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Moss P, Hartley N, Russell T. Project ECHO ®: a global cross-sectional examination of implementation success. BMC Health Serv Res 2024; 24:583. [PMID: 38702685 PMCID: PMC11069135 DOI: 10.1186/s12913-024-10920-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/28/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Organizations implement innovations to disrupt the status quo and create value. Within sectors such as healthcare, innovations need to navigate large scale system and organizational factors to succeed. This research explores the implementation of a global innovation- Project ECHO®. Project ECHO® is a validated virtual communities of practice model organizational teams implement to build workforce capacity and capability. Project ECHO® has experienced broad global adoption, particularly within the healthcare sector, and is experiencing growth across other sectors. This study sought to examine the state of implementation success for Project ECHO® globally, to understand how these implementations compare across geographic and sectoral contexts, and understand what enablers/barriers exist for organizational teams implementing the innovation. METHODS An empirical study was conducted to collect data on 54 Project ECHO® implementation success indicators across an international sample. An online survey questionnaire was developed and distributed to all Project ECHO® hub organizations globally to collect data. Data was analyzed using descriptive statistics. RESULTS The 54 implementation success indicators measured in this survey revealed that the adoption of Project ECHO® across 13 organizations varied on a case-by-case basis, with a strong rate of adoption within the healthcare sector. Implementation teams from these organizations successfully implemented Project ECHO® within 12-18 months after completing Immersion partner launch training and operated 51 ECHO® Networks at the time of data collection. Implementation teams which liaised more regularly with ECHO® Superhub mentors often went on to launch a higher number of ECHO® Networks that were sustained over the longer term. This suggests that these implementation teams better aligned and consolidated their Project ECHO® pilots as new innovations within the local context and strategic organizational priorities. Access to research and evaluation capability, and a more automated digital client relationship management system were key limitations to showcasing implementation success outcomes experienced by the majority of implementation teams. CONCLUSIONS These findings make a valuable contribution to address a knowledge gap regarding how a global sample of organizations adopting Project ECHO® measured and reported their implementation successes. Key successes included pre-launch experimentation and expansion, Superhub mentorship, stakeholder engagement, and alignment to strategic priorities.
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Affiliation(s)
- Perrin Moss
- Integrated Care, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, 4101, QLD, Australia, South Brisbane.
- School of Health and Rehabilitation Sciences, The University of Queensland, 4072, Saint Lucia, Australia, QLD.
| | - Nicole Hartley
- School of Business, The University of Queensland, The University of Queensland, 4072, Saint Lucia, Australia, QLD
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, 4072, Saint Lucia, Australia, QLD
- RECOVER Injury Research Centre, Surgical, Treatment and Rehabilitation Service (STARS), The University of Queensland, 296 Herston Rd, 4029, Australia, Herston, QLD
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Nixon P, Broccatelli C, Moss P, Baggio S, Young A, Newcomb D. Healthcare social network research and the ECHO model™: Exploring a community of practice to support cultural brokers and transfer cultural knowledge. BMC Health Serv Res 2024; 24:558. [PMID: 38693520 PMCID: PMC11062014 DOI: 10.1186/s12913-024-11024-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/22/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Project ECHO® networks at Children's Health Queensland Hospital and Health Service (CHQHHS) are communities of practice designed to mitigate services and systems fragmentation by building collaborative partnerships addressing priority child and youth health needs. Aboriginal and Torres Strait Islander people experience the negative impacts of fragmentation in addition to historical challenges of absent or culturally inappropriate health services. Access to culturally safe and responsive services can be improved by engaging Aboriginal and Torres Strait Islander Health Workers and similar roles in an online community of practice, supporting the integration of cultural and clinical knowledge and self-determination of Aboriginal and Torres Strait Islander consumers in decisions affecting their health. Analysing professional support networks and knowledge sharing patterns helps identify enablers and barriers to partnerships. Using social network research, the multilevel network inclusive of ECHO network members and their colleagues was studied to identify interdisciplinary and cross-sector advice exchange patterns, explore the position of cultural brokers and identify common relational tendencies. METHODS Social network theories and methods informed the collection of network data and analysis of advice-seeking relationships among ECHO network members and their nominees. Registered members from two ECHO networks were invited to complete the Qualtrics survey. Networks analysed comprised 398 professionals from mainstream health, Aboriginal and Torres Strait Islander Community Controlled Health Organisation, education, disability and child safety service settings. RESULTS Brokers were well represented, both those who hold knowledge brokerage positions as well as cultural brokers who incorporate clinical and cultural knowledge enabling holistic care for Aboriginal and Torres Strait Islander patients (38 individuals, 17% of network). Professionals who occupy brokerage positions outside the ECHO network tend to be more connected with co-members within the network. CONCLUSIONS This study is the first application of contemporary social network theories and methods to investigate an ECHO network. The findings highlight the connectivity afforded by brokers, enabling the coordination and collaboration necessary for effective care integration. Inclusion of cultural brokers in an ECHO network provides sustained peer group support while also cultivating relationships that facilitate the integration of cultural and clinical knowledge.
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Affiliation(s)
- Phil Nixon
- Integrated Care, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, QLD, 4101, Australia.
| | - Chiara Broccatelli
- Department of Social and Cultural Anthropology, Universitat Autònoma de Barcelona, Barcelona, 08193, Spain
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, 4068, Australia
| | - Perrin Moss
- Integrated Care, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, QLD, 4101, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, QLD, 4072, Australia
| | - Sarah Baggio
- Integrated Care, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, QLD, 4101, Australia
| | - Angela Young
- Integrated Care, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, QLD, 4101, Australia
| | - Dana Newcomb
- Integrated Care, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, QLD, 4101, Australia
- General Practice Clinical Unit, The University of Queensland, Herston, QLD, 4029, Australia
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Ashcroft R, Menear M, Dahrouge S, Silveira J, Emode M, Booton J, Bahniwal R, Sheffield P, McKenzie K. Nurturing an organizational context that supports team-based primary mental health care: A grounded theory study. PLoS One 2024; 19:e0301796. [PMID: 38687719 PMCID: PMC11060570 DOI: 10.1371/journal.pone.0301796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/23/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The expansion of the Patient-Centred Medical Home model presents a valuable opportunity to enhance the integration of team-based mental health services in primary care settings, thereby meeting the growing demand for such services. Understanding the organizational context of a Patient-Centred Medical Home is crucial for identifying the facilitators and barriers to integrating mental health care within primary care. The main objective of this paper is to present the findings related to the following research question: "What organizational features shape Family Health Teams' capacity to provide mental health services for depression and anxiety across Ontario, Canada?" METHODS Adopting a constructivist grounded theory approach, we conducted interviews with various mental health care providers, and administrators within Ontario's Family Health Teams, in addition to engaging provincial policy informants and community stakeholders. Data analysis involved a team-based approach, including code comparison and labelling, with a dedicated data analysis subcommittee convening monthly to explore coded concepts influencing contextual factors. RESULTS From the 96 interviews conducted, involving 82 participants, key insights emerged on the organizational contextual features considered vital in facilitating team-based mental health care in primary care settings. Five prominent themes were identified: i) mental health explicit in the organizational vision, ii) leadership driving mental health care, iii) developing a mature and stable team, iv) adequate physical space that facilitates team interaction, and v) electronic medical records to facilitate team communication. CONCLUSIONS This study underscores the often-neglected organizational elements that influence primary care teams' capacity to deliver quality mental health care services. It highlights the significance of strong leadership complemented by effective communication and collaboration within teams to enhance their ability to provide mental health care. Strengthening relationships within primary care teams lies at the core of effective healthcare delivery and should be leveraged to improve the integration of mental health care.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Menear
- Faculty of Medicine, Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Simone Dahrouge
- Faculty of Medicine, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jose Silveira
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Monica Emode
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jocelyn Booton
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Peter Sheffield
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Kwame McKenzie
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Wellesley Institute, Toronto, Ontario, Canada
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Lunsky Y, Lake J, Thakur A. The Power of Partnerships to Identify and Address Mental Health Concerns Experienced by Adults With Intellectual and Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:96-100. [PMID: 38411240 DOI: 10.1352/1944-7558-129.2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
There are significant research gaps with regard to understanding and addressing the mental health concerns of adults with intellectual and developmental disabilities (IDD) and their families. In this article, we reflect on research we have carried out about mental health and IDD prior to and during the pandemic in Ontario, Canada. We aim to address how partnering with people with IDD, family caregivers, service providers, and policy makers can help accelerate needed progress in this area. We conclude with some lessons learned during the pandemic about what to emphasize in building and maintaining such partnerships.
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Affiliation(s)
- Yona Lunsky
- Yona Lunsky, Johanna Lake, and Anupam Thakur, Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health and Temerty Faculty of Medicine, University of Toronto
| | - Johanna Lake
- Yona Lunsky, Johanna Lake, and Anupam Thakur, Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health and Temerty Faculty of Medicine, University of Toronto
| | - Anupam Thakur
- Yona Lunsky, Johanna Lake, and Anupam Thakur, Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health and Temerty Faculty of Medicine, University of Toronto
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de la Garza Iga FJ, Mejía Alvarez M, Cockroft JD, Rabin J, Cordón A, Elias Rodas DM, Grazioso MDP, Espinola M, O'Dea C, Schubert C, Stryker SD. Using the project ECHO™ model to teach mental health topics in rural Guatemala: An implementation science-guided evaluation. Int J Soc Psychiatry 2023; 69:2031-2041. [PMID: 37477264 DOI: 10.1177/00207640231188038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
BACKGROUND Mental health (MH) disorders are major causes of disability in Guatemala. Unfortunately, limited academic training and funding resources make MH care inaccessible to most people in rural Guatemala. These disparities leave many indigenous populations without care. Project ECHO™ is an educational model used globally to deliver virtual training for providers in rural/ underserved communities. The aim of this project was to implement and evaluate a Project ECHO™ program bridging MH training gaps for providers who serve rural communities in Guatemala. METHODS The Project ECHO™ curriculum was implemented through a partnership between educational and nonprofit institutions in Guatemala City and the United States. Participants were primary care physicians and nurses working in rural Guatemala as well as medical/nursing/psychology students. Evaluation of its implementation was guided by a RE-AIM framework. Reach, effectiveness, adoption, fidelity, sustainability, acceptability, feasibility, and appropriateness were evaluated using a mixed-methods approach, using a pre-post survey and semi-structured focus groups. RESULTS Forty unique participants attended the five sessions. Attitudes about mental health did not change quantitatively but self-efficacy improved in four of five modules. High quality fidelity scores were noted in two of five sessions. Sustainability scores across multiple domains were highly rated. Scores on instruments measuring acceptability, feasibility, and appropriateness were high. Focus groups showed two main themes: the curriculum filled a gap in education and further adaptation of the model might help improve the experience. CONCLUSION Implementation of the Project ECHO™ educational model appeared to have good reach/adoption, showed improvements in self-efficacy, illuminated facilitators and barriers to sustainability, and was felt to be acceptable, feasible, and appropriate. Qualitative analysis supported these conclusions. Future directions would include ongoing evaluation and monitoring of further Project ECHO™ curricular experiences through this partnership and adaptation of this project to other learners and settings in Latin America.
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Affiliation(s)
| | | | - Joshua D Cockroft
- Department of Family and Community Medicine, College of Medicine, University of Cincinnati, OH, USA
- Department of Psychiatry and Behavioral Neurosciences, College of Medicine, University of Cincinnati, OH, USA
| | - Julia Rabin
- Department of Psychology, College of Arts & Sciences, University of Cincinnati, OH, USA
| | - Ana Cordón
- Wuqu' Kawoq / Maya Health Alliance, Tecpan, Guatemala
| | | | | | - Maria Espinola
- Department of Psychiatry and Behavioral Neurosciences, College of Medicine, University of Cincinnati, OH, USA
| | - Christine O'Dea
- Department of Family and Community Medicine, College of Medicine, University of Cincinnati, OH, USA
| | - Charles Schubert
- Department of Family and Community Medicine, College of Medicine, University of Cincinnati, OH, USA
| | - Shanna D Stryker
- Department of Family and Community Medicine, College of Medicine, University of Cincinnati, OH, USA
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Moss P, Nixon P, Baggio S, Newcomb D. Turning Strategy into Action - Using the ECHO Model to Empower the Australian Workforce to Integrate Care. Int J Integr Care 2023; 23:16. [PMID: 37215958 PMCID: PMC10198227 DOI: 10.5334/ijic.7036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Children's Health Queensland (CHQ) established a telementoring hub in Queensland, using the Project ECHO® model, to pilot and scale a range of virtual communities of practice (CoP) to empower the Australian workforce to integrate care. Description The establishment of the first Project ECHO hub in Queensland facilitated the implementation of a variety of child and youth health CoP that strategically aligned to the organisation's approach to integrate care through workforce development. Subsequently, other organisations nationally have also been trained to implement and replicate the ECHO model to effect more integrated care through CoPs in other priority areas. Discussion Findings from a database audit and desktop analysis of project documentation highlighted that using the ECHO model was effective in establishing co-designed and interprofessional CoP to support a cross-sector workforce to deliver more integrated care. Conclusion CHQ's use of Project ECHO highlights an intentional approach to establishing virtual CoP to build workforce capability to integrate care. The approach explored in this paper highlights the value of workforce collaboration amongst non-traditional partners to foster more integrated care.
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Affiliation(s)
- Perrin Moss
- Bachelor of Business, Bachelor of Creative Industries, ECHO Program Manager, Children’s Health Queensland, and Doctor of Philosophy candidate, The University of Queensland, PO Box 3474 South Brisbane 4101, Queensland, Australia
| | - Phil Nixon
- Bachelor of Physiotherapy, Master of Development Practice, Graduate Certificate in Clinical Education, ECHO Network Coordinator, Children’s Health Queensland, PO Box 3474 South Brisbane 4101, Queensland, Australia
| | - Sarah Baggio
- Bachelor of Health Sciences (Physiotherapy), Honours Bachelor of Kinesiology (minor Gerontology), ECHO Network Coordinator, Children’s Health Queensland, PO Box 3474 South Brisbane 4101, Queensland, Australia
| | - Dana Newcomb
- Bachelor of Medicine, Bachelor of Surgery, Diploma of Child Health, Fellow of the Royal Australian College of General Practitioners, Medical Director Integrated Care, Children’s Health Queensland, and Senior Lecturer, Primary Care Clinical Unit, The University of Queensland, PO Box 3474 South Brisbane 4101, Queensland, Australia
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Bessell E, Kim JS, Chiem L, McDonald A, Thompson D, Glozier N, Simpson A, Parcsi L, Morris R, Koncz R. Effectiveness of Project ECHO Programs in Improving Clinician Knowledge and Confidence in Managing Complex Psychiatric Patients: a Waitlist-Controlled Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:25-34. [PMID: 36085406 PMCID: PMC9883324 DOI: 10.1007/s40596-022-01701-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The authors aimed to determine if Project Extension for Community Healthcare Outcomes (ECHO), a health-education model utilising teleconferencing technology, improves the capacity of clinicians in assessing and managing complex psychiatric patients. METHODS Three pilot Project ECHO programs were evaluated as a prospective waitlist-controlled trial, focusing on Adult Eating Disorders, Adult Intellectual Disability Mental Health, and General Mental Health. Each program comprised 9-10 weekly teleconferencing group sessions. Participants and waitlist-controls completed pre- and post-program surveys. The primary outcomes were self-reported knowledge and confidence in assessing and managing complex patients relevant to each group. Linear mixed models were used to assess the group-by-time interaction, or change over time, as appropriate. RESULTS Between July 2020 and June 2021, three series of the Adult Intellectual Disability Mental Health program, two series of the Adult Eating Disorders program, and two series of the General Mental Health program were delivered. Compared to waitlist-controls (n = 21), there were statistically significant improvements in self-reported knowledge and confidence for all topics amongst participants of the Adult Eating Disorders program (n = 44). In the Adult Intellectual Disability Mental Health program, there were significant improvements in self-reported knowledge and confidence amongst participants (n = 67) for most topics compared to controls (n = 21). There were no waitlist-controls for the General Mental Health program, but within-group analysis (n = 28) showed significant improvements in participants' knowledge and confidence following program completion, compared to baseline. CONCLUSION Project ECHO is a feasible and effective model to develop workforce capacity in managing complex psychiatric conditions.
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Affiliation(s)
| | - Ji Sun Kim
- Sydney Local Health District, Sydney, NSW, Australia
| | - Lyn Chiem
- Sydney Local Health District, Sydney, NSW, Australia
| | | | | | | | | | - Lisa Parcsi
- Sydney Local Health District, Sydney, NSW, Australia
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