Endo Echo Improves Primary Care Provider and Community Health Worker Self-Efficacy in Complex Diabetes Management in Medically Underserved Communities

Presentation Number: SUN 284
Date of Presentation: April 2nd, 2017

Matthew Frederick Bouchonville*1, Jessica Kirk2, Vanessa Acosta2, Nathan Troyer2 and Sanjeev Arora3
1University of New Mexico School of Medicine, Albuquerque, NM, 2University of New Mexico Health Sciences Center, 3University of New Mexico School of Medicine



The involvement of a diabetes specialist in the management of complex diabetes has been linked to higher quality, more cost-effective care, as well as fewer diabetic complications, and improved survival. Unfortunately, rates of diabetes have outpaced available resources such that we face a national shortage of endocrinologists, an increasing trend worldwide. Project ECHO (Extension for Community Healthcare Outcomes) is a disruptive innovation in healthcare delivery that uses videoconferencing technology to disseminate specialized medical knowledge to healthcare workers in underserved communities. Outcomes of patients in rural New Mexico treated for hepatitis C by primary care providers through the ECHO model were proven to be no different than from those treated at the academic medical center (1). Thus, we have applied the ECHO model to improve capacity for complex diabetes management (Endo ECHO) in rural New Mexico.


We hypothesized that the ECHO model would increase self-efficacy in complex diabetes management of rural primary care providers and community health workers participating in the Endo ECHO program.


We recruited a multidisciplinary panel from the University of New Mexico (UNM) Health Sciences Center to provide ongoing mentorship to rural healthcare workers during weekly 2-hour ECHO sessions. We partnered with primary care providers (PCPs) and community health workers (CHWs) at 10 federally qualified health centers (FQHCs) around New Mexico who agreed to participate in weekly ECHO sessions in order to become “endocrine experts” and serve as local referral providers for their communities. Weekly ECHO sessions involved case-based learning with presentation of de-identified patients over the network and didactic presentations of a best practices curriculum from November 2014 to present. Participating PCPs and CHWs completed pre/post-intervention self-efficacy surveys relating to complex diabetes management which were approved by the UNM Institutional Review Board.


Rural CHWs (n=10) and PCPs (n=13) reported significant improvement in self-efficacy in several areas of psychosocial, behavioral, and medical management of patients with complex diabetes. Overall self-efficacy scores (scale 1-7) improved from a mean of 2.59 to 6.02 (P<0.0001) in CHWs with an effect size of 2.8 standard deviations (SDs) compared to baseline, and from a mean of 3.66 to 5.84 (P<0.0001) in PCPs with an effect size of 1.7 SDs compared to baseline.


Endo ECHO was successful at increasing rural PCP and CHW self-efficacy in complex diabetes management. Further studies of enrolled patients are necessary to determine whether improved expertise in diabetes management affects diabetes outcomes.


Nothing to Disclose: MFB, JK, VA, NT, SA