Evidence map›Paper›PMID 40518551›Full record

Trial reportSchizophrenia bulletin2026

A Randomized Controlled Trial of an Extension for Community Healthcare Outcomes (ECHO) Tele-mentoring Program to Increase Clozapine Utilization.

Deanna L Kelly, Jared Hunt, Gopal Vyas, Matthew Glassman, Clayton H Brown, Li Juan Fang, Heidi J Wehring, Raymond C Love, Elaine Weiner, Gloria Reeves and 13 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Schizophrenia bulletin, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Deanna L KellyMaryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD 21228, USA.
Jared HuntMaryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD 21228, USA.
Gopal VyasMaryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD 21228, USA.
Matthew GlassmanMaryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD 21228, USA.
Clayton H BrownDepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Li Juan FangDepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Heidi J WehringMaryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD 21228, USA.
Raymond C LoveDepartment of Practice, Science and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.
Elaine WeinerMaryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD 21228, USA.
Gloria ReevesDivision of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Megan J EhretDepartment of Practice, Science and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.
Frederick C NuciforaJohns Hopkins University, Baltimore, MD 21218, USA.
Robert W BuchananMaryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD 21228, USA.
Sophie LanzkronDivision of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Brian BarrDivision of Cardiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Charles M RichardsonMaryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD 21228, USA.
Ikwunga WonodiMaryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD 21228, USA.
Ann Marie KearnsMaryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD 21228, USA.
Nicole LeistikowDepartment of Psychiatry, University of Maryland School of Medicine Baltimore, MD 21201, USA.
Fang LiuMaryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD 21228, USA.
Sharon PughMaryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD 21228, USA.
Heather A AdamsMaryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD 21228, USA.
Julie KreyenbuhlDivision of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine Baltimore, MD 21201, USA.ORCID 0000-0003-3605-3123

Funding

A Randomized Controlled Trial of a Telementoring Program, Project ECHO, to increase Clozapine PrescribingR37MH121564 · NIMH · UNIVERSITY OF MARYLAND BALTIMORE · PI KELLY, DEANNA L · 2020 to 2023
$3.1M
National Institutes of Mental Health (NIMH) MH121564NIMH NIH HHS R37 MH121564
6 · The paper itself

Abstract

background and hypothesisTo determine whether a tele-mentoring program increases clozapine utilization by improving prescriber knowledge and perceived competence in clozapine management. STUDY

designIn a cluster-randomized controlled design, we tested the effectiveness of an Extension for Community Healthcare Outcomes (ECHO) model-based intervention, consisting of 26 biweekly didactic and case-based tele-mentoring sessions, vs enhanced treatment as usual (eTAU), in which both conditions received access to a consultation phone line and a point of care device for on-site hematologic monitoring. Prescribers completed baseline and 12-month assessments of clozapine knowledge and competence, and prescription records were used to evaluate the effects of ECHO on prescribing and treatment persistence. STUDY

results266 prescribers from 43 mental health treatment settings throughout Maryland were enrolled. Prescribers randomized to ECHO demonstrated a significant increase in clozapine knowledge compared to eTAU (P < .001), and competence increased significantly in those who attended 14 or more tele-mentoring sessions (P = .017). ECHO did not increase the likelihood of clozapine prescribing during follow-up (P = .70). While there was a 17% lower hazard of clozapine discontinuation among patients of prescribers randomized to ECHO, this did not reach statistical significance (P = .72).

conclusionsA statewide tele-mentoring program increased prescriber knowledge and competence in clozapine prescribing among those attending most ECHO sessions. Median time to clozapine discontinuation was double in the ECHO group, however, neither this nor rates of prescribing were statistically significantly different from control. Additional support is needed to motivate clozapine prescribing beyond providing education and increasing confidence in clozapine management.

Indexed as

Antipsychotic AgentsClinical CompetenceClozapineCommunity Mental Health ServicesHealth Knowledge, Attitudes, PracticePractice Patterns, Physicians'SchizophreniaAdultFemaleHumansMaleMarylandMiddle AgedTelemedicineAntipsychotic AgentsClozapineclozapinecompetenceknowledgeprescribing barrierstele-mentoring

Identifiers

PMID40518551
PMCPMC12501956

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.