OUTCOMES AND QUALITY OF LIFE
Project ECHO Diabetes employs a two-pronged approach, says co-primary investigator Ashby Walker, PhD, director of health equity initiatives at the UF Diabetes Institute. In addition to direct interventions by diabetes support coaches, the program empowers primary care providers to deliver diabetes care in the family medicine setting. For many diabetes patients, their only interaction with a health care provider may occur at a primary care clinic, so providers must build a confident knowledge base to best serve this population.
This is accomplished in part through ECHO clinics held by videoconference. Walker works with Michael Haller, MD ’00, a professor and chief of pediatric endocrinology at the UF College of Medicine, and other UF experts to host a biweekly educational session, or clinic, on diabetes-related topics and run through a patient case study to discuss best practices. Physicians from across the state call in, give input and ask questions.
Walker says these clinics educate providers on health disparities some with diabetes face, including access to technologies like continuous glucose monitors or insulin pumps, products that studies have shown to be used less by some groups based on race and socioeconomic status.
“By holding these clinics, we’ve been able to educate providers on topics they have very low confidence in, like diabetes technologies,” Walker says. “We’ve seen a clear dissemination of better information to people who can be advocates for their patients to get these technologies, providers who know how to get these devices for their patients and know what their advantages are for improving patient outcomes.”
Haller serves as a co-primary investigator for Project ECHO Diabetes in collaboration with Walker. He says the 2019 grant they received enables them to assess if the program is making participants healthier by tracking patient hospitalizations, emergency room visits and blood-sugar levels. He hopes this research proves the effectiveness of ECHO programs for patients and providers.
“We want to see this become a public health initiative, where everybody utilizes ECHO programs to care for people with diabetes and other diseases,” says Haller, who holds the Silverstein Family Eminent Chair in pediatric endocrinology. “We want to show that not only do doctors feel better about providing diabetes care, but that we are tangibly improving the quality of life and health outcomes for people living with diabetes.”
ADAPTING TO A CRISIS
When the COVID-19 pandemic swept across the nation in spring 2020, Project ECHO Diabetes pivoted to focus on what its patients needed most: education and access to technology. Coaches began conducting sessions with patients over phone and video chat that focused on the risk of more severe COVID-19 complications for those living with diabetes. For patients without access to these technologies, Haller says, Project ECHO acted swiftly to provide this population with the tools they needed to receive medical attention via telehealth appointments.
“Many of the patients we are serving with Project ECHO don’t have consistent access to the internet or videoconferencing capabilities due to the lack of a computer or smartphone,” Haller says. “We are working to address those issues with additional funding from the Helmsley Trust.”
While Haller, Walker and fellow UF faculty focused their ECHO clinic videoconferences on educating providers about diabetes and COVID-19, coaches in Miami ramped up efforts to serve as many patients as possible by holding teleconference meetings for the local community.
“Our coaches in the Miami area are serving populations most impacted by disparate outcomes in COVID-19 — African American and Hispanic communities,” Walker says. “They are holding virtual town hall meetings in English and Spanish for people living with diabetes and reaching out by phone.”