Extension for Community Health Outcomes (ECHO) Diabetes Federally Qualified Health Centers (FQHCs)

We will implement a national ECHO Diabetes FQHC program by offering a 6-month tele-education intervention that includes: (1) a virtual orientation and onboarding for FQHCs (2) one-hour tele-ECHO sessions twice monthly with continuing medical education (CME) credits provided (3) real-time support with complex medical decision-making and (4) access to an online repository of diabetes resources for PCPs. The 'hub' team delivering the ECHO Diabetes FQHC program are a nationally recognized multidisciplinary team of adult and pediatric endocrinologists, a clinical health psychologist, Certified Diabetes Care and Education Specialists (CDCES), a registered dietitian, a Certified Exercise Physiologist (CEP), a medical sociologist, PCPs, and health services researchers.

We will evaluate the ECHO Diabetes FQHC program with a stepped-wedge design. This proposal will leverage and expand on key community partnerships established through ECHO Diabetes with two Health Center Controlled Networks (HCCNs), HealthChoiceNetwork (HCN) and AllianceChicago (AC) to accomplish both specific aims. These two Health Center Controlled Networks (HCCNs) have over 100 FQHCs in 29 different states and hold a central data repository for over 7 million unduplicated patients seen for care across these locations. 18 new "spokes" will be recruited from HCN and AC's national network. Covariate-constrained randomization will be used to assign spokes to three cohorts that will have staggered and phased entry into the program in 6-month intervals. Pre- and post-intervention data will be collected at the provider-level and center-level (i.e., "spoke-level") and housed using REDCap® as a central data repository. Provider-level data will include pre and post surveys assessing confidence and knowledge in diabetes care as well as self-reported diabetes care practices. Spoke-level data will include aggregate Health Effectiveness Data and Information Set (HEDIS) metrics for diabetes, Uniform Data System (UDS) metrics for diabetes, mean HbA1c for demographic subgroups, diabetes technology use (CGM and insulin pumps), and referrals for GLP1 and SGL2 medications.