Improving the Rural Provider's Ability to Manage Complex Diseases: Implementing and Facilitating the Use of Project ECHO

Purpose: To discover the challenges and potential solution(s) for the rural primary care providers using project ECHO (Extension for Community Healthcare Outcomes) to better manage common complex diseases. Rationale/Background: Research has demonstrated that those living in rural areas have higher mortality rates when compared to those living in metropolitan areas. The Project ECHO model was developed and designed to educate and enable rural primary care providers with the ability to manage common complex diseases and could be a potential solution. Project ECHO uses teleconferencing technology to connect an interdisciplinary team of experts (the "hub") with primary care providers to discuss patient conditions. Therefore, creating a positive online learning experience is important to engage providers in Project ECHO. Project ECHO is now nationwide and includes a hub in Utah; however, the Project ECHO model has not been fully implemented in Utah rural areas. Methods: Project ECHO was implemented in a clinic located in rural Cache Valley Utah. The E-Facilitation Model for creating positive online learning environment was used to guide and assess the implementation of Project ECHO. This E-Facilitation Model theorizes that three main components (preparation, engagement and ensuring value) must exist for meaningful online engagement/learning to occur. Data was collected using semi-structured interviews using the E-Facilitation model as a guide. The participants answers were then analyzed using a combination of direct and indirect content analysis. Outcome: Four providers including 2 DNPs, 1 PA, and 1 Physician agreed to participate in the project. Pre-implementation: Interview results revealed that only one of the providers had previous knowledge and had used Project ECHO. All four Participants responded positively they felt confident they could logon onto a Project ECHO session and have a reliable computer with reliable internet connection. The provider who has participated in Project ECHO also expressed that the ECHO sessions is engaging, relevant, and valuable. Lacking time was listed as the main barrier or suspected barrier to participating in Project ECHO. In addition, two providers expressed some resistance to participating on a live stream and felt uncomfortable being seen by others online. Implementation: All four providers successfully completed the online learning module introducing them to Project ECHO, how to register for it, and how to sign on for a session. Post Implementation: Despite providers reporting an overall perception of Project ECHO after the learning module none logged into a Project ECHO session. All reported time barriers and lack of clinic support as the main barriers to attending a Project ECHO session. Conclusion: Despite an overall positive perception of Project ECHO following implementation, none participated, citing lack of time and lack of clinic support as their main barriers. The provider who previously has used Project ECHO demonstrated strong motivational factors to helping underserved population, was the least experienced and was also introduced to Project ECHO in school. Possible solutions to help implement Project ECHO include: increasing clinic/employers support for the service, introduce Project ECHO to new graduates/students and although motivation may be a key factor to using Project ECHO, more research is needed to fully understand the correlation.