Reflections on project ECHO: qualitative findings from five different ECHO programs

Abstract

Project ECHO (Extension for Community Healthcare Outcomes) was developed in 2003 as an innovative model to facilitate continuing education and professional development. ECHO emphasizes ‘moving knowledge, not people.’ To accomplish this, ECHO programs use virtual collaboration and case-based learning to allow practitioners, including those in rural and underserved areas, to receive specialist training. The ECHO model has expanded rapidly and is now used in 44 countries. Preliminary research on ECHO’s efficacy and effectiveness has shown promising results, but evidence remains limited and appropriate research outcomes have not been clearly defined. To improve the evidence basis for ECHO, this study of 5 ECHO programs (cancer prevention/survivorship, integrated pain management, hepatitis C, HIV, and LGBTQ+ health care elucidated actionable insights about the ECHO programs and directions in which future evaluations and research might progress. This was a qualitative study following COREQ standards. A trained interviewer conducted 10 interviews and 5 focus groups with 25 unique, purposively sampled ECHO attendees (2 interviews and 1 focus group for each of the 5 programs). Data were transcribed verbatim and analyzed using the general inductive approach, then reviewed for reliability. We identified four major categories (reasons to join ECHO, value of participating in ECHO, ways to improve ECHO, and barriers to participation) composed of 23 primary codes. We suggest that thematic saturation was achieved, and a coherent narrative about ECHO emerged for discussion. Participants frequently indicated they received valuable learning experiences and thereby changed their practice; rigorous trials of learning and patient-level outcomes are warranted. This study also found support for the idea that the ECHO model should be studied for its role in convening communities of practice and reducing provider isolation as an outcome in itself. Additional implications, including for interprofessional education and model evolution, were also identified and discussed.

The Changing Nature of Telehealth Use by Primary Care Physicians in the United States

“…Our analysis suggests that while telehealth use in the primary care setting was largely limited before the pandemic to those with prior training and those in the South and West—where project ECHO may have increased participation in rural communities, 37 - 39 the pandemic has spurred innovation in care delivery, with younger physicians, Asian physicians, and those without formal training in medical school leading the change. While some of these trends were expected—for example younger physicians who are more comfortable with technology being more likely to adopt telehealth—other findings like Asian physicians being significantly more likely to increase their telehealth use are less easily explained.…”

A Roadmap for Modifying Clinician Behavior to Improve the Detection of Cognitive Impairment

“…Preliminary data on the ECHO model's effectiveness in pain management, cancer prevention, and HIV are promising. 20 The Alzheimer's Association has partnered with Project ECH-O to provide education on Alzheimer's diagnosis and care. In a six-month program, primary care providers participate in case-based learning led by dementia experts on topics such as evaluation and diagnosis of dementia, care planning, and care management.…”

Describing implementation outcomes for a virtual community of practice: The ECHO Ontario Mental Health experience

“…Since then, the ECHO model has expanded significantly, with over 49 countries delivering 955 ECHO projects across a range of areas within healthcare (including behavioural/mental health, chronic pain, HIV, geriatrics and cancer care) and beyond [ 2 , 4 – 6 ]. Numerous studies have shown that ECHO expands PCP knowledge of best practices, increases self-efficacy and behaviour, and improves patient outcomes as well as cost-effectiveness [ 1 , 7 – 10 ] Additionally, several qualitative studies have suggested that ECHO programmes can serve to reduce providers’ feelings of isolation or help create a community of practice [ 11 , 12 ].…”