Characterizing Project ECHO Autism Case Recommendations and Implementation

ECHO Ontario Autism was developed to grow capacity by building community providers' knowledge, skills, and confidence. This research summarizes the recommendations provided to presenting physicians through the ECHO Ontario Autism program, participant-reported recommendation uptake, reasons recommendations were not enacted, and participant perceptions of the program's impact. Case-specific surveys were sent to participating presenting community physicians to determine whether they implemented recommendations and to solicit their views on the program's clinical impact. Recommendations were classified by two researchers who inductively coded responses on reasons that recommendations were rejected and clinical impacts of ECHO Ontario Autism using conventional content analysis. The analysis included 32 cases presented by 18 physicians, resulting in 289 recommendations. Nearly three quarters (74%) of recommendations were implemented (n = 214). Recommendations not enacted were most often due to reasons relating to the child/family (e.g., family found alternatives). Providers indicated that ECHO Ontario Autism positively influenced their approach to care, increased their diagnostic capabilities, and provided interpersonal benefits with families and colleagues. Recommendations from ECHO Ontario Autism have a moderate-to-high rate of uptake in real-world practice. Participation in ECHO Ontario Autism provided benefits extending beyond recommendations for specific cases presented in the program.