Project Extension for Community Healthcare Outcomes (ECHO) in Multiple Sclerosis

Johnson, Kurt; Hertz, Deborah P.; Stobbe, Gary; Alschuler, Kevin N.; Kalb, Roland; Alexander, Katharine; Kraft, George H.; Scott, John D.

doi:10.7224/1537-2073.2016-099

Cited by 28 publications

(35 citation statements)

References 11 publications

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“…Change in confidence and self-efficacy focused on whether providers reported greater confidence in ability to diagnose and/or treat patients following EELM participation. 17,23,26,30,32,34,41,48,51,52,56,71 Metrics along these lines were reported in most studies, ranging from selfreported changes following participation, 32 to within-subjects change from baseline to endline, 48 to between-subjects comparisons in perceived competence, 30 including in one randomized controlled trial (RCT). 26 In most instances, results were positive and significant; a notable exception came from the RCT on chronic pain management.…”

Section: Provider-related Outcomesmentioning

confidence: 99%

Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

et al. 2019

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BACKGROUND: Extension for Community Health care Outcomes (ECHO) and related models of medical teleeducation are rapidly expanding; however, their effectiveness remains unclear. This systematic review examines the effectiveness of ECHO and ECHO-like medical teleeducation models of healthcare delivery in terms of improved provider-and patient-related outcomes. METHODS: We searched English-language studies in PubMed, Embase, and PsycINFO databases from 1 January 2007 to 1 December 2018 as well as bibliography review. Two reviewers independently screened citations for peer-reviewed publications reporting provider-and/ or patient-related outcomes of technology-enabled collaborative learning models that satisfied six criteria of the ECHO framework. Reviewers then independently abstracted data, assessed study quality, and rated strength of evidence (SOE) based on Cochrane GRADE criteria. RESULTS: Data from 52 peer-reviewed articles were included. Forty-three reported provider-related outcomes; 15 reported patient-related outcomes. Studies on provider-related outcomes suggested favorable results across three domains: satisfaction, increased knowledge, and increased clinical confidence. However, SOE was low, relying primarily on self-reports and surveys with low response rates. One randomized trial has been conducted. For patient-related outcomes, 11 of 15 studies incorporated a comparison group; none involved randomization. Four studies reported care outcomes, while 11 reported changes in care processes. Evidence suggested effectiveness at improving outcomes for patients with hepatitis C, chronic pain, dementia, and type 2 diabetes. Evidence is generally low-quality, retrospective, non-experimental, and subject to social desirability bias and low survey response rates. DISCUSSION: The number of studies examining ECHO and ECHO-like models of medical tele-education has been modest compared with the scope and scale of implementation throughout the USA and internationally. Given the potential of ECHO to broaden access to healthcare in rural, remote, and underserved communities, more studies are needed to evaluate effectiveness. This need for evidence follows similar patterns to other service delivery models in the literature.

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Section: Provider-related Outcomesmentioning

confidence: 99%

Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

et al. 2019

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“…In a previous publication, we comprehensively described the Project ECHO concept, our adaptation to MS, objective data describing the providers who participated in the pilot study (clinical specialty, MS experience, geographic location), the topics covered during the program, and metrics of participation and satisfaction with the program. 7 In contrast, the present article focuses exclusively on the case consultation portion of the program and summarizes qualitative feedback obtained via exit interviews.…”

Section: Overviewmentioning

confidence: 99%

“…6 Geographic, financial, and health-related barriers limit the ability of patients in underserved areas to travel to MS specialty centers, thus creating the need for improvements in the care that individuals with MS receive in these underserved areas. In a previous publication, 7 we described our successful adaptation of an approach to accelerating the transfer of knowledge from content experts to rural providers who then develop an enhanced level of clinical understanding and confidence, allowing them to serve as local experts in MS care. In this program, called MS Project ECHO (Extension for Community Healthcare Outcomes), 8 providers who care for individuals with MS (the "participants") in underserved areas join a weekly videoconference that includes a brief didactic focused on key information necessary to provide high-quality care, followed by case consultation and discussion.…”

Section: Overviewmentioning

confidence: 99%

“…Established Project ECHOs operate as ongoing programs. Attending to the development and feasibility goals, we focused our evaluation on basic metrics of success (eg, attendance, quantity of sessions, successful recruitment; reported in Johnson et al 7 ). We evaluated the preliminary effect of the program based on participant self-report collected via exit interview.…”

Section: Increased Perception That Patients Had Confidence In Particimentioning

confidence: 99%

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

Alschuler¹,

Stobbe²,

Hertz³

et al. 2019

International Journal of MS Care

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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.

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“…(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").…”

Section: Introductionmentioning

confidence: 99%

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

Alschuler

Geldern

Ball

et al. 2020

Multiple Sclerosis and Related Disorders

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Background: Healthcare providers caring for people with multiple sclerosis (MS) have had significant concerns about the intersection of MS and COVID-19. As a result, there has been an urgency to understand and share information about how to best provide MS clinical care during COVID-19. The Project ECHO model is well-suited for this challenge, as it provides a uniquely efficient and effective approach to sharing information in real-time using real cases. We report on the translation of the Project ECHO model for the rapid sharing of knowledge among MS clinical providers during COVID-19. Methods: The ECHO MS COVID-19 Response Clinic was a videoconference-based education and case consultation program offered to providers in the U.S. who care for individuals with MS. The Response Clinic was offered as four sessions, each delivered by three regional hubs. Data were collected on participation and the self-reported impact of the program. Results: A total of 132 unique providers participated in the Response Clinic, which consisted of 11 didactic modules and 43 case consultations. Participant providers overwhelmingly indicated that the program improved their knowledge, attitude, and skills for providing healthcare for people with MS during the COVID-19 pandemic. Discussion: The Project ECHO model was successfully adapted to serve the needs of the MS community during COVID-19, suggesting the program could be continued or could be expanded to other disease areas for a similar purpose. More research is needed to objectively measure the impact of the program on patient outcomes.

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Project Extension for Community Healthcare Outcomes (ECHO) in Multiple Sclerosis

Cited by 28 publications

References 11 publications

Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

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

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

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