Integrating quality improvement into the ECHO model to improve care for children and youth with epilepsy

• Published in: Epilepsia (Copenhagen) 2020-09, Vol.61 (9), p.1999-2009
• Main Authors: Joshi, Sucheta, Gali, Kari, Radecki, Linda, Shah, Amy, Hueneke, Sarah, Calabrese, Trisha, Katzenbach, Alexis, Sachdeva, Ramesh, Brown, Lawrence, Kimball, Eve, White, Patience, McManus, Peggy, Wood, David, Nelson, Eve‐Lynn, Archuleta, Pattie
• Format: Article
• Language: English
• Subjects: Adolescent; Anticonvulsants - adverse effects; Anticonvulsants - therapeutic use; Child; Chronic illnesses; Clinical Competence; Counseling; Disease Management; Documentation - standards; Epilepsy; Epilepsy - therapy; Focus Groups; Full‐length Original Research; health care transition; Humans; learning collaborative; Mass Screening; medical home; Medical personnel; Medical screening; Mental Disorders - diagnosis; Mentoring - methods; Neurology - education; Patient Education as Topic - standards; pediatric epilepsy; Pediatrics; Pediatrics - education; Physicians, Primary Care - education; Primary Health Care - standards; Project ECHO; Quality control; Quality Improvement; Referral and Consultation - standards; rural; Safety; Seizures; Self Efficacy; Side effects; Societies, Medical; subspecialty pediatrics; team‐based care; telementoring; Transition to Adult Care - standards; underserved; Videoconferencing
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1111/epi.16625

Objective Project ECHO (Extension for Community Healthcare Outcomes), a telementoring program, utilizes lectures, case‐based learning, and an “all teach–all learn” approach to increase primary care provider (PCP) knowledge/confidence in managing chronic health conditions. The American Academy of Pediatrics (AAP) Epilepsy and Comorbidities ECHO incorporated quality improvement (QI) methodology to create meaningful practice change, while increasing PCP knowledge/self‐efficacy in epilepsy management using the ECHO model. Methods Monthly ECHO sessions (May 2018 to December 2018) included lectures, case presentations/discussion, and QI review. Pediatric practices were recruited through the AAP. Practices engaged in ECHO sessions and improvement activities including monthly Plan‐Do‐Study‐Act cycles, team huddles, chart reviews, and QI coaching calls to facilitate practice change. They were provided resource toolkits with documentation templates, safety handouts, and medication side effects sheets. QI measures were selected from the American Academy of Neurology Measurement Set for Epilepsy. The AAP Quality Improvement Data Aggregator was used for data entry, run chart development, and tracking outcomes. Participants completed retrospective surveys to assess changes in knowledge and self‐efficacy. Results Seven practices participated across five states. Average session attendance was 14 health professionals (range = 13‐17). A total of 479 chart reviews demonstrated improvement in six of seven measures: health care transition (45.3%, P = .005), safety education (41.6%, P = .036), mental/behavioral health screening (32.2% P = .027), tertiary center referral (26.7%, not significant [n.s.]), antiseizure therapy side effects (23%, n.s.), and documenting seizure frequency (7.1%, n.s.); counseling for women of childbearing age decreased by 7.8%. Significance This project demonstrated that integrating QI into an ECHO model results in practice change and increases PCP knowledge/confidence/self‐efficacy in managing epilepsy.