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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.
Walker, Ashby F; Cuttriss, Nicolas; Haller, Michael J; Hood, Korey K; Gurka, Matthew J; Filipp, Stephanie L; Anez-Zabala, Claudia; Yabut, Katarina; Roque, Xanadu; Wong, Jessie J; Baer, Linda; Figg, Lauren; Bernier, Angelina; Westen, Sarah; Lewit, Eugene; Sheehan, Eleni; Basina, Marina; Lal, Rayhan; Maizel, Jennifer; Maahs, David M.
  • Walker AF; University of Florida Diabetes Institute, Gainesville, FL, USA afwalker@ufl.edu.
  • Cuttriss N; Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
  • Haller MJ; Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA.
  • Hood KK; University of Florida Diabetes Institute, Gainesville, FL, USA.
  • Gurka MJ; Department of Pediatrics, University of Florida, Gainesville, Florida, USA.
  • Filipp SL; Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA.
  • Anez-Zabala C; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
  • Yabut K; Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA.
  • Roque X; Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA.
  • Wong JJ; Department of Pediatrics, University of Florida, Gainesville, Florida, USA.
  • Baer L; Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA.
  • Figg L; Department of Pediatrics, University of Florida, Gainesville, Florida, USA.
  • Bernier A; Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA.
  • Westen S; Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA.
  • Lewit E; Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA.
  • Sheehan E; Department of Pediatrics, University of Florida, Gainesville, Florida, USA.
  • Basina M; Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA.
  • Lal R; Department of Health Research and Policy, Stanford, Palo Alto, California, USA.
  • Maizel J; Department of Pediatrics, University of Florida, Gainesville, Florida, USA.
  • Maahs DM; Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA.
BMJ Open Diabetes Res Care ; 9(1)2021 07.
Article in English | MEDLINE | ID: covidwho-1304224
ABSTRACT

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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Diabetes Mellitus, Type 1 Type of study: Experimental Studies / Observational study / Qualitative research / Randomized controlled trials Limits: Humans Language: English Year: 2021 Document Type: Article Affiliation country: Bmjdrc-2021-002262

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Diabetes Mellitus, Type 1 Type of study: Experimental Studies / Observational study / Qualitative research / Randomized controlled trials Limits: Humans Language: English Year: 2021 Document Type: Article Affiliation country: Bmjdrc-2021-002262