Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D.
Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D.
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DOI：
10.1136/bmjdrc-2021-002262
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发表时间：
2021-07
影响因子：
4.1
通讯作者：
Maahs DM
中科院分区：
文献类型：
--
作者：
Walker AF;Cuttriss N;Haller MJ;Hood KK;Gurka MJ;Filipp SL;Anez-Zabala C;Yabut K;Roque X;Wong JJ;Baer L;Figg L;Bernier A;Westen S;Lewit E;Sheehan E;Basina M;Lal R;Maizel J;Maahs DM
ECHO项目（社区医疗保健成果扩展）是一种远程教育外展模式，旨在使专业知识民主化，以减少差异并改善健康成果。内分泌学家的有限利用迫使许多初级保健提供者（PCP）在没有专业支持的情况下照顾1型糖尿病（T1 D）患者。因此，ECHO T1 D程序在佛罗里达和加州开发和试点。我们的目标是证明专注于T1 D的ECHO计划的可行性，并提高PCP管理T1 D患者的能力。ECHO T1 D试点通过创新方法招募了卫生中心（即辐条），重点是联邦合格的卫生中心，并通过使用邻里发展指数和提供商地理编码来识别高需求的集水区。参与的发言人每周通过虚拟ECHO诊所接受由佛罗里达大学和斯坦福大学中心专业团队提供的远程教育，实时支持复杂的T1 D医疗决策，访问糖尿病支持教练，并访问糖尿病护理资源的在线存储库。参与的PCP完成了评估糖尿病知识和信心的前/后测试，以及收集有关ECHO T1 D总体计划经验反馈的退出调查。在佛罗里达，12个分支研究中心招募了67家诊所，为>1000例T1 D患者提供服务。在加州，11个分支机构招募了37家诊所，为900多名T1 D患者提供服务。在为期6个月的干预期间，提供了27个远程教育诊所，来自参与发言地点的n=70名PCP（22名来自佛罗里达，48名来自加州）完成了评估糖尿病护理知识和糖尿病护理信心的前/后测试调查。糖尿病知识（p≤0.01）和糖尿病信心（p≤0.01）有统计学显著改善。ECHO T1 D试点证明了T1 D特异性ECHO计划的概念验证，并代表了一种可行的模式，可以覆盖不使用专家的医疗服务不足的社区。
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. 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. 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). 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.
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影响因子：
16.2
作者：
Walker AF;Hood KK;Gurka MJ;Filipp SL;Anez-Zabala C;Cuttriss N;Haller MJ;Roque X;Naranjo D;Aulisio G;Addala A;Konopack J;Westen S;Yabut K;Mercado E;Look S;Fitzgerald B;Maizel J;Maahs DM
通讯作者：
Maahs DM
DOI：
10.2337/cd19-0060
发表时间：
2020-04-01
期刊：
Clinical diabetes : a publication of the American Diabetes Association
影响因子：
--
作者：
Lal, Rayhan A;Cuttriss, Nicolas;Walker, Ashby F
通讯作者：
Walker, Ashby F
影响因子：
5.6
作者：
Secrest, Aaron M.;Costacou, Tina;Orchard, Trevor J.
通讯作者：
Orchard, Trevor J.
影响因子：
16.2
作者：
通讯作者：
--
影响因子：
33.9
作者：
Killerby, Marie E.;Link-Gelles, Ruth;Tate, Jacqueline E.
通讯作者：
Tate, Jacqueline E.