Primary care tele-mentoring program model sho

Tele-mentoring for primary care providers was associated with a decrease in hospitalizations of Medicaid patients with diabetes.

Primary care physicians and nurses who participated in a Rutgers Project ECHO complex endocrinology tele-mentoring program at Robert Wood Johnson Medical School (RWJMS) improved the care of patients with diabetes, according to a new study.

Project ECHO (Extension for Community Healthcare Outcomes) and similar tele-mentoring programs for healthcare providers are used extensively in the United States and around the world to improve the care of patients with a variety of medical conditions. Studies examining the effectiveness of Project ECHO programs have shown encouraging implications for learning and application of best practice by healthcare providers participating in the program, but this review is one of the few studies to show promising implications for patient outcomes.

“This review showed encouraging results about the potential of the Project ECHO model for treating diabetes in Medicaid patients,” said lead author Joel Cantor, director of the Center for State Health Policy at the Rutgers Institute for Health, Health Care Policy and Aging Research .

“Few studies to date have rigorously examined Project ECHO patient outcomes, and our novel approach shows promise for replication in other applications of the Project ECHO model.

Researchers at the Rutgers Center for State Health Policy, working independently of the RWJMS Project ECHO team, used detailed Medicaid entitlement data to match patient outcomes from primary care physicians participating in the Rutgers Project ECHO program with a matched group of general practitioners and their patients to compare patients.

the itemsPublished in Medical suppliesevaluated one of the Rutgers Project’s ECHO programs that address diabetes and other endocrine diseases, known as EndoECHO. The program is provided by Rutgers Project ECHO in New Jersey to improve care for patients with complex endocrine and metabolic disorders, such as diabetes, by providing participating providers with a virtual space to learn, collaborate, and address their patients’ challenging clinical scenarios.

Using five years of New Jersey Medicaid claims data, the researchers compared the use and expenditure of health services and the process of treatment outcomes of two groups:

  • 1,776 Medicaid patients (318 with diabetes) were matched to 25 healthcare providers participating in Rutgers’ EndoECHO program
  • 9,126 Medicaid patients (1,454 with diabetes) were matched to 119 providers who had not participated in the program but had characteristics similar to the participating providers and patients.

While the study was observational and examined a limited number of participating primary care providers caring for Medicaid patients, the researchers found that Project ECHO was associated with a reduction in inpatient hospital stays and expenses, demonstrating the feasibility and potential value of the Project ECHO applications demonstrated using this assessment method for other assessments.

“It’s important that our findings be replicated in larger studies,” says Cantor, who is also a distinguished professor at the Rutgers Edward J. Bloustein School of Planning and Public Policy.

While the researchers noted reduced hospital utilization and spending for Medicaid patients associated with providers participating in programs, important outcomes such as emergency department utilization and the diabetes care process need further investigation. Future studies in larger groups of providers and patients, and for additional health conditions, are needed to fully understand the effectiveness of Project ECHO’s programs on patient outcomes, researchers said.

“Primary care providers face challenges in caring for patients with complex needs. Programs like EndoECHO empower physicians by increasing their skills and confidence in managing patients with complicated endocrine disorders like diabetes,” said Louis Amorosa, endocrinologist at Rutgers RWJMS and co-lead of Rutgers’ EndoECHO program.

“This assessment is encouraging for these programs. Further investigation of the effectiveness of tele-mentoring models in improving patient outcomes would be of great value,” said Mary M. Bridgeman, co-lead of the Rutgers EndoECHO program, clinical professor at the Rutgers Ernest Mario School of Pharmacy.

The review’s co-authors include Sujoy Chakravarty, Jennifer Farnham and Jose Nova of Rutgers Center for State Health Policy, Sana Ahmad of Northwell Lenox Hill Hospital and James Flory of Memorial Sloan Kettering Cancer Center. This review was supported by the Nicholson Foundation and the New Jersey Department of Human Services, Division of Medical Assistance and Health Services.

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