Three programs recently received funding from the AAP Tomorrow's Children Endowment (TCE) to improve local access to and quality of pediatric specialty care using theProject ECHO (Extension for Community Healthcare Outcomes) model.
Project ECHO is a telementoring program that helps health care providers learn about diseases, conditions and/or processes from experts and provide specialized care to their own patients. Using widely available videoconferencing technology, clinical management tools, didactic presentations and case‐based learning, Project ECHO creates learning communities to improve quality, reduce variety and standardize best practices.
While used primarily in the adult health care system, the Academy has piloted the model in a variety of health systems to enhance the workforce in epilepsy, environmental health, HPV vaccination, obesity, school-based mental health, child abuse and neglect, trauma and resilience, health care transition, Zika virus and other pediatric conditions. Over the last five years, more than 40 organizations have been trained.
The model, combined with quality improvement methodology and family engagement, can be used to enhance the capacity of health care professionals (e.g., medical officers, general physicians, nurse practitioners, nurses and community health workers) to manage a condition, create sustainable change and improve outcomes for the pediatric population.
From September 2017 to September 2018, over 200 health care and child-serving professionals from 120 organizations and institutions took part in the three TCE-funded programs, impacting more than 100,000 children and adolescents.
Children’s Hospital & Medical Center Omaha in partnership with the AAP Nebraska Chapter and the Sections on Obesity and Emergency Medicine focused on evaluating and treating childhood obesity. The University of Nevada Reno partnered with the AAP Nevada Chapter and Council on School Health to address school-based mental health. Yale University School of Medicine teamed up with the AAP Connecticut Chapter and Sections on Child Abuse and Neglect and Emergency Medicine to improve detection, evaluation and treatment of child abuse and neglect.
Program evaluations indicated high participant satisfaction with the virtual learning modality and content. Learners reported increases in topic knowledge and self-efficacy in providing evidence-based clinical care. They also valued the multidisciplinary approach and opportunity to engage with subspecialists and indicated that the ECHO model facilitated a community of practice.
Focus groups highlighted how Project ECHO improved direct patient care and led to practice- and system-level changes.
Child abuse and neglect experts, for example, discussed the importance of doing a full skin exam on patients under 3 and an oral exam on infants, regardless of chief complaint.
“For patients with fractures, I often find myself now asking, ‘Do I believe that this injury is a plausible injury?’” one participant said.
Another noted that they implemented a policy to have all children wear a gown, regardless of the chief complaint, to make it easier to assess for sentinel injuries.
A participant in the school-based mental health project shared a success story of a middle school patient with school refusal. The ECHO team shared what they learned with the patient’s teachers, which prompted them to approach the student differently, and convinced the school district to provide online classes. The student went from not wanting to go to school to telling his guardian that he loves his school and his teachers. The district also saw the value of online learning, which they plan to offer to other students.
The AAP plans to use findings from the TCE projects to inform a larger-scale ECHO initiative. The TCE ECHO sites also plan to expand their offerings.
Applications are being accepted for several new ECHO programs that focus on lead testing, neurodevelopment and traumatic brain injury. Participating pediatricians will have the opportunity to earn American Board of Pediatrics Maintenance of Certification Part 4 credit (pending approval). For more information, visit http://bit.ly/2Rqx7zW.
