Behavioral Sleep Education in Pediatric Primary Care: Building Capacity Through the Extension for Community Healthcare Outcomes (ECHO) Model.

BACKGROUND: Sleep disorders are prevalent in children yet significantly underdiagnosed and undertreated in primary care. The Extension for Community Healthcare Outcomes ("Project ECHO©") is a telementoring model that connects healthcare specialists with generalists, combining brief didactic presentations and case-based learning. In this one-year project, the ECHO© model was employed to train primary care pediatricians in Rhode Island in behavioral sleep management strategies. METHODS: Monthly teleconference sessions included a didactic presentation by a pediatric behavioral sleep expert, followed by a case presentation and discussion. Practices also designed and completed a Quality Improvement project, supported by monthly meetings with a facilitator. Six practices enrolled; 10 clinicians completed both pre- and post-program evaluations. RESULTS: Providers reported increased knowledge about pediatric sleep, particularly in the areas of sleep training in infants, and addressing sleep in patients with Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder. Improvements in overall confidence and comfort to address sleep in primary care were reported. After the project, providers reported an increase in systematic tracking of sleep concerns, and an increase in frequency of follow-up visits to address sleep. CONCLUSIONS: Project ECHO© is a promising model for diffusion of practice-based behavioral sleep knowledge to primary care pediatricians. An expanded clinical skillset helps primary care pediatricians feel empowered to identify and address sleep problems in their practices, which has the potential to improve sleep care and preserve healthcare resources.