ABSTRACT
Project ECHO (Extension for Community Healthcare Outcomes) was developed in 2003 as an innovative model to facilitate continuing education and professional development. ECHO emphasizes ‘moving knowledge, not people.’ To accomplish this, ECHO programs use virtual collaboration and case-based learning to allow practitioners, including those in rural and underserved areas, to receive specialist training. The ECHO model has expanded rapidly and is now used in 44 countries. Preliminary research on ECHO’s efficacy and effectiveness has shown promising results, but evidence remains limited and appropriate research outcomes have not been clearly defined. To improve the evidence basis for ECHO, this study of 5 ECHO programs (cancer prevention/survivorship, integrated pain management, hepatitis C, HIV, and LGBTQ+ health care elucidated actionable insights about the ECHO programs and directions in which future evaluations and research might progress. This was a qualitative study following COREQ standards. A trained interviewer conducted 10 interviews and 5 focus groups with 25 unique, purposively sampled ECHO attendees (2 interviews and 1 focus group for each of the 5 programs). Data were transcribed verbatim and analyzed using the general inductive approach, then reviewed for reliability. We identified four major categories (reasons to join ECHO, value of participating in ECHO, ways to improve ECHO, and barriers to participation) composed of 23 primary codes. We suggest that thematic saturation was achieved, and a coherent narrative about ECHO emerged for discussion. Participants frequently indicated they received valuable learning experiences and thereby changed their practice; rigorous trials of learning and patient-level outcomes are warranted. This study also found support for the idea that the ECHO model should be studied for its role in convening communities of practice and reducing provider isolation as an outcome in itself. Additional implications, including for interprofessional education and model evolution, were also identified and discussed.
Acknowledgments
We would like to thank Ms. TiAura Jackson for her work in reviewing qualitative coding for a set of interviews and a focus group. We also wish to acknowledge all ECHO expert panelists, participants, and facilitators who were not part of this specific study but without whom the Fairbanks School of Public Health could not offer their ECHO programs.
Data availability
Please contact the authors regarding availability of the raw data in text format only. Sharing any transcript will be possible pending complete de-identification on behalf of both the participants and the interviewer, as well as removing other details. For reasons of confidentiality, video recordings of interviews and focus groups will not be made available.
Ethical approval
This study was approved by the Indiana University Institutional Review Board (#10643).
Author contributions
JA, JD, AJ, and AC conceptualized and designed the study. JD collected the data. JA, AJ, JR, and TJ analyzed and interpreted the data. GM and AJ obtained funding for the study. JA produced the first draft of the paper, but all authors contributed to drafting and refinement. All authors approved the final version of the manuscript.
Disclosure
No potential conflict of interest was reported by the author(s).
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