By Jill Pease
Last year, University of Florida researchers published study findings that demonstrated a tele-education program for Florida and California health care providers who treat people with diabetes resulted in significant improvements in patient outcomes. These included better blood sugar levels and increased use of medical devices to manage the disease.
Now, with the support of a new American Diabetes Association grant, UF investigators are taking the highly successful tele-education program — known as Project ECHO Diabetes — nationwide. The expanded program will be delivered to health care providers at a network of Federally Qualified Health Centers in 29 states across the U.S.
“Over 30 million medically underserved people in the U.S. receive care at Federally Qualified Health Centers and this is a promising model to reduce health disparities for people living with diabetes who are seen for care in these settings,” said the study’s lead investigator Ashby Walker, Ph.D., an associate professor in the UF College of Public Health and Health Professions Department of Health Services Research, Management and Policy and director of community and population health research at the UF Diabetes Institute.
Federally Qualified Health Centers receive federal funding to provide primary and preventative medical services in outpatient settings and they play a critical role in caring for people living with diabetes who are medically underserved.
Project ECHO Diabetes uses the Extension for Community Health Care Outcomes model, which has been adopted worldwide to train clinicians who treat patients with a variety of conditions. The study published last December by lead authors Walker, Michael J. Haller, M.D., a professor and chief of pediatric endocrinology at the UF College of Medicine, and David Maahs, M.D., Ph.D., the division chief of pediatric endocrinology at Stanford University, was the first to demonstrate in a large, randomized trial that an ECHO program not only led to improved provider knowledge, but also resulted in better patient outcomes.
“In the first iteration of ECHO Diabetes, there was significant improvement in center-level outcomes for people living with diabetes who are seen for care within the Federally Qualified Health Center setting, including a reduction in the proportion of people with an average blood sugar level, or HbA1c, above 9% and a significant increase in the use of technologies to help manage the disease such as continuous glucose monitors and insulin pumps,” Walker said.
A study published this month also found that Project ECHO Diabetes led to major health care cost savings amounting to more than $5 million for patients at the health centers in Florida and California who participated in the initial program.
Through the new funding from the American Diabetes Association’s Innovative Translational Clinical Science grant program, Walker and her team will offer a six-month continuing education intervention to physicians, nurse practitioners and social workers who care for patients with diabetes at Federally Qualified Health Centers. Providers will receive live, interactive tele-education conferences and real-time support for complex medical decision-making, as well as access to an online repository of diabetes resources. The research team will assess provider confidence and knowledge in diabetes care, both before and after the intervention.
To evaluate the effect on patient outcomes, researchers will analyze data from a central repository representing 7 million patients seen at Federally Qualified Health Centers for diabetes care. Researchers will track changes in HbA1c levels, diabetes technology use and referrals for medications designed to lower blood sugar.
“This study will allow us to better understand new implementation models of the program and to carefully evaluate patient-level, provider-level and center-level outcomes through a stepped-wedge trial design, in which the intervention is rolled out to different groups in waves,” Walker said.
Walker’s co-investigators at UF include Haller and Sarah Westen, Ph.D., a clinical associate professor in the PHHP Department of Clinical and Health Psychology. Other collaborators include colleagues at Stanford University, Emory University, the University of Virginia, AllianceChicago and Health Choice Network.