Telementoring Primary Care Clinicians to Improve Geriatric Mental Health Care

Abstract

Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.

Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

“…In several instances, satisfaction was framed in terms of participation benefits, such as "Because of [EELM], I have expanded my practice to include new skills. 19 " In addition to structured surveys, several authors conducted focus group discussions 17,20,33,54 and semi-structured interviews 24,28,43,53 to solicit feedback on aspects of EELM that worked well or less well, often with a focus on acceptability of the technology platform utilized. Here, responses were also generally positive.…”

Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study

“…Prior studies of educational programs for non-geriatrics providers have demonstrated improvements in clinician knowledge about geriatric issues and may alter treatment practices. 40,41 …”

Telemedicine as the New Outpatient Clinic Gone Digital: Position Paper From the Pandemic Health System REsilience PROGRAM (REPROGRAM) International Consortium (Part 2)

“…The importance of primary healthcare in palliative care was highlighted by the first WHO global resolution on palliative care in 2014. The Project ECHO (Extension for Community Healthcare Outcomes), as one of the examples, shows the potential of telemedicine in the training of patients, their family members, and medical workers in palliative care (82,83). The training of palliative care via telemedicine/telehealth for outpatients in primary care will increase the coverage and quality of both care and life for these patients.…”