The U.S. Air Force Medical Service (AFMS) provides medical care for active duty and retired service members and their families, which includes approximately 50,000 patients with diabetes at 76 clinics worldwide. With only 12 AFMS endocrinologists, the majority of diabetes care is provided by primary care providers (PCPs).

In a strategic PCP knowledge expansion effort in 2012, the AFMS Diabetes Center of Excellence (DCOE) established a continuing telemedicine education program patterned after the Project Extension for Community Healthcare Outcomes (ECHO) model. Content of twice monthly video teleconference sessions included various diabetes standard of care topics and opportunities to discuss actual cases in real time.

After seven years, this program has reached 560 unique individuals at 93 locations across the three military services and the Veterans’ Administration. Over time, groups of participants have expanded from providers only to a spectrum of diabetes care delivery disciplines: PCP, specialists, PharmD, NP, PA, RN, RD, and educators. From April through September 2018 alone, 11 presentations resulted in 499 potential CMEs at 33 locations. A total of 200 out of a potential 499 surveys were completed (40% response rate), which indicated an increase in moderate or strong agreement from 28 to 84% in knowledge sufficiency as a result of ECHO session participation. More importantly, those who felt moderate or strong confidence in the treatment of complex diabetes patients increased from 33 to 72%. Virtually all survey participants (96%) indicated a likelihood to make changes to their treatment practice based on content learned during ECHO sessions.

In contrast to a traditional tertiary care referral model, models like Project ECHO Diabetes provide far greater reach, leveraging expert knowledge to increase the quality of diabetes care at the primary care level. In the context of the national diabetes epidemic and endocrinologist shortage, this model represents a realistic and responsible use of diabetes experts.


D. Beckman: None. M.W. True: None. C.C. Morrow: None. N. Watson: None. J.L. Wardian: None. J.M. Tate: None. T.J. Sauerwein: Speaker's Bureau; Self; AstraZeneca, Merck & Co., Inc.

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