Primary care tele-mentoring program model shows potential to lead to improved patient care

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

According to a new study, primary care physicians and nurse practitioners who participated in a Rutgers Project ECHO complex endocrinology tele-mentoring program at Robert Wood Johnson Medical School (RWJMS) improved care for patients with diabetes.

Project ECHO (Extension for Community Healthcare Outcomes) and similar tele-mentoring programs for health care providers are being used widely across the United States and globally to improve care for patients with a variety of conditions. Studies examining the effectiveness of Project ECHO programs have shown encouraging impacts on the learning and use of best practices by the health care providers who are participating in the program, but this evaluation is one of the few studies that shows promising impacts on patient outcomes.

"This evaluation showed encouraging results about the potential of the Project ECHO model for treatment of diabetes in Medicaid patients," said lead author Joel Cantor, Director, Center for State Health Policy at Rutgers Institute for Health, Health Care Policy and Aging Research.

"To date, few studies have rigorously examined patient outcomes of Project ECHO, and our novel approach holds promise for replication in other applications of the Project ECHO model.

Researchers at Rutgers Center for State Health Policy, working independently of the RWJMS Project ECHO team, used detailed Medicaid claims data to compare outcomes of patients of primary care providers who participated in the Rutgers Project ECHO Program to a matched group of primary care providers and their patients.  

The article, published in Medical Care, evaluated one of the Rutgers Project ECHO programs addressing 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 conditions, such as diabetes, by providing a virtual space for participating providers to learn, collaborate, and address their patients' challenging clinical scenarios.

Using five years of New Jersey Medicaid claims data, the researchers compared health care service use and spending and process of care outcomes of two groups:

• 1,776 Medicaid patients (318 with diabetes) attributed to 25 health care providers who participated in the Rutgers EndoECHO program
• 9,126 Medicaid patients (1,454 with diabetes) attributed to 119 providers who did not participate in the program but who had similar characteristics as the participating providers and patients.

While the study was observational and examined a limited number of participating primary care providers serving Medicaid patients, researchers found that Project ECHO was associated with reductions of inpatient hospitalization and spending, demonstrating the feasibility and potential value of using this method of evaluation for other assessments of Project ECHO applications.

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

While researchers found reduced hospital use and spending for Medicaid patients associated with program-participating providers, important outcomes such as emergency department use and diabetes process of care need to be examined further. Future studies on larger groups of providers and patients and for additional health conditions are needed to fully understand the effectiveness of Project ECHO programs for patient outcomes, according to researchers.

"Primary care providers are faced with challenges when caring for patients with complex needs. Programs like EndoECHO support physicians by strengthening their skills and confidence in managing patients with complicated endocrinological conditions like diabetes," said Louis Amorosa, an endocrinologist at Rutgers RWJMS and co-lead of the Rutgers EndoECHO program.

"This evaluation shows promise for these programs. Further study of the effectiveness of tele-mentoring models for improving patient outcomes would be of great value," said Rutgers EndoECHO program co-lead Mary M. Bridgeman, a clinical professor at Rutgers Ernest Mario School of Pharmacy.