Integrating Quality Improvement into the ECHO Model to Improve Care for Children and Youth with Epilepsy

• Main Authors: Joshi, S. M., Gali, K., Radecki, L., Sachdeva, P. R., Calabrese, T., Shah, A., Huenke, S., Brown, L., Kimball, E., Wood, David
• Published: Digital Commons @ East Tennessee State University 2019
• Subjects: ECHO model; youth; epilepsy; Pediatrics
• Online Access: https://dc.etsu.edu/etsu-works/7671

Objective: Telementoring programs like Project ECHO® (Extension for Community Healthcare Outcomes) employ didactics, case-based learning and an “all teach-all learn”approach to increase PCP knowledge/confidence in managing chronic health conditions. The AAP Epilepsy and Comorbidities ECHO aimed to incorporate Quality Improvement (QI) methodology to create sustainable practice change, while increasing PCP knowledge/confidence/self-efficacy in epilepsy management using the ECHO model. Methods: ECHO sessions occurred monthly (5/2018-12/2018). Sessions included lectures, case presentations/discussion and QI review. Practices, recruited through the AAP, implementedmonthly PDSA cycles using team huddles, chart reviews, QI coaching calls and discussion. Measures for improvement were selected from the American Academy of Neurology Epilepsy Measures set. The AAP Quality Improvement Data Aggregator was used for data entry, run chart development, tracking outcomes. Participants completed pre and post-surveys and received Maintenance of Certification Part 4 credits. Results: Average session attendance was 14 (13-17), across 7 practices in 5 states. QI coaching facilitated practice change and development of resource toolkits with documentation templates, safety handouts, medication side effects sheets. Individual and aggregate run charts with data analysis augmented workflow changes. 479 chart reviews demonstrated improvement in 6/7 measures (Table1): documenting seizure frequency (7.1% increase), anti-seizure therapy side effects (23%), safety education(41.6%, p=0.036); Mental/behavioral health screening(32.2% p=0.027); Tertiary Center referral(26.7%); Health Care transition(45.3%, p=0.005). Counseling for women of childbearing age decreased by 7.8%. Participants reported gains in knowledge/confidence/self-efficacy regarding epilepsy management (p< 0.02). Conclusions: This project demonstrated that integrating QI into an ECHO model results in sustainable practice change and increases PCP knowledge/confidence/self-efficacy in managing epilepsy.