Department of Population Health, NYU School of Medicine, New York, New York; Department of Medicine, NYU School of Medicine, New York, New York.
Flatiron Health, Inc, New York, New York.
Endocr Pract. 2020 Oct;26(10):1070-1076. doi: 10.4158/EP-2019-0535.
The Endocrinology ECHO intervention utilized a tele-mentoring model that connects primary care providers (PCPs) and community health workers (CHWs) with specialists for training in diabetes care. We evaluated the impact of the Endo ECHO intervention on healthcare utilization and care for Medicaid patients with diabetes in New Mexico.
Between January 2015 and April 2017, patients with complex diabetes from 10 health centers in NM were recruited to receive diabetes care from a PCP and CHW upskilled through Endo ECHO. We matched intervention patients in the NM Medicaid claims database to comparison Medicaid beneficiaries using 5:1 propensity matching. We used a difference-in-difference (DID) approach to compare utilization and processes of care between intervention and comparison patients.
Of 541 Medicaid patients enrolled in Endo ECHO, 305 met inclusion criteria and were successfully matched. Outpatient visits increased with Endo ECHO for intervention patients as compared to comparison patients (rate ratio, 1.57; 95% confidence interval [CI], 1.43 to 1.72). The intervention was associated with an increase in emergency department (ED) visits (rate ratio, 1.30; 95% CI, 1.04 to 1.63) but no change in hospitalizations (rate ratio, 1.47; 95% CI, 0.95 to 2.23). Among intervention patients, utilization of metformin increased from 57.1% to 60.7%, with a DID between groups of 8.8% (95% CI, 4.0% to 13.6%). We found similar increases in use of statins (DID, 8.5%; 95% CI, 3.2% to 13.8%), angiotensin-converting enzyme inhibitors (DID, 9.5%; 95% CI, 3.5% to 15.4%), or antidepressant therapies (DID, 9.4%; 95% CI, 1.1% to 18.1%).
Patient enrollment in Endo ECHO was associated with increased outpatient and ED utilization and increased uptake of prescription-related quality measures. No impact was observed on hospitalization.
内分泌 ECHO 干预利用远程指导模式将初级保健提供者（PCP）和社区卫生工作者（CHW）与专家联系起来，为糖尿病护理培训提供帮助。我们评估了内分泌 ECHO 干预对新墨西哥州医疗补助计划（Medicaid）糖尿病患者医疗保健利用和护理的影响。
2015 年 1 月至 2017 年 4 月，新墨西哥州 10 个医疗中心的复杂糖尿病患者被招募，由经过内分泌 ECHO 培训的 PCP 和 CHW 提供护理。我们在新墨西哥州 Medicaid 索赔数据库中对干预患者进行匹配，以 5:1 的倾向得分匹配与比较 Medicaid 受益人进行匹配。我们使用差异（DID）方法比较干预组和对照组患者的医疗利用率和护理流程。
541 名参加内分泌 ECHO 的 Medicaid 患者中，有 305 名符合纳入标准并成功匹配。与对照组患者相比，接受内分泌 ECHO 治疗的干预组患者门诊就诊次数增加（就诊率比，1.57；95%置信区间[CI]，1.43 至 1.72）。该干预措施与急诊就诊次数增加相关（就诊率比，1.30；95% CI，1.04 至 1.63），但住院率无变化（就诊率比，1.47；95% CI，0.95 至 2.23）。在干预组患者中，二甲双胍的使用率从 57.1%增加到 60.7%，两组之间的差异为 8.8%（95% CI，4.0%至 13.6%）。我们发现他汀类药物（差异，8.5%；95% CI，3.2%至 13.8%）、血管紧张素转换酶抑制剂（差异，9.5%；95% CI，3.5%至 15.4%）或抗抑郁药物（差异，9.4%；95% CI，1.1%至 18.1%）的使用也有类似的增加。
内分泌 ECHO 项目的患者入组与门诊和急诊就诊次数的增加以及处方相关质量指标的使用率增加有关。但未观察到对住院的影响。
