Background: National trends in diabetes outcomes, particularly in rural communities, do not mirror the significant benefits seen in clinical trials with emerging therapeutics and technologies. This disconnect is partly attributable to therapeutic inertia around uptake of clinical practice guidelines that have prioritized cardiorenal risk reduction. Project ECHO is a workforce development program that supports implementation of guidelines in under-resourced areas through virtual communities of practice and case-based learning. We hypothesized that the care of patients with diabetes treated by rural ECHO-trained providers would be non-inferior to those treated by specialists at an academic medical center (AMC).
Methods: A multidisciplinary team from a minority-majority state-funded AMC launched a weekly 2-hour diabetes ECHO program to mentor care dyads consisting of a primary care provider and community health worker at 10 rural primary care clinics. We compared cardiorenal risk factor changes in patients with diabetes treated by ECHO-trained dyads to patients treated by specialists at the AMC. Multiple regression models were adjusted for age, sex, baseline A1c and BMI, baseline risk factor outcome, and interactions with site. All model assumptions were satisfied.
Results: The mean follow-up duration was 21 months in the ECHO cohort and 18 months in the AMC cohort. Compared to the AMC cohort (n=151), patients in the ECHO cohort (n=856) experienced a greater A1c reduction (-1.4% vs -0.3%; P=0.017) and were more likely to achieve an A1c<8% (20.1% vs. 0.3% increase in those achieving A1c<8%; P<0.001). Changes from baseline in BP, LDL, and urine microalbumin were similar between groups (P>0.05).
Conclusions: ECHO may be a suitable intervention for improving diabetes and cardiorenal risk factor outcomes in rural, under-resourced communities where access to a specialist is limited.
M.F.Bouchonville: None. E.B.Erhardt: None. Y.L.Leyva: None. L.Myaskovsky: None. M.L.Unruh: None. S.Arora: None.
