Call to Address Diabetes and CKD Disparities Leveraging the Project ECHO Model

Background: Racial, ethnic and socioeconomic disparities in diabetes and CKD outcomes are disheartening. Due to the shortage of specialists, the majority of adults with complex diabetes and CKD will be treated by primary care professionals (PCPs). From a health equity and population health level perspective, approaches to improving the care of diabetes and CKD must target this care setting and population. The Project ECHO® (Extension for Community Healthcare Outcomes) model is a proven tele-education and mentoring model that is designed to explicitly target frontline PCPs to address health disparities and improve patient outcomes. Methods: To address the urgent need to offer diabetes-related ECHO programs with CKD program content, the ECHO Diabetes Action Network (EDAN) facilitated a learning collaborative to implement ECHO programing to address Diabetes Disparities & CKD in primary care. Selected "hubs" were ECHO Colorado, Rutgers, and University of Washington. Shared guiding principles drove programing. Topics, case presentation materials and evaluation tools were share. Hubs included multidisciplinary and interprofessional faculty (nephrologist, endocrinologist, behavioral health specialist, primary care clinician, pharmacist, diabetes educator, community health worker and patient advocate). Participant recruitment prioritized PCPs in safety-net/community-focused settings such as FQHCs. Results: ECHO programs were completed within 5 months (Sep2022–Jan2023). 582 total learners participated from 70 community clinics across the country. 33% (+/- 19%) of learners participated in ≥50% of the teleECHO sessions across programs. Average weekly participation (31 +/-11) varied across hub sites. Learner evaluations demonstrated low baseline confidence in managing diabetes-related CKD. Post-program evaluation, including learner confidence and knowledge surveys. The collaborative created a replication toolkit to support additional organizations launch diabetes and CKD-related programming. Conclusion: The care of people with diabetes and CKD falls on PCPs and community health centers due to limited access to specialists. This is compounded for minorities, the underserved and those with disparities. Implementation of the ECHO model is a strategy to explicitly address disparities in CKD through education, mentoring and collaboration among all stakeholders in the healthcare system while improving clinician satisfaction. Funding: Commercial Support - Bayer Healthcare