JMIR Publications

ABSTRACT

Background:

Pneumoconiosis prevalence is increasing in rural US, especially among coal miners. Contemporaneously with an increased need for miners for specialized multidisciplinary care, there is a shortage of experts to fulfill this need. Miners' Wellness ECHO is a digital community of practice based on interprofessional discussion for knowledge transfer. The program has been demonstrated to increase participants' self-efficacy for clinical, medicolegal, and “soft “skills related to miners' health.

Objective:

To examine characteristics associated with interprofessional discussions and suggest ways to strengthen knowledge transfer.

Methods:

This mixed methods study used an exploratory sequential design. We video-recorded and transcribed ECHO sessions over 14 months from July 2018 to September 2019 and conducted content analysis to examine discussions among participants. We focused on participants’ statements of expertise followed by other participants' acceptance or eschewal of these statements (together described as utterances). We then conducted quantitative analyses to examine the association of active participation in discussion (primary outcome variable, defined as making any utterances). We analyzed the association of the outcome on the following predictors: 1) participant group status, 2) study timeframe, 3) participant ECHO experience status, 4) concordance of participant group identity between presenter and participant, 5) video usage, and 6) attendance frequency. We used generalized estimating equations approach for longitudinal data, logit link function for binary outcomes, and LSmeans to examine least squares means of fixed effects.

Results:

We studied 23 sessions, with 158 unique participants and 539 total participants, averaging 23.4 (SD=5.6) participants per session. Clinical providers, the largest participant group constituting 37% (n=58) of unique participants, were the most vocal group (21.74 [SD=2.11] average utterances per person-session). Benefits counselors were the least vocal group, with average utterance rate of 0.57 (SD=0.29) per person-session and constituting 8% (n=13) of unique participants. Thus, various participant groups exhibited different rates of utterances across sessions (p=0.003). Experienced participants may tend to dominate active participation in discussion compared to those with less or intermediate experience levels, but this difference was not statistically significant (p=0.11). When the didactic presenter and participant were from the same participant group, active participation by the silent group participants was greater than when both were from different groups. This association was not seen in vocal group participants (interaction p=0.003). Compared to those participating by audio, those participating on video tended to have higher rates of active participation, but this difference was not statistically significant (p=0.11).

Conclusions:

Our findings provide insight into the mechanics of interprofessional discussion in a digital community of practice managing pneumoconiosis. Our results underscore the capacity of the novel ECHO model to leverage technology and workforce diversity to facilitate interprofessional discussions on the multidisciplinary care of miners. Future research will evaluate whether this translates into improved patient outcomes. Clinical Trial: N/a