Project ECHO Diabetes Trial Improves Outcomes for Medically Underserved People

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posted on 2024-12-17, 00:10 authored by Ashby F. Walker, Michael J. Haller, Ananta Addala, Stephanie L. Filipp, Rayhan A. Lal, Matthew J. Gurka, Lauren E. Figg, Melanie Hechavarria, Dessi P. Zaharieva, Keilecia G. Malden, Korey K. Hood, Sarah C. Westen, Jessie J. Wong, William T. Donahoo, Marina Basina, Angelina V. Bernier, David M. Maahs

Objective: The Project ECHO model is used in 180 countries to address chronic disease care through a provider empowerment, tele-education approach. Few studies have rigorously evaluated the impact of the program on patient outcomes using randomized designs.

Research Design and Methods: Implementation of an ECHO Diabetes program was evaluated using a stepped-wedge design with recruitment of 20 Federally Qualified Health Centers (FQHCs) across California and Florida with randomized, phased-in intervention entry. Participating FQHCs (“spokes”) provided aggregate data including Healthcare Effectiveness Data and Information Set (HEDIS) and diabetes technology use. Patients were recruited from spokes and data collection involved historical and prospective HbA1c measures, HEDIS markers, and pre/post surveys. Linear mixed models were used to generate patient-level monthly HbA1c estimates, evaluating change over time; Poisson regression was used to model clinic-level technology use.

Results: The spoke-level cohort included 32,796 people with T1D (3.4%) and T2D (96.6%) with 72.7% publicly-insured or uninsured. The patient-level cohort included 582 adults with diabetes (33.0% T1D, 67.0% T2D), mean age 51.1 years, 80.7% publicly-insured or uninsured, 43.7% non-Hispanic White (NHW), 31.6% Hispanic, 7.9% non-Hispanic Black (NHB) 16.8% other. At the spoke-level, there were statistically significant reductions pre/post intervention in the proportion of people with HbA1c >9% (31.7% to 26.7%, p=0.033). At the patient-level, there were statistically significant increases in CGM (25.1% to 36.8%, p<0.0001) and pump use (15.3% to 18.3%, p<0.001) pre/post intervention.

Conclusions: The ECHO model demonstrates promise for reducing health disparities in diabetes and contributes to our understanding of program benefits beyond the provider-level.