The impact of the ECHO® model on monitoring people diagnosed with diabetes mellitus: a scoping review

Souza, Isla Evellen Santos; Silva, Marcela Santos da; Araújo, Cindy Kemille Andrade de; Ferreira, Beatriz Carvalho; Cardoso, Alice; Silva, Glebson Moura; Otero, Liudmila Miyar

doi:10.1590/1413-81232025301.14792023

person Isla Evellen Santos Souza

conception of the manuscript theme · design · analysis, interpretation of data · writing · critical review · final review of the text · approval of the version to be published

schoolPrograma de Pós-Graduação em Enfermagem, Universidade Federal de Sergipe. Av. Marechal Rondom s/n, Jardim Rosa Elze. 49100-000 São Cristóvão SE Brasil. ievellenss@gmail.com

0000-0002-0703-7493

person Marcela Santos da Silva

methodological approach · analysis and interpretation of data · writing · final review of the text · approval of the version to be published

schoolUniversidade Federal de Sergipe. São Cristóvão SE Brasil.

0009-0006-8412-5979

person Cindy Kemille Andrade de Araújo

methodological approach · analysis and interpretation of data · writing · final review of the text · approval of the version to be published

schoolUniversidade Federal de Sergipe. São Cristóvão SE Brasil.

0009-0002-8921-1973

person Beatriz Carvalho Ferreira

writing of the article · critical review · final review of the text · approval of the version to be published

schoolPrograma de Pós-Graduação em Enfermagem, Universidade Federal de Sergipe. Av. Marechal Rondom s/n, Jardim Rosa Elze. 49100-000 São Cristóvão SE Brasil. ievellenss@gmail.com

0000-0002-5202-283X

person Alice Cardoso

writing of the article · critical review · final review of the text · approval of the version to be published

schoolUniversidade Federal de Sergipe. São Cristóvão SE Brasil.

0000-0001-7835-3306

person Glebson Moura Silva

idealization of the theme · guidance of writing · final review of the text · approval of the version to be published

schoolDepartamento de Enfermagem, Universidade Federal de Sergipe. Lagarto SE Brasil.

0000-0002-4977-2787

person Liudmila Miyar Otero

idealization of the theme · guidance of writing · final review of the text · approval of the version to be published

schoolDepartamento de Enfermagem, Universidade Federal de Sergipe. Aracaju SE Brasil.

0000-0002-4436-2877

Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva

Database	Search Strategy
Pubmed (MEDLINE)	((((((((“Diabetes mellitus”[MeSH Terms]) OR (“Diabetes mellitus”[Title/Abstract])) OR (“Diabetes mellitus”[Other Term])) OR (“Diabete Melito”[Title/Abstract])) OR (“Diabete Melito”[Other Term])) OR (Diabetes[Title/Abstract])) OR (Diabetes[Other Term])) OR (“Diabetes Melito”[Title/Abstract])) OR (“Diabetes Melito”[Other Term]) AND (((((“model ECHO”[Title/Abstract]) OR (“model ECHO”[Other Term])) OR (“Project ECHO”[Title/Abstract])) OR (“Project ECHO”[Other Term])) OR (“Extension for Community Healthcare Outcomes”[Title/Abstract])) OR (“Extension for Community Healthcare Outcomes”[Other Term])
Embase	((“diabetes mellitus”/exp) OR (“diabetes mellitus”:ab,ti,de) OR (“Diabete Melito”:ab,ti,de) OR (diabete:ab,ti,de)) AND ((“model echo”:ab,ti,de) OR (“project echo”:ab,ti,de) OR (“extension for community healthcare outcomes”):ab,ti,de)
Cochrane Library	#1: MeSH descriptor: [Diabetes Mellitus] explode all trees #2: (“Diabetes mellitus”):ti,ab,kw #3: (“Diabete Melito”):ti,ab,kw) #4: (Diabetes):ti,ab,kw #5: (“Diabetes Melito”):ti,ab,kw #6: (“model ECHO”):ti,ab,kw #7: (“Project ECHO”):ti,ab,kw #8: (“Extension for Community Healthcare Outcomes”):ti,ab,kw #9: (#1 OR #2 OR #3 OR #4 OR #5) AND (#6 OR #7 OR #8)
Scopus	TITLE-ABS-KEY ({Diabetes mellitus} OR {Diabete Melito} OR Diabetes) AND ({model ECHO} OR {Project ECHO} OR {Extension for Community Healthcare Outcomes})
Biblioteca Virtual em Saúde	((mh:(“Diabetes Mellitus”)) OR (“Diabetes Mellitus”) OR (“Diabete Melito”) OR (“Diabetes”) OR (“Diabetes Melito”)) AND ((“modelo ECHO”) OR (“model ECHO”) OR (“projeto ECHO”) OR (“project ECHO”) OR (“Proyecto ECHO”) OR (“Extensão para Resultados de Saúde Comunitária”) OR (“Extensión para resultados de salud comunitaria”) OR (“Extension for Community Healthcare Outcome”))
Web of Science	TÓPICO: (“Diabetes mellitus” OR “Diabete Melito” OR Diabetes) AND (“model ECHO” OR “Project ECHO” OR “Extension for Community Healthcare Outcomes”)

Authors	Year	Recomendantion Degree*	Evidence Level*	Scope	Journal	Qualis
Addala, A et al.¹⁵	2022	C	4	Interstate - California and Florida, USA	Frontiers in endocrinology	A3
Blecker S et al.¹⁹	2022	B	3	State - New Mexico, USA	The American Journal of Medicine	A1
Bouchonville MF et al.²⁴	2018	C	4	State - New Mexico, USA	Endocrine Practice	A2
Cantor JC et al.¹⁷	2022	B	3	State - New Jersey, USA.	Medical Care	--
Colleran K et al.¹¹	2012	C	4	State - New Mexico, USA	The Diabetes Educator	--
Cuttriss N et al.²⁵	2020	C	4	Interstate - California and Florida, USA	Pediatric Clinics of North America	A2
Paul MM et al.²¹	2020	C	4	Interstate - New Jersey and New Mexico, USA	Journal of Health Care for te Poor and Underserved	B3
Walker AF et al.²⁶	2021	C	4	Interstate - California and Florida, USA	BMJ Open Diabetes Research & Care	A3
Watts SA et al.²⁷	2015	B	3	Local - Cleveland, Ohio, USA	Journal of Telemedicine and Telecare	A2
Swigert et al.¹⁶	2014	C	4	State - New Mexico, USA	Clinical Diabetes	B2

Authors	Objective	Methods	Results
Addala A et al.¹⁵	To assess the impact of the ECHO Project on the PHC workers’ self-confidence in providing DM treatment.	Pre- and post-intervention survey with data collected at the beginning of the study and six and 12 months after the educational intervention.	The PHC professionals presented greater self-confidence in managing DM in all the subjects addressed, especially the ability to prescribe, manage, and solve problems, and in all the domains concerning the education and management of diabetes.
Blecker S et al.¹⁹	To analyze the effects of Endo ECHO in the glycemic control of patients with complex DM.	Retrospective cohort study that assessed data available in electronic databases.	The results show a decrease of 1.2% in the patients’ mean basal HbA1c, a significant increase in patients who’s HbA1c was under control, and a decrease among those in which this parameter was poorly controlled.
Bouchonville MF et al.²⁴	To determine whether participation in a multidisciplinary telementoring model improves the self-confidence of PHC workers and CHWs in managing patients with complex DM in clinically underprivileged regions.	Intervention study in which a questionnaire was applied two years after the program was implemented to assess the participant’ self-efficacy.	The results showed significant improvement in self-efficacy in all the complex DM management measures. Global self-efficacy increased by 130% for CHWs and 60% for PHC professionals.
Cantor JC et al.¹⁷	To assess the impact of the PHC workers’ participation in the ECHO Project in providing care to those enrolled in Medicaid.	Retrospective cohort study with a five-year data analysis comparing the expenditures of patients cared for by PHC professionals trained by the ECHO model with those of patients cared for by non-trained PHC professionals.	ECHO’s performance was associated with significantly decreasing hospitalizations and costs. Hospitalizations decreased by 44.3%, and hospitalization costs decreased by 61.9%, approximately US$327 per patient, compared to non-participant PHC professionals. Additionally, improved results were found among PHC professionals who attended more sessions.
Colleran K et al.¹¹	To determine whether the ECHO project is efficacious in qualifying CHWs to become members of the DM healthcare center.	Intervention study with the application of three questionnaires before and after the program.	CHWs showed significant improvements in knowledge (>12%), self-confidence in their clinical (>1.4) and non-clinical skills (>0.9), and attitudes toward the DM severity and psychological impact.
Cuttriss N et al.²⁵	To describe the development and implementation of the ECHO program directed to people with T1D.	Pilot study addressing the development and implementation of ECHO T1D.	The study described the preparatory process of developing a program using the ECHO methodology focused on T1D, the steps to develop it, and participant engagement.
Paul MM et al.²¹	To assess the effects of the Endo ECHO on patients with type 1 and 2 DM through changes the patients observed regarding the service provided by the qualified PHC service.	Intervention study with CHWs applying a questionnaire face-to-face before the intervention and via telephone one year after the intervention.	After taking the program, the patients reported improved quality and access to healthcare. Significant improvement was also found in the number of visits to treatment sources, the provision of exams such as HbA1c and feet examination, and greater adherence to the eye examination guidelines.
Walker AF et al.²⁶	To show the viability of an ECHO program centered on T1D and increase the management ability of PHC professionals to meet the needs of patients with T1D.	An intervention study in which a questionnaire was administered before and after an educational intervention to assess the participants’ knowledge and self-confidence.	The Pilot ECHO T1D is a viable model that promotes significant improvements in the participants’ knowledge and self-confidence, besides high levels of participant satisfaction.
Watts SA et al.²⁷	To determine the efficacy of the SCAN ECHO program in managing DM through clinical improvement based on HbA1c levels.	Retrospective study in which the medical records of the study population and patients with similar characteristics but not treated by PHC professionals qualified by ECHO were analyzed.	This study confirmed the program’s efficacy, significantly decreasing the mean HbA1c among patients cared for by PHC workers qualified by SCAN-ECHO. This finding diverges from what was found among patients with similar characteristics but not treated by qualified PHC workers; HbA1c levels increased among these patients.
Swigert et al.¹⁶	To qualify PHC professionals to obtain knowledge, support, and self-confidence, seeking to optimize the management of patients with complex DM.	Intervention study of a program focused on the military, with the application of pre- and post-tests at each meeting to assess the participants’ knowledge and self-confidence.	The results show improved knowledge and self-confidence in caring for patients with complex DM. Approximately 97% of the PHC professionals reported likely change in their clinical practice after receiving training under the ECHO model.

[TFN6n] Source: Authors.

The impact of the ECHO® model on monitoring people diagnosed with diabetes mellitus: a scoping review

Abstract