Impact of Multiple Sclerosis Project ECHO (Extension for Community Healthcare Outcomes) on Provider Confidence and Clinical Practice

Abstract

Background: Project ECHO (Extension for Community Healthcare Outcomes) represents a novel approach to addressing disparities in multiple sclerosis (MS) care. A primary mechanism of the program is the use of case consultations to rapidly transfer knowledge from content experts to community providers who care for individuals with MS. Methods: MS Project ECHO was pilot tested as a weekly 60-minute videoconference delivered to 24 clinicians across 13 practice sites over 41 weeks. Participants completed a variety of measures related to their experience in the program and answered qualitative questions via exit interview. We report on the responses to exit interview questions related to the case consultation component of MS Project ECHO. Results: Participant responses regarding case consultations generated four themes: 1) improved confidence among participants inthe existing treatment decision, 2) direct change in the care of the patient provided by the participant, 3) changed practice habits for all of the participant's patients with MS, and 4) increased perception that patients had confidence in the participant as an MS care provider. Conclusions: Participant responses support MS Project ECHO as a program that may directly and indirectly affect the way providers deliver MS care in underserved areas. Further research is needed to examine the resulting effect on patient outcomes. Int J MS Care. 2019;21:143-150.

Rapid transfer of knowledge for multiple sclerosis clinical care during COVID-19: ECHO MS

“…This is consistent with the variety of peer-reviewed publications that have reported on program evaluation data from Project ECHOs. ( Arora et al., 2007 ; Arora et al., 2010 ; Arora et al., 2014 ; Colleran et al., 2012 ; Johnson et al., 2017 ; Alschuler et al., 2019 ) With that said, participants indicated a greater benefit in knowledge, attitude, and skills relative to the likelihood that it would change their clinical practice. While we initially viewed this as an unexpected finding, we recognized that participants in this particular series of sessions were primarily experienced MS providers who were generally already aligned in their perspectives but were seeking confirmation or consensus in an environment of significant uncertainty.…”

“…The ease of participation, coupled with a format that emphasizes discussion and application to real cases was engaging and was met with positive feedback from participants. This is now the third iteration of an MS-focused application of the model, with prior efforts focused on non-MS specialist providers ( Johnson et al., 2017 ; Alschuler et al., 2019 ) and an international audience. ( Alschuler et al., 2016 ) All have achieved similarly positive self-reported and qualitative results, suggesting further development of the model in the MS community may be worthwhile.…”

“…(University of New Mexico, 2020) This includes one prior translation of the Project ECHO model for management of patients with MS, which resulted in participants self-reporting improvement in perceived knowledge, expertise, and provider behavior. (Johnson et al, 2017;Alschuler et al, 2019) A related demonstration project also showed the model could be used to aid an international audience in improving their knowledge of DMTs for MS that were newly approved in their country but had been utilized for a number of years in the U.S. (Alschuler et al, 2016) Project ECHO has been previously recommended as a model for facilitating the rapid sharing of knowledge during global health crises (e. g., Zika crisis (Heard-Garris et al, 2017)) and has preliminary evidence for utility with the MS healthcare community. Thus, the National MS Society sought to leverage the model to expedite knowledge sharing for the management of persons living with MS during the COVID-19 pandemic ("ECHO MS COVID-19 Response Clinic").…”

“…( University of New Mexico, 2020 ) This includes one prior translation of the Project ECHO model for management of patients with MS, which resulted in participants self-reporting improvement in perceived knowledge, expertise, and provider behavior. ( Johnson et al., 2017 ; Alschuler et al., 2019 ) A related demonstration project also showed the model could be used to aid an international audience in improving their knowledge of DMTs for MS that were newly approved in their country but had been utilized for a number of years in the U.S. ( Alschuler et al., 2016 )…”

Extension of Community Healthcare Outcomes in Parkinson Disease (Parkinson ECHO): A Feasibility Study

“…While initially starting with hepatitis C in New Mexico (Arora et al ., 2007), ECHO program topics have rapidly expanded to other chronic conditions. More recently it has expanded into the realm of neurological disorders including dementia (Lindauer et al ., 2020), epilepsy (McDonald et al ., 2021), and multiple sclerosis (Johnson et al ., 2017, Alschuler et al ., 2019).…”