Exploring Provider Barriers to Patient Case Submissions for an Academic-Based Behavioral Health ECHO Program

Background: Behavioral Health ECHO (Extension for Community Healthcare Outcomes) is a telementoring program that connects providers in rural and underserved areas to behavioral health specialists. The program uses case-based discussions and didactic lessons to enhance the knowledge and skill of providers, so they may deliver specialized care without patients having to travel far from home. Access to care is an essential aspect of the health of an individual and community. With a maldistribution and shortage of behavioral health providers, access to specialty care becomes complicated -less than half of behavioral health patients receive specialized care (Hager et al., 2018). Also, rural providers have a lack of access to continuing education and training (Hager et al., 2018; Komaromy et al., 2017). Project ECHO helps fill the gap by increasing access - giving primary care providers the tools and knowledge to provide high-quality, evidence-based care. The Behavioral Health Program in this study historically has had high attendance rates from providers but has lacked submission of patient cases. The purpose of this DNP project was to explore provider barriers to submitting and presenting patient cases. By understanding these barriers, the program can strive to improve their processes and increase awareness, which will lead to more patient case submissions and improved patient outcomes.Methods: A quality improvement project was developed to explore provider barriers to patient case submission for a local Behavioral Health ECHO program. A survey was used to assess knowledge of the program, patient case submission process, and barriers to submitting cases for presentation. Additionally, an educational tool was developed and used to increase awareness of the Behavioral Health ECHO program and how to submit patient cases. The educational tool included a video demonstration of a patient case presentation. Results: Sixty surveys were completed and returned. Participants who stated they treat patients were the ones included in the data (n=30). It was noted that 20 percent (n=6) of providers perceived time as a barrier to submitting and presenting patient cases. Twenty percent (n=6) of providers also selected comfort and confidence level as a barrier. Concern for confidentiality was reported by 14 percent (n=4) of providers, and 48 percent (n=12) stated they were likely or very likely to submit a case if there was an option for anonymous submissions. Eighteen percent (n=5) said they would rather refer their mental health patients to a specialist than participate in an ECHO session for case consultation.Conclusions: Both the lack of time and confidence appear to be the most common barriers among providers in this study. The Behavioral Health ECHO program must discuss the implications and process for anonymous submissions. Continuing to foster a collaborative approach between Project ECHO and the healthcare community will enhance data and results. Replication of this project is needed to evaluate further provider-level barriers to submitting patient cases. Additionally, differences between providers and their perceived barriers require assessment. Taking these steps will allow the program to break down barriers, increase patient case presentations, and ultimately improve patient care and outcomes.