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Open Access 01-12-2021 | Protocol

Effectiveness and experiences of the Extension for Community Healthcare Outcomes (ECHO) Model in developing competencies among healthcare professionals: a mixed methods systematic review protocol

Authors: Gabrielle Chicoine, José Côté, Jacinthe Pepin, Guillaume Fontaine, Marc-André Maheu-Cadotte, Quan Nha Hong, Geneviève Rouleau, Daniela Ziegler, Didier Jutras-Aswad

Published in: Systematic Reviews | Issue 1/2021

Abstract

Background

The Extension for Community Healthcare Outcomes (ECHO) Model of continuing tele-education is an innovative guided-practice model aiming at amplifying healthcare professionals’ competencies in the management of chronic and complex health conditions. While data on the impact of the ECHO model is increasingly available in the literature, what influences the model effectiveness remains unclear. Therefore, the overarching aim of this systematic review is to identify, appraise, and synthesize the available quantitative (QUAN) and qualitative (QUAL) evidence regarding the ECHO Model effectiveness and the experiences/views of ECHO’s participants about what influences the development of competencies in healthcare professionals.

Methods

The proposed systematic review was inspired by the Joanna Briggs Institute (JBI) methodology for Mixed Methods Systematic Reviews (MMSR) and will follow a convergent segregated approach. A systematic search will be undertaken using QUAN, QUAL and mixed methods (MM) studies of ECHO-affiliated programs identified in six databases. A publication date filter will be applied to find the articles published from 2003 onwards. Sources of unpublished studies and gray literature will be searched as well. Retrieved citations will independently be screened by two reviewers. Disagreements will be resolved through discussion until a consensus is reached or by including a third reviewer. Studies meeting the predefined inclusion criteria will be assessed on methodological quality and the data will be extracted using standardized data extraction forms. Separate QUAN and QUAL synthesis will be performed, and findings will be integrated using a matrix approach for the purpose of comparison and complementarity.

Discussion

This MMSR will fulfill important gaps in the current literature on the ECHO Model as the first to provide estimates on its effectiveness and consider simultaneously the experiences/views of ECHO’s participants. As each replication of the ECHO Model greatly varies depending on the context, topic, and targeted professionals, a better understanding of what influences the model effectiveness in developing healthcare professionals’ competencies is crucial to inform future implementation.

Systematic review registration

PROSPERO CRD42020197579

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Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923–58.PubMedCrossRef

Meretoja R, Koponen L. A systematic model to compare nurses’ optimal and actual competencies in the clinical setting. J Adv Nurs. 2012;68(2):414–22.PubMedCrossRef

Pepin J, Goudreau J, Lavoie P, Belisle M, Blanchet Garneau A, Boyer L, et al. A nursing education research framework for transformative learning and interdependence of academia and practice. Nurse Educ Today. 2017;52:50–2.PubMedCrossRef

Fernandez N, Dory V, Ste-Marie LG, Chaput M, Charlin B, Boucher A. Varying conceptions of competence: an analysis of how health sciences educators define competence. Med Educ. 2012;46(4):357–65.PubMedCrossRef

Watson R, Stimpson A, Topping A, Porock D. Clinical competence assessment in nursing: a systematic review of the literature. J Adv Nurs. 2002;39(5):421–31.PubMedCrossRef

Fukada M. Nursing competency: definition, structure and development. Yonago Acta Med. 2018;61(1):1–7.PubMedPubMedCentralCrossRef

Rizany I, Hariyati RTS, Handayani H. Factors that affect the development of nurses' competencies: a systematic review. Enferm Clin. 2018;28(Suppl 1):154–7.CrossRef

Batt AM, Tavares W, Williams B. The development of competency frameworks in healthcare professions: a scoping review. Adv in Health Sci Educ. 2019;25:913–87.CrossRef

McBain RK, Sousa JL, Rose AJ, Baxi SM, Faherty LJ, Taplin C, et al. Impact of project ECHO models of medical tele-education: a systematic review. J Gen Intern Med. 2019;34(12):2842–57.PubMedPubMedCentralCrossRef

10.

Axley L. Competency: a concept analysis. Nurs Forum. 2008;43(4):214–22.PubMedCrossRef

11.

Tardif J. L’évaluation des compétences: Documenter le parcours de développement: Montreal. Canada: Chenelière-éducation; 2006.

12.

Charette M, Goudreau J, Alderson M. An evolutionist analysis of competence. Rech Soins Infirm. 2014;116(1):28–39.CrossRef

13.

Cooper E. Creating a culture of professional development: a milestone pathway tool for registered nurses. J Contin Educ Nurs. 2009;40(11):501–8.PubMedCrossRef

14.

Manley K, McCormack B, Wilson V. International practice development in nursing and healthcare. Oxford: Blackwell publishing; 2008.

15.

Babenko O, Koppula S, Daniels L, Nadon L, Daniels V. Lifelong learning along the education and career continuum: meta-analysis of studies in health professions. J Adv Med Educ Prof. 2017;5(4):157–63.PubMedPubMedCentral

16.

Fleet LJ, Kirby F, Cutler S, Dunikowski L, Nasmith L, Shaughnessy R. Continuing professional development and social accountability: a review of the literature. J Interprof Care. 2008;22(Suppl 1):15–29.PubMedCrossRef

17.

Price S, Reichert C. The importance of continuing professional development to career satisfaction and patient care: meeting the needs of novice to mid- to late-career nurses throughout their career span. Adm Sci. 2017;7(2):17.CrossRef

18.

Institute of Medicine (US) Committee on Planning a Continuing Health Professional Education Institute: Redesigning continuing education in the health professions. Summary, vol. 2020. Washington, DC: National Academies Press; 2010.

19.

Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf F, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009;2009(2):Cd003030.PubMedCentral

20.

Kononowicz AA, Woodham LA, Edelbring S, Stathakarou N, Davies D, Saxena N, et al. Virtual patient simulations in health professions education: systematic review and meta-analysis by the digital health education collaboration. J Med Internet Res. 2019;21(7):e14676.PubMedPubMedCentralCrossRef

21.

McLoughlin C, Patel KD, O'Callaghan T, Reeves S. The use of virtual communities of practice to improve interprofessional collaboration and education: findings from an integrated review. J Interprof Care. 2018;32(2):136–42.PubMedCrossRef

22.

Ranmuthugala G, Plumb JJ, Cunningham FC, Georgiou A, Westbrook JI, Braithwaite J. How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Serv Res. 2011;11:273.PubMedPubMedCentralCrossRef

23.

Rouleau G, Gagnon M-P, Côté J, Payne-Gagnon J, Hudson E, Dubois C-A, et al. Effects of e-learning in a continuing education context on nursing care: systematic review of systematic qualitative, quantitative, and mixed-studies reviews. J Med Internet Res. 2019;21(10):e15118.PubMedPubMedCentralCrossRef

24.

Wang R, DeMaria S Jr, Goldberg A, Katz D. A systematic review of serious games in training health care professionals. Simul Healthc. 2016;11(1):41–51.PubMedCrossRef

25.

Rouleau G, Gagnon M-P, Côté J, Richard L, Chicoine G, Pelletier J: Virtual patient simulation to improve nurses’ relational skills in a continuing education context: a convergent mixed methods study. BMC Nurs 2020, PREPRINT (Version 1). Available from: https://www.researchsquare.com/article/rs-43757/v1 [accessed 11.10.2020].

26.

Coventry TH, Maslin-Prothero SE, Smith G. Organizational impact of nurse supply and workload on nurses continuing professional development opportunities: an integrative review. J Adv Nurs. 2015;71(12):2715–27.PubMedCrossRef

27.

University of New Mexico: Project ECHO. University of New Mexico, School of Medicine; 2020. Available from: https://echo.unm.edu/ [accessed 28 Sept 2020].

28.

Arora S, Kalishman S, Thornton K, Dion D, Murata G, Deming P, et al. Expanding access to hepatitis C virus treatment--Extension for Community Healthcare Outcomes (ECHO) project: disruptive innovation in specialty care. Hepatology. 2010;52(3):1124–33.PubMedCrossRef

29.

Arora S, Kalishman S, Dion D, Som D, Thornton K, Bankhurst A, et al. Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care. Health Aff. 2011;30(6):1176–84.CrossRef

30.

Arora S, Kalishman SG, Thornton KA, Komaromy MS, Katzman JG, Struminger BB, et al. Project ECHO: a telementoring network model for continuing professional development. J Contin Educ Health Prof. 2017;37(4):239–44.PubMed

31.

Arora S, Murata GH, Thornton K, Parish B, Jenkusky SM, Dunkelberg JC, et al. 380 Project ECHO (Extension for Community Healthcare Outcomes): knowledge networks expand access to hepatitis C (HCV) treatment with pegylated interferon and ribavirin in rural areas and prisons. Care is as safe and effective as a university HCV clinic. Gastroenterology. 2008;134(4):A-50–1.CrossRef

32.

Arora S, Thornton K, Jenkusky SM, Parish B, Scaletti JV. Project ECHO: linking university specialists with rural and prison-based clinicians to improve care for people with chronic hepatitis C in New Mexico. Public Health Rep. 2007;122(Suppl 2):74–7.PubMedPubMedCentralCrossRef

33.

Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364(23):2199–207.PubMedCrossRef

34.

Cianciolo AT, Regehr G. Learning theory and educational intervention: producing meaningful evidence of impact through layered analysis. Acad Med. 2019;94(6):789–94.PubMedCrossRef

35.

Bandura A. Self-efficacy: the exercise of control. New York: Freeman; 1997.

36.

Vygotsky LS. Mind in society: the development of higher psychological processes. Cambridge: Harvard University Press; 1978.

37.

Lave J, Wenger E. Situated learning: legitimate peripheral participation. Cambridge: Cambridge University Press; 1991.CrossRef

38.

Wenger E. Communities of practice: learning, meaning, and identity. 1st ed. Cambridge: Cambridge University Press; 1998.CrossRef

39.

Bordage G. Conceptual frameworks to illuminate and magnify. Med Educ. 2009;43:312–9.PubMedCrossRef

40.

Bronfenbenner U. The ecology of human development: experiments by nature and design. Cambrigde: Harvard University Press; 1979.

41.

McHale S, Dotterer A, Kim J-Y. An ecological perspective on the media and youth development. Am Behav Sci. 2009;52:1186–203.PubMedPubMedCentralCrossRef

42.

Zhou C, Crawford A, Serhal E, Kurdyak P, Sockalingam S. The impact of project ECHO on participant and patient outcomes: a systematic review. Acad Med. 2016;91(10):1439–61.PubMedCrossRef

43.

Socolovsky C, Masi C, Hamlish T, Aduana G, Arora S, Bakris G, et al. Evaluating the role of key learning theories in ECHO: a telehealth educational program for primary care providers. Prog Community Health Partnersh. 2013;7(4):361–8.PubMedCrossRef

44.

Stern C, Lizarondo L, Carrier J, Godfrey C, Rieger K, Salmond S, et al. Methodological guidance for the conduct of mixed methods systematic reviews. JBI Evid Synth. 2020;18(10):2108–18.

45.

Faherty LJ, Rose AJ, Chappel A, Taplin C, Martineau M, Fischer SH. Assessing and expanding the evidence base for project ECHO and ECHO-like models: findings of a technical expert panel. J Gen Intern Med. 2020;35(3):899–902.PubMedPubMedCentralCrossRef

46.

Lizarondo L, Stern C, Carrier J, C. G, Rieger K, Salmond S, et al. Chapter 8: mixed methods systematix reviews. In: Aromataris E, Munn Z, JBI, editors. JBI Manual for Evidence Synthesis; 2020. Available from: https://synthesismanual.jbi.global [accessed 19 Oct 2020].

47.

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Sys Rev. 2015;4(1). https://doi.org/10.1186/2046-4053-4-1.

48.

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349:g7647.CrossRef

49.

Page MJ, Moher D, Bossuyt P, Boutron I, Hoffmann T, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews [Internet]. MetaArXiv. 2020; Available from: osf.io/preprints/metaarxiv/gwdhk [accessed 23 Oct 2020].

50.

Hong QN, Pluye P, Bujold M, Wassef M. Convergent and sequential synthesis designs: implications for conducting and reporting systematic reviews of qualitative and quantitative evidence. Syst Rev. 2017;6(1):61.PubMedPubMedCentralCrossRef

51.

Pluye P, Hong QN, Vedel I. Toolkit for mixed studies reviews. Version 3. Quebec: Department of Family Medicine, McGill University, and Quebec-SPOR SUPPORT Unit; 2016. Available from: http://toolkit4mixedstudiesreviews.pbworks.com [accessed 18 June 2020]

52.

U.S. Department of Health and Human Services: Report to ECHO Act Congress: current state of technology-enabled collaborative learning and capacity building models; 2019. Available from: https://aspe.hhs.gov/system/files/pdf/260691/ECHOAct-ConsolidatedReportToCongress.pdf [accessed 30 May 2021].

53.

Kirkpatrick JD, Kirkpatrick WK. Kirkpatrick’s for levels of training evaluation. Alexandria: ATD Press; 2016.

54.

Higgins JPT, Thomas J, Chandler J, Cumpston MLT, Page M, editors. Cochrane handbook for systematic reviews of interventions. Version 6.1 (updated September 2020): The Cochrane Collaboration; 2020. Available from: www.training.cochrane.org/handbook. Accessed 2 Oct 2020.

55.

Moore DE Jr, Green JS, Gallis HA. Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities. J Contin Educ Health Prof. 2009;29(1):1–15.PubMedCrossRef

56.

Bramer WM, Giustini D, de Jonge GB, Holland L, Bekhuis T. De-duplication of database search results for systematic reviews in EndNote. JMLA. 2016;104(3):240–3.PubMedPubMedCentralCrossRef

57.

Hong QN, Gonzalez-Reyes A, Pluye P. Improving the usefulness of a tool for appraising the quality of qualitative, quantitative and mixed methods studies, the mixed methods appraisal tool (MMAT). J Eval Clin Pract. 2018;24(3):459–67.PubMedCrossRef

58.

Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M, et al. Improving the content validity of the mixed methods appraisal tool: a modified e-Delphi study. J Clin Epidemiol. 2019;111:49–59.e41.PubMedCrossRef

59.

Pluye P, Gagnon MP, Griffiths F, Johnson-Lafleur J. A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in mixed studies reviews. Int J Nurs Stud. 2009;46(4):529–46.PubMedCrossRef

60.

Batista MM, Paludo AC, Gula JN, Pauli PH, Tartaruga MP. Physiological and cognitive demands of orienteering: a systematic review. Sport Sci Health. 2020;16(4):591–600.CrossRef

61.

Crowe M, Sheppard L. A review of critical appraisal tools show they lack rigor: alternative tool structure is proposed. J Clin Epidemiol. 2011;64(1):79–89.PubMedCrossRef

62.

Tufanaru CMZ, Aromataris E, Campbell J, Hopp L. Chapter 3: systematic reviews of effectiveness. In: Aromataris EMZ, JBI, editors. JBI Manual for Evidence Synthesis; 2020. Available from: https://synthesismanual.jbi.global [accessed 22 Sept 2020].

63.

Lockwood CPK, Munn Z, Rittenmeyer L, Salmond S, Bjerrum M, Loveday H, et al. Chapter 2: systematic reviews of qualitative evidence. In: E A, Z M: JBI, editor. JBI Manual for Evidence Synthesis; 2020. Available from: https://synthesismanual.jbi.global [accessed 18 Oct 2020].

64.

Phillips AC, Lewis LK, McEvoy MP, Galipeau J, Glasziou P, Moher D, et al. Development and validation of the guideline for reporting evidence-based practice educational interventions and teaching (GREET). BMC Med Educ. 2016;16(1):237.PubMedPubMedCentralCrossRef

65.

Sutcliffe K, Thomas J, Stokes G, Hinds K, Bangpan M. Intervention component analysis (ICA): a pragmatic approach for identifying the critical features of complex interventions. Syst Rev. 2015;4(1):140.PubMedPubMedCentralCrossRef

66.

Kuckartz U, Rädiker S: Analyzing qualitative data with MAXQDA: text, audio and video: Springer Nature Switzerland AG 2019; 2019. Available from: https://link.springer.com/book/10.1007%2F978-3-030-15671-8 [accessed 03 June 2020].

67.

Cohen J. A power primer. Psychol Bull. 1992;112(1):155–9.PubMedCrossRef

68.

Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8(1):45.PubMedPubMedCentralCrossRef

69.

Miles MB, Huberman AM, Saldaña J. Qualitative data analysis: a methods sourcebook. 4th ed. Los Angeles: SAGE; 2020.

70.

Pluye P, Kaur N, Granikov V, Garcia Bengoechea E, Tang D. Mixing phases, results and data in patient oriented research. Int J Mult Res Approaches. 2018;10(1):41–56.CrossRef

71.

Harden A, Thomas J, Cargo M, Harris J, Pantoja T, Flemming K, et al. Cochrane qualitative and implementation methods group guidance series-paper 5: methods for integrating qualitative and implementation evidence within intervention effectiveness reviews. J Clin Epidemiol. 2018;97:70–8.PubMedCrossRef

72.

Hong QN, Rees R, Sutcliffe K, Thomas J. Variations of mixed methods reviews approaches: a case study. Res Syn Meth. 2020;11(6):795–811. https://doi.org/10.1002/jrsm.1437.

73.

Guetterman TC, Fetters MD, Creswell JW. Integrating quantitative and qualitative results in health science mixed methods research through joint displays. Annals Fam Med. 2015;13(6):554–61.CrossRef

74.

Candy B, King M, Jones L, Oliver S. Using qualitative synthesis to explore heterogeneity of complex interventions. BMC Med Res Methodol. 2011;11(1):124.PubMedPubMedCentralCrossRef

75.

Thompson Coon J, Gwernan-Jones R, Garside R, Nunns M, Shaw L, Melendez-Torres GJ, et al. Developing methods for the overarching synthesis of quantitative and qualitative evidence: the interweave synthesis approach. Res Syn Meth. 2020;11(4):507–21.CrossRef

Title: Effectiveness and experiences of the Extension for Community Healthcare Outcomes (ECHO) Model in developing competencies among healthcare professionals: a mixed methods systematic review protocol
Authors: Gabrielle Chicoine
José Côté
Jacinthe Pepin
Guillaume Fontaine
Marc-André Maheu-Cadotte
Quan Nha Hong
Geneviève Rouleau
Daniela Ziegler
Didier Jutras-Aswad
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: Systematic Reviews / Issue 1/2021
Electronic ISSN: 2046-4053
DOI: https://doi.org/10.1186/s13643-021-01832-0

At a glance: The STEP trials

Springer Medicine

Effectiveness and experiences of the Extension for Community Healthcare Outcomes (ECHO) Model in developing competencies among healthcare professionals: a mixed methods systematic review protocol

Abstract

Background

Methods

Discussion

Systematic review registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Discussion

Systematic review registration

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