Background

Education is one of the four missions of the Department of Veterans Affairs (VA) Veterans Health Administration (VHA). The VA Extension for Community Healthcare Outcomes (VA-ECHO) Expansion in Specialty Care is a workforce training and education program supported by the VHA Office of Rural Health (ORH).

VA-ECHO began in 2012. It provides live, online continuing education taught by VHA specialty care providers and clinical experts. These sessions are designed for other members of the VHA health care team who care for Veterans.

The program includes content that is specific to Veterans and to the way care is delivered in VA. This type of information is often not available outside the VA. VA-ECHO focuses especially on engaging clinicians who serve rural Veterans and those who have fewer chances to attend traditional education and professional development events.

Medical knowledge changes quickly, and the best ways to treat many conditions continue to evolve. Ongoing clinical education is essential so that health care teams can provide care based on the latest science and guidelines.

Rural health care team members often have less access to this type of education. They may be far from large, urban medical centers that are linked with universities and offer more training. Travel for in-person education can be costly, take time away from clinic, and reduce Veterans’ access to care. These factors can also make rural providers feel professionally isolated.

VA-ECHO is designed to reduce these barriers. The program offers fair and consistent access to high-quality, ongoing clinical education for all members of the health care team, no matter where they work. It also builds a community of practice so learners across the country can connect, learn together, and support one another.

Goals and Objectives

The main goal of VA-ECHO is to improve the quality of care and access to care for Veterans by promoting evidence-based treatment for a wide range of conditions. These include heart disease, diabetes, kidney disease, lung disease, neurologic conditions, and service-related health problems.

The primary objectives of VA-ECHO are to:

• Offer regular, recurring, accredited clinical education that uses case-based learning and focuses on improving the day-to-day practice of health care team members working in many different disciplines, specialties, and care settings.
• Strengthen VHA-based care delivery by sharing information, resources, and best practices that are specific to VHA and Veteran health care, with an ongoing emphasis on rural health care needs.
• Promote a sense of community among VA-based providers by creating a learning environment that welcomes all members of the health care team to learn, share, and network together.

Methodology

VA-ECHO sessions are delivered through an online learning platform. Each year, the program offers more than 400 live sessions on a wide range of specialty topics.

To support adult learning, VA-ECHO uses several key strategies:

• Case-based learning, where real or realistic patient cases are discussed to show how to apply evidence-based care in practice.
• Interactive engagement, where learners can ask questions, share experiences, and participate in discussion.
• Live question-and-answer segments with VA-based experts in each topic area.

After each session, learners complete an evaluation. This feedback is used to improve session content and format over time. Recordings of many sessions are also made available on demand, so health care team members can watch them later if they cannot attend live.

Recent VA-ECHO session topics include:

• Access to Spinal Cord Injury Care for Rural Veterans
• Airborne Hazards and Burn Pits
• Benefits for Veterans with Amyotrophic Lateral Sclerosis (ALS)
• Communication about Deployment-Related Health Concerns
• Dental Care for Homeless Veterans
• Improving Patient Aligned Care Team (PACT) Workflows
• Managing Pain with Depression and Posttraumatic Stress Disorder
• Native American Veteran Suicide and Rural Native Veterans
• Occupational and Environmental Lung Disease in Veterans
• Rural Health Inequities
• Understanding VA Grants and Benefits
• Unique Health Concerns of Women Veterans
• VA Care in the Community
• VA Virtual Resources for Chronic Kidney Disease Management

The curriculum for each VA-ECHO program is developed by a multidisciplinary planning committee. Content is tailored to Veteran health care, with a continuing focus on rural needs.

National stakeholders and VA-ECHO Nurse Coordinators help ensure that planning committees are aware of key VHA initiatives and ORH priorities. The committees use their expertise, needs assessments, and program evaluation data to design curricula that promote evidence-based care and highlight VA-based resources and initiatives.

Content is meant to be relevant to the daily clinical work of a wide range of health care team members, including physicians, nurses, nurse practitioners, physician assistants, pharmacists, social workers, dentists, psychologists, and others.

Impact on Rural Veteran Health

VA-ECHO improves the quality of care and access to care for rural Veterans by expanding high-quality, ongoing clinical education and by building a strong community of practice among learners nationwide.

• In Fiscal Year (FY) 2024, VA-ECHO delivered 434 sessions across many clinical topics. Ninety‑two percent of learners reported that, without VA-ECHO, this type of education would have required travel, time away from clinic, or would not have been available at all.
• VA-ECHO helps create a sense of community among learners, which is especially important for those working in rural locations. Eighty‑nine percent of learners reported feeling more connected to a community of practice because of their participation.
• In October 2024, VA-ECHO hosted a two-day Rural Health workshop with multiple sessions. The workshop welcomed 550 unique learners, showing that VA providers are interested in rural health topics regardless of whether they work in rural or urban settings.
• VA-ECHO has launched a monthly Rural Health Primary Care Community of Practice in partnership with the Rural Scholars Program. Over the past year, this series has provided eight sessions and more than 500 contact hours and has been well received.
• In FY 2024, VA-ECHO engaged 12,965 unique VA-based learners from 51% of all VA sites of care, including 164 rural clinical sites.

These results show that VA-ECHO is expanding access to education for providers who care for rural Veterans and is helping them stay informed, connected, and supported in their work.

Key Takeaways

Since it began in 2012, VA-ECHO has delivered thousands of specialty care education sessions and has become a key part of VA’s strategy to support high-quality care for Veterans, including those in rural areas.

• By July 2025, VA-ECHO had offered more than 3,275 sessions and over 346,000 contact hours of education in many clinical areas, including Cardiology, Diabetes, Emergency Medicine, Gastroenterology, Nephrology, Pain, and Primary Care.
• In FY 2024 alone, VA-ECHO delivered 434 sessions across 28 specialty programs, providing 77,265 contact hours.
• Learners report that VA-ECHO improves access to care for Veterans, builds a sense of community, and leads to meaningful changes in clinical practice.
• Eighty‑nine percent of learners say that the content is relevant to their daily practice, and 79% expect to change their practice or work based on what they learned in a session.
• More than 75% of VA-ECHO sessions include information about VA-specific initiatives, such as service-related toxic exposures or rural health care delivery, and highlight VA tools like the Chronic Kidney Disease Dashboard, the Primary Care Equity Dashboard, and Veteran Benefits Administration resources.
• Attendees frequently describe VA-ECHO as one of the best education series available, noting that it helps them stay current with academic and research-based knowledge, especially in rural settings where such access can be limited.

For many rural and remote health care team members, VA-ECHO provides education that would otherwise be difficult or impossible to access. This helps ensure that Veterans receive high-quality, patient-centered, and Veteran-focused care across the VHA system.

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References

• Mattox, E. A., Yantsides, K. E., Borgerding, J., Beste, L. A., Parsons, E. C., Fleet, M., Palen, B. N., O'Hearn, D., Germani, M. W., & Chang, M. F. (2022). Participant Characteristics and Attendance Patterns for a Multispecialty Veterans Affairs ECHO Program 2012–2018. Telemedicine and e-Health. doi:10.1089/tmj.2021.0626.
• Mattox, E. A., Yantsides, K. E., Germani, M. W., & Parsons, E. C. (2023). Utilizing the RE-AIM framework for a multispecialty Veterans Affairs Extension for Community Healthcare Outcomes (VA-ECHO) program 2018–2022. Frontiers in Health Services, 3, 1217172. doi:10.3389/frhs.2023.1217172.

Contact

• Program Contact: Elizabeth Mattox, MSN, MS, ARNP, Clinical Program Manager and VA-ECHO Evaluation Lead, VA Puget Sound Health Care System, Seattle, WA. Elizabeth.Mattox@va.gov
• Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PRFY-00578.
• Suggested Citation: Mattox, E. A. (2025). VA-ECHO Expansion in Specialty Care. Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health.

Rural Health - Navigation

• Office of Rural Health Home page:
  https://www.ruralhealth.va.gov/index.asp
• Enterprise-Wide Initiatives (EWI) page:
  https://www.ruralhealth.va.gov/Enterprise-Wide-Initiatives-EWI.asp
• Veterans Rural Health Resource Centers (VRHRC) page:
  https://www.ruralhealth.va.gov/Veterans-Rural-Health-Resource-Center-VRHRC.asp