Academic Health Center Management of Chronic Diseases through Knowledge Networks: Project ECHO

Abstract

The authors describe an innovative academic health center (AHC)-led program of health care delivery and clinical education for the management of complex, common, and chronic diseases in underserved areas, using hepatitis C virus (HCV) as a model. The program, based at the University of New Mexico School of Medicine, represents a paradigm shift in thinking and funding for the threefold mission of AHCs, moving from traditional fee-for-service models to public health funding of knowledge networks. This program, Project Extension for Community Health care Outcomes (ECHO), involves a partnership of academic medicine, public health offices, corrections departments, and rural community clinics dedicated to providing best practices and protocol-driven health care in rural areas. Telemedicine and Internet connections enable specialists in the program to comanage patients with complex diseases, using case-based knowledge networks and learning loops. Project ECHO partners (nurse practitioners, primary care physicians, physician assistants, and pharmacists) present HCV-positive patients during weekly two-hour telemedicine clinics using a standardized, case-based format that includes discussion of history, physical examination, test results, treatment complications, and psychiatric, medical, and substance abuse issues. In these case-based learning clinics, partners rapidly gain deep domain expertise in HCV as they collaborate with university specialists in hepatology, infectious disease, psychiatry, and substance abuse in comanaging their patients. Systematic monitoring of treatment outcomes is an integral aspect of the project. The authors believe this methodology will be generalizable to other complex and chronic conditions in a wide variety of underserved areas to improve disease outcomes, and it offers an opportunity for AHCs to enhance and expand their traditional mission of teaching, patient care, and research.

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.…”

“…As the Project SCAN-ECHO requires collaboration between primary and specialty care, in which the specialist is "mentoring" primary care physicians on HCV management, context exploration could determine important characteristics of the mentoring specialist which facilitated a collaborative and team-based approach. Borrowing lessons learned from the contextual elements of the New Mexico-based Project SCAN-ECHO could include terming specialty and primary care coordinated care as "learning loops" or "collaborative groups" to reinforce the team-based, dialectical approach to care [43,44]. Contextual assessment would strongly influence the early processes of implementation by simultaneously developing the optimal organizational and clinical environment for the intervention and tailoring the intervention with the contextual environment.…”

Innovative Tele-mentoring in Addiction Management for Remote Primary Care Physicians: A Feasibility Study

“…The heart of the ECHO model is "hub and spoke" knowledge sharing network linking expert interdisciplinary specialist teams located at academic medical centres (hub) with PCPs in rural and underserved areas (spokes) virtually through tele-ECHO clinics, where experts mentor and share their expertise via case-based learning, enabling PCPs to develop the ability to treat patients with complex conditions in their own communities (Fig. 3&4) [4].…”

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

“…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.…”

“…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).…”