549-P: Understanding PCP Perspectives in a Project ECHO T1D Program Using the Consolidated Framework for Implementation Research
Authors: WALKER ASHBY F. , HALLER MICHAEL J. , SHEEHAN ELENI , WESTEN SARAH C. , ANEZ-ZABALA CLAUDIA , ROQUE XANADU , FITZGERALD BRIAN C. , BERNIER ANGELINA , GURKA MATTHEW J. , FILIPP STEPHANIE L. , TURNER KEA , ZORI GAIA L. , MAIZEL JENNIFER , CUTTRISS NICOLAS , BAER LINDA G. , FIGG LAUREN , HOOD KOREY K. , LAL RAYHAN , BASINA MARINA , WONG JESSIE J. , YABUT KATARINA , NARANJO DIANA , LEWIT EUGENE , MAAHS DAVID M. 
Published: June 2021

The Project Extension for Community Healthcare Outcomes (ECHO™) model addresses disparities by empowering primary care provider (PCPs), through tele-education, to meet the needs of underserved communities lacking access to subspecialty care. Given the rapid replication of this model, it is vital to understand the perspectives of participating PCPs to refine program implementation. Project ECHO™ Type 1 Diabetes (T1D) program was piloted in Florida and California with &gt;15 Federally Qualified Health Centers (FQHC). PCPs completed pre/post-test surveys assessing knowledge and confidence in T1D care. Exit surveys and focus groups were conducted to understand their experiences (N=92 providers, 41 from FL and 51 from CA were queried). Qualitative analysis of open-ended survey feedback and thematic analysis of focus group data used the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies five domains that affect intervention implementation - including internal and external factors to the healthcare organization. Pre/post surveys demonstrated significant improvements in providers’ diabetes knowledge; mean ± SD change in score for an 11-item knowledge evaluation from pre/post: (1.0 ± 1.8, [Min: -2, Max: +5], p-value: 0.0003) and increase in overall confidence evaluated on a 4-point likert scale (0.6 ± 0.4 [Min: -0.1, Max: 1.6] p-value &lt;0.0001). 95% of providers would recommend the program to a colleague and 63% reported a change in their T1D clinical care practices. CFIR identified the quality of content presented in ECHO sessions and the expertise of the subspecialty mentors as characteristics that facilitated success. Inner setting factors identified as barriers included challenges related to attending weekly ECHO sessions and lack of resources to cover providers’ time away from clinic. Evaluation of Project ECHO programs should include the use of CFIR to better anticipate facilitators and barriers to program implementation.

Disclosure
A. F. Walker: None. S. L. Filipp: None. K. Turner: None. G. L. Zori: None. J. Maizel: None. N. Cuttriss: Consultant; Self; Cecelia Health. L. G. Baer: None. L. Figg: None. K. K. Hood: Consultant; Self; Cecelia Health, Cercacor, LifeScan Diabetes Institute. R. Lal: Consultant; Self; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Morgan Stanley, Tidepool. M. Basina: None. M. J. Haller: Board Member; Self; SAB Biotherapeutics, Inc., Consultant; Self; MannKind Corporation, Other Relationship; Self; Janssen Pharmaceuticals, Inc., Sanofi. J. J. Wong: None. K. Yabut: None. D. Naranjo: None. E. Lewit: None. D. M. Maahs: Advisory Panel; Self; Abbott Diabetes, Dompe, Eli Lilly and Company, Medtronic, Novo Nordisk, Consultant; Self; aditxt. E. Sheehan: None. S. C. Westen: None. C. Anez-zabala: None. X. Roque: None. B. C. Fitzgerald: None. A. Bernier: None. M. J. Gurka: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust