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Show-Me ECHO: Project Evaluation
Mirna Becevic, PhD, MHAAssistant Research ProfessorDepartment of DermatologyMissouri Telehealth Network
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Show-Me ECHO• Extension for Community Health Care Outcomes (ECHO) is a guided practice
model utilizing disruptive innovation technologies
• Guided practice: Practicing new learning under direct supervision (hear/see/do)1
• Disruptive innovation technologies: using complicated products and services (telehealth) in a new, simpler way (telementoring)2
1Dr. Madeline Hunter’s model of mastery learning http://www.onetohio.org/library/Documents/Dr%20Madeline%20Hunter%20Article1.pdf
2Hwang, Jason, and Clayton M. Christensen. "Disruptive innovation in health care delivery: a framework for business-model innovation." Health Affairs27.5 (2008): 1329-1335
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Show-Me ECHO
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Show-Me ECHO
Demonstrations
CME didactics
Case-based learning
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Show-Me ECHOObjective:
To educate rural health clinicians in a specific disease state in order to fill considerable gaps in expertise, and expand access to specialty care for rural and underserved Missourians3
3Katzman, J. G., Comerci, G., Boyle, J. F., Duhigg, D., Shelley, B., Olivas, C., Daitz, B., Carroll, C., Som, D., Monette, R., Kalishman, S. and Arora, S. (2014), Innovative Telementoring for Pain Management: Project ECHO Pain. J. Contin. Educ. Health Prof., 34: 68–75. doi: 10.1002/chp.21210
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Show-Me ECHO
Evaluation methods:
1. Evaluation of aggregate attendee data
2. Assessment of participating provider practice change (Medicaid claims data)
3. Participating provider self-efficacy (pre-post)
4. Anonymous CME evaluations
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1. ENDO ECHO evaluation example
• 132 board certified endocrinologists
• 62 of those in St. Louis area
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2. ENDO ECHO evaluation example
Map of board certified endocrinologists
Prevalence of diabetes in Missouri, 20114
4Missouri Diabetes Report 2015, MO HealthNet Division and DHSS
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2. ENDO ECHO evaluation example
Blue: endocrinologists
Orange: ENDO ECHO participants
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1. Evaluation of aggregate attendee data (ENDO ECHO)
Measure NumberTotal sessions 25Total attendees 244Individual attendees 89Case presentations 69 (67 new, 2 follow-up)CME credits awarded 16.5 hours (MDs and Dos)
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1. Evaluation of specific topics (ENDO ECHO)
Thyroid block
(3 topics)
• Case presentations
• Presenter
Diabetes block 1
(5 topics)
• Case presentations
• Presenter
Diabetes block 2
(3 topics)
• Case presentation
• Presenter
Fall curriculum
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2. Medicaid claims data
Objective: To educate rural health clinicians in a specific disease state in order to fill considerable gaps in expertise, and expand access to specialty care for rural Missourians3
Outcomes:
• Provider behavior change (prescription patterns), pre-post;
• Change in patient specific type (diagnoses), pre-post
• Change in patient behavior (ED visits, hospitalizations, outpatient visits), pre-post
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2. Medicaid claims data
• Baseline for all ECHOs, 2014.
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2. Medicaid claims data – ENDO ECHO example
PCP1 PCP2 PCP3 PCP4 Control PCP
Number of sessions attended
X XX Y YY 0
Number of cases presented
X XX Y YY 0
Type of case presentation (DX)
X XX Y YY 0
Number of sessions withoutcases presented
X XX Y YY 0
Didactic topic A attended
X XX Y YY 0
Didactic topic B attended
X XX Y YY 0
Number of patients with DX A
X XX Y YY Z
Number of Drug A prescriptions
X XX Y YY Z
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3. PCP self-efficacy• ECHO intervention (education) may influence provider
decision making, which may affect their capacity to see certain types of patients.
• Self-efficacy is based on the social cognitive theory: unless people believe that they can achieve something, they will lack motivation to do it, and doubt that they can make difference by taking or changing their actions3.
• Primary care physician self-efficacy is associated with self-reported preventative care delivery in adult and pediatric primary care setting4
3Bandura, A. (2010). Self-Efficacy. In Corsini Encyclopedia of Psychology. 1-3
4Ozer, E., Adams, S., Gardner, L., et al (2004) Provider self-efficacy and the screening of adolescents for risky health behaviors. Journal of Adolescent Health. 35(2), 101-107
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3. PCP self-efficacy
• Pre-Post survey
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3. PCP self-efficacy – ENDO ECHO example• Observed decrease in self efficacy in some cases
• High pre-ECHO self efficacy (confidence in screening of patients with diabetes, glucose self-monitoring, etc), much lower post-ECHO self efficacy
Knowing what you don’t know is more important than knowing what you think you know.
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4. CME surveys
• 5-point Likert scale
• Follow standard CME wording, and adjusted to ECHO specific terminology
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Asthma – preliminary results
Asthma prevalence in Missouri ("Asthma in Missouri," [Online]. Available: https://www.cdc.gov/asthma/stateprofiles/asthma_in_mo.pdf. [Accessed 12 January 2017].) and map of counties analyzed
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Asthma preliminary results
Average daily cost of asthma visit
Number of visits saved
Cost-effectiveness
$850 (in-patient) 1,600 $1,360,000
$500 (ED) 1,173 $586,500
TOTAL 2,773 $1,946,500
Estimated average cost by MO HealthNet
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Asthma preliminary results
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Thank you!