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Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D
BMJ Open Diabetes Research & Care ( IF 4.1 ) Pub Date : 2021-07-01 , DOI: 10.1136/bmjdrc-2021-002262
Ashby F Walker 1, 2 , Nicolas Cuttriss 3 , Michael J Haller 4, 5 , Korey K Hood 3, 6 , Matthew J Gurka 7 , Stephanie L Filipp 7 , Claudia Anez-Zabala 5 , Katarina Yabut 3 , Xanadu Roque 5 , Jessie J Wong 3 , Linda Baer 3 , Lauren Figg 3 , Angelina Bernier 5 , Sarah Westen 8 , Eugene Lewit 9 , Eleni Sheehan 5 , Marina Basina 3, 10 , Rayhan Lal 3, 10 , Jennifer Maizel 11 , David M Maahs 3
Affiliation  

Introduction Project ECHO (Extension for Community Healthcare Outcomes) is a tele-education outreach model that seeks to democratize specialty knowledge to reduce disparities and improve health outcomes. Limited utilization of endocrinologists forces many primary care providers (PCPs) to care for patients with type 1 diabetes (T1D) without specialty support. Accordingly, an ECHO T1D program was developed and piloted in Florida and California. Our goal was to demonstrate the feasibility of an ECHO program focused on T1D and improve PCPs’ abilities to manage patients with T1D. Research design and methods Health centers (ie, spokes) were recruited into the ECHO T1D pilot through an innovative approach, focusing on Federally Qualified Health Centers and through identification of high-need catchment areas using the Neighborhood Deprivation Index and provider geocoding. Participating spokes received weekly tele-education provided by the University of Florida and Stanford University hub specialty team through virtual ECHO clinics, real-time support with complex T1D medical decision-making, access to a diabetes support coach, and access to an online repository of diabetes care resources. Participating PCPs completed pre/post-tests assessing diabetes knowledge and confidence and an exit survey gleaning feedback about overall ECHO T1D program experiences. Results In Florida, 12 spoke sites enrolled with 67 clinics serving >1000 patients with T1D. In California, 11 spoke sites enrolled with 37 clinics serving >900 patients with T1D. During the 6-month intervention, 27 tele-education clinics were offered and n=70 PCPs (22 from Florida, 48 from California) from participating spoke sites completed pre/post-test surveys assessing diabetes care knowledge and confidence in diabetes care. There was statistically significant improvement in diabetes knowledge (p≤0.01) as well as in diabetes confidence (p≤0.01). Conclusions The ECHO T1D pilot demonstrated proof of concept for a T1D-specific ECHO program and represents a viable model to reach medically underserved communities which do not use specialists. Data are available upon reasonable request.

中文翻译:

初级保健环境中 1 型糖尿病专科保健的民主化以减少健康差异:社区医疗保健成果 (ECHO) T1D 项目扩展

简介 Project ECHO(社区医疗保健成果扩展)是一种远程教育外展模式,旨在使专业知识民主化,以减少差异并改善健康结果。内分泌学家的有限利用迫使许多初级保健提供者 (PCP) 在没有专业支持的情况下照顾 1 型糖尿病 (T1D) 患者。因此,在佛罗里达州和加利福尼亚州开发并试点了 ECHO T1D 计划。我们的目标是证明专注于 T1D 的 ECHO 计划的可行性,并提高 PCP 管理 T1D 患者的能力。研究设计和方法健康中心(即辐条)通过一种创新方法被招募到 ECHO T1D 试点中,专注于联邦合格的卫生中心,并通过使用邻里剥夺指数和提供者地理编码来识别高需求集水区。参与的发言人每周接受由佛罗里达大学和斯坦福大学中心专业团队提供的远程教育,通过虚拟 ECHO 诊所、对复杂 T1D 医疗决策的实时支持、获得糖尿病支持教练以及访问在线知识库糖尿病护理资源。参与的 PCP 完成了评估糖尿病知识和信心的前/后测试,以及收集有关 ECHO T1D 计划整体体验的反馈的退出调查。结果 在佛罗里达州,12 个辐射站点注册了 67 家诊所,为超过 1000 名 T1D 患者提供服务。在加利福尼亚州,有 11 个辐条站点和 37 家诊所注册,为超过 900 名 T1D 患者提供服务。在为期 6 个月的干预期间,提供了 27 家远程教育诊所,来自参与中心的 n=70 PCP(22 名来自佛罗里达,48 名来自加利福尼亚)完成了评估糖尿病护理知识和糖尿病护理信心的测试前/测试后调查。糖尿病知识 (p≤0.01) 和糖尿病信心 (p≤0.01) 均有统计学显着改善。结论 ECHO T1D 试点展示了 T1D 特定 ECHO 计划的概念证明,并代表了一种可行的模式,可以覆盖不使用专家的医疗服务不足的社区。可应合理要求提供数据。糖尿病知识 (p≤0.01) 和糖尿病信心 (p≤0.01) 均有统计学显着改善。结论 ECHO T1D 试点展示了 T1D 特定 ECHO 计划的概念证明,并代表了一种可行的模式,可以覆盖不使用专家的医疗服务不足的社区。可应合理要求提供数据。糖尿病知识 (p≤0.01) 和糖尿病信心 (p≤0.01) 均有统计学显着改善。结论 ECHO T1D 试点展示了 T1D 特定 ECHO 计划的概念证明,并代表了一种可行的模式,可以覆盖不使用专家的医疗服务不足的社区。可应合理要求提供数据。
更新日期:2021-07-08
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