Democratizing Specialized Care in the Digital Age: Project ECHO as a Learning Environment for Continuing Professional Development.

<h3>Objectives</h3> The Extension for Community Healthcare Outcomes (ECHO) is a proven model to improve specialty care for underserved communities. The IGCS uses the Project ECHO platform to connect multi-disciplinary teams across disparate regions, through virtual tumor board case discussions and didactic presentations. In the Project ECHO sessions, international pathologists provide pathology review, which is often based on limited imaging embedded in Power Point slide presentations. We present an initial review of our experience integrating pathologists into the IGCS virtual tumor boards. <h3>Methods</h3> We solicited feedback from pathologists and clinicians participating in the IGCS ECHO sessions in individual and small group settings. <h3>Results</h3> Clinicians appreciate the inclusion of pathology images and teaching in ECHO sessions with good clinical and educational value. However, challenges were noted with engagement and scheduling with in-country pathologists. Challenges noted by the consulting pathologists included: being asked to offer an opinion with limited information or images, poor quality images, lack of the final pathology report, coping with apparent diagnostic errors, lacking an established relationship with the local pathologist, and the local pathologist not always being present to discuss or explain findings. Opportunities identified include: establishing telepathology connections to facilitate case review, leveraging the IGCS Global Curriculum international mentor/local mentor/trainee model to create parallel and synergistic international and local pathologist collaborative relationships beyond ECHO sessions, further program strengthening through international exchange trips for international and local pathologists. <h3>Conclusions</h3> Inclusion of pathology experts in Project ECHO sessions is key to successful tumor boards. Addressing the above-noted challenges will strengthen the entire collaboration.

Despite evidence of effectiveness, most US hospitals do not deliver hospital-based addictions care. ECHO (Extension for Community Healthcare Outcomes) is a telementoring model for providers across diverse geographic areas. We developed and implemented a substance use disorder (SUD) in hospital care ECHO to support statewide dissemination of best practices in hospital-based addictions care. Assess the feasibility, acceptability, and effects of ECHO and explore lessons learned and implications for the spread of hospital-based addictions care. Mixed-methods study with a pre-/post-intervention design. Interprofessional hospital providers and administrators across Oregon. A 10-12-week ECHO that included participant case presentations and brief didactics delivered by an interprofessional faculty, including peers with lived experience in recovery. To assess feasibility and acceptability, we collected enrollment, attendance, and participant feedback data. To evaluate ECHO effects, we used pre-/post-ECHO assessments and performed a thematic analysis of open-ended survey responses and participant focus groups. We recruited 143 registrants to three cohorts between January and September 2019, drawing from 32 of Oregon's 62 hospitals and one southwest Washington hospital. Ninety-six (67.1%) attended at least half of ECHO sessions. Participants were highly satisfied with ECHO. After ECHO, participants were more prepared to treat SUD; however, prescribing did not change. Participants identified substantial gains in knowledge and skills, particularly regarding the use of medications for opioid use disorder; patient-centered communication with people who use drugs; and understanding harm reduction as a valid treatment approach. ECHO built a community of practice and reduced provider isolation. Participants recognized the need for supportive hospital leadership, policies, and SUD resources to fully implement and adopt hospital-based SUD care. A statewide, interprofessional SUD hospital care ECHO was feasible and acceptable. Findings may be useful to health systems, states, and regions looking to expand hospital-based addictions care.

Although hepatitis C virus (HCV) infection is curable, treatment of difficult to access populations (DTAP) presents unique challenges. Project ECHO (PE) (Extension for Community Healthcare Outcomes) is a telementoring programme adopted to support clinicians treating DTAP. To determine if the PE model supports primary care clinicians treating HCV and to compare cohort of PE patients with those in a tertiary liver clinic (TLC). Weekly PE group video conferences were conducted. Clinical information, laboratory indices, psychosocial elements and treatment outcomes, including sustained virological response (SVR) data were recorded in the first 100 consecutive cases and retrospectively compared to 100 consecutive patients seen at a TLC from July 2016 to April 2017. Some patient characteristics were similar between PE and TLC: gender (72% vs 75% male; P = 0.23), median age (45 vs 50; P = 0.344) and the proportion of treatment naïve patients (95.0% vs 90.9%). Treatment for HCV was commenced in 78% of the PE patients and 81% of the TLC patients; 67/68 of the TLC patients and 60/61 PE patients with virological follow up who completed treatment and attended follow up have confirmed SVR. PE patients are more likely to have ongoing substance use (44% vs 17% P < 0.001), be active intravenous drug users (32% vs 17%; P < 0.001) and polysubstance abusers (26% vs 7%; P < 0.001) and were more likely to be taking opioid substitution therapy (74% vs 20%; P < 0.001). Indigenous patients were three times more greatly represented in PE (15% vs 5%; P = 0.018). PE is an effective model to support primary healthcare providers treating HCV in DTAP with similar rates of treatment uptake and SVR compared to patients in TLC.

Healthcare providers (HCPs) practicing in community settings are critical to improving access to pain care, yet there are significant gaps in training opportunities designed for interprofessional learners. Project Extension for Community Healthcare Outcomes (Project ECHO®) is an established model for delivering online HCP education through virtual clinics and cultivating a community of practice. However, to our knowledge, the integration of pain core competency education into the ECHO® model has not been previously attempted. This innovation could enhance the ECHO® model while also addressing the growing calls for more accessible interprofessional pain curricula. This paper describes efforts to implement and evaluate core competency curricula within the context of Pediatric Project ECHO for Pain, one of the first pediatric-pain focused ECHO programs in the world. Needs assessments informed curricula development. The first delivered core competency model consisted of synchronous webinar-style sessions while the second model included a mixture of asynchronous (eLearning course) and synchronous (virtual clinical debrief) elements. A convenience sample of HCPs was recruited from ECHO program registrants. Participants completed baseline and follow-up surveys to assess core competency acceptability as well as impact on knowledge and self-efficacy related to managing pediatric pain. Usability of the eLearning platform (model 2 only) was also evaluated. Surveys used 5-point Likert scales to capture outcomes. A priori targets included mean scores ≥4/5 for acceptability and ≥80% of learners reporting knowledge and self-efficacy improvements. The study received local research ethics approval. The core competency was found to be highly acceptable to interprofessional learners (n = 31) across delivery models, surpassing a priori targets. Specifically, it was characterized as a worthwhile and satisfactory experience that was helpful in supporting learning. The core competency was also associated with improvements in knowledge and self-efficacy by 97% and 90% of learners, respectively. The eLearning platform was reported to have high usability with clinically realistic cases (100% of respondents) that were helpful to inform care delivery (94% of respondents). The integration of core competency learning within the Project ECHO® model was a successful approach to deliver pediatric pain education to interprofessional HCPs.

4051 Background: Accurate assessment of biomarkers (including HER2 and PD-L1) is integral to treatment selection in upper gastrointestinal (GI) cancers. However, challenges in integrating biomarker testing and targeted therapies are commonly reported in community settings. The Project Extension for Community Healthcare Outcomes (Project ECHO) model addresses this gap by connecting experts in tertiary care settings with rural healthcare teams. Through case-based teaching, the model builds the knowledge and skills needed to provide evidence-based, equitable care regardless of geographic location. Methods: In October 2024, 57 healthcare professionals (HCPs) from 2 US and 4 Canadian community oncology clinics participated in Project ECHO sessions. Led by an expert oncologist, each session featured interactive discussions of real-world anonymized case presentations to address key practice gaps in integrating biomarker-based therapies and coordinating multidisciplinary care for patients (pts) with upper GI cancers. Following each session, HCPs developed and implemented site-specific action plans to address gaps in care. Pre-activity and post-activity surveys measured the impact on knowledge, confidence, and competence and 90-day follow-up surveys will be collected to assess ongoing performance. Results: The top HCP-reported barriers to individualized care for pts with upper GI cancer included keeping up with the latest efficacy and safety data (44%), selecting and sequencing treatments based on individual and disease factors (40%), and limited availability/cost of biomarker testing (39%). Additionally, relatively few HCPs reported providing supportive care services for the majority of their patients, such as palliative care referrals (40%), distress screening (26%), psychosocial support (35%), and end of life counseling (19%). Following the Project ECHO sessions, HCPs demonstrated improved knowledge, competence, and confidence in biomarker testing and managing adverse events. Additionally, HCPs planned to increase patient education about disease and treatment-related side effects (65%), improve team education on biomarker testing and treatment selection (61%), establish standardized biomarker testing protocols (35%), and increase supportive care referrals (22%). Team action plans included implementing routine testing protocols, establishing a network of specialists to coordinate care, and increasing education on the use of immunotherapy. Conclusions: Project ECHO-based education improved HCP capacity to integrate biomarker-directed therapies and coordinate multidisciplinary care for patients with upper GI cancers. Full findings will detail long-term impacts on practice and inform future community-based ECHO initiatives.

Project Extension for Community Healthcare Outcomes (ECHO) uses tele-education to bridge knowledge gaps between specialists at academic health centers and primary care providers from remote areas. It has been implemented to address multiple medical conditions. The authors examined evidence of the impact of all Project ECHO programs on participant and patient outcomes. The authors searched PubMed, MEDLINE, EMBASE, PsycINFO, and ProQuest from January 2000 to August 2015 and the reference lists of identified reviews. Included studies were limited to those published in English, peer-reviewed articles or indexed abstracts, and those that primarily focused on Project ECHO. Editorials, commentaries, gray literature, and non-peer-reviewed articles were excluded. The authors used Moore's evaluation framework to organize study outcomes for quality assessment. The authors identified 39 studies describing Project ECHO's involvement in addressing 17 medical conditions. Evaluations of Project ECHO programs generally were limited to outcomes from Levels 1 (number of participants) to 4 (providers' competence) of Moore's framework (n = 22 studies, with some containing data from multiple levels). Studies also suggested that Project ECHO changed provider behavior (n = 1), changed patient outcomes (n = 6), and can be cost-effective (n = 2). Project ECHO is an effective and potentially cost-saving model that increases participant knowledge and patient access to health care in remote locations, but further research examining its efficacy is needed. Identifying and addressing potential barriers to Project ECHO's implementation will support the dissemination of this model as an education and practice improvement initiative.

BackgroundGroup peer telementoring supports interprofessional learning through multi-directional and synchronous engagement where experienced and knowledgeable individuals exchange guidance and support with differently experienced and knowledgeable individuals. A leading example of group peer telementoring among medical specialists and medical generalists is Project Extension for Community Healthcare Outcomes (Project ECHO), a rapidly spreading program with demonstrated learning outcomes among community-based medical generalists. Yet the multi-directional exchanges that characterize group peer telementoring interactions suggest that specialists facilitating sessions may also learn from the group experiences. We explored what medical specialists learn from community-based medical generalists and from other specialists as a result of facilitating and participating in group peer telementoring.MethodsPairs of ECHO administrative staff and researchers interviewed medical specialists who facilitated Project ECHO work. Using interview transcripts, we identified 129 learning episodes in which 53 specialists discussed what they learned from their Project ECHO experiences. An inductive multi-phase thematic analysis was used to identify what medical specialists were learning and from whom.ResultsThree primary themes emerged from the data. Specialists learned about community-based health care, including learning about unique and novel community-based treatments and patient needs. Specialists broadened and deepened their knowledge of patient care, including taking an interprofessional view and learning more about their own specialty area. Specialists also learned about learning, including revelations about power hierarchies, the importance of opening space for learning, and practicing humility.ConclusionsProject ECHO’s emphasis on group peer telementoring brought the realities of community-centric care to the attention of medical specialists, deepening their knowledge about patient care and about learning. Specialists learned from community-based medical generalists, other medical specialists within their discipline, and from medical specialists with other expertise. The "all teach, all learn" space that medical specialists endeavored to create in Project ECHO for community-based medical generalists created a safe space for specialists to admit what they did not know. Continued facilitation and participation in group peer telementoring may provide medical specialists with feedback about diagnoses, treatments, and community-based resources for low-income rural and inner-city patients that contributes to their continued development and medical education.

A major challenge with current systems of CME is the inability to translate the explosive growth in health care knowledge into daily practice. Project ECHO (Extension for Community Healthcare Outcomes) is a telementoring network designed for continuing professional development (CPD) and improving patient outcomes. The purpose of this article was to describe how the model has complied with recommendations from several authoritative reports about redesigning and enhancing CPD. This model links primary care clinicians through a knowledge network with an interprofessional team of specialists from an academic medical center who provide telementoring and ongoing education enabling community clinicians to treat patients with a variety of complex conditions. Knowledge and skills are shared during weekly condition-specific videoconferences. The model exemplifies learning as described in the seven levels of CPD by Moore (participation, satisfaction, learning, competence, performance, patient, and community health). The model is also aligned with recommendations from four national reports intended to redesign knowledge transfer in improving health care. Efforts in learning sessions focus on information that is relevant to practice, focus on evidence, education methodology, tailoring of recommendations to individual needs and community resources, and interprofessionalism. Project ECHO serves as a telementoring network model of CPD that aligns with current best practice recommendations for CME. This transformative initiative has the potential to serve as a leading model for larger scale CPD, nationally and globally, to enhance access to care, improve quality, and reduce cost.

This review aimed to identify the impact of the ECHO® model on monitoring people diagnosed with diabetes mellitus. It followed the Joanna Briggs Institute and the PRISMA-ScR Checklist. The search was conducted in the Cochrane Library, Embase, Virtual Health Library, PubMed/MEDLINE, Scopus, and Web of Science databases. The strategy included the descriptors "Diabetes mellitus," "Diabetes Melito," "Diabetes," "Diabetes Melito," "Model ECHO," "Project ECHO," and "Extension for Community Healthcare Outcomes." Two independent reviewers selected the studies using the Rayyan-Intelligent Systematic Review management software. Nine of the 151 studies initially identified were selected, and one study was identified through gray literature. The ten studies were published in English between 2012 and 2022. Improvements were found in the professionals' knowledge and self-confidence, besides decreased glycated hemoglobin levels, hospital admissions, and hospitalization costs among people with diabetes. The conclusion is that the ECHO® Model positively impacted the monitoring of people with diabetes mellitus, especially in vulnerable communities.

This review aimed to identify the impact of the ECHO® model on monitoring people diagnosed with diabetes mellitus. It followed the Joanna Briggs Institute and the PRISMA-ScR Checklist. The search was conducted in the Cochrane Library, Embase, Virtual Health Library, PubMed/MEDLINE, Scopus, and Web of Science databases. The strategy included the descriptors “Diabetes mellitus,” “Diabetes Melito,” “Diabetes,” “Diabetes Melito,” “Model ECHO,” “Project ECHO,” and “Extension for Community Healthcare Outcomes.” Two independent reviewers selected the studies using the Rayyan-Intelligent Systematic Review management software. Nine of the 151 studies initially identified were selected, and one study was identified through gray literature. The ten studies were published in English between 2012 and 2022. Improvements were found in the professionals’ knowledge and self-confidence, besides decreased glycated hemoglobin levels, hospital admissions, and hospitalization costs among people with diabetes. The conclusion is that the ECHO® Model positively impacted the monitoring of people with diabetes mellitus, especially in vulnerable communities.

Introduction: Project ECHO offers a virtual, interactive sessions to connect health care providers with specialists. Evaluation efforts have focused on quantitatively identifying the implementation process and provider’s perspectives. This case demonstrates that patient success stories are able to provide a wealth of information that can be used as part of evaluation efforts. Background: Through presenting a patient case to the expert panel of a Pain Prescribing ECHO, an Advanced Practice Registered Nurse was able to assist a desperate patient who suffered from negative effects of opioid use for many years. This paper explores the experiences of the care provider during the ECHO sessions as well as afterwards when recommendations from the ECHO team were used by the provider.

BackgroundThe COVID‐19 pandemic has significantly impacted family caregivers of adults with intellectual and developmental disabilities (IDD). This study evaluated a virtual course for family caregivers from across Canada, focused on supporting the mental health and well‐being of adults with IDD and their families. The evaluation examined the feasibility and acceptability of the course, as well as the impact of the intervention on participants' overall health and well‐being.MethodsThe 6‐week virtual course, informed by a parallel Extension for Community Healthcare Outcomes (ECHO) course for service providers, combined didactic instruction with applied activities. A total of 126 family caregiver course participants consented to be part of the research evaluation delivered over three cycles between October 2020 and April 2021.Attendance was measured at each weekly session. Satisfaction was assessed weekly and post‐program. Learning, self‐efficacy, and well‐being were assessed pre‐ and post‐course, and again at follow‐up (8 weeks post‐course). Mixed‐effects models assessed changes between and within individuals across time.ResultsParticipants had consistent attendance, low‐dropout rates, and reported high satisfaction, with 93% of participants reporting that their expectations for the course were met. Compared with pre‐course, participants reported improved self‐efficacy and well‐being post‐course, which were maintained at follow‐up.ConclusionsAn interactive and applied virtual education course delivered to a large group of family caregivers of adults with IDD was both feasible and acceptable. It positively impacted participants' well‐being by offering much needed mental health support and creating a peer‐led community of practice.

Remote learning opportunities increase access to public health training. Innovative approaches are needed to promote active engagement and learning when tackling more complex, adaptive challenges that are nuanced, lack quick and easy solutions, and require a transformation of values and beliefs. The Rocky Mountain Public Health Training Center's (RM-PHTC's) training framework considers the complexity of the challenge (technical to adaptive) when selecting the learning modality. Remote learning opportunities on adaptive challenges are addressed using virtual workshops, online courses, ECHO (Extension for Community Healthcare Outcomes) series, and communities of practice that include a combination of multiple sessions, cohort-based learning, peer learning, practice-based application, and live, interactive sessions. The specific modality chosen depends on the audience and amount of content delivery. Virtual workshops are single events that encourage peer learning using a blend of instruction and practice-based work. Online courses deliver content to learning cohorts through an online platform combined with multiple, facilitated "live learning sessions." ECHO series include a short delivery of content, combined with multiple, facilitated, face-to-face, case-based learning sessions with a cohort of peers. Communities of practice encourage a bidirectional peer exchange of resources, approaches, and challenges through online sharing platforms and virtual meetings. Using the Kirkpatrick training evaluation model, learners of public health reported that their understanding of the subject matter improved and that they had identified actions that they would apply to their work. In qualitative feedback, learners shared feedback on elements that facilitated learning on adaptive challenges, including interactive breakout groups with peers and practice-based applications. Remote learning opportunities increase access for public health professionals in rural areas and encourage knowledge exchange region-wide. The RM-PHTC's training framework matches learning opportunities that address adaptive challenges with modalities that include elements that encourage the sharing of ideas and cocreation of solutions.

PurposeThe faculties are crucial to education. They should have enough training facilities and be encouraged to actively contribute to high-quality education and successful learning. Faculty engagement and development activities should be explored and included in learning organizations and employee engagement in India. This paper aims to describe higher education as a learning organization. The research will also assess how faculty development programs affect faculty engagement behaviors in these institutions and if professional development mediates this effect, which has not been previously examined.Design/methodology/approachThis study was conducted with quantitative data collected from 267 faculties through reliable and validated adapted questionnaires. Semistructured interviews were conducted with heads and professor-level faculties to gain insights into faculty development and engagement. Partial least squares structural equation modeling technique (PLS-SEM 3.3.6 version) was used to test the conceptually drafted model.FindingsFaculty professional development programs shown to improve higher education faculty engagement and professional progress. The studies also showed that higher education institutions must prioritize faculty development to become learning organizations. Professional development reduced the direct effects of faculty development program (FDP) on faculty engagement. This suggests that professional growth mediates the research.Practical implicationsThis research emphasizes and professional development to boost teacher involvement in B-Schools. Management must design faculty development programs to construct professional development and learning organizations, according to the results. Developing and writing rules that encourage faculty engagement in such internal and external programs would also enhance their academic and administrative abilities and assist higher education institutions become learning organizations.Originality/valueThe study is one of the few to examine the impact of faculty development programs and professional development on faculty engagement in higher education institutions, particularly B-Schools, and its competitive mediating role.

Project ECHOTM (Extension for Community Healthcare Outcomes) is a hub-spoke telehealth outreach model that democratizes specialty knowledge to reduce disparities and improve health outcomes. Limited access to endocrinologists forces many primary care providers (PCPs) to manage patients with type 1 diabetes (T1D) without specialty support. As such, Stanford and the University of Florida partnered to develop and pilot “ECHO T1D”, a teleECHOTM clinic focused on T1D in California (CA) and Florida (FL), respectively. Our goal was to demonstrate the feasibility of ECHO T1D and improve PCPs’ abilities to manage patients with T1D. Primary care spokes were recruited targeting Federally Qualified Health Centers (FQHCs) where vulnerable T1D patient populations more likely rely on PCPs for care. In CA, 11 spokes enrolled with 37 clinics serving ∼900 patients with T1D who do not receive routine specialty T1D care. In FL, 12 spokes enrolled with 67 clinics serving ∼1,000 patients with T1D. Multidisciplinary hub team specialists were recruited and a 6-month curriculum was developed. Weekly 1-hour teleECHO sessions consisting of didactic presentations and case reviews were offered for 27 sessions. Weekly engagement of the 70 participating PCPs (69% in CA) ranged from 0 to 27 (mean 14) sessions and 65 completed both baseline and exit surveys. Baseline data demonstrated low confidence in providing T1D care, especially related to diabetes technology. Pre/post surveys demonstrated statistically significant improvements in provider confidence in T1D management and knowledge (p=0.02). PCPs who attended ≥ 50% sessions had the largest improvements. Over 90% of PCPs reported changes in medical practice (e.g., insulin and pump adjustments) and 95% would recommend the program to colleagues. The ECHO model can be applied to T1D to improve PCPs’ ability to manage patients with T1D. Future directions include evaluating influence on patient level outcomes and applying the model to insulin-requiring T2D patients. Disclosure N. Cuttriss: None. C. Anez-Zabala: None. L.G. Baer: None. S.L. Filipp: None. M. Basina: None. M.J. Gurka: None. L. Figg: None. M.J. Haller: Advisory Panel; Self; SAB Biotherapeutics, Inc. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. X. Roque: None. R. Lal: Consultant; Self; Abbott, Biolinq. S.C. Westen: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. M. Town: Other Relationship; Self; Insulet Corporation. C. Wang: None. J.J. Wong: None. K. Yabut: None. A.F. Walker: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust