Expanding Access to Hepatitis C Virus Treatment—Extension for Community Healthcare Outcomes (ECHO) Project: Disruptive Innovation in Specialty Care†

Abstract

The Extension for Community Healthcare Outcomes (ECHO) Model was developed by the University of New Mexico Health Sciences Center (UNMHSC) as a platform to deliver complex specialty medical care to underserved populations through an innovative educational model of team-based inter-disciplinary development. Using state-of-the-art telehealth technology, best practice protocols, and case based learning, ECHO trains and supports primary care providers to develop knowledge and self-efficacy on a variety of diseases. As a result, they can deliver best practice care for complex health conditions in communities where specialty care is unavailable. ECHO was first developed for the management of hepatitis C virus (HCV), optimal management of which requires consultation with multi-disciplinary experts in medical specialties, mental health and substance abuse. Few practitioners, particularly in rural and underserved areas, have the knowledge to manage its emerging treatment options, side effects, drug toxicities and treatment-induced depression. In addition data was obtained from observation of ECHO weekly clinics and database of ECHO clinic participation and patient presentations by clinical provider, evaluation of the ECHO program incorporates annual survey integrated into the ECHO annual meeting and routine surveys of community providers about workplace learning, personal and professional experiences, systems and environmental factors associated with professional practice, self-efficacy, facilitators and barriers to ECHO. The initial survey data show a significant improvement in provider knowledge, self-efficacy and professional satisfaction through participation in ECHO HCV clinics. Clinicians reported a moderate to major benefit from participation. We conclude that ECHO expands access to best practice care for underserved populations, builds communities of practice to enhance professional development and satisfaction of primary care clinicians, and expands sustainable capacity for care by building local centers of excellence.

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

“…The VHA is implementing a new model of telemedicine care, based on New Mexico's Project ECHO (Extension for Community Healthcare Outcomes) telemedicine program that would consolidate liver telemedicine care into one provider to provider visit [42][43][44]. The model is based on case-based learning like a tumor board conference whereby primary care providers dialing in from multiple outpatient clinics present a patient's case to the specialists and discuss options for management.…”

Thematic elements of the postgraduate NP residency year and transition to the primary care provider role in a Federally Qualified Health Center

“…These factors: clinical and systemic complexity, poverty and low literacy, behavioral health and substance abuse issues, and the challenge of managing chronic pain, opioid use, and requests for controlled substances are part of the daily fabric of life as a PCP in a FQHC and represent enormous stress for new NP in the residency. In fact, the experience of the NP Residents in addressing some of these very complex issues is shared by even experienced PCPs and has led CHCI to develop major new supports for all PCPs and their teams through participation in several Project ECHO-CT, an ongoing case-based distance learning intervention to address high complexity health problems, originally developed at the University of New Mexico (U.S.), [49] and now led by a number of organizations, including CHCI. [50,51] The stress and intensive workload of primary care practice and the life of a primary care provider is sobering, but witnessing and working with providers who maintain their sense of humor, commitment, and professional satisfaction is a critical offset.…”

The Use of Telemedicine for the Management of Hepatitis C & the California Telehealth Network

“…Unfortunately, many PCPs are unprepared to evaluate and manage the complexity of patients with chronic HCV and practice patterns are highly variable. Few rural practitioners have experience with the complex mental health and substance abuse issues that are common among patients with hepatitis C infection (Arora et al, 2010). In addition, they may perceive greater challenges when managing treatment side effects of pegylated interferons and ribavirin (depression, thrombocytopenia, neutropenia, anemia, GI side effects and skin rash).…”

“…One model, The Extension for Community Healthcare Outcomes (ECHO) Model was developed by the University of N e w M e x i c o H e a l t h S c i e n c e s C e n t e r t o d e liver complex specialty medical care to underserved populations (Arora et al, 2007;Arora et al, 2010). The ECHO model was first developed for the management of HCV.…”

“…ECHO provides health care delivery and clinical education to rural primary care practitioners via video conferencing (Arora et al 2007). The ECHO model uses "telehealth technology, best practice protocols, and case-based learning" to train and support primary care providers in the development of their knowledge and selfefficacy for managing chronic diseases (Arora et al, 2010). Initial survey data of the project have demonstrated a significant improvement in provider knowledge, self-efficacy, and professional satisfaction through participation in ECHO HCV clinics (Arora et al, 2010).…”