Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D

David M Maahs; Angelina Bernier; Ashby F Walker; Nicolas Cuttriss; Michael J Haller; Korey K Hood; Matthew J Gurka; Stephanie L Filipp; Claudia Anez-Zabala; Katarina Yabut; Xanadu Roque; Jessie J Wong; Linda Baer; Lauren Figg; Sarah Westen; Eugene Lewit; Eleni Sheehan; Marina Basina; Rayhan Lal; Jennifer Maizel

doi:10.1136/bmjdrc-2021-002262

BMJ Open Diabetes Research & Care (Aug 2021)

Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D

David M Maahs,
Angelina Bernier,
Ashby F Walker,
Nicolas Cuttriss,
Michael J Haller,
Korey K Hood,
Matthew J Gurka,
Stephanie L Filipp,
Claudia Anez-Zabala,
Katarina Yabut,
Xanadu Roque,
Jessie J Wong,
Linda Baer,
Lauren Figg,
Sarah Westen,
Eugene Lewit,
Eleni Sheehan,
Marina Basina,
Rayhan Lal,
Jennifer Maizel

Affiliations

David M Maahs: Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
Angelina Bernier: Department of Pediatrics, University of Florida, Gainesville, Florida, USA
Ashby F Walker: University of Florida Diabetes Institute, Gainesville, FL, USA
Nicolas Cuttriss: Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
Michael J Haller: University of Florida Diabetes Institute, Gainesville, FL, USA
Korey K Hood: Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
Matthew J Gurka: Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
Stephanie L Filipp: Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
Claudia Anez-Zabala: Department of Pediatrics, University of Florida, Gainesville, Florida, USA
Katarina Yabut: Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
Xanadu Roque: Department of Pediatrics, University of Florida, Gainesville, Florida, USA
Jessie J Wong: Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
Linda Baer: Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
Lauren Figg: Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
Sarah Westen: Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
Eugene Lewit: Department of Health Research and Policy, Stanford, Palo Alto, California, USA
Eleni Sheehan: Department of Pediatrics, University of Florida, Gainesville, Florida, USA
Marina Basina: Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
Rayhan Lal: Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
Jennifer Maizel: College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA

DOI: https://doi.org/10.1136/bmjdrc-2021-002262
Journal volume & issue: Vol. 9, no. 1

Abstract

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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.

Published in BMJ Open Diabetes Research & Care

ISSN: 2052-4897 (Online)
Publisher: BMJ Publishing Group
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the endocrine glands. Clinical endocrinology
Website: http://drc.bmj.com/

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