Telementoring program helps health professionals provide specialized care
from AAP Public Health Promotion
Three programs recently received funding from the AAP Tomorrow's Children Endowment (TCE) to improve local access to and quality of pediatric specialty care using theProject ECHO (Extension for Community Healthcare Outcomes) model.
Project ECHO is a telementoring program that helps health care providers learn about
diseases, conditions and/or processes from experts and provide specialized care to
their own patients. Using widely available videoconferencing technology, clinical
management tools, didactic presentations and case‐based learning, Project ECHO creates
learning communities to improve quality, reduce variety and standardize best practices.
While used primarily in the adult health care system, the Academy has piloted the
model in a variety of health systems to enhance the workforce in epilepsy, environmental
health, HPV vaccination, obesity, school-based mental health, child abuse and neglect,
trauma and resilience, health care transition, Zika virus and other pediatric conditions.
Over the last five years, more than 40 organizations have been trained.
The model, combined with quality improvement methodology and family engagement, can
be used to enhance the capacity of health care professionals (e.g., medical officers,
general physicians, nurse practitioners, nurses and community health workers) to manage
a condition, create sustainable change and improve outcomes for the pediatric population.
From September 2017 to September 2018, over 200 health care and child-serving professionals
from 120 organizations and institutions took part in the three TCE-funded programs,
impacting more than 100,000 children and adolescents.
Children’s Hospital & Medical Center Omaha in partnership with the AAP Nebraska Chapter
and the Sections on Obesity and Emergency Medicine focused on evaluating and treating
childhood obesity. The University of Nevada Reno partnered with the AAP Nevada Chapter
and Council on School Health to address school-based mental health. Yale University
School of Medicine teamed up with the AAP Connecticut Chapter and Sections on Child
Abuse and Neglect and Emergency Medicine to improve detection, evaluation and treatment
of child abuse and neglect.
Program evaluations indicated high participant satisfaction with the virtual learning
modality and content. Learners reported increases in topic knowledge and self-efficacy
in providing evidence-based clinical care. They also valued the multidisciplinary
approach and opportunity to engage with subspecialists and indicated that the ECHO
model facilitated a community of practice.
Focus groups highlighted how Project ECHO improved direct patient care and led to
practice- and system-level changes.
Child abuse and neglect experts, for example, discussed the importance of doing a
full skin exam on patients under 3 and an oral exam on infants, regardless of chief
“For patients with fractures, I often find myself now asking, ‘Do I believe that this
injury is a plausible injury?’” one participant said.
Another noted that they implemented a policy to have all children wear a gown, regardless
of the chief complaint, to make it easier to assess for sentinel injuries.
A participant in the school-based mental health project shared a success story of
a middle school patient with school refusal. The ECHO team shared what they learned
with the patient’s teachers, which prompted them to approach the student differently,
and convinced the school district to provide online classes. The student went from
not wanting to go to school to telling his guardian that he loves his school and his
teachers. The district also saw the value of online learning, which they plan to offer
to other students.
The AAP plans to use findings from the TCE projects to inform a larger-scale ECHO
initiative. The TCE ECHO sites also plan to expand their offerings.
Applications are being accepted for several new ECHO programs that focus on lead testing,
neurodevelopment and traumatic brain injury. Participating pediatricians will have
the opportunity to earn American Board of Pediatrics Maintenance of Certification
Part 4 credit (pending approval). For more information, visit http://bit.ly/2Rqx7zW.