A Health Equity ECHO Learning Series for Interdisciplinary Providers
Authors: Shook-Chiles Lisa M , Farrell Christina Bennett , Crosby Lori E , Nelson Stephen 
Published: June 2024

Presentation Date: 6/9/2024

Presentation Start Time: 1:15:00 PM

Background

Sickle cell disease (SCD) is the most common genetic disorder in the US affecting nearly 100,000 Americans with the majority of patients identifying as Black. Studies have shown individuals with SCD face stigmatization and often receive low-quality care stemming from institutional racism and implicit bias by providers. Provider biases result from a lack of awareness of their own racial identity, failure to develop an anti-racist or social justice lens, and absence of skills to mitigate racist practices/policies.

The Sickle Treatment and Outcomes Research in the Midwest (STORM) network developed an innovative health equity learning series using the Project ECHO ® virtual telementoring model, to educate healthcare providers about implicit bias, racial identity, racism, whiteness, a social justice framework, and strategies for dismantling individual and institutional racist practices.

Methods

Using the Project ECHO© framework, two Health Equity ECHO cohorts were completed (2022 and 2023) with a series of 7 and 6 hour-long sessions, respectively. A third cohort launched in January 2024 with expected completion in April 2024. The curriculum included foundations for racial justice; race; racism; whiteness/white supremacy and white privilege; white normativity; and actions, applications and implementations to dismantle structural racism. Virtual sessions were held via Zoom© and Canvas Learning Management System was used for supplemental learning materials.

Results

There were 32 participants in cohort 1 (81% female, 19% male) with approximately half reporting their racial identity as White (n = 15), Black (n = 11), multi-racial (n = 2) and the remaining (n = 4) not responding. There were 25 participants in cohort 2 (100% female, 0% male) with participants reporting their race as White (n = 18), Black (n = 2), American Indian/ Pacific Islander (n = 1), multi-racial (n = 1) and the remaining (n = 3) preferring not to answer. Registrants included physicians, community health workers, nurse practitioners, pharmacists, psychologists, newborn screening coordinators, patient advocates and other multidisciplinary pediatric and adult providers from over 10 states.

Participants from cohorts 1-2 (n = 23) completed a demographics form and a six-item survey using a five point Likert scale (very low to very high or strongly disagree to strongly agree) before and after the learning series assessing awareness of racism in the US, awareness of racism impacting patients with SCD in the United States, impact of racism on healthcare delivery, provider effectiveness for caring for white patients compared to patients of color, provider feeling equipped to care for patients of color, and the impact of racism on provider ability to deliver quality care.

Participants also provided qualitative feedback about how the series has impacted their work, changes in practice that will be made as a result of the learning series, and what they liked best about the series. Participants noted that they liked the breakout sessions for deeper discussion; lessons were multifaceted and had easily digestible content; there was vulnerability and it was a powerful series. Participants noted that the series provided a new perspective and definition to race, racism, systemic racism and white privilege in a safe space to learn from each other. Participants also proposed being more vocal and echoing patient concerns until they feel they have been address and will work on implementing education for nursing staff and other providers.

Awareness of the impact of racism on health care in general as well as specific to SCD increased significantly in all (p = 0.04). There were significant differences in the baseline results between Black and White participants. As such, White participants tended to show greater changes because of training. White participants showed a slight decrease in self-efficacy in caring for patients of color when compared to White patients.

Conclusions

Feasibility and acceptability data from the Health Equity ECHO cohorts suggest that this is a promising innovative training platform for multidisciplinary healthcare providers and trainees to raise self-awareness about implicit bias and racism, engage in a safe community of practice for self-discovery, and build skills to address inequities within healthcare settings. It provides an educational platform that is easily accessible and applicable for multidisciplinary healthcare providers to engage in reflection for learning about their own biases, as well as provide a safe environment for deep discussions. Future directions include expanding the reach of the learning series.