Innovative Telementoring for Pain Management: Project ECHO Pain

Katzman, Joanna G.; Comerci, George D.; Boyle, Jeannie F.; Duhigg, Daniel; Shelley, Brian M.; Olivas, Cynthia; Daitz, Benson; Carroll, Christie L.; Som, Dara; Monette, Rebecca; Kalishman, Summers; Arora, Sanjeev

doi:10.1002/chp.21210

Cited by 103 publications

(81 citation statements)

References 23 publications

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“…All domains of self-efficacy improved and the overall confidence of CHN's perceived ability to do their job and provide care to patients and their relatives/carers also improved. These findings are similar to results from other studies that have used Project ECHO for chronic pain,20 hypertension21 and diabetes 3. The focus groups confirmed this, with CHNs reporting how they felt more confident as knowledge increased along with encouragement from the hub and each-other.…”

Section: Discussionsupporting

confidence: 91%

Supporting and improving community health services—a prospective evaluation of ECHO technology in community palliative care nursing teams

White¹,

McIlfatrick²,

Dunwoody³

et al. 2015

BMJ Support Palliat Care

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IntroductionProject ECHO (Extension for Community Healthcare Outcomes) uses teleconferencing technology to support and train healthcare providers (HCPs) remotely, and has improved care across the USA. A 6-month pilot was trialled in a community palliative care nursing setting to determine if ECHO would be effective in the UK in providing education and support to community hospice nurses (CHN).MethodsThe pilot involved weekly 2 hour sessions of teaching and case-based discussions facilitated by hospice staff linking with nine teams of CHN using video conferencing technology. A mixed-methods prospective longitudinal cohort study was used to evaluate the pilot. Each CHN provided demographic data, and completed a written knowledge assessment and a self-efficacy tool before and after the pilot. Two focus groups were also performed after the pilot.Results28 CHNs completed the evaluation. Mean knowledge score improved significantly from 71.3% to 82.7% (p=0.0005) as did overall self-efficacy scores following the ECHO pilot. Pre-ECHO (p=0.036) and Retro-Pretest ECHO (p=0.0005) self-efficacy were significantly lower than post-ECHO. There was no significant difference between Pretest and Retro-Pretest ECHO self-efficacy (p=0.063). 96% recorded gains in learning, and 90% felt that ECHO had improved the care they provided for patients. 83% would recommend ECHO to other HCPs. 70% stated the technology used in ECHO had given them access to education that would have been hard to access due to geography.ConclusionsThis study supports the use of Project ECHO for CHNs in the UK by demonstrating how a 6-month pilot improved knowledge and self-efficacy. As a low-cost high-impact model, ECHO provides an affordable solution to addressing growing need.

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Section: Discussionsupporting

confidence: 91%

Supporting and improving community health services—a prospective evaluation of ECHO technology in community palliative care nursing teams

White¹,

McIlfatrick²,

Dunwoody³

et al. 2015

BMJ Support Palliat Care

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“…Data consistently show that through participation in ECHOs, community-based PCPs are able to provide higher quality evidence-based chronic disease care and management (36). An additional benefit has been the creation of ‘communities of practice’, which increases PCP's satisfaction and reduces isolation and burnout (37). …”

Section: Discussionmentioning

confidence: 99%

Translating sickle cell guidelines into practice for primary care providers with Project ECHO

Shook

Farrell

Kalinyak

et al. 2016

Medical Education Online

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BackgroundApproximately 100,000 persons with sickle cell disease (SCD) live in the United States, including 15,000 in the Midwest. Unfortunately, many patients experience poor health outcomes due to limited access to primary care providers (PCPs) who are prepared to deliver evidence-based SCD care. Sickle Treatment and Outcomes Research in the Midwest (STORM) is a regional network established to improve care and outcomes for individuals with SCD living in Indiana, Illinois, Michigan, Minnesota, Ohio, and Wisconsin.MethodsSTORM investigators hypothesized that Project ECHO® methodology could be replicated to create a low-cost, high-impact intervention to train PCPs in evidence-based care for pediatric and young adult patients with SCD in the Midwest, called STORM TeleECHO. This approach utilizes video technology for monthly telementoring clinics consisting of didactic and case-based presentations focused on the National Heart, Lung and Blood Institute (NHLBI) evidence-based guidelines for SCD.ResultsNetwork leads in each of the STORM states assisted with developing the curriculum and are recruiting providers for monthly clinics. To assess STORM TeleECHO feasibility and acceptability, monthly attendance and satisfaction data are collected. Changes in self-reported knowledge, comfort, and practice patterns will be compared with pre-participation, and 6 and 12 months after participation.ConclusionsSTORM TeleECHO has the potential to increase implementation of the NHLBI evidence-based guidelines, especially increased use of hydroxyurea, resulting in improvements in the quality of care and outcomes for children and young adults with SCD. This model could be replicated in other pediatric chronic illness conditions to improve PCP knowledge and confidence in delivering evidence-based care.

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“…Project Extension for Community Health Outcomes (ECHO) pain: To provide virtual access to pain specialists, Project ECHO for pain care38 was introduced at CHCI, providing weekly videoconferences for selected PCPs during which they could present complex pain cases to an expert multidisciplinary team of pain specialists. One provider from each CHCI practice site joined the weekly sessions to serve as the onsite pain “champion”.…”

Section: Methodsmentioning

confidence: 99%

Improving pain care through implementation of the Stepped Care Model at a multisite community health center

Anderson¹,

Zlateva²,

Coman

et al. 2016

JPR

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PurposeTreating pain in primary care is challenging. Primary care providers (PCPs) receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM) at a large, multisite Federally Qualified Health Center.MethodsThe Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention) cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence.ResultsProviders’ pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009). There was no significant change in opioid prescribing.ConclusionImplementation of the SCM-PM resulted in clinically significant improvements in several quality of pain care outcomes. These findings, if sustained, may translate into improved patient outcomes.

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Innovative Telementoring for Pain Management: Project ECHO Pain

Cited by 103 publications

References 23 publications

Supporting and improving community health services—a prospective evaluation of ECHO technology in community palliative care nursing teams

Supporting and improving community health services—a prospective evaluation of ECHO technology in community palliative care nursing teams

Translating sickle cell guidelines into practice for primary care providers with Project ECHO

Improving pain care through implementation of the Stepped Care Model at a multisite community health center

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