Reflections on project ECHO: qualitative findings from five different ECHO programs

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.

KEYWORDS:

• ECHO
• Project ECHO
• medical education
• continuing education
• professional development

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).

Supplemental Material

Supplemental data for this article can be accessed here

Additional information

Funding

The IUPUI ECHO Center programs described in this proposal received funding or in-kind support from the from the Indiana University Grand Challenge: Responding to the Addictions Crisis, the Indiana Department of Health, specifically the Division of HIV, Viral Hepatitis and Harm Reduction, the Division of Trauma & Injury Prevention, and the Division of Chronic Disease, Primary Care, Rural Health, the Health Foundation of Greater Indianapolis, Indiana Immunization Coalition, Eskenazi Health, IU-Health, Riley Children’s Hospital, American Cancer Society, Indiana Cancer Consortium, and the Indiana Clinical and Translational Sciences Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of any of the listed organizations or programs.