Berry, Carolyn A.

Qualitative interviews and focus groups are commonly used methods to elicit participants’ voices in program evaluations. However, the use of these data-gathering methods can fall short of the goal; even with open-ended questions, the protocols guiding and shaping interviews and focus groups heavily reflect the evaluators’ understanding and experience of the program or intervention under consideration and its target population(s). In this paper, we describe three cases that employed a method of inquiry that is underutilized in evaluation but one that we believe holds great potential as a method to enhance interpersonal reflexivity, namely participant-generated photo-elicitation interviewing (PEI). Across three diverse settings and interventions, we readily added participant-generated PEI to our mixed methods evaluations. We found participant-generated PEI to add great value to the evaluations by complementing our other data collection methods, allowing for greater participant voice, challenging evaluators’ assumptions, enhancing dissemination efforts, and fostering our reflexivity.

Objective To identify primary care structures and processes that have the highest and lowest impact on chronic disease management and screening and prevention outcomes as well as to assess the feasibility of implementing these structures and processes into practice. Design A two-round Delphi study was conducted to establish consensus on the impact and feasibility of 258 primary care structures and processes. Participants 29 primary care providers, health system leaders and health services researchers in the USA. Outcomes Primary outcomes were (1) consensus on the impact of each structure and process on chronic disease management and screening and prevention outcomes, separately and (2) consensus on feasibility of implementation by primary care practices. Results Consensus on high impact and feasibility of implementation was reached on four items for chronic disease management: ‘Providers use motivational interviewing to help patients set goals’, ‘Practice has designated staff to manage patient panel’, ‘Practice has onsite providers or staff that speak the most dominant, non-English language spoken by patients’ and ‘Practice includes mental health providers and/or behavioural health specialists in care team’ and seven items for screening and prevention: ‘Practice utilizes standing protocols and orders’, ‘Practice generates reports to alert clinicians to missed targets and to identify gaps in care, such as overdue visits, needed vaccinations, screenings or other preventive services’, ‘Practice has designated staff to manage patient panel’, ‘Practice sets performance goals and uses benchmarking to track quality of care’, ‘Practice uses performance feedback to identify practice-specific areas of improvement’, ‘Practice builds quality improvement activities into practice operations’ and ‘Pre-visit planning data are reviewed during daily huddles’. Only ‘Practice has designated staff to manage patient panel’ appeared on both lists. Conclusion Findings suggest that practices need to focus on implementing mostly distinct, rather than common, structures and processes to optimise chronic disease and preventive care.

Abstract Background Endocrine ECHO (Extension for Community Healthcare Outcomes) is a scalable model of healthcare education that extends enhanced training through ongoing telementoring of community primary care providers (PCPs) by a team of specialists. The purpose of this study was to assess whether patients of providers engaged in the Endocrine ECHO program (Endo ECHO) exhibited improvements in lifestyle, and self-management behaviors. Methods A sample of 533 adult Endo ECHO patients diagnosed with type 1 or complex type 2 diabetes (insulin dependent and/or with an HbA1c of 9% or higher) took a comprehensive survey during Endo ECHO study enrollment (pre-test) and again after at least one year past their first exposure to the intervention (post-test). We assessed pre/post changes in patient-reported outcomes on well-being, lifestyle, and self-management behaviors using McNemar’s tests for paired data. Results A broad array of patients’ self-reported well-being, lifestyle, and self-management behaviors improved over the course of their engagement in the Endo ECHO program. Despite relatively low average health literacy and numeracy, patients’ confidence and self-efficacy to manage their disease also improved significantly from pre-test to post-test. Discussion Endo ECHO may be an effective means of enhancing primary care for individuals with type 1 and complex type 2 diabetes and improving patient capacity to perform the extensive array of lifestyle and self-care behaviors necessary to effectively manage their diabetes outside of the clinical setting. Conclusions The ECHO model of care has been shown to improve provider and satisfaction, quality of care, and in some cases clinical outcomes across various program areas. This study indicates that endocrinology-focused ECHO programs may also lead to behavior changes among patients in between visits to their provider. Further research should examine the impact of the ECHO model on patient behavior.