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Project Extension for Community Healthcare Outcomes Intervention Evaluations: A Scoping Review of Research Methods
Jennifer Maizel1, Stephanie L Filipp, Gaia Zori
1Dr. Maizel: Department of Health Services Research, Management, and Policy, University of Florida College of Public Health and Health Professions, Gainesville, FL, and Behavioral Health and Health Policy Practice, Westat, Rockville, MD. Ms. Filipp: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL. Dr. Zori: Department of Health Services Research, Management, and Policy, University of Florida College of Public Health and Health Professions, Gainesville, FL. Dr. Yadav: Department of Health Services Research, Management, and Policy, University of Florida College of Public Health and Health Professions, Gainesville, FL. Mr. Avaiya: National Heart, Lung, and Blood Institute, Bethesda, MD. Ms. Figg: Department of Pediatrics and Division of Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, CA. Ms. Hechavarria: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL. Ms. Roque: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL. Ms. Anez-Zabala: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL. Dr. Lal: Department of Pediatrics and Division of Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, CA. Dr. Addala: Department of Pediatrics and Division of Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, CA. Dr. Haller: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL. Dr. Maahs: Department of Pediatrics and Division of Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, CA. Dr. Walker: Department of Health Services Research, Management, and Policy, University of Florida College of Public Health and Health Professions, Gainesville, FL.
Introduction:
Since its inception in 2003, the Project Extension for Community Healthcare Outcomes (ECHO) tele-education model has reached and improved outcomes for patients, providers, and health centers through interventions in >180 countries. Utilization of this model has recently increased due to the COVID-19 pandemic and a higher demand for remote education. However, limited research has examined the methodologies used to evaluate Project ECHO interventions.
Methods:
We conducted a scoping review to determine the extent and types of research methods used to evaluate outcomes and implementation success of Project ECHO interventions and to identify gaps and opportunities for future investigation. Using Arksey and O'Malley's scoping review framework and the PRISMA-ScR checklist, we reviewed study designs, temporality, analysis methods, data sources, and levels and types of data in 121 articles evaluating Project ECHO interventions.
Results:
Most interventions addressed substance use disorders (24.8%, n = 30), infectious diseases (24%, n = 29), psychiatric and behavioral health conditions (21.5%, n = 26), and chronic diseases (19%, n = 23). The most frequently reported evaluation methods included cohort studies (86.8%, n = 105), longitudinal designs (74.4%, n = 90), mixed methods analysis (52.1%, n = 63), surveys (61.2%, n = 74), process evaluation measures (98.3%, n = 119), and provider-level outcome measures (84.3%, n = 102). Few evaluations used experimental designs (1.7%, n = 2), randomization (5.8%, n = 7), or comparison groups (14%, n = 17), indicating limited rigor.
Discussion:
This scoping review demonstrates the need for more rigorous evaluation methods to test the effectiveness of the Project ECHO model at improving outcomes and standardized reporting guidelines to enhance the dissemination of evaluation data from future Project ECHO interventions.
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