Rural children have increased obesity and cardio-metabolic risk than their urban counterparts. Transportation problems and limited specialty care capacity reduce access to pediatric weight management (PWM). An effective strategy may be to increase primary care provider capacity to deliver PWM. We pilot tested Project ECHO (Extension for Community Healthcare Outcome), a video platform case based learning collaborative, to measure the efficacy of rural healthcare providers in PWM care.
Rural sites were randomized into two arms, ECHO + usual support or usual support alone. Usual support comprised 6 months of 1) webinars teaching prevention and PWM with use of clinical decision support and motivational interviewing, 2) telemedicine dietician services for PWM patients, and 3) quality improvement (QI) support. ECHO comprised 12 additional monthly case-based learning collaboratives. Self-reported effectiveness and skills using two validated surveys were administered at 6 months (retrospective baseline) and 18 months (retrospective post-intervention). Provider care was compared (baseline and post-intervention) in the documented recognition of obesity status, co-morbidity order testing, and PWM appointments offered.
5 sites (9 providers) participated in usual care and 2 of these sites (4 providers) were assigned to the ECHO group. Average attendance was 86% of 6 usual care sessions and 70% of 10 ECHO sessions with 11 cases presented. Satisfaction (5-point Likert scale) was high for ECHO content and case-based format (4.3 to 4.8). All sites met QI goals for prevention strategies during well-child visits. However, between the groups, there were no differences on self-reported effectiveness or skills nor in provider care based on chart review.
ECHO had high learner satisfaction and participation. This study was not powered to demonstrate added benefit of case-based learning to usual systems support for PWM. Further study would be needed with larger provider numbers.