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Wang CJ, Lewit EM, Clark CL, Lee FSW, Maahs DM, Haller MJ, Addala A, Lal RA, Cuttriss N, Baer LG, Figg LE, Añez-Zabala C, Sheehan EP, Westen SC, Bernier AV, Donahoo WT, Walker AF. Multisite Quality Improvement Program Within the Project ECHO Diabetes Remote Network. Jt Comm J Qual Patient Saf 2024; 50:66-74. [PMID: 37718146 DOI: 10.1016/j.jcjq.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 08/05/2023] [Accepted: 08/09/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The telementoring Project ECHO (Extension for Community Healthcare Outcomes) model has been shown to improve disease management in diabetes in many underserved communities. The authors aim to evaluate if ECHO could also be an effective tool for quality improvement (QI) of diabetes care in these communities. METHODS Thirteen clinics in underserved communities in California and Florida participating in Project ECHO Diabetes were recruited for a 12-month QI program. The program provided weekly tele-education sessions, including a didactic presentation and case-based discussion. In addition, clinics chose their own set of quality measures to improve and met remotely to discuss their efforts, successes, and setbacks every quarter with mentorship from QI experts. RESULTS Of the 31 QI initiatives attempted by different clinics, all had either made improvements (25 initiatives, 80.6%) or were in the process of making improvements (6 initiatives, 19.4%) in structural, process, and outcome measures. Examples of these measures include whether clinics have protocols to identify high-risk patients (structure), numbers of continuous glucose monitor prescriptions submitted by the clinics (process), and percentage of patients with diabetes whose most recent HbA1c are > 9% (outcome). For one measure, 40.0% of the clinics had achieved a higher percentage of cumulative HbA1c measurement in the third quarter of the year, compared to the fourth quarter in the previous year. The cost of QI implementation varied widely due to different number of personnel involved across sites. CONCLUSION A QI program delivered via Project ECHO Diabetes can facilitate quality improvements in underserved communities.
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Lewit EM, Figg LE, Addala A, Filipp SL, Lal R, Gurka MJ, Herndon JB, Haller MJ, Maahs DM, Walker AF. Project ECHO Diabetes Cost Modeling to Support the Replication and Expansion of Tele-mentoring Programs in Non-research Settings. Diabetes Ther 2023; 14:509-518. [PMID: 36680682 PMCID: PMC9981830 DOI: 10.1007/s13300-022-01364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/23/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Project ECHO Diabetes is a tele-education learning model for primary care providers (PCPs) seeking to improve care for patients with diabetes from marginalized communities. Project ECHO Diabetes utilized expert "hub" teams comprising endocrinologists, dieticians, nurses, psychologists, and social workers and "spokes" consisting of PCPs and their patients with diabetes. This Project ECHO Diabetes model provided diabetes support coaches to provide additional support to patients. We sought to estimate the costs of operating a Project ECHO Diabetes hub, inclusive of diabetes support coach costs. METHODS Data from Project ECHO Diabetes from June 2021 to June 2022 and wages from national databases were used to estimate hub and diabetes support coach costs to operate a 6-month, 24-session Project ECHO Diabetes program at hubs (University of Florida and Stanford University) and spokes (PCP clinic sites in Florida and California). RESULTS Hub costs for delivering a 6-month Project ECHO Diabetes program to five spoke clinics were $96,873. Personnel costs were the principal driver. Mean cost was $19,673 per spoke clinic and $11.37 per spoke clinic patient. Diabetes support coach costs were estimated per spoke clinic and considered scalable in that they would increase proportionately with the number of spoke clinics in a Project ECHO Diabetes cohort. Mean diabetes support coach costs were $6,506 per spoke clinic and $3.72 per patient. Total program costs per hub were $129,404. Mean cost per clinic was $25,881. Mean cost per patient was $15.03. CONCLUSION Herein, we document real-world costs to operate a Project ECHO Diabetes hub and diabetes support coaches. Future analysis of Project ECHO Diabetes will include estimates of spoke participation costs and changes in health care costs and savings. As state agencies, insurers, and philanthropies consider the replication of Project ECHO Diabetes, this analysis provides important initial information regarding primary operating costs.
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Affiliation(s)
- Eugene M Lewit
- Department of Health Policy, Stanford University, Stanford, CA, USA.
- , 2448 Emerson Street, Palo Alto, CA, 94301, USA.
| | - Lauren E Figg
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - Ananta Addala
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - Stephanie L Filipp
- Department of Pediatrics, Pediatric Endocrinology, University of Florida, PO Box 100296, Gainesville, FL, 32610, USA
| | - Rayhan Lal
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
- Department of Medicine, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - Matthew J Gurka
- Department of Pediatrics, Pediatric Endocrinology, University of Florida, PO Box 100296, Gainesville, FL, 32610, USA
| | | | - Michael J Haller
- Department of Pediatrics, Pediatric Endocrinology, University of Florida, PO Box 100296, Gainesville, FL, 32610, USA.
| | - David M Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - Ashby F Walker
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
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Addala A, Filipp SL, Figg LE, Anez-Zabala C, Lal RA, Gurka MJ, Haller MJ, Maahs DM, Walker AF. Tele-education model for primary care providers to advance diabetes equity: Findings from Project ECHO Diabetes. Front Endocrinol (Lausanne) 2022; 13:1066521. [PMID: 36589850 PMCID: PMC9800890 DOI: 10.3389/fendo.2022.1066521] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction In the US, many individuals with diabetes do not have consistent access to endocrinologists and therefore rely on primary care providers (PCPs) for their diabetes management. Project ECHO (Extension for Community Healthcare Outcomes) Diabetes, a tele-education model, was developed to empower PCPs to independently manage diabetes, including education on diabetes technology initiation and use, to bridge disparities in diabetes. Methods PCPs (n=116) who participated in Project ECHO Diabetes and completed pre- and post-intervention surveys were included in this analysis. The survey was administered in California and Florida to participating PCPs via REDCap and paper surveys. This survey aimed to evaluate practice demographics, protocols with adult and pediatric T1D management, challenges, resources, and provider knowledge and confidence in diabetes management. Differences and statistical significance in pre- and post-intervention responses were evaluated via McNemar's tests. Results PCPs reported improvement in all domains of diabetes education and management. From baseline, PCPs reported improvement in their confidence to serve as the T1D provider for their community (pre vs post: 43.8% vs 68.8%, p=0.005), manage insulin therapy (pre vs post: 62.8% vs 84.3%, p=0.002), and identify symptoms of diabetes distress (pre vs post: 62.8% vs 84.3%, p=0.002) post-intervention. Compared to pre-intervention, providers reported significant improvement in their confidence in all aspects of diabetes technology including prescribing technology (41.2% vs 68.6%, p=0.001), managing insulin pumps (41.2% vs 68.6%, p=0.001) and hybrid closed loop (10.2% vs 26.5%, p=0.033), and interpreting sensor data (41.2% vs 68.6%, p=0.001) post-intervention. Discussion PCPs who participated in Project ECHO Diabetes reported increased confidence in diabetes management, with notable improvement in their ability to prescribe, manage, and troubleshoot diabetes technology. These data support the use of tele-education of PCPs to increase confidence in diabetes technology management as a feasible strategy to advance equity in diabetes management and outcomes.
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Affiliation(s)
- Ananta Addala
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, United States
| | - Stephanie L Filipp
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Lauren E Figg
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, United States
| | - Claudia Anez-Zabala
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Rayhan A Lal
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, United States
- Department of Medicine, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, United States
| | - Matthew J Gurka
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Michael J Haller
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - David M Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, United States
| | - Ashby F Walker
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, United States
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