P3D126: A Pediatric Tele-education Model for Primary Care Providers and Outcomes in Provider Self-efficacy and Patient Emergency Department Use

Background: The 175% rise in the prevalence of autism spectrum disorder (ASD) over the past 2 decades has overburdened the system of healthcare for children and youth with ASD (CYASD), with parents more likely to report unmet needs. Having a medical home with a pediatric primary care provider (PCP) is associated with fewer unmet needs. However, PCPs hesitate to manage the many comorbidities common to ASD reporting lack of self-perceived competency and knowledge. This study utilized the Project ECHO (Extension for Community Healthcare Outcomes) Autism tele-education model. The model uses deidentified case-based learning and didactics to connect an autism specialty team to PCPs, and boost PCP self-efficacy in the care of CYASD, to benefit patients.

Objectives: 1) determine differences in self-efficacy between two groups; PCPs participating in ECHO Autism compared to PCPs who did not participate, and 2) compare the change in ED usage between CYASD empaneled to PCPs who did vs. did not participate in ECHO Autism.

Methods: The design was a prospective cohort design for measuring PCP self-efficacy, and a retrospective analysis for measuring ED visits. Participants included six participant PCPs and eleven non-participant PCPs from regional clinics within a hospital system during the study period (08/01/2019 to 01/31/2022). Self-efficacy was assessed anonymously one month pre- and 1-month post-intervention using the fifty-seven item Primary Care Autism Self-Efficacy (PCASE) survey. The ED usage was measured for all patients empaneled to each PCP in the 6-month period before the onset of the tele-education intervention and in the 6-month period after conclusion of the intervention by chart review in aggregate (131 patients for participant PCPs; 264 patients for non-participant PCPs). We evaluated overall ED usage and compared the overall change. Differences in change in self-efficacy and ED usage were tested using the Wilcoxon rank-sum test and zero-inflated Poisson regression, respectively.

Results: Pre- to post intervention, participant vs. non-participant PCP self-efficacy improved by 40.5%, vs. 1.8% respectively (p=.001) (Figure 1). The change in odds of zero ED visits for patients receiving care from participant providers was 4.78 times (CI: 1.01, 22.7, p = 0.049) that of patients receiving care from non-participant providers (Figure 2).

Conclusion: Use of the ECHO Autism model was associated with significant improvement in self-efficacy in participant PCPs compared to non-participant PCPs. There was a significant increase in odds of zero ED visits for patients empaneled to participant PCPs compared to non-participant PCPs. Findings suggest up-skilling PCPs may reduce ED visits, favoring utilization of the medical home.