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Impact of Participation in Technology-Enabled Collaborative Learning and Capacity Building (ECHO) Models on Provider Retention

Publication Date

This analysis, which used data on participation in Project ECHO provided by New Mexico’s ECHO Institute, explored two retention-related hypotheses:

  • Participation in an ECHO intervention results in increased provider retention at the individual practitioner level; and

  • Sites with an ECHO presence may generate synergies that translate into higher levels of professional satisfaction and achievement even for providers who do not participate in ECHO so that overall provider retention at such sites increases.

Lewin’s analysis did not find evidence that participation in an ECHO intervention increased provider retention at either the individual practitioner or site levels.  However, the study did find an association between ECHO participation and retention in HPSAs.  The retention in the same HPSA where the initial ECHO site was located was larger for ECHO providers than the retention of non-ECHO participants by 10 to 12 percentage points in each year.  ECHO participants were also much more likely to remain in HPSAs (whether at the initial site or any other site located within a HPSA) than the non-ECHO participants, with the differential between 20 and 28 percentage points in each year after the start year.  We were not able to examine why higher retention rates observed in the HPSA analysis did not translate into higher practice site level retention

There were limitations to this study.  Available data cannot adequately address the issue of reverse causality and does not reflect additional efforts individuals who want to continue practicing at their current location may take to improve their skills and interact with other medical professionals. Under ideal research circumstances, evaluation of the intervention would have been structured such that practitioners would have been randomized into ECHO, thereby controlling for potential unobservable characteristics influencing provider behavior.  In reality, implementation of the ECHO model has spread through voluntary adoption over time without a structured evaluation in mind.  Instead, implementation of the ECHO model has spread through voluntary adoption over time without a structured evaluation in place.  Some of the data were incomplete and involved small sample sizes.  Finally, given the recent growth in ECHO interventions in the past several years, not enough time has passed to fully examine ECHO’s retention effects.  Nevertheless, we felt that this study was a useful first step in examining retention and suggests how future work could be structured. 

ASPE funded this research in concert with a broader examination of the evidence for technology-enabled collaborative learning and capacity building models that was called for in the “Expanding Capacity for Health Outcomes (ECHO) Act,” Public Law 114-270.  ASPE’s report to Congress responding to the ECHO Act can be found at: Report to Congress: Current State of Technology-Enabled Collaborative Learning and Capacity Building Models