A virtual community-of-practice approach by rural stakeholders in managing pneumoconiosis in the USA: a cross-sectional analysis.

INTRODUCTION: The re-emergence of pneumoconiosis, particularly among coal miners (ie black lung), in the USA is a challenge for rural communities because more miners require specialized care while expertise is scarce. The Miners' Wellness TeleECHO (Extension for Community Health Outcomes) Clinic, jointly held by the University of New Mexico and a community hospital in New Mexico, provides structured telementoring to professionals caring for miners, including clinicians, respiratory therapists, home health professionals, benefits counselors, lawyers/attorneys and others, forming a virtual 'community of practice'. This approach has not been utilized and evaluated previously. METHODS: The study's bimonthly program uses the ECHO telementoring model, which uses technology to leverage scarce mentoring resources; uses a disease-management model that is proven to improve outcomes in other disease states, by reducing variation in processes of care and sharing best practices; uses the principle of case-based learning with highly contextualized discussions, which fulfils key learning theory principles; creates a virtual community of practice; and uses an internet-based database to monitor outcomes. This 1-year cross-sectional study from September 2018 to September 2019 used geographical mapping of all attendee locations, web-based continuing medical education surveys completed by attendees using iECHO software, and a Research Electronic Data Capture-based survey of a convenience sample of participants, which obtained detailed information on demographics, knowledge, self-efficacy and collective efficacy. Knowledge sharing among participants was examined using insights and methods from social network analysis. Subgroup analysis involved comparisons between clinical and non-clinical professional groups, and between new and existing participants. Groups were compared using Fisher's exact test for categorical variables, and non-parametric Wilcoxon ranked sum test or student's t-test for continuous variables. RESULTS: Participants were largely located in pneumoconiosis mortality hotspots of the USA. In a convenience sample of 70 participants, clinical professional groups such as clinicians (29%), home health professionals (20%) and respiratory therapists (17%) constituted the majority of the stakeholders. Participants demonstrated the lowest knowledge score on 'legal pneumoconiosis' among the knowledge areas questioned; reported low self-efficacy with respect to managing miners' conditions and interpreting test results; and rated the learning community highly in terms of trust (86%), willingness to help each other (93%) and being closely knit (87%). Analysis of knowledge sources indicated that participants receive substantial proportions of knowledge from individuals outside of their stakeholder and professional groups, but proportions differ among clinical and non-clinical professional groups, as well as among 'fresh' and existing participants. CONCLUSION: The present study demonstrates the successful creation of a virtual multidisciplinary community of practice in pneumoconiosis mortality hotspot rural regions of the USA, with participants reporting multidisciplinary knowledge transfer. The community is regarded highly by participants in relation to trust, willingness to help and being closely knit. This innovative educational approach may help ensure the delivery of high-quality interdisciplinary care to rural miners in pneumoconiosis mortality hotspots in the USA.

Bone Health TeleECHO: a Force Multiplier to Improve the Care of Skeletal Diseases in Underserved Communities.

PURPOSE OF REVIEW: This review describes the global development of a model of technology-enabled collaborative learning for healthcare professionals called Project ECHO (Extension for Community Healthcare Outcomes) and its applications for the management of patients with skeletal diseases. RECENT FINDINGS: The prototype Bone Health TeleECHO was established in 2015, with others now operational in the USA and other countries, and more expected to follow soon. Each teleECHO program, in the right language and convenient time zone, provides a virtual community of practice for healthcare professionals to benefit from real-time interactive case-based learning and brief didactic presentations on topics of interest. Bone Health TeleECHO elevates the level of knowledge of participants and improves self-confidence in managing patients with skeletal diseases. The development of many teleECHO programs worldwide serves as a force multiplier, with the potential to narrow the osteoporosis treatment gap and enhance the effectiveness of fracture liaison services.

Project ECHO: Telehealth to Expand Capacity to Deliver Best Practice Medical Care.

Project ECHO (Extension for Community Healthcare Outcomes) was developed at the University of New Mexico Health Sciences Center to educate health care professionals in underserved communities to treat chronic complex diseases, allowing patients to receive better care, closer to home, with greater convenience, and at lower cost than referral to a specialty center. Videoconferencing technology is used to create learning networks, with case-based discussions as the primary method of education. The 3-year experience of Bone Health TeleECHO, a strategy to improve the care of osteoporosis and reduce the large treatment gap, is discussed.

Leveraging Scarce Resources With Bone Health TeleECHO to Improve the Care of Osteoporosis.

Osteoporosis is a common condition with serious consequences because of fractures. Despite availability of treatments to reduce fracture risk, there is a large osteoporosis treatment gap that has reached crisis proportions. There are too few specialists to provide services for patients who need them. Bone Health Extension for Community Health Care Outcomes (TeleECHO) is a strategy using real-time ongoing videoconferencing technology to mentor health care professionals in rural and underserved communities to achieve an advanced level of knowledge for the care of patients with skeletal diseases. Over the first 21 months of weekly Bone Health TeleECHO programs, there were 263 registered health care professionals in the United States and several other countries, with 221 attending at least 1 online clinic and typically 35 to 40 attendees at each session at the end of the reported period. Assessment of self-confidence in 20 domains of osteoporosis care showed substantial improvement with the ECHO intervention (P = 0.005). Bone Health TeleECHO can contribute to mitigating the crisis in osteoporosis care by leveraging scarce resources, providing motivated practitioners with skills to provide better skeletal health care, closer to home, with greater convenience, and lower cost than referral to a specialty center. Bone Health TeleECHO can be replicated in any location worldwide to reach anyone with Internet access, allowing access in local time zones and languages. The ECHO model of learning can be applied to other aspects of bone care, including the education of fracture liaison service coordinators, residents and fellows, and physicians with an interest in rare bone diseases.