P1249945237agqFW

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Climate Change in Public Health A
Multi-Disciplinary, Inter-Agency View Project
ECHO New Mexico Department of Health Public
Health Division, Region 5 April 9, 2008
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Region 5 Counties

• Border Zone Counties
• (100 km of International Border with Mexico)
• Doña Ana
• Grant
• Hidalgo
• Luna
• Otero
• Sierra

Border Adjacent Counties
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Public Health Region 5 Service Trends

• From infectious diseases and reproductive health
  (STDs, family planning, prenatal care) and social
  norms with community mobilization (seatbelts,
  smoking, DWI) to
• Chronic diseases and conditions (diabetes,
  asthma, obesity, arthritis, hepatitis C) to
• Behavioral health issues (addiction, depression)
• Note previous phase does not go away, resources
  rarely increase as climate of organization
  evolves

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A Multi-Disciplinary Approach

• December 2003 the Community Wellness Program was
  established to focus on chronic diseases and
  conditions, e.g., diabetes, asthma, arthritis,
  obesity, hepatitis C, addictions, and depression
• January 2004 the Public Health Resource Center
  opened to provide education, counseling, support,
  coordination, and care for priority target groups
  with chronic illnesses

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Inter-Agency Initiatives

• Project ECHO (Extension for Community Healthcare
  Outcomes)
• School-Based Health Centers
• Detention Center Public Health Office
• Free Clinic, Primary Care Centers
• Community Resource Centers
• Community Health Councils, Issue -Oriented
  Coalitions Consortia

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Project ECHO Beginnings

• In June 2004 the NM Hepatitis C Virus Network for
  Education Treatment (HCV NET) became Project
  ECHO (Extension for Community Healthcare
  Outcomes)
• The ECHO agency partners are UNMHSC, NMDOH, NMCD,
  NMPCA
• PHR 5 (formerly District 3) was one of original
  pilot project sites in the state since June 2003

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NM HCV Timeline Milestones

• July 6, 2004 Hepatitis C was added as a priority
  to the Statewide Comprehensive Health Plan,
  subsequently renamed the NM Comprehensive
  Strategic Health Plan.
• FY06 (July 05 June 06) first State General Fund
  appropriation for HCV approximately 1.6M
• August 2007 Project ECHO winner of RWJF
  Changemakers Competition for Disruptive
  Innovation in Health Healthcare

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Project ECHO Methods

• Technology (Telemedicine and Internet) to
  leverage scarce healthcare resources (Knowledge
  Network)
• Disease Management Model focused on improving
  outcomes by reducing variation in processes of
  care and sharing best practices
• Case based learning with co-management of
  patients with UNMHSC specialists (Learning
  Loops)
• Centralized database HIPAA compliant to monitor
  outcomes (Ihealth CMT EHR)

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ECHO Support

• Weekly telehealth sessions via videoconferencing
  case presentations to Treatment Review Committee
• On-call case consultation by phone as needed
• Training opportunities in UNMHSC Internal
  Medicine Department Clinic
• Workshop (Grand Rounds) given in local facilities
  as requested
• Technical assistance site visits for CQI
• Development and sharing of forms/records,
  protocols MIS software

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Project ECHOTelehealth Sessions

• HCV
• Integrated Addiction / Psychiatry Clinic
• HIV
• Diabetes in Pregnancy Clinic
• Cardiovascular Risk Reduction Clinic
• Rheumatology Clinic
• Pulmonary Clinic

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ECHO Benefits

• Brings expertise of academic medicine to southern
  NM health infrastructure
• Promotes greater inter-agency collaboration with
  public and community health partners
• Brings programmatic bridges among infectious
  disease, chronic illness, and behavioral
  disorders
• Results in high return on investment (ROI) with
  General Fund appropriate securing pharmacy (Roche
  Schering Plough) and laboratory (TriCore) no
  cost donated items
• Takes innovative health care model in NM to
  attention of others nationally and
  internationally with many other possible
  applications in chronic disease service delivery

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ECHO Questions

• Technology component (database,
  videoconferencing) has been less than optimal
  from day one
• Deciding how much to export model to involve
  nurses in local health offices outside of Las
  Cruces
• Determining to what degree public health staff
  would provide direct clinical care and
  relationship to patients medical home
• Setting up surveillance field follow-up
  processes little written guidance and abundance
  of reports from local and state levels

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ECHO Expectations

• To provide operational foundation for replication
  in other regions and/or with other complex,
  common chronic diseases/conditions
• To facilitate state-level research about
  important health issues
• To lead to other resource opportunities for such
  collaboration

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ECHO ExperienceView of Public Health

• Change how partners/public see PH and how we see
  ourselves (hardest) teacher, consultant,
  auditor, advocate, politician, partner
• Change Levels of Sharing
• Patients with referrals, common cause in
  coalition, training opportunities
• Objectives/dollars with contracts
• Common vision, values, ventures in leadership
  share space, staff

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For More Information

• Contact
• Ray Stewart, NMDOH PHR5 Director
• Email Ray.Stewart_at_state.nm.us
• Phone [phone]
• Or on Internet
• Web http//www.healthynm.org/