Assessing and Expanding the Evidence Base for Project ECHO and ECHO-Like Models: Findings of a Technical Expert Panel

Abstract

BACKGROUND: In 2003, Project ECHO (Extension for Community Healthcare Outcomes) began using technology-enabled collaborative models of care to help general practitioners in rural settings manage hepatitis C. Today, ECHO and ECHO-like models (EELM) have been applied to a variety of settings and health conditions, but the evidence base underlying EELM is thin, despite widespread enthusiasm for the model. METHODS: In April 2018, a technical expert panel (TEP) meeting was convened to assess the current evidence base for EELM and identify ways to strengthen it. RESULTS: TEP members identified four strategies for future implementors and evaluators of EELM to address key challenges to conducting rigorous evaluations: (1) develop a clear understanding of EELM and what they are intended to accomplish; (2) emphasize rigorous reporting of EELM program characteristics; (3) use a wider variety of study designs to fill key knowledge gaps about EELM; (4) address structural barriers through capacity building and stakeholder engagement. CONCLUSIONS: Building a strong evidence base will help leverage the innovative aspects of EELM by better understanding how, why, and in what contexts EELM improve care access, quality, and delivery, while also improving provider satisfaction and capacity.

COVID-19 and telehealth, education, and research adaptations

“…The limited evidence we do have suggests that provider related outcomes such as provider satisfaction, knowledge and confidence are favorably impacted [16,17]. Studies evaluating patient related outcomes indicate that Project Echo is most effective for the management of chronic illnesses like hepatitis C, chronic pain, or type 2 diabetes [16,17]. Moving forward, we must rigorously evaluate models like Project Echo using randomized controlled trials or big data technology to determine if such models truly improve patient and provider related outcomes while also improving access and cost.…”

“…While early evidence supporting Project Echo (and similar models) appears promising it is important to recognize that the studies to date are relatively weak as they are all retrospective, non-experimental and subject to various types of biases [17]. The limited evidence we do have suggests that provider related outcomes such as provider satisfaction, knowledge and confidence are favorably impacted [16,17]. Studies evaluating patient related outcomes indicate that Project Echo is most effective for the management of chronic illnesses like hepatitis C, chronic pain, or type 2 diabetes [16,17].…”

“…Originally developed in 2003 at the University of New Mexico to help primary care providers manage Hepatitis C, the model's success has led to rapid expansion [13]. Project Echo now operates more than 220 hubs for more than 100 diseases and conditions in 34 countries [16]. Using the power and potential of telehealth, Project Echo seeks to simultaneously improve care, increase access, decrease cost, educate providers, and expand opportunities for research [16].…”

“…Project Echo now operates more than 220 hubs for more than 100 diseases and conditions in 34 countries [16]. Using the power and potential of telehealth, Project Echo seeks to simultaneously improve care, increase access, decrease cost, educate providers, and expand opportunities for research [16].…”

Impact of a videoconferencing educational programme for the management of concurrent disorders on nurses’ competency development and clinical practice: protocol for a convergent mixed methods study

“… 35 48 The majority of these studies contain insufficient information on how the implemented programme was replicated or adapted and how well it was delivered. 48 49 Although few studies have been conducted to assess the impact of ECHO on nurses, 50 51 these studies were not specific to CDs and have not adequately captured nurses’ views on how and in which conditions they developed their competencies. Indeed, limited research has been conducted so far to explore ECHO’s impact on competency development, and how these new acquisitions were applied into clinical nursing practice.…”