Clinician training program leads to better outcomes for patients with diabetes
University of Florida team members meet via videoconference with physicians participating in Project ECHO Diabetes tele-education. Photo by Louis Brems.
GAINESVILLE, Fla. 鈥� A tele-education program for health care providers who treat people with diabetes resulted in significant improvements in patient outcomes, including better blood sugar levels and increased use of medical devices to manage the disease, a University of Florida study finds.
Led by researchers in the and the , the program used the Extension for Community Health Care Outcomes model, which has been adopted worldwide to train clinicians who treat patients with a variety of conditions.
Known as Project ECHO, the concept of provider education leading to better patient health may seem intuitive, but the current UF study is one of the first to demonstrate patient benefits for the program in a large, randomized trial. The appear in the journal Diabetes Care.
鈥淲hile there have been more than 500 studies published on Project Echo programs, most of them have focused on the programs鈥� ability to improve provider knowledge and confidence in different areas of chronic and infectious disease,鈥� said an assistant professor of in the UF College of Public Health and Health Professions, and director of health equity initiatives at the . 鈥淥ur evaluation showed there is a benefit to people living with diabetes who are under the care of providers who participate in the program. Our study adds to the narrative that Project ECHO is a really powerful mechanism for reducing health disparities for people in underserved communities.鈥�
Walker and a professor and chief of pediatric endocrinology at the UF College of Medicine, led the new study in collaboration with Stanford University researchers. They implemented Project ECHO Diabetes across California and Florida at 20 Federally Qualified Health Centers, nonprofit organizations that provide primary health care services to underserved populations. Participating health care providers in Project ECHO Diabetes, such as physicians, nurse practitioners, and social workers, received live, interactive tele-education conferences and real-time support for complex medical decision-making.
After just six months of provider education and support, the program demonstrated significant improvements in patient health. Among the nearly 33,000 patients with Type 1 or Type 2 diabetes who were treated at one of the 20 participating health centers, there was a statistically significant reduction in the proportion of people with an average blood sugar level, or HbA1c, above 9%. Reducing the proportion of people above this threshold translates to markedly lower short- and long-term risk for disease complications, Haller said.
鈥淚n the short term, people with diabetes may have fewer nights where they鈥檙e getting up to urinate excessively, or they may feel more energetic because they鈥檙e not hyperglycemic all the time,鈥� Haller said. 鈥淏ut the really huge benefits are going to be in the longer term as reductions in average glucose over years leads to reduced risk for many of the serious complications associated with diabetes, including eye, kidney, nerve, and heart disease.鈥�
The researchers found that improvements extended not just to patients treated directly by providers who participated in the education program, but also to all patients with diabetes who received care at the health centers, suggesting that Project ECHO Diabetes had a positive impact on the organizations鈥� culture.
The study also evaluated outcomes among a group of nearly 600 racially and ethnically diverse patients with diabetes treated at the participating health care organizations. Investigators found Project ECHO Diabetes resulted in increases in the adoption of technology to improve disease management, including a nearly 47% increase in the use of continuous glucose monitors, and a nearly 20% increase in the use of insulin pumps.
Walker and Haller share the credit of Project ECHO Diabetes鈥� results with the providers who participated in the program.
鈥淭he fact that we were able to see these results in six months bears testimony to the dedication of the primary care providers we worked with and their relationships with patients,鈥� Walker said. 鈥淵ou could see how eager the providers were to improve the lives of their patients. I think that鈥檚 why ECHO has such potential. You鈥檙e working with community providers who have something that you can鈥檛 replicate artificially, which is patient trust.鈥�
Project ECHO Diabetes was funded by a grant from the Leona M. and Harry B. Helmsley Charitable Trust.
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