Assessing and Expanding the Evidence Base for Project ECHO and ECHO-Like Models: Findings of a Technical Expert Panel



In 2003, Project ECHO (Extension for Community Healthcare Outcomes) began using technology-enabled collaborative models of care to help general practitioners in rural settings manage hepatitis C. Today, ECHO and ECHO-like models (EELM) have been applied to a variety of settings and health conditions, but the evidence base underlying EELM is thin, despite widespread enthusiasm for the model.


In April 2018, a technical expert panel (TEP) meeting was convened to assess the current evidence base for EELM and identify ways to strengthen it.


TEP members identified four strategies for future implementors and evaluators of EELM to address key challenges to conducting rigorous evaluations: (1) develop a clear understanding of EELM and what they are intended to accomplish; (2) emphasize rigorous reporting of EELM program characteristics; (3) use a wider variety of study designs to fill key knowledge gaps about EELM; (4) address structural barriers through capacity building and stakeholder engagement.


Building a strong evidence base will help leverage the innovative aspects of EELM by better understanding how, why, and in what contexts EELM improve care access, quality, and delivery, while also improving provider satisfaction and capacity.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Figure 1


  1. 1.

    Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364(23):2199–2207.

  2. 2.

    Expanding Capacity for Health Outcomes Act (ECHO Act). In. Public Law No: 114–270. Washington, DC: 114th Congress (2015–2016); 2016.

  3. 3.

    Office of the Assistant Secretary for Planning and Evaluation. Report to Congress: Current State of Technology-Enabled Collaborative Learning and Capacity Building Models. Available at: 03/01/2019. Accessed 21 October 2019.

Download references


The authors gratefully acknowledge the following contributors: the funders of this project at the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE), including Nancy De Lew, Caryn Marks, and Rose Chu for their support. Among our colleagues at the RAND Corporation, we are grateful to Jessica Sousa, Ryan McBain, Tricia Soto, Lisa Turner, Justin Timbie, Lori Uscher-Pines, Christine Eibner, and Paul Koegel.

Funding Information

This work was supported by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, under master contract, Building Analytic Capacity for Monitoring and Evaluating the Implementation of the ACA, HHSP23320095649WC. Dr. Faherty, Dr. Rose, Dr. Fischer, and Ms. Martineau received support through this contract with ASPE.

Author information

Correspondence to Laura J. Faherty MD, MPH, MS.

Ethics declarations

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material


(DOCX 17.8 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Faherty, L.J., Rose, A.J., Chappel, A. et al. Assessing and Expanding the Evidence Base for Project ECHO and ECHO-Like Models: Findings of a Technical Expert Panel. J GEN INTERN MED (2020) doi:10.1007/s11606-019-05599-y

Download citation


  • telemedicine
  • telehealth
  • Project ECHO
  • evaluation
  • evidence base
  • distance learning
  • continuing medical education
  • capacity building