Impact of a Provider Tele-mentoring Learning Model on the Care of Medicaid-enrolled Patients With Diabetes

Abstract

Background: Project ECHO (Extension for Community Healthcare Outcomes), a tele-mentoring program for health care providers, has been shown to improve provider-reported outcomes, but there is insufficient research on patient-level outcomes. Objectives: To evaluate the impact of primary care provider (PCP) participation in Project ECHO on the care of Medicaid enrollees with diabetes. Research Design: New Jersey Medicaid claims and encounter data and difference-in-differences models were used to compare utilization and spending between Medicaid patients seen by PCPs participating in a Project ECHO program to those of matched nonparticipating PCPs. Subjects: A total of 1776 adult Medicaid beneficiaries (318 with diabetes), attributed to 25 participating PCPs; and 9126 total (1454 diabetic) beneficiaries attributed to 119 nonparticipating PCPs. Measures: Utilization and spending for total inpatient, diabetes-related inpatient, emergency department, primary care, and endocrinologist services; utilization of hemoglobin A1c tests, eye exams, and diabetes prescription medications among diabetics, and total Medicaid spending. Results: Participation in Project ECHO was associated with decreases of 44.3% in inpatient admissions (P=0.001) and 61.9% in inpatient spending (P=0.021) among treatment relative to comparison patients. Signs of most other outcome estimates were consistent with hypothesized program effects but without statistical significance. Sensitivity analyses largely confirmed these findings. Conclusions: We find evidence that Project ECHO participation was associated with large and statistically significant reductions of inpatient hospitalization and spending. The study was observational and limited by a small sample of participating PCPs. This study demonstrates the feasibility and potential value of quasi-experimental evaluation of Project ECHO patient outcomes using claims data.

Project ECHO Diabetes Cost Modeling to Support the Replication and Expansion of Tele-mentoring Programs in Non-research Settings

“…Despite the widespread implementation of Project ECHO Ò programs to address a variety of health care issues, there appear to be few published studies of the costs of these programs [11] and even fewer still with regard to using Project ECHO Ò to improve outcomes in people with diabetes [12]. Moreover, Project ECHO Diabetes employed diabetes support coaches, which is a relatively novel addition to traditional Project ECHO Ò programs [13].…”

Telementoring With Project ECHO: A New Era in Diabetes-Related Continuing Education for Primary Care to Address Health Disparities

“…Significant changes were seen in those who attended 20 or more of the 64 sessions. 52 University of New Mexico’s program also recently showed a 1.2% initial improvement in A1c among spoke sites but no significant difference from controls (difference 0.2% at 3 months and 0.3% at 12 months). However, in long-term follow-up, PWD treated by ECHO-trained clinicians were more likely to achieve an A1c of less than 8% than community peers.…”

The Association of Telehealth Availability and Quality of Care Measures for Patients With Diabetes at Federally Qualified Health Centers: Retrospective Cohort Study

“…Telehealth has the potential to improve access to and quality of care for low-income patients with chronic conditions such as diabetes [1][2][3][4]. This includes patients served by federally qualified health centers (FQHCs), which provide comprehensive primary and preventive care services to millions of low-income patients across the United States.…”