# A Randomized Controlled Trial of a Telementoring Program, Project ECHO, to increase Clozapine Prescribing

> **NIH NIH R37** · UNIVERSITY OF MARYLAND BALTIMORE · 2020 · $773,580

## Abstract

PROJECT SUMMARY
 Schizophrenia is one of the leading causes of disability worldwide and the burden of this disease on
individual health and society at large is substantial. While new pharmacological treatments are emerging, no
treatment has yet to rival the efficacy of clozapine. Yet the number of people with schizophrenia who are
prescribed clozapine is <5% nationally, despite its recommended use in about 30-50% of people with
treatment-resistant schizophrenia. Arguably, clozapine is one of the most underutilized evidence-based
treatments in psychiatry and optimization of its use would improve patient outcomes and lower treatment costs.
Many barriers contribute to clozapine underutilization; however, our pilot data and data from others show that
lack of prescriber competence to use clozapine and challenging logistics for absolute neutrophil counts (ANC)
monitoring outside of the office are two of the greatest barriers to clozapine use. Further, pilot data shows that
prescriber self-reported competence in using clozapine correlates with their prescription of clozapine.
Therefore, without improving competence, changes in prescribing of clozapine are unlikely to occur.
 In the last 15 years, a unique, structured and empirically validated tele-mentoring model has emerged
called Project ECHO (Extension for Community Healthcare Outcomes). ECHO is a “hub” and “spoke” sharing
network led by an expert academic team (the “hub”) that uses multipoint video conferencing to conduct virtual
clinics with non-expert prescribers (the “spokes”) located in areas outside the academic hub site. The use of
ECHO has been shown to significantly improve best-practice specialty care in sites that lack expertise in a
variety of disease states. Importantly, multiple studies have established its efficacy in improving prescriber
competence, the “target mechanism,” we hypothesize to be linked to increased clozapine prescribing.
 In a randomized controlled design with 26 biweekly sessions over 12 months, we propose to test the
effectiveness of an ECHO-based intervention, “CHAMPION”, that includes 1.25 hours sessions which include:
1) active dissemination of knowledge and information by an expert “hub” followed by 2) clozapine case
presentations and vignettes submitted by the “spokes”. To minimize ANC monitoring barriers and maximize
recruitment, we will provide Food and Drug Administration (FDA)-approved ANC point of care (POC)
monitoring devices to all study sites, including those in the control condition (the PI has been extensively
involved with the development and testing of the POC device). We will enroll 300 prescribers from 60
outpatient mental health clinics (OMHCs); half the OHMCs will be randomized to CHAMPION and half
randomized to enhanced treatment as usual (ETAU). Our primary outcomes are to increase clozapine use and
persistence of clozapine (measured by analysis of Medicaid prescription data), to measure changes in
prescriber knowledge and self-reported competen...

## Key facts

- **NIH application ID:** 9871899
- **Project number:** 1R37MH121564-01
- **Recipient organization:** UNIVERSITY OF MARYLAND BALTIMORE
- **Principal Investigator:** DEANNA L KELLY
- **Activity code:** R37 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $773,580
- **Award type:** 1
- **Project period:** 2020-02-01 → 2023-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9871899

## Citation

> US National Institutes of Health, RePORTER application 9871899, A Randomized Controlled Trial of a Telementoring Program, Project ECHO, to increase Clozapine Prescribing (1R37MH121564-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9871899. Licensed CC0.

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