The Impact of Project ECHO on Participant and Patient Outcomes: A Systematic Review

Zhou, Carrol; Crawford, Allison; Serhal, Eva; Kurdyak, Paul; Sockalingam, Sanjeev

doi:10.1097/acm.0000000000001328

Cited by 283 publications

(289 citation statements)

References 23 publications

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“…Despite wide uptake of the SCAN‐ECHO program in the VHA, data are limited regarding the clinical impact of VA SCAN‐ECHO, particularly on patient outcomes such as mortality . We previously showed that an in‐person specialist consultation visit is associated with improved survival in liver disease patients .…”

mentioning

confidence: 99%

“…Despite wide uptake of the SCAN-ECHO program in the VHA, data are limited regarding the clinical impact of VA SCAN-ECHO, particularly on patient outcomes such as mortality. (2,(4)(5)(6)(7)(8)(9)(10) We previously showed that an in-person specialist consultation visit is associated with improved survival in liver disease patients. (11) This study sought to extend those findings by examining whether a virtual specialty SCAN-ECHO consultation visit had a similar positive effect on survival of patients with liver disease.…”

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confidence: 99%

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Virtual Consultations Through the Veterans Administration SCAN‐ECHO Project Improves Survival for Veterans With Liver Disease

Glass

Tapper

et al. 2018

Hepatology

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Access to specialty care has been associated with improved survival in patients with liver disease but universal access is not always feasible. Methods of care delivery using virtual modalities including the SCAN-ECHO (Specialty Access Network-Extension of Community Healthcare Outcome) program were implemented by the Veterans Health Administration (VHA) to address this need but limited data are available on patient outcomes. We sought to evaluate the efficacy of a SCAN-ECHO visit within the context of a regional cohort of patients with liver disease in the VHA (n = 62,237) following implementation in the Ann Arbor SCAN-ECHO Liver Clinic from June 1, 2011, to March 31, 2015. The effect of a SCAN-ECHO visit on all-cause mortality was compared with patients with no liver clinic visit. To adjust for the differences among patients who had a SCAN-ECHO visit versus those with no visit, propensity score matching was performed on condition factors that affect the likelihood of a SCAN-ECHO visit: demographics, geographic location, liver disease diagnosis, severity, and comorbidities. During the study period, 513 patients who had a liver SCAN-ECHO visit were found within the cohort. Patients who had completed a virtual SCAN-ECHO visit were more likely younger, rural, with more significant liver disease, and evidence for cirrhosis. Propensity-adjusted mortality rates using the Cox Proportional Hazard Model showed that a SCAN-ECHO visit was associated with a hazard ratio of 0.54 (95% confidence interval 0.36-0.81, P = 0.003) compared with no visit. Conclusion: Improved survival in patients using SCAN-ECHO suggests that this approach may be an effective method to improve access for selected patients with liver disease, particularly in rural and underserved populations where access to specialty care is limited.

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confidence: 99%

mentioning

confidence: 99%

Virtual Consultations Through the Veterans Administration SCAN‐ECHO Project Improves Survival for Veterans With Liver Disease

Glass

Tapper

et al. 2018

Hepatology

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“…The ECHO project connects primary care providers in rural and underserved communities around the world with specialists in academic centers. 20 The iPath platform provides expert pathologic review for colleagues in developing countries. 21 In addition, the SickKids-Caribbean Initiative 22 is a regional program sponsored by the Hospital for Sick Children in Toronto, Canada, to build capacity in six Caribbean countries to improve the outcomes of children with cancers and blood disorders.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Prospective Telemedicine Implementation in the Management of Childhood Acute Lymphoblastic Leukemia in Recife, Brazil

Pedrosa

Shaikh

Rivera

et al. 2017

Telemedicine and e-Health

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“…Telehealth has additionally benefitted clinical care through models such as a hub and spoke network delivery system in which an anchor "hub" provides comprehensive expertise to secondary "spokes", including local healthcare providers [19]. One such model known as the Extension for Community Healthcare Outcomes (ECHO) has been applied to Phelan-McDermid Syndrome [20] and provides a platform for video-consultation between local physicians and academic experts to support clinical care in communities, thereby reducing the burden of care on both healthcare providers and caregivers. These telehealth models may prove effective in addressing challenges in recruitment for clinical trials, and importantly, disseminating academic expertise and evidence-based intervention to communities.…”

Section: Discussionmentioning

confidence: 99%

A telehealth approach to improving clinical trial access for infants with tuberous sclerosis complex

Hyde¹,

Pizzano²,

McDonald³

et al. 2020

J Neurodevelop Disord

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Background: Research in rare genetic syndromes associated with ASD is often hampered by the wide geographic distribution of families and the presence of medical comorbidities, such as epilepsy, that may preclude travel to clinical sites. These challenges can limit the sample size and generalizability of the cohorts included in both natural history studies and clinical trials. Tuberous sclerosis complex (TSC) is a rare genetic syndrome that confers an elevated risk for autism spectrum disorder (ASD), with social communication delays identified in this population as early as 12 months of age. Early identification of risk necessitates parallel testing of early intervention, prompting the first randomized controlled clinical trial of behavioral intervention for infants with TSC (NCT03422367). However, considerable early recruitment challenges have mandated the systematic identification of enrollment barriers followed by modification of the study design to address these barriers. Methods: Caregivers were interviewed regarding barriers to enrollment (phase 1). Adaptations to the intervention were made to address these barriers (phase 2). Outcomes based on this modification to the study design were defined by enrollment rate and participant demographics. Results: Qualitative reports from caregivers indicated that distance and time were the primary barriers to clinical trial enrollment. The intervention was then modified to a remote model, with at-home, parent-delivered intervention, and weekly video conferencing with interventionists at the study sites. Enrollment increased 10-fold (from 3 to 30 participants) within 1 year and included a more diverse and clinically representative cohort of infants. Conclusion: The design and implementation of more scalable methods to disseminate research remotely can substantially improve access to clinical trials in rare neurodevelopmental disorders. The lessons learned from this trial can serve as a model for future studies not only in rare conditions, but in other populations that lack adequate access, such as families with limited financial or clinical resources. Continued efforts will further refine delivery methods to enhance efficiency and ease of these delivery systems for families.

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The Impact of Project ECHO on Participant and Patient Outcomes: A Systematic Review

Cited by 283 publications

References 23 publications

Virtual Consultations Through the Veterans Administration SCAN‐ECHO Project Improves Survival for Veterans With Liver Disease

Virtual Consultations Through the Veterans Administration SCAN‐ECHO Project Improves Survival for Veterans With Liver Disease

The Impact of Prospective Telemedicine Implementation in the Management of Childhood Acute Lymphoblastic Leukemia in Recife, Brazil

A telehealth approach to improving clinical trial access for infants with tuberous sclerosis complex

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