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McBain RK, Sousa JL, Rose AJ, et al. Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review. J Gen Intern Med. 2019 Sep 4. pii: 10.1007/s11606-019-05291-1. doi: 10.1007/s11606-019-05291-1. (Systematic review)
Abstract

BACKGROUND: Extension for Community Health care Outcomes (ECHO) and related models of medical tele-education are rapidly expanding; however, their effectiveness remains unclear. This systematic review examines the effectiveness of ECHO and ECHO-like medical tele-education models of healthcare delivery in terms of improved provider- and patient-related outcomes.

METHODS: We searched English-language studies in PubMed, Embase, and PsycINFO databases from 1 January 2007 to 1 December 2018 as well as bibliography review. Two reviewers independently screened citations for peer-reviewed publications reporting provider- and/or patient-related outcomes of technology-enabled collaborative learning models that satisfied six criteria of the ECHO framework. Reviewers then independently abstracted data, assessed study quality, and rated strength of evidence (SOE) based on Cochrane GRADE criteria.

RESULTS: Data from 52 peer-reviewed articles were included. Forty-three reported provider-related outcomes; 15 reported patient-related outcomes. Studies on provider-related outcomes suggested favorable results across three domains: satisfaction, increased knowledge, and increased clinical confidence. However, SOE was low, relying primarily on self-reports and surveys with low response rates. One randomized trial has been conducted. For patient-related outcomes, 11 of 15 studies incorporated a comparison group; none involved randomization. Four studies reported care outcomes, while 11 reported changes in care processes. Evidence suggested effectiveness at improving outcomes for patients with hepatitis C, chronic pain, dementia, and type 2 diabetes. Evidence is generally low-quality, retrospective, non-experimental, and subject to social desirability bias and low survey response rates.

DISCUSSION: The number of studies examining ECHO and ECHO-like models of medical tele-education has been modest compared with the scope and scale of implementation throughout the USA and internationally. Given the potential of ECHO to broaden access to healthcare in rural, remote, and underserved communities, more studies are needed to evaluate effectiveness. This need for evidence follows similar patterns to other service delivery models in the literature.

Ratings
Discipline Area Score
Psychologist 6 / 7
Nurse 5 / 7
Physician 4 / 7
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Comments from MORE raters

Nurse rater

This is a well conducted study.

Nurse rater

This is a very interesting review. One would expect more positive outcomes, however, the limited rigor of the studies reviewed may have impacted the ability to see positive changes. Like many educational interventions, it is hard to separate "standard of care" from the intervention. These models, however, do show promise so more research is definitely indicated.

Nurse rater

This is not a model I have used, but it seems informative and to have benefits.

Nurse rater

As an advance practice nurse and nurse researcher, I find the findings are not surprising. The review provides evidence that can serve as the foundation for the refinement and further development of EELM, and identification of meaningful outcome measures.

Nurse rater

This systematic review offers exemplar investigation and data reporting. However, the low level of relevance clinically is well documented. This information is good for researchers interested in collecting patient centered outcomes through telemedicine. It is not relevant to day-to-day clinicians.

Nurse rater

Extention Community Health care Outcomes (ECHO) is a promoted strategy in nursing. This review shows the present evidence base. From here research and practice may focus anew.

Nurse rater

This is a well developed review indicating need for more robust studies to examine the outcomes of provider and patient involvement in the rapidly expanding EELM programs and technology.

Nurse rater

This is a very useful article.

Nurse rater

This is an important article in that it points toward improvements that should be made in EELM approaches as well as objective criteria to evaluate quality.

Physician rater

Extension for Community Health care Outcomes (ECHO) and related models of medical tele-education is an interesting idea and potentially may be an efficient way for continuing education. Effective education theoretically can improve provider's capacity and confidence in patient care. A better more systematic design will be needed to see whether improved capacity and confidence of providers can translate into improved care and patient outcomes.

Physician rater

This is very unconvincing evidence.

Physician rater

With improvement of technological innovations, Medical tele-education is very useful but implementation at all settings and countries, I think, is not practical yet.

Physician rater

This type of education is expanding all around the world and seems to be important, but most of practitioners probably do not know that more studies are needed to evaluate effectiveness.

Psychologist rater

This is a very useful and timely review.
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