title: The Impact of Project ECHO on Participant and Patient Outcomes: A Systematic Review.
abstract: OBJECTIVE
  Project Extension for Community Healthcare Outcomes (ECHO) uses tele-education to bridge knowledge gaps between specialists at academic health centers and primary care providers from remote areas. It has been implemented to address multiple medical conditions. The authors examined evidence of the impact of all Project ECHO programs on participant and patient outcomes.
  
  
  METHODS
  The authors searched PubMed, MEDLINE, EMBASE, PsycINFO, and ProQuest from January 2000 to August 2015 and the reference lists of identified reviews. Included studies were limited to those published in English, peer-reviewed articles or indexed abstracts, and those that primarily focused on Project ECHO. Editorials, commentaries, gray literature, and non-peer-reviewed articles were excluded. The authors used Moore's evaluation framework to organize study outcomes for quality assessment.
  
  
  RESULTS
  The authors identified 39 studies describing Project ECHO's involvement in addressing 17 medical conditions. Evaluations of Project ECHO programs generally were limited to outcomes from Levels 1 (number of participants) to 4 (providers' competence) of Moore's framework (n = 22 studies, with some containing data from multiple levels). Studies also suggested that Project ECHO changed provider behavior (n = 1), changed patient outcomes (n = 6), and can be cost-effective (n = 2).
  
  
  CONCLUSIONS
  Project ECHO is an effective and potentially cost-saving model that increases participant knowledge and patient access to health care in remote locations, but further research examining its efficacy is needed. Identifying and addressing potential barriers to Project ECHO's implementation will support the dissemination of this model as an education and practice improvement initiative.
authors.affiliation: C. Zhou is a psychiatry resident, Department of Psychiatry, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.A. Crawford is assistant professor, Department of Psychiatry, University of Toronto, Faculty of Medicine, and director of psychiatry outreach and telepsychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.E. Serhal is manager, ECHO Ontario Mental Health Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.P. Kurdyak is associate professor, Department of Psychiatry, University of Toronto, Faculty of Medicine, medical director, Performance Improvement, Centre for Addiction and Mental Health, and assistant professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.S. Sockalingam is associate professor, Department of Psychiatry, University of Toronto, Faculty of Medicine, and deputy psychiatrist-in-chief, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Carrol
authors.initials: C
authors.lastname: Zhou
authors.forename: Allison
authors.initials: A
authors.lastname: Crawford
authors.forename: Eva
authors.initials: E
authors.lastname: Serhal
authors.forename: Paul
authors.initials: P
authors.lastname: Kurdyak
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam