Project ECHO Diabetes Trial Improves Outcomes for Medically Underserved People

• DOI: 10.2337/figshare.27625425
• Publication Date: 2024-12-17T00:14:41Z
• Authors: 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
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Original Article

<p dir="ltr">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 program on patient outcomes using randomized designs. </p><p dir="ltr">Research Design and Methods: Implementation an Diabetes was stepped-wedge design with recruitment 20 Federally Qualified Health Centers (FQHCs) across California Florida randomized, phased-in intervention entry. Participating FQHCs (“spokes”) provided aggregate data including Healthcare Effectiveness Data Information Set (HEDIS) diabetes technology use. Patients were recruited from spokes collection involved historical prospective HbA1c measures, HEDIS markers, pre/post surveys. Linear mixed models generate patient-level monthly estimates, evaluating change over time; Poisson regression clinic-level dir="ltr">Results: spoke-level cohort included 32,796 people T1D (3.4%) T2D (96.6%) 72.7% publicly-insured or uninsured. 582 adults (33.0% T1D, 67.0% T2D), mean age 51.1 years, 80.7% uninsured, 43.7% non-Hispanic White (NHW), 31.6% Hispanic, 7.9% Black (NHB) 16.8% other. At spoke-level, there statistically significant reductions proportion >9% (31.7% 26.7%, p=0.033). patient-level, increases CGM (25.1% 36.8%, p<0.0001) pump use (15.3% 18.3%, p<0.001) intervention.</p><p><br></p><p dir="ltr">Conclusions: demonstrates promise for reducing health disparities contributes our understanding benefits beyond provider-level.</p>