Adapting the Consolidated Framework for Implementation Research to Create Organizational Readiness and Implementation Tools for Project ECHO

Abstract

The Project Extension for Community Healthcare Outcomes (ECHO) model expands primary care provider (PCP) capacity to manage complex diseases by sharing knowledge, disseminating best practices, and building a community of practice. The model has expanded rapidly, with over 140 ECHO projects currently established globally. We have used validated implementation frameworks, such as Damschroder's (2009) Consolidated Framework for Implementation Research (CFIR) and Proctor's (2011) taxonomy of implementation outcomes, combined with implementation experience to (1) create a set of questions to assess organizational readiness and suitability of the ECHO model and (2) provide those who have determined ECHO is the correct model with a checklist to support successful implementation. A set of considerations was created, which adapted and consolidated CFIR constructs to create ECHO-specific organizational readiness questions, as well as a process guide for implementation. Each consideration was mapped onto Proctor's (2011) implementation outcomes, and questions relating to the constructs were developed and reviewed for clarity. The Preimplementation list included 20 questions; most questions fall within Proctor's (2001) implementation outcome domains of ”Appropriateness“ and ”Acceptability.“ The Process Checklist is a 26-item checklist to help launch an ECHO project; items map onto the constructs of Planning, Engaging, Executing, Reflecting, and Evaluating. Given that fidelity to the ECHO model is associated with robust outcomes, effective implementation is critical. These tools will enable programs to work through key considerations to implement a successful Project ECHO. Next steps will include validation with a diverse sample of ECHO projects.

Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic

“…Technology-delivered care can be helpful in scaling interventions for rural adults with obesity residing in remote areas Policymakers can enhance reimbursement and incentives to promote telemedicine-delivered care to adults Enhancing patient/staff engagement and culture can overcome organizational stress and enhance reach of the intervention the Consolidated Framework for Implementation Research (CFIR) and RE-AIM [5]. These frameworks have previously been applied in the context of telemedicine and have found that patient and leadership engagement, comfort levels with the technology, and a need to have similar efficacy and workflows to in-person visits were important factors [6][7][8]. As such, the purpose of this analysis was to apply these established implementation frameworks to refine our intervention for a future, large-scale trial that could ensure its long-term success and program sustainability in rural areas.…”

A mixed methods evaluation of the feasibility, acceptability, and impact of a pilot project ECHO for community health workers (CHWs)

“…In this paper, we examine the feasibility, acceptability, and impact of a national Project ECHO training program created specifically for CHWs to enhance their competency and improve their ability to address patients' SDOH. Prior implementation research related to Project ECHO has identified feasibility and acceptability as key components to ensuring implementation success [20], yet it is unknown to what extent CHWs will choose to participate in and have their learning needs met by a national ECHO with a broader curriculum. In addition to feasibility and acceptability, we also assess impact so as to understand immediate outcomes related to the intervention.…”

Addressing opioid use disorder among rural pregnant and postpartum women: a study protocol

“…Due to the physical distance between the community of interest and the research team, the use of video and telecommunication is key in delivering this intervention. Previous research has adapted the CFIR to assess readiness for and suitability of a tele-mentoring platform, the Project Extension for Community Healthcare Outcomes (ECHO), and created ECHO-specific organizational readiness questions and a process guide for implementation [ 65 ]. Using the CFIR as a guide for our project may also yield information that can be adapted and utilized as guidelines for other interventions involving OUD-specific remote education.…”