将 1 型糖尿病专科护理在基层医疗环境中普及化，以减少健康差距：社区医疗保健结果（ECHO）T1D 项目扩展。
Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D.
机构信息
University of Florida Diabetes Institute, Gainesville, FL, USA
Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
出版信息
BMJ Open Diabetes Res Care. 2021 Jul;9(1). doi: 10.1136/bmjdrc-2021-002262.
INTRODUCTION
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.
RESEARCH DESIGN AND METHODS
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.
RESULTS
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).
CONCLUSIONS
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.
简介
ECHO（社区医疗保健成果扩展）项目是一种远程教育拓展模式，旨在将专业知识民主化，以减少差异，改善健康结果。内分泌学家的利用有限，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（T1D）患者。因此，在佛罗里达州和加利福尼亚州开发并试点了一个 ECHO T1D 项目。我们的目标是展示专注于 T1D 的 ECHO 计划的可行性，并提高 PCP 管理 T1D 患者的能力。
研究设计和方法
通过一种创新的方法招募医疗中心（即辐条）参加 ECHO T1D 试点，该方法侧重于合格的联邦医疗中心，并通过使用邻里贫困指数和提供商地理编码确定高需求的集水区来确定。参与辐条通过虚拟 ECHO 诊所每周接受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 T1D 医疗决策，获得糖尿病支持教练，并访问糖尿病护理资源在线存储库。参与的 PCP 完成了糖尿病知识和信心的预/后测试，并完成了出口调查，以收集有关整个 ECHO T1D 计划经验的反馈。
结果
在佛罗里达州，有 12 个辐条站点参与，有 67 个诊所为超过 1000 名 T1D 患者提供服务。在加利福尼亚州，有 11 个辐条站点参与，有 37 个诊所为超过 900 名 T1D 患者提供服务。在 6 个月的干预期间，提供了 27 次远程教育诊所，来自参与辐条站点的 70 名 PCP（来自佛罗里达州的 22 名，加利福尼亚州的 48 名）完成了糖尿病护理知识和糖尿病护理信心的预/后测试调查。糖尿病知识（p≤0.01）和糖尿病信心（p≤0.01）均有统计学显著改善。
结论
ECHO T1D 试点为特定于 T1D 的 ECHO 计划证明了概念的可行性，并且代表了一种可行的模式，可以接触到没有使用专家的医疗服务不足的社区。
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