Development of the University of Colorado Endocrine ECHO Program

Background: The Extension for Community Health Outcomes (ECHO) model aims to improve rural community healthcare by providing specialist-lead telementoring for primary care providers (PCPs) in a didactic and discussion-based format.1 There is a notable shortage of endocrinologists in Colorado, particularly in rural and frontier counties. Best estimate is that 14 of 64 Colorado counties have at least one practicing endocrinologist. Here we describe the development and initial experience with an endocrine-specific ECHO program. Methods: Grant-funding was obtained to develop a longitudinal endocrine ECHO program to support PCPs who care for a large proportion of patients with Medicaid insurance. Program development occurred with input from endocrinologists, primary care physicians, and ECHO Colorado staff. Program participation results in continuous medical education credit. PCP recruitment occurred through listserv emails sent to various Colorado-based medical organizations. Endocrinologists provided weekly hour-long sessions focused on 5 main topic domains: diabetes, obesity/lipids, thyroid disorders, reproductive and adrenal disorders, and bone/calcium disorders. Results: Our endocrine ECHO program started in August 2020 and consisted of 30 weekly sessions (i.e. 9 diabetes, 8 obesity/lipids, 3 thyroid disorders, 5 reproductive and adrenal disorders, 4 bone/calcium disorders, and 1 pseudo-endocrine disorders). A total of 65 clinicians registered for the ECHO series. Sessions were designed by academic endocrinologists and fellows-in-training at the University of Colorado. During block 1 (diabetes block) there were 45 participants of which 12% practice in rural or frontier designated areas, 80% serve patients with Medicaid, and 42% primarily care for an underserved population. Matched pre/post-surveys asking about PCPs’ confidence with each ECHO session were obtained and final results are currently pending completion of the full series in March 2021. Survey data will inform future iterations of this program which is slated to run annually for at least 3 years. Conclusion: Access to endocrinologists is often a scarce resource for rural communities and underserved populations. The ECHO model can serve as a means to provide longitudinal education and support for PCPs across a range of endocrine topics. Here we describe our initial experience with a 30-week endocrine ECHO program in Colorado and highlight future directions of this program.