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04.09.2019 | Review Paper

Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

verfasst von: Ryan K. McBain, PhD, MPH, Jessica L. Sousa, MPH, MSW, Adam J. Rose, MD, MS, Sangita M. Baxi, MAS, Laura J. Faherty, MD, MPH, MS, Caroline Taplin, MS, Andre Chappel, PhD, Shira H. Fischer, MD, PhD

Erschienen in: Journal of General Internal Medicine | Ausgabe 12/2019

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Abstract

Background

Extension for Community Healthcare Outcomes (ECHO) and related models of medical tele-education are rapidly expanding; however, their effectiveness remains unclear. This systematic review examines the effectiveness of ECHO and ECHO-like medical tele-education models of healthcare delivery in terms of improved provider- and patient-related outcomes.

Methods

We searched English-language studies in PubMed, Embase, and PsycINFO databases from 1 January 2007 to 1 December 2018 as well as bibliography review. Two reviewers independently screened citations for peer-reviewed publications reporting provider- and/or patient-related outcomes of technology-enabled collaborative learning models that satisfied six criteria of the ECHO framework. Reviewers then independently abstracted data, assessed study quality, and rated strength of evidence (SOE) based on Cochrane GRADE criteria.

Results

Data from 52 peer-reviewed articles were included. Forty-three reported provider-related outcomes; 15 reported patient-related outcomes. Studies on provider-related outcomes suggested favorable results across three domains: satisfaction, increased knowledge, and increased clinical confidence. However, SOE was low, relying primarily on self-reports and surveys with low response rates. One randomized trial has been conducted. For patient-related outcomes, 11 of 15 studies incorporated a comparison group; none involved randomization. Four studies reported care outcomes, while 11 reported changes in care processes. Evidence suggested effectiveness at improving outcomes for patients with hepatitis C, chronic pain, dementia, and type 2 diabetes. Evidence is generally low-quality, retrospective, non-experimental, and subject to social desirability bias and low survey response rates.

Discussion

The number of studies examining ECHO and ECHO-like models of medical tele-education has been modest compared with the scope and scale of implementation throughout the USA and internationally. Given the potential of ECHO to broaden access to healthcare in rural, remote, and underserved communities, more studies are needed to evaluate effectiveness. This need for evidence follows similar patterns to other service delivery models in the literature.

Nur mit Berechtigung zugänglich

Kvedar J, Coye MJ, Everett W. Connected health: A review of technologies and strategies to improve patient care with telemedicine and telehealth. Health Affairs (Project Hope) 2014;33(2):194–9.CrossRef

Dorsey ER, Topol EJ. State of telehealth. N Engl J Med 2016;375(2):154–61.CrossRef

Alkmim MB, Figueira RM, Marcolino MS, Cardoso CS, Abreu MPD, Cunha LR, et al. Improving patient access to specialized health care: The Telehealth Network of Minas Gerais, Brazil. Bull World Health Organ 2012;90:373–8.CrossRef

Terwiesch C, Asch DA, Volpp KG. Technology and Medicine: Reimagining Provider Visits as the New Tertiary Care. Ann Intern Med 2017;167(11):814–5. doi:https://doi.org/10.7326/m17-0597 CrossRefPubMed

Ricketts TC. The migration of physicians and the local supply of practitioners: a five-year comparison. Acad Med 2013;88(12):1913–8.CrossRef

Liddy C, Rowan MS, Afkham A, Maranger J, Keely E. Building access to specialist care through e-consultation. Open Med 2013;7(1):e1.PubMedPubMedCentral

Kirch DG, Petelle K. Addressing the physician shortage: The peril of ignoring demography. JAMA. 2017;317(19):1947–8. doi:https://doi.org/10.1001/jama.2017.2714 CrossRefPubMed

Kinfu Y, Dal Poz MR, Mercer H, Evans DB. The health worker shortage in Africa: Are enough physicians and nurses being trained? : SciELO Public Health; 2009.

ECHO Act, Pub L No. 114–270, 130 Stat 1395 (2016).

10.

University of New Mexico. Project ECHO. Available at: https://echo.unm.edu/. Accessed June 16, 2019.

11.

Fischer SH, Rose AJ, McBain RK, Faherty LJ, Sousa J, Martineau M. Evaluation of technology-enabled collaborative learning and capacity building models: Materials for a report to Congress. Santa Monica, CA: RAND Corporation, 2019. Available at: https://www.rand.org/pubs/research_reports/RR2934.html.

12.

Zhou C, Crawford A, Serhal E, Kurdyak P, Sockalingam S. The impact of Project ECHO on participant and patient outcomes: A systematic review. Academic medicine : journal of the Association of American Medical Colleges 2016;91(10):1439–61. doi:https://doi.org/10.1097/acm.0000000000001328 CrossRef

13.

Ryan R, Hill S. How to GRADE the quality of the evidence. Cochrane Consumers and Communication Group. 2016. Available at: http://cccrg.cochrane.org/author-resources. Version 3.0. Accessed June 16, 2019.

14.

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med 2009;151(4):264–9.CrossRef

15.

Anderson D, Zlateva I, Davis B, Bifulco L, Giannotti T, Coman E, et al. Improving pain care with Project ECHO in community health centers. Pain Med (Malden, Mass.). 2017;18(10):1882–9. doi:https://doi.org/10.1093/pm/pnx187 CrossRef

16.

Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med 2011;364(23):2199–207. doi:https://doi.org/10.1056/NEJMoa1009370 CrossRef

17.

Ball S, Wilson B, Ober S, McHaourab A. SCAN-ECHO for Pain Management: Implementing a Regional Telementoring Training for Primary Care Providers. Pain Med (Malden, Mass.). 2018;19(2):262–8. doi:https://doi.org/10.1093/pm/pnx122 CrossRef

18.

Beste LA, Glorioso TJ, Ho PM, Au DH, Kirsh SR, Todd-Stenberg J, et al. Telemedicine specialty support promotes hepatitis C treatment by primary care providers in the Department of Veterans Affairs. Am J Med. 2017;130(4):432–8.e3. doi:https://doi.org/10.1016/j.amjmed.2016.11.019 CrossRef

19.

Beste LA, Mattox EA, Pichler R, Young BA, Au DH, Kirsh SF, et al. Primary care team members report greater individual benefits from long- versus short-term specialty telemedicine mentorship. Telemedicine journal and e-health : the official journal of the American Telemedicine Association 2016;22(8):699–706. doi:https://doi.org/10.1089/tmj.2015.0185 CrossRef

20.

Carlin L, Zhao J, Dubin R, Taenzer P, Sidrak H, Furlan A. Project ECHO telementoring intervention for managing chronic pain in primary care: Insights from a qualitative study. Pain Med (Malden, Mass.). 2018;19(6):1140–6. doi:https://doi.org/10.1093/pm/pnx233 CrossRef

21.

Catic AG, Mattison ML, Bakaev I, Morgan M, Monti SM, Lipsitz L. ECHO-AGE: an innovative model of geriatric care for long-term care residents with dementia and behavioral issues. J Am Med Dir Assoc 2014;15(12):938–42. doi:https://doi.org/10.1016/j.jamda.2014.08.014 CrossRefPubMed

22.

Chaple MJ, Freese TE, Rutkowski BA, Krom L, Kurtz AS, Peck JA, Warren P, Garrett S. Using ECHO Clinics to Promote Capacity Building in Clinical Supervision. American Journal of Preventive Medicine, 54:S275-S280. 2018.

23.

Cofta-Woerpel L, Lam C, Reitzel LR, Wilson W, Karam-Hage M, Beneventi D, et al. A tele-mentoring tobacco cessation case consultation and education model for healthcare providers in community mental health centers. Cogent Med. 2018;5(1). doi:https://doi.org/10.1080/2331205X.2018.1430652

24.

Cordasco KM, Zuchowski JL, Hamilton AB, Kirsh S, Veet L, Saavedra JO, et al. Early lessons learned in implementing a women’s health educational and virtual consultation program in VA. Med Care 2015;53(4 Suppl 1):S88–92. doi:https://doi.org/10.1097/mlr.0000000000000313 CrossRefPubMedPubMedCentral

25.

Covell NH, Foster FP, Margolies PJ, Lopez LO, Dixon LB. Using distance technologies to facilitate a learning collaborative to implement stagewise treatment. Psychiatric services (Washington, D.C.). 2015;66(6):645–8. doi:https://doi.org/10.1176/appi.ps.201400155 CrossRef

26.

Eaton LH, Godfrey DS, Langford DJ, Rue T, Tauben DJ, Doorenbos AZ. Telementoring for improving primary care provider knowledge and competence in managing chronic pain: A randomised controlled trial. J Telemed Telecare. 2018:1357633x18802978. doi:https://doi.org/10.1177/1357633x18802978

27.

Farris G, Sircar M, Bortinger J, Moore A, Krupp JE, Marshall J, et al. Extension for Community Healthcare Outcomes-Care Transitions: Enhancing geriatric care transitions through a multidisciplinary videoconference. J Am Geriatr Soc 2017;65(3):598–602. doi:https://doi.org/10.1111/jgs.14690 CrossRefPubMed

28.

Fisher E, Hasselberg M, Conwell Y, Weiss L, Padron NA, Tiernan E, et al. Telementoring primary care clinicians to improve geriatric mental health care. Popul Health Manag 2017;20(5):342–7. doi:https://doi.org/10.1089/pop.2016.0087 CrossRefPubMed

29.

Glass LM, Waljee AK, McCurdy H, Su GL, Sales A. Specialty Care Access Network-Extension of Community Healthcare Outcomes model program for liver disease improves specialty care access. Dig Dis Sci 2017;62(12):3344–9. doi:https://doi.org/10.1007/s10620-017-4789-2 CrossRefPubMed

30.

Haozous E, Doorenbos AZ, Demiris G, Eaton LH, Towle C, Kundu A, et al. Role of telehealth/videoconferencing in managing cancer pain in rural American Indian communities. Psychooncology. 2012;21(2):219–23. doi:https://doi.org/10.1002/pon.1887 CrossRefPubMed

31.

Jansen BD, Brazil K, Passmore P, Buchanan H, Maxwell D, McIlfatrick SJ, Morgan SM, Watson M, Parsons C. Evaluation of the impact of telementoring using ECHO© technology on healthcare professionals’ knowledge and self-efficacy in assessing and managing pain for people with advanced dementia nearing the end of life. BMC Helath Services Research, 18:228. 2018.

32.

Johnson KL, Hertz D, Stobbe G, Alschuler K, Kalb R, Alexander KS, et al. Project Extension for Community Healthcare Outcomes (ECHO) in multiple sclerosis: Increasing clinician capacity. Int J MS Care 2017;19(6):283–9. doi:https://doi.org/10.7224/1537-2073.2016-099 CrossRefPubMedPubMedCentral

33.

Katzman JG, Comerci G Jr., Boyle JF, Duhigg D, Shelley B, Olivas C, et al. Innovative telementoring for pain management: Project ECHO Pain. J Contin Educ Heal Prof 2014;34(1):68–75. doi:https://doi.org/10.1002/chp.21210 CrossRef

34.

Kauth MR, Shipherd JC, Lindsay JA, Kirsh S, Knapp H, Matza L. Teleconsultation and training of VHA providers on transgender care: Implementation of a multisite hub system. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2015;21(12):1012–8. doi:https://doi.org/10.1089/tmj.2015.0010 CrossRef

35.

Komaromy M, Bartlett J, Manis K, Arora S. Enhanced primary care treatment of behavioral disorders with ECHO case-based learning. Psychiatr Serv (Washington, D.C.). 2017;68(9):873–5. doi:https://doi.org/10.1176/appi.ps.201600471 CrossRef

36.

Komaromy M, Ceballos V, Zurawski A, Bodenheimer T, Thom DH, Arora S. Extension for Community Healthcare Outcomes (ECHO): A new model for community health worker training and support. J Public Health Policy 2018;39(2):203–16. doi:https://doi.org/10.1057/s41271-017-0114-8 CrossRefPubMed

37.

Lewiecki EM, Rochelle R, Bouchonville MF 2nd, Chafey DH, Olenginski TP, Arora S. Leveraging scarce resources with Bone Health TeleECHO to improve the care of osteoporosis. J Endoc Soc 2017;1(12):1428–34. doi:https://doi.org/10.1210/js.2017-00361 CrossRef

38.

Marciano S, Haddad L, Plazzotta F, Mauro E, Terraza S, Arora S, et al. Implementation of the ECHO(R) telementoring model for the treatment of patients with hepatitis C. J Med Virol 2017;89(4):660–4. doi:https://doi.org/10.1002/jmv.24668 CrossRefPubMed

39.

Masi C, Hamlish T, Davis A, Bordenave K, Brown S, Perea B, et al. Using an established telehealth model to train urban primary care providers on hypertension management. J Clin Hypertens (Greenwich) 2012;14(1):45–50. doi:https://doi.org/10.1111/j.1751-7176.2011.00559.x CrossRef

40.

Mazurek MO, Brown R, Curran A, Sohl K. ECHO Autism. Clinical Pediatrics, 56: 247-256. 2017.

41.

Mehrotra K, Chand P, Bandawar M, Rao Sagi M, Kaur S, G A, et al. Effectiveness of NIMHANS ECHO blended tele-mentoring model on Integrated Mental Health and Addiction for counsellors in rural and underserved districts of Chhattisgarh, India. Asian J Psychiatr. 2018;36:123–7. doi:https://doi.org/10.1016/j.ajp.2018.07.010 CrossRefPubMed

42.

Meins AR, Doorenbos AZ, Eaton L, Gordon D, Theodore B, Tauben D. TelePain: A community of practice for pain management. J Pain Relief. 2015;4(2). doi:https://doi.org/10.4172/2167-0846.1000177

43.

Ní Cheallaigh C, O’Leary A, Keating S, Singleton A, Heffernan S, Keenan E, et al. Telementoring with Project ECHO: A pilot study in Europe. BMJ Innov 2017;3(3):144–51. doi:https://doi.org/10.1136/bmjinnov-2016-000141 CrossRefPubMedPubMedCentral

44.

Oliveira TC, Branquinho MJ, Goncalves L. State of the art in telemedicine - concepts, management, monitoring and evaluation of the telemedicine programme in Alentejo (Portugal). Stud Health Technol Inform 2012;179:29–37.PubMed

45.

Parsons C, Mattox EA, Beste LA, Au DH, Young BA, Chang MF, Palen BN. Development of a Sleep Telementorship Program for Rural Department of Veterans Affairs Primary Care Providers: Sleep Veterans Affairs Extension for Community Healthcare Outcomes. Annals of American Thoracic Society, 14: 267-274.

46.

Qaddoumi I, Mansour A, Musharbash A, Drake J, Swaidan M, Tihan T, et al. Impact of telemedicine on pediatric neuro-oncology in a developing country: The Jordanian-Canadian experience. Pediatr Blood Cancer 2007;48(1):39–43. doi:https://doi.org/10.1002/pbc.21085 CrossRefPubMed

47.

Rahman AN, Simmons SF, Applebaum R, Lindabury K, Schnelle JF. The coach is in: Improving nutritional care in nursing homes. The Gerontologist 2012;52(4):571–80. doi:https://doi.org/10.1093/geront/gnr111 CrossRefPubMed

48.

Ray RA, Fried O, Lindsay D. Palliative care professional education via video conference builds confidence to deliver palliative care in rural and remote locations. BMC Health Serv Res 2014;14:272. doi:https://doi.org/10.1186/1472-6963-14-272 CrossRefPubMedPubMedCentral

49.

Salgia RK, Mullan PB, McCurdy H, Sales A, Moseley RH, Su GL. The educational impact of the Specialty Care Access Network-Extension of Community Healthcare Outcomes program. Telemedicine Journal and E-Health, 20: 1004-8.

50.

Shipherd JC, Kauth MR, Firek AF, Garcia R, Mejia S, Laski S, et al. Interdisciplinary Transgender Veteran Care: Development of a Core Curriculum for VHA Providers. Transgender Health 2016;1(1):54–62. doi:https://doi.org/10.1089/trgh.2015.0004 CrossRefPubMedPubMedCentral

51.

Sockalingam S, Arena A, Serhal E, Mohri L, Alloo J, Crawford A. Building Provincial Mental Health Capacity in Primary Care: An Evaluation of a Project ECHO Mental Health Program. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry 2018;42(4):451–7. doi:https://doi.org/10.1007/s40596-017-0735-z CrossRef

52.

Swigert TJ, True MW, Sauerwein TJ, Dai H. U.S. Air Force Telehealth Initiative to Assist Primary Care Providers in the Management of Diabetes. Clin Diabetes 2014;32(2):78–80. doi:https://doi.org/10.2337/diaclin.32.2.78 CrossRefPubMedPubMedCentral

53.

Van Ast P, Larson A. Supporting rural carers through telehealth. Rural Remote Health 2007;7(1):634.PubMed

54.

Volpe T, Boydell KM, Pignatiello A. Mental health services for Nunavut children and youth: Evaluating a telepsychiatry pilot project. Rural Remote Health 2014;14(2):2673.PubMed

55.

White C, McIlfatrick S, Dunwoody L, Watson M. Supporting and improving community health services--a prospective evaluation of ECHO technology in community palliative care nursing teams. BMJ Supportive & Palliative Care. 9: 202-208.

56.

Wood BR, Mann MS, Martinez-Paz N, Unruh KT, Annese M, Spach DH, et al. Project ECHO: Telementoring to educate and support prescribing of HIV pre-exposure prophylaxis by community medical providers. Sex Health 2018;15(6):601–5. doi:https://doi.org/10.1071/sh18062 CrossRefPubMed

57.

Wood BR, Mann MS, Martinez-Paz N, Unruh KT, Annese M, Spach DH, Scott JD, Stekler JD. Project ECHO: telementoring to educate and support prescribing of HIV pre-exposure prophylaxis by community medical providers. Sexual Health, 15: 601-605.

58.

Carey EP, Frank JW, Kerns RD, Ho PM, Kirsh SR. Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis. J Rehabil Res Dev 2016;53(1):147–56. doi:https://doi.org/10.1682/jrrd.2014.10.0247 CrossRefPubMed

59.

Frank JW, Carey EP, Fagan KM, Aron DC, Todd-Stenberg J, Moore BA, et al. Evaluation of a telementoring intervention for pain management in the Veterans Health Administration. Pain Med (Malden, Mass.). 2015;16(6):1090–100. doi:https://doi.org/10.1111/pme.12715 CrossRef

60.

Gordon SE, Dufour AB, Monti SM, Mattison ML, Catic AG, Thomas CP, et al. Impact of a videoconference educational intervention on physical restraint and antipsychotic use in nursing homes: Results from the ECHO-AGE pilot study. J Am Med Dir Assoc 2016;17(6):553–6. doi:https://doi.org/10.1016/j.jamda.2016.03.002 CrossRefPubMedPubMedCentral

61.

Katzman JG, Qualls CR, Satterfield WA, Kistin M, Hofmann K, Greenberg N, et al. Army and Navy ECHO Pain telementoring improves clinician opioid prescribing for military patients: An observational cohort study. J Gen Intern Med 2018. doi:https://doi.org/10.1007/s11606-018-4710-5 CrossRef

62.

Mohsen W, Chan P, Whelan M, Glass A, Mouton M, Yeung E, et al. Hepatitis C treatment for difficult to access populations; can telementoring (as distinct from telemedicine) help? Intern Med J 2018. doi:https://doi.org/10.1111/imj.14072 CrossRef

63.

Moore AB, Krupp JE, Dufour AB, Sircar M, Travison TG, Abrams A, et al. Improving transitions to postacute care for elderly patients using a novel video-conferencing program: ECHO-Care Transitions. Am J Med 2017;130(10):1199–204. doi:https://doi.org/10.1016/j.amjmed.2017.04.041 CrossRefPubMed

64.

Su GL, Glass L, Tapper EB, Van T, Waljee AK, Sales AE. Virtual Consultations through the Veterans Administration SCAN-ECHO Project Improves Survival for Veterans with Liver Disease. Hepatology. 2018. doi:https://doi.org/10.1002/hep.30074 CrossRef

65.

Watts SA, Roush L, Julius M, Sood A. Improved glycemic control in veterans with poorly controlled diabetes mellitus using a Specialty Care Access Network-Extension for Community Healthcare Outcomes model at primary care clinics. J Telemed Telecare 2016;22(4):221–4. doi:https://doi.org/10.1177/1357633x15598052 CrossRefPubMed

66.

Moore JE, Rashid S, Park JS, Khan S, Straus SE. Longitudinal evaluation of a course to build core competencies in implementation practice. Implementation Sci : IS 2018;13(1):106.CrossRef

67.

Metz A, Louison L, Ward C, Burke K. Global Implementation Specialist Practice Profile: Skills and competencies for implementation practitioners. Chapel Hill, N.C.: National Implementation Research Network and Centre for Effective Services, 2017. Available at: https://fpg.unc.edu/node/9178.

68.

Agency for Healthcare Research and Quality. Types of health care quality measures. 2011. Available at: http://www.ahrq.gov/talkingquality/measures/types.html. Accessed June 16, 2019.

69.

U.S. Department of Health & Human Services. Office of the Assistant Secretary for Planning and Evaluation. Available at: https://aspe.hhs.gov/. Accessed June 16, 2019.

70.

Rahman AN, Schnelle JF, Yamashita T, Patry G, Prasauskas R. Distance learning: A strategy for improving incontinence care in nursing homes. The Gerontologist 2010;50(1):121–32. doi:https://doi.org/10.1093/geront/gnp126 CrossRefPubMed

71.

Ricketts EJ, Goetz AR, Capriotti MR, Bauer CC, Brei NG, Himle MB, et al. A randomized waitlist-controlled pilot trial of voice over Internet protocol-delivered behavior therapy for youth with chronic tic disorders. J Telemed Telecare 2016;22(3):153–62. doi:https://doi.org/10.1177/1357633x15593192 CrossRefPubMed

72.

Baxter AJ, Tweed EJ, Katikireddi SV, Thomson H. Effects of Housing First approaches on health and well-being of adults who are homeless or at risk of homelessness: Systematic review and meta-analysis of randomised controlled trials. J Epidemiol Community Health. 2019:jech-2018-210981.

Titel: Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review
verfasst von: Ryan K. McBain, PhD, MPH
Jessica L. Sousa, MPH, MSW
Adam J. Rose, MD, MS
Sangita M. Baxi, MAS
Laura J. Faherty, MD, MPH, MS
Caroline Taplin, MS
Andre Chappel, PhD
Shira H. Fischer, MD, PhD
Publikationsdatum: 04.09.2019
Verlag: Springer US
Erschienen in: Journal of General Internal Medicine / Ausgabe 12/2019
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-019-05291-1

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Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

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