Project Summary Chronic intestinal failure (CIF) is a devastating condition where individuals are unable to eat and drink enough to meet basic survival needs. Patients with CIF are dependent on parenteral nutrition (PN) delivered intravenously by a pump via an indwelling central venous catheter. While PN is lifesaving, life-threatening complications can cause considerable morbidity, impair quality of life (QOL) and carry significant mortality risk. Care of patients with CIF is highly complex and best delivered by experienced multi-disciplinary (multi-D) teams working in intestinal rehabilitation programs (IRP). Our recent work has shown a critical lack of expertise in CIF among US gastroenterologists and over half the states in the US do not offer IRP. This lack of widely available expertise results in significant healthcare disparities for patients with CIF. Our recent work has shown that use of technology to disseminate knowledge through the LIFT-ECHO Project, based on the well- established ECHO Model can fill a critical gap in CIF care. However, getting non-specialist primary car doctors and community gastroenterologists to engage in LIFT-ECHO has been challenging, because each community doctor likely manages no more than one to two patients at most and participation in LIFT_ECHO is time- consuming. With the following specific aims, we will test the hypothesis that provision of multi-D education and support directly to CIF patients and their family care providers through a live, virtual learning model – the Patient Intestinal Failure-ECHO Project (PIF-ECHO) – will enhance knowledge, increase confidence in self- care, and foster a virtual support group system, for patients to learn from each other's lived experiences. AIM 1a: Demonstrate that the ECHO™ Model can be successfully adapted to allow patients with CIF and their family care givers direct access to case-based education and tele-mentoring though a virtual multi-D team. Aim 1b: Demonstrate safety, acceptability, and value of the PIF-ECHO Model for patients with rare diseases like CIF, using a pilot evaluation framework. Aim 1c: Evaluate effectiveness of PIF-ECHO and disseminate results widely. There are only very rare instances of applying the ECHO Model, directly to patients and family caregivers, and none has been systematically evaluated. Our novel patient-centric approach directly aligns with AHRQ priorities by supporting disadvantaged populations living with disabilities [SEN NOT-HS- 24-004]. Our study will help improve healthcare safety and indirectly increase access to expert healthcare for patients with CIF, while providing a 360-degree view of CIF patients in the communities in which they live.