Implementation effectiveness of the Long COVID and Fatiguing Illnesses Recovery Program (LC&FIRP): a multimodal Extension for Community Healthcare Outcomes (ECHO) model for clinician learning
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
- 3Herbert Wertheim School of Public Health and Longevity Science, UC San Diego, La Jolla, CA, United States
- 4Department of Pediatrics Nutrition Section, School of Medicine, University of Colorado, Aurora, CO, United States
- 5National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
- 6Project ECHO, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
- 7Department of Medicine, University of Washington, Seattle, WA, 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
IntroductionLong COVID and other infection-associated chronic conditions (IACC) present management challenges for primary care clinicians and often require patient access to multidisciplinary specialists. To strengthen primary care capacity, the Long COVID and Fatiguing Illnesses Recovery Program (LC&FIRP) implemented a multi-modal learning model combining Extension for Community Healthcare Outcomes (ECHO) case-based learning with complementary educational modalities. The ECHO learning component was evaluated for effectiveness in a Type II hybrid design randomized control trial, and an implementation evaluation assessed implementation of the full LC&FIRP model to inform future implementation and scale-up.MethodsWe conducted a qualitatively driven mixed-methods implementation evaluation of the LC&FIRP model, assessing acceptability, feasibility, fidelity, sustainability, and scalability. Participants comprised clinicians from a federally qualified health center serving predominantly uninsured, low-income, and medically underserved patients in San Diego, CA. All trial clinicians were offered monthly webinars and quarterly asynchronous online short courses; intervention clinicians were additionally offered weekly ECHO sessions. Data sources were session surveys at the end of every session or short-course, quarterly clinician follow-up surveys, and interviews with participants, subject matter experts (SMEs) and clinic administrators at program end.ResultsAcceptability findings reflected high clinician satisfaction and perceived utility of the weekly and monthly offerings but moderate sustained engagement and negligible participation in the quarterly short courses. Clinicians valued most the interactive peer exchange; practical diagnostic and treatment approaches; and lessons from SMEs with lived experience. Feasibility barriers included competing clinical and administrative demands and the time commitment required for participation. Most program components were implemented with fidelity but fewer weekly ECHO sessions and case presentations were delivered than planned. Sustainability and scalability showed early promise with the continuation of weekly and monthly offerings after trial end, but future barriers remain.DiscussionThis study demonstrates that a multi-modal program combining ECHO case-based learning with complementary educational offerings may be feasibly implemented and is acceptable to clinicians for supporting primary care management of complex chronic conditions, although sustaining engagement and scaling the model will require adaptations to reduce participation burden and resource requirements.
Related
- Teacher-delivered transdiagnostic child mental healthcare in rural Indian primary schools (Tealeaf): study protocol for a batched stepped-wedge cluster randomized controlled trial with a hybrid effectiveness-implementation-context design.
- Artificial intelligence-enabled mental health applications for adolescents: a scoping review of safety, effectiveness and clinical implementation
- The MCH-HB Adjara Study: protocol for a non-randomised hybrid type 1 effectiveness–implementation study of the Maternal and Child Health Handbook in Georgia
- Upright Participation for Learners with Physical Disabilities: A Pilot Randomized Crossover Effectiveness-Implementation Trial of Robot-assisted Walking in Schools
- Modelling pharyngolaryngeal effectiveness using multimodal non-invasive sensors: study protocol for the PhLEs clinical trial
BibTeX
@article{zuber2026implementation,
title = {{Implementation effectiveness of the Long COVID and Fatiguing Illnesses Recovery Program (LC&FIRP): a multimodal Extension for Community Healthcare Outcomes (ECHO) model for clinician learning}},
author = {Alexandra Zuber and Jonathan T. Rothwell and Job G. Godino and Job G. Godino 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 Christian B. Ramers and Christian B. Ramers and Christian B. Ramers},
journal = {Frontiers in Health Services},
year = {2026},
month = oct,
doi = {10.3389/frhs.2026.1912278},
url = {https://doi.org/10.3389/frhs.2026.1912278},
note = {CC BY},
}
RIS
TY - JOUR
TI - Implementation effectiveness of the Long COVID and Fatiguing Illnesses Recovery Program (LC&FIRP): a multimodal Extension for Community Healthcare Outcomes (ECHO) model for clinician learning
AU - Alexandra Zuber
AU - Jonathan T. Rothwell
AU - Job G. Godino
AU - Job G. Godino
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 - Christian B. Ramers
AU - Christian B. Ramers
AU - Christian B. Ramers
PY - 2026
DA - 2026/10/23
JO - Frontiers in Health Services
DO - 10.3389/frhs.2026.1912278
UR - https://doi.org/10.3389/frhs.2026.1912278
AB - IntroductionLong COVID and other infection-associated chronic conditions (IACC) present management challenges for primary care clinicians and often require patient access to multidisciplinary specialists. To strengthen primary care capacity, the Long COVID and Fatiguing Illnesses Recovery Program (LC&FIRP) implemented a multi-modal learning model combining Extension for Community Healthcare Outcomes (ECHO) case-based learning with complementary educational modalities. The ECHO learning component was evaluated for effectiveness in a Type II hybrid design randomized control trial, and an implementation evaluation assessed implementation of the full LC&FIRP model to inform future implementation and scale-up.MethodsWe conducted a qualitatively driven mixed-methods implementation evaluation of the LC&FIRP model, assessing acceptability, feasibility, fidelity, sustainability, and scalability. Participants comprised clinicians from a federally qualified health center serving predominantly uninsured, low-income, and medically underserved patients in San Diego, CA. All trial clinicians were offered monthly webinars and quarterly asynchronous online short courses; intervention clinicians were additionally offered weekly ECHO sessions. Data sources were session surveys at the end of every session or short-course, quarterly clinician follow-up surveys, and interviews with participants, subject matter experts (SMEs) and clinic administrators at program end.ResultsAcceptability findings reflected high clinician satisfaction and perceived utility of the weekly and monthly offerings but moderate sustained engagement and negligible participation in the quarterly short courses. Clinicians valued most the interactive peer exchange; practical diagnostic and treatment approaches; and lessons from SMEs with lived experience. Feasibility barriers included competing clinical and administrative demands and the time commitment required for participation. Most program components were implemented with fidelity but fewer weekly ECHO sessions and case presentations were delivered than planned. Sustainability and scalability showed early promise with the continuation of weekly and monthly offerings after trial end, but future barriers remain.DiscussionThis study demonstrates that a multi-modal program combining ECHO case-based learning with complementary educational offerings may be feasibly implemented and is acceptable to clinicians for supporting primary care management of complex chronic conditions, although sustaining engagement and scaling the model will require adaptations to reduce participation burden and resource requirements.
SN - 2813-0146
ER -