Project ECHO COVID-19: Vulnerable Populations and Telehealth Early in the Pandemic.

INTRODUCTION/OBJECTIVES: Project ECHO COVID-19 was launched nationwide on March 4, 2020 to disseminate guidance about COVID-19 in a timely and scalable manner to meet the urgent needs of primary care settings, the first line of defense in a pandemic. METHODS: Data from post-session surveys were analyzed to assess participant satisfaction, knowledge gaps, change in knowledge, and anticipated changes in practice as a result of Project ECHO COVID-19. A content analysis was conducted of the 243 questions and concerns posted by over 2000 participants in the Question and Answer function of Zoom during the first 8 sessions (March 4-April 29, 2020). RESULTS: Of 5243 registrants, 49% attended at least one session. Respondents agreed or strongly agreed that didactic sessions (97%) and case presentations (96%) met their learning needs; 93% reported gaining new knowledge, and 88% would implement that knowledge. Only 32% and 53% of respondents anticipated changing workflows and adapting to telehealth, respectively, despite the need for both as the pandemic continued. The content analysis identified 3 categories: clinical operations (eg, testing, triage, telehealth, billing); patient care (diagnosis and treatment of COVID-19, management of high-risk vulnerable populations); and epidemiology (viral spread, implications for public health). CONCLUSIONS: Care of vulnerable populations and clinical operations should be addressed when planning education and clinical interventions for public health crises. Adapting the Project ECHO model to be more scalable was an effective means of creating a community of practice among health professionals when evidence-based guidance was not available to manage the implications of a pandemic.

Project ECHO Chronic Pain: A Qualitative Analysis of Recommendations by Expert Faculty and the Process of Knowledge Translation.

INTRODUCTION: Previous studies of the same Project ECHO Chronic Pain cohort demonstrated that recommendations to primary care providers (PCPs) by expert faculty follow CDC Guidelines for Prescribing Opioids and that participating PCPs change their practice accordingly. The purpose of this study was to identify how expert faculty translates knowledge, so that PCPs can act on it. METHODS: One hundred ninety-seven PCPs from 82 practices in 14 states attended at least one Project ECHO Chronic Pain session over 10 months, hosted by a large federally qualified health center. Expert faculty was a multidisciplinary panel of six clinicians. Recommendations for 25 randomly selected case presentations were transcribed, yielding 406 discrete units of data. A thematic analysis contributed to a concept map for knowledge translation. RESULTS: Expert faculty addressed psychosocial issues in 40% of recommendations. Three themes represented a familiar clinical decision-making process: recommendations for treatment accounted for risk factors and patient engagement and behavior. A concept map placed the recommendations for selected cases in the first phase of the action cycle in the Knowledge-to-Action framework, where knowledge is shared but not yet acted on. DISCUSSION: Project ECHO Chronic Pain is an example of iterative guided practice, wherein expert faculty use published guidelines and professional experience to make recommendations for patient care to PCPs. This occurs using shared social-cultural-historical language and context consistent with social constructivist theories of learning.

Academic microsystems: adapting Clinical Microsystems as an evaluation framework for community-based nursing education.

When an academic nursing program and clinical agency form a partnership to both educate students and effect changes in the health care of the community, evaluation presents a challenge for measuring structure, processes, and outcomes at three levels: student educational processes and outcomes; student-sensitive outcomes for the community; and the effectiveness of the partnership itself. This article describes how we adapted the Clinical Microsystems model as an Academic Microsystems model to evaluate the complementary processes and outcomes for the community and for the nursing program in a senior Community Capstone course. The Capstone is a community-based initiative in which students assess community needs, intervene appropriately, evaluate their intervention, and pass the initiative on to the next year's class. Although outcomes for students and the community were positive, the model revealed that developing the frontline microsystem of student/faculty/community nurse mentor was the key to success.

Community-based student practice: a transformational model of nursing education.

Nursing and nursing faculty shortages demand innovation of nurse-educators and nursing leaders to prepare nursing students for the environment in which they will practice. This article outlines the process of curricular revision undertaken by a department of nursing in a small rural liberal arts college, in partnership with clinical affiliates, based on a structure-process-outcome framework. An expanding literature base promotes service learning in nursing education. Comparison of service-learning and community-based nursing education led the partners to view community-based nursing education experience as practice, and, as such, an emerging model that transcends service learning. Community-based student nursing experiences that meet student, program, and community outcomes are planned and implemented in collaboration with community partners. This model provides students with opportunities to develop a rich understanding of the professional nursing role, while promoting nursing workforce development at both the individual and organizational levels.

Medicare funding for nursing education: proposal for a coherent policy agenda.

Medicare Graduate Medical Education (GME) funding for nursing education, established in 1965, no longer represents a coherent policy agenda, which must support educating the nursing workforce from classroom to practice. Three key concepts must be addressed: nursing education costs for both service and educational institutions, defining nursing education in federal rules and regulations, and the community's role in supporting nursing education. Responsibility for educating a nursing workforce must be shared by the community of academic, health care, professional, and government institutions and organizations, a policy supported by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). Knowledge about costs, funding streams, and policies for nursing education is essential for nursing educators to advocate for funding of nursing education and practice. Nursing programs and academic institutions need to initiate discussions with policy makers and potential community partners about service/education partnerships. Finally, community investment in nursing education pays dividends by providing essential health services of a highly skilled professional workforce.