Extension for Community Health Outcomes Diabetes FQHC will provide tele-education to primary care providers (PCP) in Federally Qualified Health Centers in the U.S. using the "hub" and "spoke" training model established in the Project ECHO model. Participating FQHCs (called "spokes") will receive twice monthly tele-education sessions delivered by UF's "hub" team in a 6-month program. The program will be evaluated using pre/posttest provider-level surveys and center-level aggregate data in a stepped-wedge trial design with 3 cohorts of FQHCs. The primary outcomes are the proportion of people >9% HbA1c and technology use (CGM and insulin pump).

We will implement a national ECHO Diabetes FQHC program by offering a 6-month tele-education intervention that includes: (1) a virtual orientation and onboarding for FQHCs (2) one-hour tele-ECHO sessions twice monthly with continuing medical education (CME) credits provided (3) real-time support with complex medical decision-making and (4) access to an online repository of diabetes resources for PCPs. The 'hub' team delivering the ECHO Diabetes FQHC program are a nationally recognized multidisciplinary team of adult and pediatric endocrinologists, a clinical health psychologist, Certified Diabetes Care and Education Specialists (CDCES), a registered dietitian, a Certified Exercise Physiologist (CEP), a medical sociologist, PCPs, and health services researchers.

We will evaluate the ECHO Diabetes FQHC program with a stepped-wedge design. This proposal will leverage and expand on key community partnerships established through ECHO Diabetes with two Health Center Controlled Networks (HCCNs), HealthChoiceNetwork (HCN) and AllianceChicago (AC) to accomplish both specific aims. These two Health Center Controlled Networks (HCCNs) have over 100 FQHCs in 29 different states and hold a central data repository for over 7 million unduplicated patients seen for care across these locations. 18 new "spokes" will be recruited from HCN and AC's national network. Covariate-constrained randomization will be used to assign spokes to three cohorts that will have staggered and phased entry into the program in 6-month intervals. Pre- and post-intervention data will be collected at the provider-level and center-level (i.e., "spoke-level") and housed using REDCap® as a central data repository. Provider-level data will include pre and post surveys assessing confidence and knowledge in diabetes care as well as self-reported diabetes care practices. Spoke-level data will include aggregate Health Effectiveness Data and Information Set (HEDIS) metrics for diabetes, Uniform Data System (UDS) metrics for diabetes, mean HbA1c for demographic subgroups, diabetes technology use (CGM and insulin pumps), and referrals for GLP1 and SGL2 medications.

Inclusion Criteria: Federally Qualified Health centers (spokes) are eligible to participate that are part of Health Choice Network (HCN) or Alliance Chicago (AC). All people living with diabetes 18 and older are included in aggregate data sharing to evaluate outcomes.

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Exclusion Criteria:

• Non FQHC, not part of HCN or AC

All people 18 and older with diabetes (T1D, T2D) seen for care at participating Federally Qualified Health Centers.

Aggregate data will be shared upon reasonable requests made to project PIs

Upon publication of data or per request of journals via the publication process

Any one making a reasonable request for data -- all data is aggregated and do not include PHI or identifiers