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Florida/Caribbean AETC Project ECHO™ Program: Co-management of HIV/AIDS by Community Health
Care Providers and Specialists
Joanne J. Orrick, PharmD, AAHIVEAssociate Director
Florida/Caribbean AETCUniversity of South Florida Center for HIV Education and Research
Jeffrey Beal, MD, AAHIVS
Clinical Director & Principal Investigator
Kimberly Molnar, MAcc
Director, F/C AETC
Saniyyah Mahmoudi, ARNP
Faculty Facilitator
Joanne Orrick, PharmD, AAHIVE
Faculty Facilitator
Todd Wills, MD
Faculty Facilitator
Hesborn Wao, PhD
Evaluator
Sean McIntosh, AS
Program Coordinator
Adis Kreso, BS
Statistical Data Analyst
Danchelle Jones
Program Support
Maximo Lora, BA
Marketing & Technical Support
Christine Makar, BA
Continuing Education Support
Nathan McMullen
Technical Support
Theresa C. Skipper, MPH
Logistical Management
F/C AETC-Project ECHO™ Team
Outline
Implementation Evaluation Preliminary results Challenges Future Directions Question/Answer
Implementation
• F/C AETC site visit to University of New Mexico Project ECHO™
• Weekly implementation meetings with F/C AETC program staff
• Technical assistance from University of New Mexico Project ECHO™
• Polycom vs. Adobe Connect platform• Provider interest gauged at Annual F/C
ATEC conference and through email contact
Session Overview
• Sessions scheduled twice per month • 15 minute didactic presentation by a F/C
AETC faculty member• Remainder of time (1.5 hours scheduled
per session) spent discussing patient cases submitted by providers throughout the region
• F/C AETC faculty member facilitates discussion among participants and other F/C AETC faculty
Case Presentation FormInteractive Fillable PDF
Evaluation of the Program
Purpose of the evaluationDetermine extent to which F/C AETC Project ECHO™ helps in developing capacity among health care professionals in rural and underserved areas of Florida, Puerto Rico, and the U.S. Virgin Islands to safely and effectively treat HIV/AIDS and to monitor outcomes of this treatmentLearn from our implementation experience so that we can better manage performance and improve program design
Program logic model
Evaluation of the Program
Type of evaluation Needs evaluation: Determine care provider needs Process evaluation: Assess program activities/processes Outcome evaluation: Assess program effects/impact
Time points Participant registration: Prior to scheduled session Immediate post-training: ≤1 week (All participants) Follow-up evaluation: 4-6 months (Case presenters)
Methodology: Mixed-methods approach Quantitative: Survey (numeric items) Qualitative: Survey (open-ended items)
Program Logic Model
Evaluation Data Collection
Immediate post-trainingDemographicsObjectives for attendingKirkpatrick's levels:
Satisfaction/reaction Intention to change Knowledge,
Skills, & Attitudes (KSA) Learning (change in KSA) KSA transfer to workplace Improved patient outcome
Suggestions for improvement
Follow-up evaluationPatient benefited?Change in KSAKSA learned used to manage other patients?KSA learned shared with others at workplace?Challenges faced while implementing suggestions
Kirkpatrick, D. L. (1994). Evaluating training programs. San Francisco: Berrett-Koehler Publishers, Inc.
Evaluation of the Program
AimsDetermine HCP’s satisfaction with the programExamine change in HCPs’ KSA pre and post-sessionDetermine extent KSA are transferable to workplaceDetermine degree program impacts patient outcomes
ProcedureRetrieve data from NEC system (Excel) and cleanEnsure data integrity: Evaluation/data management team separate from program implementation teamPresent results using graphs, charts and text
Data analysis
Preliminary Results
Participants (6 ECHO sessions: 11/2011 - 02/2012)
Preliminary Results
Preliminary Results
Increase knowledge (41% participants)“Broaden my knowledge about HIV resistance testing”“Discuss ideas for increasing medication compliance” “Increase my knowledge on perinatal HIV”“Learn from every case I hear about”
Update knowledge (20% participants)“Stay updated and learn from others' experiences”“Obtain newest information in HIV care“Educate & update on providing holistic care to HIV pts”
Examples of objectives by category
Preliminary Results
Observe (13% participants)“Observe Perinatal Project ECHO™, learn about new perinatal guidelines”“Observe the new ECHO ™ session offered by F/C AETC”“Observe the TeleECHO clinic”
Network (8% participants) “Network with other HIV providers”“Hear what others perinatal providers around the state are doing”
Examples of objectives by category (cont.)
Preliminary Results
Level 1: Participants’ satisfaction/reaction
Preliminary Results
Level 1: Participants’ satisfaction/reaction cont
Preliminary Results
Level 2a: Learning (Change in Knowledge)
Preliminary Results
Level 2b: Intention to change in practice
Following the F/C AETC-Project ECHO™ session, I intend to make the following changes:“…consider role-play for pts struggling with disclosure”“Speak more directly with pts about missed doses…”“Provide local providers with updated guidelines for administration of AZT”“Change regimen on the patient that was discussed”“Network with persons with similar duties”
Preliminary Results
Level 3: Transfer of KSA to workplace
Preliminary Results
Level 3: Transfer of KSA to workplace
Preliminary Results
What participants liked MOST:
“Ability to participate without travel” “Being able to interface with a panel of experts…” “Expert discussion, 2) Enough data on the patient to
be able to follow the discussion, 3) Collegial nature of the discussion”
“Hearing from experts, discussion with logic behind it, the different opinions”
“The format: Didactic and case presentations”
Preliminary Results
What participants liked LEAST:
“It would be nice to see all the people on the call” “Would like more case presentations each session” “Early on - the technical difficulties” “Not enough time to ask questions about our own
case” “Could not see all participants” “The difficulty in getting the webcam to operate” “Technical difficulties”
Preliminary Results
How F/C AETC-Project ECHO™ can be improved
“Have a constant banner/header with how to mute/unmute phone lines”
“Include more non-clinical/treatment educational resources and alternative ways non-clinical/ treatment health care providers can implement the material and utilize within the community & patients.”
“Have more information presented on cases” “Decrease background noise, presentation of more
than one case study”
Resolution of Challenges
• Troubleshoot technical difficulties• Check list for each program• Increase participants who participate with
webcams• Engage more participants in the discussion• Increase the number of F/C AETC faculty
who serve as facilitators• Increase the number of participating clinics
and providers
Future Directions
• Curriculum outlined through June 2012• Includes Pediatric/Adolescent specialty sessions
• Develop curriculum and brochure detailing all programs for July 2012-June 2013 AETC grant year
• Expand to include other sub-specialty sessions (e.g. Hepatitis and HIV co-infection)
• Collaborate and share resources with other AETCs using the Project ECHO™ model