Building Provincial Mental Health Capacity in Primary Care: An Evaluation of a Project ECHO Mental Health Program

Sockalingam, Sanjeev; Arena, Amanda; Serhal, Eva; Mohri, Linda; Alloo, Javed; Crawford, Allison

doi:10.1007/s40596-017-0735-z

Cited by 100 publications

(93 citation statements)

References 18 publications

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“…Several care models from primary care may provide useful guidance in this regard. For example, Project ECHO utilizes expert‐led video conferences to provide advanced training of primary care providers in mental health treatment. Integrated behavioral health care models embed mental health providers of various levels directly into the primary care clinic environment .…”

Section: Discussionmentioning

confidence: 99%

Depression in Emergency Department Patients and Association With Health Care Utilization

Beiser

Ward

et al. 2019

Academic Emergency Medicine

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Background: Depression is one of the most common illnesses in the United States, with increased prevalence among people with lower socioeconomic status and chronic mental illness who often seek care in the emergency department (ED). We sought to estimate the rate and severity of major depressive disorder (MDD) in a nonpsychiatric ED population and its association with subsequent ED visits and hospitalizations.Methods: This prospective cohort study enrolled a convenience sample of English-speaking adults presenting to an urban academic medical center ED without psychiatric complaints between January 1, 2015, and September 21, 2015.Patients completed a computerized adaptive depression diagnostic screen (CAD-MDD) and dimensional depression severity measurement test (CAT-DI) via tablet computer. Primary outcomes included number of ED visits and hospitalizations assessed from index visit until January 1, 2016. Negative binomial regression modeling was performed to assess associations between depression, depression severity, clinical covariates, and utilization outcomes.Results: Of 999 enrolled patients, 27% screened positive for MDD. The presence of MDD conveyed a 61% increase in the rate of ED visits (incidence rate ratio [IRR] = 1.61, 95% confidence interval [CI] = 1.27 to 2.03) and a 49% increase in the rate of hospitalizations (IRR = 1.49, 95% CI = 1.06-2.09). For each 10% increase in MDD severity, there was a 10% increase in the relative rate of subsequent ED visits (IRR = 1.10, 95% CI = 1.04 to 1.16) and hospitalizations (IRR = 1.10, 95% CI = 1.02 to 1.18). Across the range of the severity scale there was over a 2.5-fold increase in the rate of ED visits and hospitalization rates.Conclusions: Rates of depression were high among a convenience sample of English-speaking adult ED patients presenting with nonpsychiatric complaints and independently associated with increased risk of subsequent ED utilization and hospitalization. Standardized assessment tools that provide rapid, accurate, and precise classification of MDD severity have the potential to play an important role in identifying ED patients in need of urgent psychiatric resource referral.From the

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Section: Discussionmentioning

confidence: 99%

Depression in Emergency Department Patients and Association With Health Care Utilization

Beiser

Ward

et al. 2019

Academic Emergency Medicine

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“…The principle of Project Extension for Community Healthcare Outcomes (Project ECHO) is to de-monopolize specialized medical knowledge and expertise and to increase access to this specialized knowledge and expertise in rural and underserved areas through videoconferencing technology and case-based learning [35]. Psychiatry and addictions-focused ECHO programs seem to be effective in increasing primary care physicians' knowledge and selfefficacy and in potentially reducing feelings of isolation [36].…”

Section: Overcoming Challenges and Seeing The Opportunities Of Rural mentioning

confidence: 99%

Rural Mental Health Training: an Emerging Imperative to Address Health Disparities

et al. 2018

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“… 9 In addition, in a recent assessment of our ECHO Ontario Mental Health project outcomes, our team found that there was a significant improvement in pre-post knowledge of over 12% for participating primary care providers ( P < .001, d = 1.13). 10 …”

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confidence: 99%

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

Serhal

Arena

Sockalingam

et al. 2018

J Contin Educ Health Prof

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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.

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Building Provincial Mental Health Capacity in Primary Care: An Evaluation of a Project ECHO Mental Health Program

Cited by 100 publications

References 18 publications

Depression in Emergency Department Patients and Association With Health Care Utilization

Depression in Emergency Department Patients and Association With Health Care Utilization

Rural Mental Health Training: an Emerging Imperative to Address Health Disparities

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

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