Key result
Project ECHO quality initiative cuts A1C >9% rates by ~27% and improves obesity documentation.
Why the study?
Adults in rural areas experience high rates of type 2 diabetes and obesity, but access to care remains limited.
Does a regionally coordinated QI initiative using the Project ECHO model improve diabetes and obesity care metrics in rural clinics?
Does a regionally coordinated QI initiative using the Project ECHO model improve diabetes and obesity care metrics in rural clinics?
A multisite QI project using the Project ECHO model in rural clinics successfully reduced the proportion of patients with poorly controlled T2D and improved obesity care documentation.
Supports ECHO-based QI for rural T2D care; hypothesis-generating pending controlled trials.
Introduction and Objective: Adults in rural areas experience high rates of type 2 diabetes (T2D) and obesity, but access to care remains limited. This project aimed to assess whether participation in a regionally coordinated quality improvement (QI) initiative with Area Health Education Centers (AHEC) using the Project ECHO® model could (1) reduce the proportion of patients with T2D with A1C >9%, and (2) increase the proportion of adults with BMI >25 kg/m² who had a documented follow-up plan in their medical record. Methods: A 12-month project was conducted in partnership with the National AHEC Organization and rural AHEC sites in Montana and Utah. Sites participated in 10, once-monthly virtual sessions featuring brief didactic instructions and case-based learning with QI and clinical experts. Each site selected site-specific aims and submitted deidentified aggregate data at baseline and project completion. Descriptive statistics were used to assess changes over time. Clinics also reported implementation of new services and procedures. This project was funded by an educational grant from Eli Lilly and Company. Results: Eight clinics enrolled, with four submitting final data. All sites reported reductions in patients with A1C >9% with a total aggregate reduction of 27%. Other improvements included increasing documentation of obesity from 12.5% to 49.5% at 1 site, follow-up plan documentation in 19% of eligible patients at another, and a 22.6% increase in prescribing T2D medications with weight-loss benefits. Clinics also implemented or expanded services such as medical nutrition therapy programs, intensive behavioral therapy, and diabetes prevention programs, and initiated structured referral and education pathways. Project discontinuation was linked to the limited time and resources rural care centers could dedicate to the project. Conclusion: This initiative demonstrates the feasibility and impact of implementing targeted, scalable QI strategies to improve care of patients with T2D and obesity at primary care centers in rural settings. Disclosure L. Van Ravenswaay: Stock/Shareholder; Current; Lilly. Stock/Shareholder; Ended; Bristol-Myers Squibb Company. Stock/Shareholder; Current; AbbVie Inc., Abbott. R.L. Black: None. P. Langdon: None.
No takes yet. Share an insight, caveat, or question.
Ravenswaay et al. (2026) studied Type 2 diabetes and obesity. Quality improvement initiative using the Project ECHO model vs. Baseline was evaluated on Proportion of patients with T2D with A1C >9% and proportion of adults with BMI >25 kg/m² with a documented follow-up plan. A 12-month quality improvement initiative using the Project ECHO model in rural clinics resulted in a 27% aggregate reduction in patients with A1C >9% and improved obesity documentation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: