Table 2 Challenges to Conducting Rigorous Evaluations of EELM and Potential Options to Address Them

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

ChallengePotential options to address the challengeSummary actions
1: Diversity of intended purposes of EELMa: Build consensus around the definition and purposes of EELMDevelop a clear understanding of EELM
b: Evaluation outcomes should reflect intended purposes of EELM
2: Variable implementation of the modela: Programs should document details of model implementationEmphasize rigorous reporting of program characteristics and implementation
3: Limited use of variety of study designsa: Consider strategies to facilitate randomizationUse a wider variety of study designs
b: Leverage non-randomized study designs that have advantages over study designs that have been used to date
c. Choose meaningful comparators
d: Document persistence or waning of effects of EELM over time, and spillover into other patients that were not presented as cases
4: Structural barriers to high-quality evaluationa: Support sustainable funding streams for EELM evaluationsProvide technical assistance and build capacity; engage with policymakers and funders
b: Enlist champions to support evaluations of EELM
c: Provide technical assistance and build capacity to conduct evaluations of EELM
d: Support data-sharing and interoperability