ECHO Care: Providing Multidisciplinary Specialty Expertise to Support the Care of Complex Patients

Abstract

BACKGROUND: Programs for high-need, high-cost (HNHC) patients can improve care and reduce costs. However, it may be challenging to implement these programs in rural and underserved areas, in part due to limited access to specialty consultation. AIM: Evaluate the feasibility of using the Extension for Community Health Outcomes (ECHO) model to provide specialist input to outpatient intensivist teams (OITs) dedicated to caring for HNHC patients. SETTING: Weekly group videoconferencing sessions that connect multidisciplinary specialists with OITs. PARTICIPANTS: Six OITs across New Mexico, typically consisting of a nurse practitioner or physician assistant, a registered nurse, a counselor or social worker, and at least one community health worker. PROGRAM DESCRIPTION: OITs and specialists participated in weekly teleECHO sessions focused on providing the OITs with case-based mentoring and support. PROGRAM EVALUATION: OITs and specialists discussed 427 highly complex patient cases, many of which had social or behavioral health components to address. In 70% of presented cases, the teams changed their care plan for the patient, and 87% reported that they applied what they learned in hearing case presentations to other HNHC patients. DISCUSSION: Pairing the ECHO model with intensive outpatient care is a feasible strategy to support OITs to provide high-quality care for HNHC patients.

Telemedicine, COVID-19 and liver diseases: Revamping remote care initiatives in hepatology

“…The program showed successful results as the sustained virologic responses achieved by those patients treated in primary care settings under the guidance of ECHO were similar to those observed when patients were treated by specialists [6]. Since then, the ECHO project expanded to many states in the U.S. as well as in many other countries and was also adopted by other medical specialties [7,8]. Currently, this type of care is considered a vital tool for the goal of global elimination of HCV infection [9].…”

Comparative Effectiveness of a Complex Care Program for High-Cost/High-Need Patients: a Retrospective Cohort Study

“…46 One study found mortality reduction at 1 year of a relative 42% (6.2% vs. 10.6% for controls). 47,48 A Swedish intervention study found reduced mortality risk (HR-0.66) over 24 months, 49 and another found reduced relative mortality of 45% (16% vs 29%) at 6months, 50 among older frail patients. Thus, our findings are not unprecedented.…”

Delivering Complex Care: Designing for Patients and Physicians

“…Primary care physicians within academic medical centers would seem well positioned to manage patients with multimorbidity given their need for specialty care and interdisciplinary coordination. 17,18 However, designing this type of practice for an academic environment poses specific challenges. Physicians at academic centers are already keenly aware of the need to juggle clinical responsibilities with scholarship and teachingserving the faculty mission of advancing medical knowledge through education and research.…”