社区医疗成果拓展项目（ECHO）糖尿病项目的显著成功：病例系列
The Promising Success of Project Extension for Community Healthcare Outcomes (ECHO) Diabetes: Case Series.
作者信息
Figg Lauren, Addala Ananta, Jain Ishaan, Anez Claudia, Midney Paul, DeChirico Corin, Symanski Colleen, Fitzgerald Brian C, Colbert Kristi, Raymer Terry, Stockton-Joreteg Candy, Murphy Elizabeth, Collins Leah, Bernstein Cyd, Hechavarria Melanie, Sheehan Eleni P, Bernier Angelina, Westen Sarah C, Hood Korey K, Zaharieva Dessi P, Basina Marina, Cuttriss Nicolas, Filipp Stephanie L, Gurka Matthew J, Walker Ashby F, Maahs David M, Haller Michael J, Lal Rayhan A
机构信息
Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States.
Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States.
出版信息
JMIR Diabetes. 2023 Aug 3;8:e46050. doi: 10.2196/46050.
BACKGROUND
In the United States, there are over 37 million people with diabetes but only 8000 endocrinologists. Therefore, many people with diabetes receive care exclusively from primary care providers (PCPs). To democratize knowledge regarding insulin-requiring diabetes through tele-education, Stanford University and the University of Florida developed Project Extension for Community Healthcare Outcomes (ECHO) Diabetes.
OBJECTIVE
ECHO Diabetes uses a Hub and Spoke model connecting specialists (the "Hub") with PCPs (the "Spokes"). One-hour, weekly sessions include Hub diabetes didactic presentations and Spoke deidentified case presentations. Lessons learned during these sessions target provider knowledge and confidence surrounding diabetes management and patient care.
METHODS
Spokes were asked to provide short descriptions of people with diabetes whose diabetes management improved directly or indirectly from their providers' participation or their involvement with a Diabetes Support Coach (DSC). We provide a case series to describe individuals and outcomes. Because this study was not a randomized controlled trial and was a prospective observation of patients with the intervention delivered to providers, the trial is not registered in a public trials registry.
RESULTS
A case series of 11 people with diabetes was compiled from 10 PCPs and 1 DSC from California and Florida between 2021 and 2022. The principal impact of ECHO Diabetes is the education amplified from PCPs and DSCs to people with diabetes. In all cases, people with diabetes reported increased engagement and improved diabetes management. Several cases reflected increased access to diabetes technology, improvement in glycemic outcomes, and positive trends in mental health measures.
CONCLUSIONS
This case series elucidates the potential value of the ECHO Diabetes program to people with diabetes who receive their diabetes care from PCPs. Those matched with a DSC saw clinically significant improvements in hemoglobin A and mental health outcomes.
背景
在美国，有超过3700万人患有糖尿病，但内分泌科医生只有8000名。因此，许多糖尿病患者仅由初级保健提供者（PCP）提供护理。为了通过远程教育普及有关胰岛素依赖型糖尿病的知识，斯坦福大学和佛罗里达大学开发了社区医疗成果项目扩展（ECHO）糖尿病项目。
目的
ECHO糖尿病项目采用中心辐射模式，将专家（“中心”）与初级保健提供者（“辐条”）联系起来。每周一小时的课程包括中心的糖尿病教学讲座和辐条的去识别化病例报告。在这些课程中学到的经验教训针对提供者在糖尿病管理和患者护理方面的知识和信心。
方法
要求辐条提供对糖尿病患者的简短描述，这些患者的糖尿病管理因提供者的参与或与糖尿病支持教练（DSC）的接触而直接或间接得到改善。我们提供一个病例系列来描述个体和结果。由于这项研究不是随机对照试验，而是对接受干预的提供者的患者进行的前瞻性观察，该试验未在公共试验注册库中注册。
结果
2021年至2022年期间，从加利福尼亚州和佛罗里达州的10名初级保健提供者和1名糖尿病支持教练那里收集了一个由11名糖尿病患者组成的病例系列。ECHO糖尿病项目的主要影响是知识从初级保健提供者和糖尿病支持教练传播到糖尿病患者。在所有病例中，糖尿病患者报告参与度提高，糖尿病管理得到改善。几个病例反映出获得糖尿病技术的机会增加、血糖结果改善以及心理健康指标呈积极趋势。
结论
这个病例系列阐明了ECHO糖尿病项目对从初级保健提供者那里接受糖尿病护理的患者的潜在价值。那些与糖尿病支持教练匹配的患者在糖化血红蛋白和心理健康结果方面有临床上的显著改善。
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