社区医疗保健成果干预评估项目扩展：研究方法的范围综述

Project Extension for Community Healthcare Outcomes Intervention Evaluations: A Scoping Review of Research Methods.

作者信息

Maizel Jennifer, Filipp Stephanie L, Zori Gaia, Yadav Sandhya, Avaiya Kishan, Figg Lauren, Hechavarria Melanie, Roque Xanadu, Anez-Zabala Claudia, Lal Rayhan, Addala Ananta, Haller Michael J, Maahs David M, Walker Ashby F

机构信息

Dr. Maizel: Department of Health Services Research, Management, and Policy, University of Florida College of Public Health and Health Professions, Gainesville, FL, and Behavioral Health and Health Policy Practice, Westat, Rockville, MD. Ms. Filipp: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL. Dr. Zori: Department of Health Services Research, Management, and Policy, University of Florida College of Public Health and Health Professions, Gainesville, FL. Dr. Yadav: Department of Health Services Research, Management, and Policy, University of Florida College of Public Health and Health Professions, Gainesville, FL. Mr. Avaiya: National Heart, Lung, and Blood Institute, Bethesda, MD. Ms. Figg: Department of Pediatrics and Division of Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, CA. Ms. Hechavarria: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL. Ms. Roque: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL. Ms. Anez-Zabala: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL. Dr. Lal: Department of Pediatrics and Division of Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, CA. Dr. Addala: Department of Pediatrics and Division of Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, CA. Dr. Haller: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL. Dr. Maahs: Department of Pediatrics and Division of Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, CA. Dr. Walker: Department of Health Services Research, Management, and Policy, University of Florida College of Public Health and Health Professions, Gainesville, FL.

出版信息

J Contin Educ Health Prof. 2025 Apr 1;45(2):89-100. doi: 10.1097/CEH.0000000000000572. Epub 2024 Aug 14.

DOI:10.1097/CEH.0000000000000572

PMID:39162718

Abstract

INTRODUCTION

Since its inception in 2003, the Project Extension for Community Healthcare Outcomes (ECHO) tele-education model has reached and improved outcomes for patients, providers, and health centers through interventions in >180 countries. Utilization of this model has recently increased due to the COVID-19 pandemic and a higher demand for remote education. However, limited research has examined the methodologies used to evaluate Project ECHO interventions.

METHODS

We conducted a scoping review to determine the extent and types of research methods used to evaluate outcomes and implementation success of Project ECHO interventions and to identify gaps and opportunities for future investigation. Using Arksey and O'Malley's scoping review framework and the PRISMA-ScR checklist, we reviewed study designs, temporality, analysis methods, data sources, and levels and types of data in 121 articles evaluating Project ECHO interventions.

RESULTS

Most interventions addressed substance use disorders (24.8%, n = 30), infectious diseases (24%, n = 29), psychiatric and behavioral health conditions (21.5%, n = 26), and chronic diseases (19%, n = 23). The most frequently reported evaluation methods included cohort studies (86.8%, n = 105), longitudinal designs (74.4%, n = 90), mixed methods analysis (52.1%, n = 63), surveys (61.2%, n = 74), process evaluation measures (98.3%, n = 119), and provider-level outcome measures (84.3%, n = 102). Few evaluations used experimental designs (1.7%, n = 2), randomization (5.8%, n = 7), or comparison groups (14%, n = 17), indicating limited rigor.

DISCUSSION

This scoping review demonstrates the need for more rigorous evaluation methods to test the effectiveness of the Project ECHO model at improving outcomes and standardized reporting guidelines to enhance the dissemination of evaluation data from future Project ECHO interventions.

摘要

引言

自2003年创立以来，社区医疗成果推广项目（ECHO）远程教学模式已通过在180多个国家开展干预措施，惠及患者、医疗服务提供者和健康中心，并改善了相关成果。由于2019冠状病毒病大流行以及对远程教育的更高需求，该模式的应用最近有所增加。然而，对用于评估ECHO项目干预措施的方法的研究有限。

方法

我们进行了一项范围综述，以确定用于评估ECHO项目干预措施的结果和实施成功情况的研究方法的范围和类型，并确定未来调查的差距和机会。我们使用阿克斯和奥马利的范围综述框架以及PRISMA-ScR清单，对121篇评估ECHO项目干预措施的文章中的研究设计、时间性、分析方法、数据源以及数据的水平和类型进行了综述。

结果

大多数干预措施涉及物质使用障碍（24.8%，n = 30）、传染病（24%，n = 29）、精神和行为健康状况（21.5%，n = 26）以及慢性病（19%，n = 23）。最常报告的评估方法包括队列研究（86.8%，n = 105）、纵向设计（74.4%，n = 90）、混合方法分析（52.1%，n = 63）、调查（61.2%，n = 74）、过程评估措施（98.3%，n = 119）以及医疗服务提供者层面的结果指标（84.3%，n = 102）。很少有评估使用实验设计（1.7%，n = 2）、随机化（5.8%，n = 7）或对照组（14%，n = 17），这表明严谨性有限。