes care and self-management behaviors. Methods: Endocrinology-focused Extension for Community Healthcare Outcomes (ECHO Endo) patients completed surveys assessing demographics, access to care, health care quality, and self-management behaviors at enrollment and 1 year after program enrollment. Diabetes Comprehensive Care Center (DCCC) patients completed surveys at comparable time points. Results: At baseline, ECHO patients were less likely than DCCC patients to identify English as their primary language, have postsecondary education, and private insurance. One year postenrollment, ECHO patients visited their usual source of diabetic care more frequently. There were no differences in A1C testing or feet checking by health care professionals, but ECHO patients were less likely to report eye exams and smoking status assessment. ECHO and DCCC patients did not differ in consumption of high-fat foods and soda, physical activity, or home feet checks. ECHO patients were less likely to space carbohydrates evenly and test glucose levels and more likely to have smoked cigarettes. Conclusions: Endo ECHO is a suitable alternative to specialty care for patients in underserved communities with restricted access to specialty care. Results support the value of the Project ECHO telementoring model in addressing barriers to high-quality care for underserved communities.
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