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ACG 2006

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develop the capacity to safely and effectively treat chronic, common and complex ... Orthopedics. 28. VISION FOR THE FUTURE. DISEASE SELECTION. Quality and Safety ... – PowerPoint PPT presentation

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Title: ACG 2006


1
  • Sanjeev Arora M.D., FACG
  • Professor of Medicine
  • Executive Vice Chairman
  • Department of Medicine
  • Director of Project ECHO
  • University of New Mexico School of Medicine
  • sarora_at_salud.unm.edu
  • 505-272-2808

2
MISSION
MISSION
The mission of Project ECHO is to develop the
capacity to safely and effectively treat chronic,
common and complex diseases in rural and
underserved areas and to monitor outcomes.
Supported by Agency for Health Research and
Quality HIT grant 1 UC1 HS015135-04, and MRISP,
R24HS16510-02 and the New Mexico Legislature
3
Hepatitis C A Global Health Problem
170 Million Carriers Worldwide, 3-4 MM new
cases/year
EAST MEDITERRANEAN 20M
WEST EUROPE 9 M
FAR EAST ASIA 60 M
U.S.A. 4 M
SOUTH EAST ASIA 30 M
AFRICA 32 M
SOUTH AMERICA 10 M
AUSTRALIA 0.2 M
Source WHO 1999
4
HEPATITIS C IN NEW MEXICO
HEPATITIS C IN NEW MEXICO
  • Estimated number is greater than 28,000
  • Less than 5 had been treated
  • Without treatment 8,000 patients will develop
    cirrhosis between 2010-2015 with several thousand
    deaths
  • 2300 prisoners diagnosed in corrections system
    (expected number is greater than 2400) - None
    treated
  • Highest rate of chronic liver disease/cirrhosis
    deaths in the nation


5
Rural New Mexico
RURAL NEW MEXICO
Underserved Area for Healthcare Services
  • 32 of 33 New Mexico counties are listed as
    Medically Underserved Areas (MUAs)
  • 14 counties designated as Health Professional
    Shortage Areas (HPSAs)
  • 121,356 sq miles
  • 1.83 million people
  • 42.1 Hispanic
  • 9.5 Native American
  • 17.7 poverty rate compared to 11.7 nationally
  • gt22 lack health insurance

6
HEALTHCARE IN NEW MEXICO
HEALTH CARE IN NEW MEXICO
  • 20 practice in rural or frontier areas

New Mexico Physician Survey 2001
7
GOALS
GOALS
  • Develop capacity to safely and effectively treat
    Hepatitis C in all areas of New Mexico and to
    monitor outcomes
  • Develop a model to treat complex diseases in
    rural locations and developing countries

8
PROJECT ECHO
PARTNERS
  • University of New Mexico School of Medicine Dept
    of Medicine, Telemedicine and CME
  • NM Department of Corrections
  • NM State Health Department
  • Indian Health Service
  • Community Providers with interest in Hepatitis C
    and Primary Care Association

9
METHOD
METHOD
  • Use Technology (telemedicine and internet) to
    leverage scarce healthcare resources
  • Disease Management Model focused on improving
    outcomes by reducing variation in processes of
    care and sharing best practices
  • Case based learning Co-management of patients
    with UNMHSC specialists
  • Centralized database HIPAA compliant to monitor
    outcomes

10
STEPS
STEPS
  • Train providers, nurses, pharmacists, educators
    in Hepatitis C
  • Install protocols and software on site
  • Conduct telemedicine clinics Knowledge
    Network
  • Initiate co-management Learning loops
  • Collect data and monitor outcomes centrally
  • Assess cost and effectiveness of programs

11
BENEFITS TO RURAL PROVIDERS
COMMUNITY PARTNERS
  • No cost CMEs and Nursing CEUs
  • Professional interaction with colleagues with
    similar
  • interest
  • Less isolation with improved recruitment and
    retention
  • A mix of work and learning
  • Obtain HCV certification
  • Access to specialty consultation with GI,
    hepatology,
  • psychiatry, infectious diseases, addiction
    specialist,
  • pharmacist, patient educator

12
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13
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14
Solution Functional Capabilities
Comprehensive Electronic Medical Record
Dynamic Forms
15
DISEASE SELECTION
DISEASE SELECTION
  • Common diseases
  • Management is complex
  • Evolving treatments and medicines
  • High societal impact (health and economic)
  • Serious outcomes of untreated disease
  • Improved outcomes with disease management

16
BUILDING BRIDGES
HEALTHCARE IN NEW MEXICO
BUILDING BRIDGES
PARETTOS PRINCIPLE
State Health Dept
Community Health Centers
Private Practice
UNM HSC
Hepatitis C
Asthma and COPD
Substance Use and Mental Health Disorders
17
KNOWLEDGE IMPORTANT - NOT TITLE
FORCE MULTIPLIER
HEALTHCARE IN NEW MEXICO
Use Existing Community Providers
Primary Care
Nurse Practitioners
Physician Assistants
Specialists
Hepatitis C
Asthma and COPD
Substance Use and Mental Health Disorders
18
COMMUNITY HEALTH EXTENSION AGENT
COMMUNITY HEALTH EXTENSION AGENT
CHEA
19
KNOWLEDGE IMPORTANT - NOT TITLE
FORCE MULTIPLIER
HEALTHCARE IN NEW MEXICO
Chronic Disease Management is a Team Sport
Community Health Worker
Medical Assistant
Primary Care
Nurse
Hepatitis C
Asthma and COPD
Substance Use and Mental Health Disorders
20
ROLE OF KNOWLEDGE NETWORK
A KNOWLEDGE NETWORK IS NEEDED
Increasing Gap
Medical Knowledge
Learning Capacity
Time
Expanding the Definition of Underserved
Population
21
  • How well has model worked?
  • 305 HCV Telehealth Clinics have been conducted
  • 3016 patients entered HCV disease management
    program
  • CMEs/CEs issued
  • 3631 CME/CE hours issued to ECHO providers at
  • no-cost.
  • 205 hours of HCV Training conducted at rural
    sites
  • National Recognition as Model for Complex Disease
    Care

22
Project ECHO Annual Meeting Survey
23
Project ECHO Providers HCV Knowledge Skills and
Abilities (Self-Efficacy) scale 1 none or no
skill at all 7 expert-can teach others
24
Project ECHO Providers HCV Knowledge Skills and
Abilities (Self-Efficacy)
25
Project ECHO Providers HCV Knowledge
Skills and Abilities (Self-Efficacy)
26
Project ECHO Providers HCV Knowledge Skills
and Abilities (Self-Efficacy)
Cronbachs alpha for the BEFORE ratings 0.92
and Cronbachs alpha for the TODAY ratings 0.86
indicating a high degree of consistency in the
ratings on the 9 items
27
Ashoka and Robert Wood Johnson Changemaker Award
KNOWLEDGE MODEL
  • Applications sought for Disruptive Innovations in
    Healthcare New Models that would change
    healthcare nationally and globally
  • 307 Applications from 27 countries
  • 9 finalists selected by a panel of Judges
  • Project ECHO selected one of three winners by
    worldwide online voting

28
VISION FOR THE FUTURE
VISION FOR THE FUTURE
28
29
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30
Potential Benefits of the ECHO Model
DISEASE SELECTION
  • Quality and Safety
  • Access for Rural and Underserved Patients
  • Workforce Training and Force Multiplier
  • Improving Professional Satisfaction/ Retention
  • Cost Effective Care- Avoid Excessive Testing and
    Travel
  • Integration of Public Health

31
Use of telemedicine, best practice protocols,
co-management of patients with case based
learning (the ECHO model) is a robust method to
to safely and effectively treat chronic, common
and complex diseases in rural and underserved
areas and to monitor outcomes.
Supported by Agency for Health Research and
Quality HIT grant 1 UC1 HS015135-04, and MRISP,
R24HS16510-02 and the New Mexico Legislature
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