Effectiveness of an Extension for Community Health Outcomes case-based virtual community of practice model on clinician outcomes for the management of long COVID and fatiguing illnesses: a randomized control trial
9 affiliations
- 1Ata Health Strategies, LLC, Washington, DC, United States
- 2Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
- 3Department of Pediatrics, Nutrition Section, University of Colorado, School of Medicine, Aurora, CO, United States
- 4National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
- 5Project ECHO, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
- 6Department of Medicine, University of Washington, Seattle, WA, United States
- 7Herbert Wertheim School of Public Health and Longevity Science, UC San Diego, La Jolla, CA, United States
- 8School of Medicine, University of California San Diego, La Jolla, CA, United States
- 9School of Public Health, San Diego State University, San Diego, CA, United States
Abstract
Introduction: Patients with Long COVID and other infection-associated chronic conditions (IACC) often face barriers to accessing specialist care, prompting the need to strengthen primary care capacity to manage these complex conditions. Our study evaluated the effectiveness of an ECHO case-based virtual community of practice model for improving clinician knowledge, confidence, and practice for Long COVID and other IACC in a randomized controlled trial (RCT) [Clinicaltrials.gov (NCT05167227)].
Methods: The study was a two-arm, single-blind, cluster RCT; intervention clinicians were invited to participate in weekly case-based, interactive, expert-led virtual learning sessions focused on patient care for individuals with Long COVID and other IACC. Intervention and control groups were also invited to monthly interactive webinars and quarterly short courses. Virtual learning occurred on Zoom videoconferencing software. Data were collected from routine clinician surveys, participation records, and electronic health records. The analysis identified treatment effects using generalized linear models predicting scaled scores for knowledge, changes to practice, and confidence in the management of patients with Long COVID and other IACC.
Results: Adjusting for baseline controls, the intervention group achieved significantly higher levels of knowledge (standardized beta coefficient: b = 0.77, 95% CI 0.20 to 1.33) and confidence (b = 0.48, 95% CI 0.09 to 0.88), but not changes to practice (b = 0.52, 95% CI -0.08 to 1.12). The number of sessions attended significantly predicted all three outcomes. As hypothesized, these improvements coincided with a reduction in specialist referrals by intervention group clinicians, per patient assigned to them (b = −0.44, 95% CI −0.62 to -.26), with no significant difference in visit duration or patient load.
Discussion: Our findings provide randomized trial evidence that the ECHO case-based virtual community of practice model can generate improvements to clinician knowledge and confidence in the care of patients with IACC and decreased reliance on specialist referrals. This offers a promising strategy for strengthening primary care capacity to address these complex conditions.
Clinical Trial Registration: Clinicaltrials.gov, identifier NCT05167227.
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BibTeX
@article{zuber2026effectiveness,
title = {{Effectiveness of an Extension for Community Health Outcomes case-based virtual community of practice model on clinician outcomes for the management of long COVID and fatiguing illnesses: a randomized control trial}},
author = {Alexandra Zuber and Jonathan T. Rothwell and Jane C. Samaniego and Sydney P. Sharp and Douglas Taren and Elizabeth R. Unger and Jeanne Bertolli and Jin-Mann S. Lin and Joanna J. Regan and Amy J. Armistad and John D. Scott and Bruce B. Struminger and Job G. Godino and Christian B. Ramers},
journal = {Frontiers in Health Services},
year = {2026},
month = oct,
doi = {10.3389/frhs.2026.1912262},
url = {https://doi.org/10.3389/frhs.2026.1912262},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Effectiveness of an Extension for Community Health Outcomes case-based virtual community of practice model on clinician outcomes for the management of long COVID and fatiguing illnesses: a randomized control trial
AU - Alexandra Zuber
AU - Jonathan T. Rothwell
AU - Jane C. Samaniego
AU - Sydney P. Sharp
AU - Douglas Taren
AU - Elizabeth R. Unger
AU - Jeanne Bertolli
AU - Jin-Mann S. Lin
AU - Joanna J. Regan
AU - Amy J. Armistad
AU - John D. Scott
AU - Bruce B. Struminger
AU - Job G. Godino
AU - Christian B. Ramers
PY - 2026
DA - 2026/10/21
JO - Frontiers in Health Services
DO - 10.3389/frhs.2026.1912262
UR - https://doi.org/10.3389/frhs.2026.1912262
AB - Introduction: Patients with Long COVID and other infection-associated chronic conditions (IACC) often face barriers to accessing specialist care, prompting the need to strengthen primary care capacity to manage these complex conditions. Our study evaluated the effectiveness of an ECHO case-based virtual community of practice model for improving clinician knowledge, confidence, and practice for Long COVID and other IACC in a randomized controlled trial (RCT) [Clinicaltrials.gov (NCT05167227)]. Methods: The study was a two-arm, single-blind, cluster RCT; intervention clinicians were invited to participate in weekly case-based, interactive, expert-led virtual learning sessions focused on patient care for individuals with Long COVID and other IACC. Intervention and control groups were also invited to monthly interactive webinars and quarterly short courses. Virtual learning occurred on Zoom videoconferencing software. Data were collected from routine clinician surveys, participation records, and electronic health records. The analysis identified treatment effects using generalized linear models predicting scaled scores for knowledge, changes to practice, and confidence in the management of patients with Long COVID and other IACC. Results: Adjusting for baseline controls, the intervention group achieved significantly higher levels of knowledge (standardized beta coefficient: b = 0.77, 95% CI 0.20 to 1.33) and confidence (b = 0.48, 95% CI 0.09 to 0.88), but not changes to practice (b = 0.52, 95% CI -0.08 to 1.12). The number of sessions attended significantly predicted all three outcomes. As hypothesized, these improvements coincided with a reduction in specialist referrals by intervention group clinicians, per patient assigned to them (b = −0.44, 95% CI −0.62 to -.26), with no significant difference in visit duration or patient load. Discussion: Our findings provide randomized trial evidence that the ECHO case-based virtual community of practice model can generate improvements to clinician knowledge and confidence in the care of patients with IACC and decreased reliance on specialist referrals. This offers a promising strategy for strengthening primary care capacity to address these complex conditions. Clinical Trial Registration: Clinicaltrials.gov, identifier NCT05167227.
SN - 2813-0146
ER -