338-OR: Leveraging the Project ECHO Model for Type 1 Diabetes (T1D) in California and Florida: Democratizing Knowledge in Underserved T1D Communities

Cuttriss, Nicolas; Añez-Zabala, Claudia; Baer, Linda G.; Bernier, Angelina; Basina, Marina; Filipp, Stephanie L.; Hood, Korey K.; Gurka, Matthew J.; Lal, Rayhan; Haller, Michael J.; Maahs, David M.; Hu, Hui; Town, Marissa; Sheehan, Eleni; Wang, C. Jason; Yabut, Katarina; Walker, Ashby F.

doi:10.2337/db19-338-or

Cited by 4 publications

(5 citation statements)

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“…It is likely that transition represents a period where those with type 1 diabetes are likely to be lost to follow-up. Indeed, at least 2,000 adults with type 1 diabetes among 23 primary care practices in California and Florida do not receive care from an endocrinologist (15).…”

Section: Introductionmentioning

confidence: 99%

The Guided Transfer of Care Improves Adult Clinic Show Rate

et al. 2020

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Objective: Every year, 500,000 youths in the U.S. with chronic disease turn 18 years of age and eventually require transfer to adult subspecialty care. Evidence-based interventions on the organization of transfer of care are limited, although engagement and retention in adult clinic are considered appropriate outcomes. Sustained continuity of care improves patient satisfaction and reduces hospitalization. Methods: We conducted a prospective, nonrandomized cohort study of patients with pediatric endocrine conditions, age 16 to 26 years, enrolled upon referral to the adult endocrine clinic of a physician trained in both adult and pediatric endocrinology (Med+Peds endocrinologist). Patients differed based on whether their referral originated from another pediatric endocrinologist (traditional transfer) or if the Med+Peds endocrinologist previously saw the patient in his pediatric endocrine clinic (guided transfer). Rather than relying on arbitrary age criteria, guided transfer to adult clinic occurred when physician and patient considered it appropriate. The primary outcome was show rate at the first and second adult visits. Results: Of 36 patients, 21 were referred by another pediatric endocrinologist and 15 underwent guided transfer. For traditional transfer, show rate to the first and second visit was 38%, compared to 100% in the guided transfer group ( P = .0001). Subgroup analysis of 27 patients with diabetes revealed that both groups had similar initial hemoglobin A1c ( P = .38), and the guided transfer group maintained hemoglobin A1c. Conclusion: Most traditional transfers were unsuccessful. Guided transfer was significantly more effective, with every patient successfully transferring, and could be implemented with adult endocrinologists willing to see patients in the pediatric clinic. Abbreviations: DKA = diabetic ketoacidosis; HbA1c = hemoglobin A1c; Med+Peds = Internal Medicine and Pediatrics

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Section: Introductionmentioning

confidence: 99%

The Guided Transfer of Care Improves Adult Clinic Show Rate

et al. 2020

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“…Examples of topics for diabetes-related didactics include diabetes practice guidelines, multiple daily injections insulin management, diabetes and CKD, cardiometabolic disease, diabetes technology, beyond A1c targets, motivational interviewing, behavioral health and depression, social determinants of health, insulin affordability, and access to local resources. Specialized cohort-specific diabetes ECHOs have also been implemented for complex diabetes, 36,37 type 1 diabetes (T1D), 38 CKD 35 and cardiometabolic disease. 34 While the didactic curriculum varies across hub sites, the key objective of using case presentations is to facilitate best practice sharing among participants.…”

Section: Curriculummentioning

confidence: 99%

“…Barriers identified included cost of insulin, long wait times, distance to see specialists, lack of local support groups, and patient preference for PCP care for their T1D. 38,39 These findings from the "ECHO T1D" program add to the growing evidence base of the practical need to support PCPs. As noted, diabetes technology utilization has been lower in vulnerable T1D populations.…”

Section: Model To Address Urgent Need Of Complex Diabetes In Primary ...mentioning

confidence: 99%

“…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. 38 Three unique diabetes ECHOs representing 4 regions (Chicago, DC, NM, and Washington) evaluated comfort or perception of prescribing practice changes for community PCPs. Self-reported prescription use for newer diabetes medications with cardiovascular indications increased significantly, as did the perceived likelihood of prescribing intensive insulin therapy.…”

Section: Improving Clinician Knowledge Confidence and Change In Perce...mentioning

confidence: 99%

Section: The Echo Model: Telementoring Primary Care Professionals To ...mentioning

confidence: 99%

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Telementoring With Project ECHO: A New Era in Diabetes-Related Continuing Education for Primary Care to Address Health Disparities

Ehrhardt

Bouchonville

Peek

et al. 2023

J Diabetes Sci Technol

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Project ECHO® is a telementoring workforce development model that targets under-resourced communities lacking access to specialty care. The model builds virtual communities of practice, including specialists and community primary care professionals (PCPs) to combat clinical inertia and health disparities. While the ECHO model has gained global recognition, implementation of the model related to diabetes is lagging compared to other specialty conditions. This review highlights diabetes-endocrine (ENDO)-focused ECHOs using data reported in the ECHO Institute’s centralized data repository (iECHO) and the learning collaborative for diabetes ECHOs. It also describes the implementation of diabetes ECHOs and their evaluation. Learner and patient-centered outcomes related to diabetes ECHOs are reviewed. Program implementation and evaluations have demonstrated utility of the ECHO model for diabetes programs to (1) address unmet needs of diabetes care in the primary care setting, (2) improve knowledge and confidence in managing complex diabetes and change provider prescribing habits, (3) improve patient outcomes, and (4) address diabetes quality improvement practices in primary care. More studies with broader collaboration among sites are needed to evaluate the model related to diabetes, especially applied to addressing therapeutic inertia, adoption of diabetes technology, and reducing health disparities.

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