Latent Tuberculosis
Conditions
Keywords
Project ECHO, primary care
Brief summary
This study explores primary care team members' knowledge, attitudinal, and skill gaps related to latent tuberculosis infection (LTBI) testing and treatment. The gaps identified will inform the design of a survey and telementoring educational program (tuberculosis (TB) infection ECHO course). The EMR data query will further explore the reach of the expansion for community healthcare outcomes (ECHO) model. The hypothesis for this study is that the TB infection ECHO course will be feasible, will have a significant impact on primary care provider participants' learning and performance related to LTBI testing and treatment in their primary care practices, and will increase the number of LTBI tests and treatment prescribed in primary care.
Detailed description
This pilot study will use a mixed-methods design called an exploratory sequential translational research design. In this type of study design, the initial qualitative phase informs the design of an intervention (in this case a TB infection ECHO) and an instrument (in this case structured surveys) to study the intervention. The third phase implements the designed intervention and/or instrument to collect data and quantitatively assess the outcomes of interest (in this case feasibility and impact). The final aspect of the third phase explores an EMR data query to assess the reach of the intervention (providers' testing and treatment in the real world). In Aim 1, 25 primary care team members from our Brown Family Medicine, Care New England, and federally qualified health center networks will be purposively sampled to undergo key informant interviews regarding LTBI testing and treatment knowledge, attitudinal, and skill gaps. Questions will be asked to ascertain gaps throughout the entire latent TB infection care cascade. The results from Aim 1 will be used to design the survey instrument and the curriculum for an innovative, telementoring program (TB infection ECHO). In Aim 2, 12 primary care team members will be recruited to participate in a virtual six-month TB infection ECHO course. Participants will be asked to complete quantitative surveys before and after the course as well as post-session surveys following each session. Survey questions will assess feasibility measures related to process, resources, and management and impact measures related to learning and performance. Paired data from pre- and post-course surveys will be analyzed accordingly depending on the distribution of results. In Aim 3, data will be extracted from two ECHO participants' clinic sites before, during, and after ECHO implementation. Data will include information about LTBI testing and treatment to understand the reach and impact of the intervention of providers' testing and treatment behavior. This study will lead to an ECHO research framework that can be used for future ECHO courses that address other diseases in Rhode Island (RI).
Interventions
OTHERTB Infection ECHO
A six-month virtual telementoring course regarding TB infection testing and treatment that incorporates didactics, case presentation, and discussion
Sponsors
National Institute of General Medical Sciences (NIGMS)
Kent Hospital, Rhode Island
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
OTHER
Masking
NONE
Intervention model description
25 primary care team members will be purposively sampled to undergo key informant interviews regarding LTBI testing and treatment knowledge, attitudinal, and skill gaps. Then, 12 primary care team members will be recruited to participate in a virtual six-month TB infection ECHO course. Participants will be asked to complete quantitative surveys before and after the course as well as post-session surveys following each session. Paired data from pre- and post-course surveys will be analyzed accordingly depending on the distribution of results.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* \> 18 years of age * Primary care team members in Rhode Island including doctors, nurses, nurse practitioners, physician assistants, or other healthcare providers who are involved in primary care.
Exclusion criteria
* \< 18 years of age * Primary care team members who do not primarily work in Rhode Island
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Reach: LTBI Treatment | Three-months prior, ECHO course, three- months post | Patient level LTBI treatment before, during and after ECHO implementation to assess providers' behavior change. Proportion(# of TB treatment initiated/# of patients diagnosed with LTBI) of patients treated for LTBI in a health center population before, during and after ECHO implementation to assess providers' behavior change. This data will be obtained from an electronic medical record data query. |
| Feasibility: Participant Attendance | Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21 | Number of consented participants attending each expansion for community healthcare outcomes (ECHO) session who consented to participate in the course |
| Feasibility: Participant Retention | Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21 | Percentage of registered participants attending one of the last two ECHO sessions |
| Impact: Procedural Knowledge | Pre-survey was emailed 2 weeks prior to the course and could be filled out anytime before a participant attended their first session. The post-survey was emailed immediately following the final session (3/4/2021) and were completed within three weeks. | Change in participants' confidence in assessing a patient's risk for tuberculosis (TB) infection based on a likert scale rating (1=not at all confident and 5=extremely confident) included in the pre- and post- structured surveys administered before and after the ECHO intervention. |
| Impact: Self-reported LTBI Screening Percentage by Participants on Pre- and Post-ECHO Course Surveys | Pre-survey was emailed 2 weeks prior to the course and could be filled out anytime before a participant attended their first session. The post-survey was emailed immediately following the final session (3/4/2021) and were completed within three weeks. | Change in participants' self-reported estimates of patients screened for TB infection. Participants estimated their screening percentage on a sliding scale from 0-100%. Mean estimates will be calculated for the pre- and post- structured survey responses administered before and after the ECHO intervention. |
| Impact: Participants' Self-reported LTBI Treatment Percentages on Pre- and Post ECHO Surveys | Pre-survey was emailed two weeks prior to the course and could be filled out anytime before a participant attended their first session. The post-survey was emailed immediately following the final session on 3/4/2021 and were completed within three weeks. | Change in participants' self-reported estimates of patients treated for TB infection. Participants will estimate the percentage of patients started on any TB treatment on a sliding scale from 0-100%. Mean percentages will be calculated between the pre- and post- structured survey responses administered before and after the ECHO intervention. |
| Reach: LTBI Testing | Three-months prior, ECHO course, three- months post | Proportion(# of TB tests/# of visits) of patients tested for LTBI in a health center population before, during and after ECHO implementation to assess providers' behavior change. This data will be obtained from an electronic medical record data query |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility: Connectivity | Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21 | Percentage of participants' who agree that connectivity was adequate during the ECHO session. This will be collected monthly from post-session surveys via a likert scale (1=strongly disagree and 5=strongly agree) |
| Feasibility: Case Submission | Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21 | Percentage of cases submitted by participants on time during the ECHO course |
| Feasibility: ECHO Session Timing | Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21 | Percentage of participants' who agree that session timing was convenient. This will be collected monthly from post-session surveys via a likert scale (1=strongly disagree and 5=strongly agree) |
| Feasibility: Communication With ECHO Hub | Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21 | Percentage of participants' who agree that the communication with the ECHO hub team was adequate during the ECHO session. This will be collected monthly from post-session surveys via a likert scale (1=strongly disagree and 5=strongly agree) |
| Feasibility: Videoconferencing Equipment | Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21 | Percentage of participants' who agree that videoconferencing equipment was adequate during the ECHO session. This will be collected monthly from post-session surveys via a likert scale (1=strongly disagree and 5=strongly agree) |
| Feasibility: Content Expert Facilitation | Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21 | Participants rating of whether the speaker demonstrated excellent educational skills. This will be collected monthly from post-session surveys via a likert scale (1=strongly disagree and 5=strongly agree) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Primary Care Providers' and Nurses' Reported Frequency in Conducting LTBI Screening | Interviews were conducted between October 2, 2019 and June 17, 2020 | Qualitative interviews were conducted with primary care providers and nurses in RI regarding their knowledge, attitudes, and skills regarding LTBI management. A key focus of the interview was related to frequency of conducting LTBI screening. Here we summarize the frequency of providers and nurses who reported never conducting TB screening, infrequently conducting TB screening, or frequently conducting TB screening. |
Countries
United States
Participant flow
Pre-assignment details
Aim 1: one participant was excluded because it turned out they did not actually conduct primary care which was an inclusion criterion. Aim 2: completing the pre and post surveys was voluntary after consent. Several participants did not voluntarily complete both surveys. Aim 3: retrospective chart review was only completed for one site before the ECHO course
Participants by arm
| Arm | Count |
|---|---|
| Aim 1: Key Informant Interviews RI Primary care team members who consented to participate in key informant interviews regarding their knowledge, attitudes, and skills about latent tuberculosis infection testing and treatment. | 25 |
| Aim 2: RI LTBI ECHO Participants Some as well as several new individuals participated in the Rhode Island Latent Tuberculosis ECHO program and consented to be part of aim 2. Participants were asked to complete a pre and post course survey. | 8 |
| Aim 3: Retrospective Chart Review Individuals \> 18 years identified via a retrospective chart review who had a positive interferon gamma release assay test or TST and/or ICD-10 codes for LTBI between April 2019 and April 2020. | 51 |
| Total | 84 |
Baseline characteristics
| Characteristic | Aim 2: RI LTBI ECHO Participants | Aim 3: Retrospective Chart Review | Aim 1: Key Informant Interviews | Total |
|---|---|---|---|---|
| Age, Categorical Aim 1 <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Aim 1 >=65 years | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Age, Categorical Aim 1 Between 18 and 65 years | 3 Participants | 0 Participants | 21 Participants | 24 Participants |
| Age, Categorical Aim 2 <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Aim 2 >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Aim 2 Between 18 and 65 years | 7 Participants | 0 Participants | 0 Participants | 7 Participants |
| Age, Categorical Aim 3 <=18 years | — | 0 Participants | — | 0 Participants |
| Age, Categorical Aim 3 >=65 years | — | 8 Participants | — | 8 Participants |
| Age, Categorical Aim 3 Between 18 and 65 years | — | 43 Participants | — | 43 Participants |
| Credentials Aim 1: Key Informant Interviews Not Applicable | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Credentials Aim 1: Key Informant Interviews Nurse | 0 Participants | 0 Participants | 3 Participants | 3 Participants |
| Credentials Aim 1: Key Informant Interviews Primary care clinician | 4 Participants | 0 Participants | 18 Participants | 22 Participants |
| Credentials Aim 2: RI LTBI ECHO Participants Not Applicable | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Credentials Aim 2: RI LTBI ECHO Participants Nurse | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Credentials Aim 2: RI LTBI ECHO Participants Primary care clinician | 8 Participants | 0 Participants | 0 Participants | 8 Participants |
| Credentials Aim 3: Retrospective Chart Review Not Applicable | 0 Participants | 51 Participants | 0 Participants | 51 Participants |
| Credentials Aim 3: Retrospective Chart Review Nurse | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Credentials Aim 3: Retrospective Chart Review Primary care clinician | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Aim 1: Key Informant Interviews Hispanic or Latino | 0 Participants | 0 Participants | 2 Participants | 2 Participants |
| Ethnicity (NIH/OMB) Aim 1: Key Informant Interviews Not Hispanic or Latino | 4 Participants | 0 Participants | 19 Participants | 23 Participants |
| Ethnicity (NIH/OMB) Aim 1: Key Informant Interviews Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Aim 2: RI LTBI ECHO Participants Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Aim 2: RI LTBI ECHO Participants Not Hispanic or Latino | 8 Participants | 0 Participants | 0 Participants | 8 Participants |
| Ethnicity (NIH/OMB) Aim 2: RI LTBI ECHO Participants Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Aim 3: Retrospective Chart Review Hispanic or Latino | 0 Participants | 24 Participants | 0 Participants | 24 Participants |
| Ethnicity (NIH/OMB) Aim 3: Retrospective Chart Review Not Hispanic or Latino | 0 Participants | 27 Participants | 0 Participants | 27 Participants |
| Ethnicity (NIH/OMB) Aim 3: Retrospective Chart Review Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Aim 1: Key Informant Interviews American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Aim 1: Key Informant Interviews Asian | 0 Participants | 0 Participants | 2 Participants | 2 Participants |
| Race (NIH/OMB) Aim 1: Key Informant Interviews Black or African American | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Aim 1: Key Informant Interviews More than one race | 0 Participants | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Aim 1: Key Informant Interviews Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Aim 1: Key Informant Interviews Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Aim 1: Key Informant Interviews White | 4 Participants | 0 Participants | 18 Participants | 22 Participants |
| Race (NIH/OMB) Aim 2: RI LTBI ECHO Participants American Indian or Alaska Native | 0 Participants | 0 Participants | — | 0 Participants |
| Race (NIH/OMB) Aim 2: RI LTBI ECHO Participants Asian | 0 Participants | 0 Participants | — | 0 Participants |
| Race (NIH/OMB) Aim 2: RI LTBI ECHO Participants Black or African American | 0 Participants | 0 Participants | — | 0 Participants |
| Race (NIH/OMB) Aim 2: RI LTBI ECHO Participants More than one race | 0 Participants | 0 Participants | — | 0 Participants |
| Race (NIH/OMB) Aim 2: RI LTBI ECHO Participants Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | — | 0 Participants |
| Race (NIH/OMB) Aim 2: RI LTBI ECHO Participants Unknown or Not Reported | 0 Participants | 0 Participants | — | 0 Participants |
| Race (NIH/OMB) Aim 2: RI LTBI ECHO Participants White | 8 Participants | 0 Participants | — | 8 Participants |
| Race (NIH/OMB) Aim 3: Retrospective Chart Review American Indian or Alaska Native | — | 0 Participants | — | 0 Participants |
| Race (NIH/OMB) Aim 3: Retrospective Chart Review Asian | — | 1 Participants | — | 1 Participants |
| Race (NIH/OMB) Aim 3: Retrospective Chart Review Black or African American | — | 17 Participants | — | 17 Participants |
| Race (NIH/OMB) Aim 3: Retrospective Chart Review More than one race | — | 1 Participants | — | 1 Participants |
| Race (NIH/OMB) Aim 3: Retrospective Chart Review Native Hawaiian or Other Pacific Islander | — | 0 Participants | — | 0 Participants |
| Race (NIH/OMB) Aim 3: Retrospective Chart Review Unknown or Not Reported | — | 28 Participants | — | 28 Participants |
| Race (NIH/OMB) Aim 3: Retrospective Chart Review White | — | 4 Participants | — | 4 Participants |
| Region of Enrollment United States | 8 participants | 51 participants | 25 participants | 33 participants |
| Sex: Female, Male Aim 1: Key Informant Interviews Female | 2 Participants | 0 Participants | 12 Participants | 14 Participants |
| Sex: Female, Male Aim 1: Key Informant Interviews Male | 2 Participants | 0 Participants | 9 Participants | 11 Participants |
| Sex: Female, Male Aim 2: RI LTBI ECHO Participants Female | 5 Participants | 0 Participants | 0 Participants | 5 Participants |
| Sex: Female, Male Aim 2: RI LTBI ECHO Participants Male | 3 Participants | 0 Participants | 0 Participants | 3 Participants |
| Sex: Female, Male Aim 3: Retrospective Chart Review Female | 0 Participants | 37 Participants | 0 Participants | 37 Participants |
| Sex: Female, Male Aim 3: Retrospective Chart Review Male | 0 Participants | 14 Participants | 0 Participants | 14 Participants |
| Years out of training Aim 1: Key Informant Interviews 5 or more years out of training | 3 Participants | 0 Participants | 3 Participants | 6 Participants |
| Years out of training Aim 1: Key Informant Interviews < 5 years out of training | 1 Participants | 0 Participants | 12 Participants | 13 Participants |
| Years out of training Aim 1: Key Informant Interviews In training | 0 Participants | 0 Participants | 3 Participants | 3 Participants |
| Years out of training Aim 1: Key Informant Interviews unknown | 0 Participants | 0 Participants | 3 Participants | 3 Participants |
| Years out of training Aim 2: RI LTBI ECHO Participants 5 or more years out of training | 3 Participants | 0 Participants | 0 Participants | 3 Participants |
| Years out of training Aim 2: RI LTBI ECHO Participants < 5 years out of training | 3 Participants | 0 Participants | 0 Participants | 3 Participants |
| Years out of training Aim 2: RI LTBI ECHO Participants In training | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Years out of training Aim 2: RI LTBI ECHO Participants unknown | 2 Participants | 0 Participants | 0 Participants | 2 Participants |
| Years out of training Aim 3: Retrospective Chart Review 5 or more years out of training | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Years out of training Aim 3: Retrospective Chart Review < 5 years out of training | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Years out of training Aim 3: Retrospective Chart Review In training | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Years out of training Aim 3: Retrospective Chart Review unknown | 0 Participants | 51 Participants | 0 Participants | 51 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 0 |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Primary
Feasibility: Participant Attendance
Number of consented participants attending each expansion for community healthcare outcomes (ECHO) session who consented to participate in the course
Time frame: Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21
Population: The number of consented participants who attended the RI LTBI ECHO program
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| RI LTBI ECHO Program Participants | Feasibility: Participant Attendance | Launch Session | 10 participants |
| RI LTBI ECHO Program Participants | Feasibility: Participant Attendance | Session 1 | 9 participants |
| RI LTBI ECHO Program Participants | Feasibility: Participant Attendance | Session 5 | 8 participants |
| RI LTBI ECHO Program Participants | Feasibility: Participant Attendance | Session 6 | 6 participants |
| RI LTBI ECHO Program Participants | Feasibility: Participant Attendance | Session 2 | 7 participants |
| RI LTBI ECHO Program Participants | Feasibility: Participant Attendance | Session 3 | 8 participants |
| RI LTBI ECHO Program Participants | Feasibility: Participant Attendance | Session 4 | 8 participants |
Primary
Feasibility: Participant Retention
Percentage of registered participants attending one of the last two ECHO sessions
Time frame: Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21
Population: Number of consented participants who attended sessions 5 or 6
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| RI LTBI ECHO Program Participants | Feasibility: Participant Retention | 9 Participants |
Primary
Impact: Participants' Self-reported LTBI Treatment Percentages on Pre- and Post ECHO Surveys
Change in participants' self-reported estimates of patients treated for TB infection. Participants will estimate the percentage of patients started on any TB treatment on a sliding scale from 0-100%. Mean percentages will be calculated between the pre- and post- structured survey responses administered before and after the ECHO intervention.
Time frame: Pre-survey was emailed two weeks prior to the course and could be filled out anytime before a participant attended their first session. The post-survey was emailed immediately following the final session on 3/4/2021 and were completed within three weeks.
Population: Participation in the surveys was voluntary so not all participants answered all questions. All 12 participants answered some of the pre-survey questions (only 4 answered the question of interest). Out of the 12, only 8 responded to the post survey. Of those 8, 5 answered the question of interest.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| RI LTBI ECHO Program Participants | Impact: Participants' Self-reported LTBI Treatment Percentages on Pre- and Post ECHO Surveys | Pre-Survey | 50 percentage of patients started on tx | Standard Deviation 50 |
| RI LTBI ECHO Program Participants | Impact: Participants' Self-reported LTBI Treatment Percentages on Pre- and Post ECHO Surveys | Post-Survey | 11 percentage of patients started on tx | Standard Deviation 19.6 |
Primary
Impact: Procedural Knowledge
Change in participants' confidence in assessing a patient's risk for tuberculosis (TB) infection based on a likert scale rating (1=not at all confident and 5=extremely confident) included in the pre- and post- structured surveys administered before and after the ECHO intervention.
Time frame: Pre-survey was emailed 2 weeks prior to the course and could be filled out anytime before a participant attended their first session. The post-survey was emailed immediately following the final session (3/4/2021) and were completed within three weeks.
Population: Consented Survey Participants who participated in the RI LTBI ECHO and responded to the pre-survey and/or post-survey question. Please rate your confidence in performing each of the areas of latent TB infection practice below: Assessing a patient's risk for TB infection 1=Not at all confident, 2=Not very confident, 3=moderately confident, 4=very confident, 5=extremely confident
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| RI LTBI ECHO Program Participants | Impact: Procedural Knowledge | Pre-Survey | 3.09 score on a scale | Standard Deviation 0.51 |
| RI LTBI ECHO Program Participants | Impact: Procedural Knowledge | Post-Survey | 4.25 score on a scale | Standard Deviation 0.66 |
Comparison: Non-parametric Wilcoxon signed rank test for paired data was used to test for significant change in confidence.p-value: 0.02Wilcoxon signed rank test
Primary
Impact: Self-reported LTBI Screening Percentage by Participants on Pre- and Post-ECHO Course Surveys
Change in participants' self-reported estimates of patients screened for TB infection. Participants estimated their screening percentage on a sliding scale from 0-100%. Mean estimates will be calculated for the pre- and post- structured survey responses administered before and after the ECHO intervention.
Time frame: Pre-survey was emailed 2 weeks prior to the course and could be filled out anytime before a participant attended their first session. The post-survey was emailed immediately following the final session (3/4/2021) and were completed within three weeks.
Population: Consented participants who responded to both pre- and post-surveys were asked to participate voluntarily. All 12 participants answered some of the pre-survey questions (only 6 answered the question of interest). Out of the 12, only 8 responded to the post survey. Of the 8, 7 answered the question of interest.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| RI LTBI ECHO Program Participants | Impact: Self-reported LTBI Screening Percentage by Participants on Pre- and Post-ECHO Course Surveys | Pre-Survey | 45.67 percentage of patients screened | Standard Deviation 38.6 |
| RI LTBI ECHO Program Participants | Impact: Self-reported LTBI Screening Percentage by Participants on Pre- and Post-ECHO Course Surveys | Post Survey | 25.86 percentage of patients screened | Standard Deviation 25.99 |
Primary
Reach: LTBI Testing
Proportion(# of TB tests/# of visits) of patients tested for LTBI in a health center population before, during and after ECHO implementation to assess providers' behavior change. This data will be obtained from an electronic medical record data query
Time frame: Three-months prior, ECHO course, three- months post
Population: data were not collected
Primary
Reach: LTBI Treatment
Patient level LTBI treatment before, during and after ECHO implementation to assess providers' behavior change. Proportion(# of TB treatment initiated/# of patients diagnosed with LTBI) of patients treated for LTBI in a health center population before, during and after ECHO implementation to assess providers' behavior change. This data will be obtained from an electronic medical record data query.
Time frame: Three-months prior, ECHO course, three- months post
Population: data were not collected
Secondary
Feasibility: Case Submission
Percentage of cases submitted by participants on time during the ECHO course
Time frame: Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21
Population: Participants who were asked to submit a case
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| RI LTBI ECHO Program Participants | Feasibility: Case Submission | 6 Participants |
Secondary
Feasibility: Communication With ECHO Hub
Percentage of participants' who agree that the communication with the ECHO hub team was adequate during the ECHO session. This will be collected monthly from post-session surveys via a likert scale (1=strongly disagree and 5=strongly agree)
Time frame: Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21
Population: Data were not collected
Secondary
Feasibility: Connectivity
Percentage of participants' who agree that connectivity was adequate during the ECHO session. This will be collected monthly from post-session surveys via a likert scale (1=strongly disagree and 5=strongly agree)
Time frame: Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21
Population: Data were not collected
Secondary
Feasibility: Content Expert Facilitation
Participants rating of whether the speaker demonstrated excellent educational skills. This will be collected monthly from post-session surveys via a likert scale (1=strongly disagree and 5=strongly agree)
Time frame: Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21
Population: Participation in post session evaluations was voluntary. Not all 9 consented participants who completed any of the evaluations completed all of the evaluations.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| RI LTBI ECHO Program Participants | Feasibility: Content Expert Facilitation | Session 1 | 4.83 score on a scale | Standard Deviation 0.41 |
| RI LTBI ECHO Program Participants | Feasibility: Content Expert Facilitation | Session 2 | 4.86 score on a scale | Standard Deviation 0.38 |
| RI LTBI ECHO Program Participants | Feasibility: Content Expert Facilitation | Session 3 | 4.43 score on a scale | Standard Deviation 0.79 |
| RI LTBI ECHO Program Participants | Feasibility: Content Expert Facilitation | Session 4 | 4.71 score on a scale | Standard Deviation 0.49 |
| RI LTBI ECHO Program Participants | Feasibility: Content Expert Facilitation | Session 5 | 4.83 score on a scale | Standard Deviation 0.41 |
| RI LTBI ECHO Program Participants | Feasibility: Content Expert Facilitation | Session 6 | 4.33 score on a scale | Standard Deviation 0.82 |
Secondary
Feasibility: ECHO Session Timing
Percentage of participants' who agree that session timing was convenient. This will be collected monthly from post-session surveys via a likert scale (1=strongly disagree and 5=strongly agree)
Time frame: Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21
Population: Data were not collected
Secondary
Feasibility: Videoconferencing Equipment
Percentage of participants' who agree that videoconferencing equipment was adequate during the ECHO session. This will be collected monthly from post-session surveys via a likert scale (1=strongly disagree and 5=strongly agree)
Time frame: Session 1 10/8/20; Session 2 11/5/20; Session 3 12/10/20; Session 4 1/7/21; Session 5 2/4/21; Session 6 3/4/21
Population: Data were not collected
Other Pre-specified
Primary Care Providers' and Nurses' Reported Frequency in Conducting LTBI Screening
Qualitative interviews were conducted with primary care providers and nurses in RI regarding their knowledge, attitudes, and skills regarding LTBI management. A key focus of the interview was related to frequency of conducting LTBI screening. Here we summarize the frequency of providers and nurses who reported never conducting TB screening, infrequently conducting TB screening, or frequently conducting TB screening.
Time frame: Interviews were conducted between October 2, 2019 and June 17, 2020
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| RI LTBI ECHO Program Participants | Primary Care Providers' and Nurses' Reported Frequency in Conducting LTBI Screening | Never conduct TB screening | 3 Participants |
| RI LTBI ECHO Program Participants | Primary Care Providers' and Nurses' Reported Frequency in Conducting LTBI Screening | Infrequently conduct TB screening | 14 Participants |
| RI LTBI ECHO Program Participants | Primary Care Providers' and Nurses' Reported Frequency in Conducting LTBI Screening | Frequently conduct TB screening | 7 Participants |