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Academic Medicine
Vol. 82, No. 2
February 2007
"Academic Health Center Management of Chronic Diseases through Knowledge
Networks: Project ECHO" |
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 co-manage 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
co-managing 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. (PDF) |
Public Health Reports
2007 Supplement 2
Volume 122
Project ECHO: Linking University
Specialists with Rural and Prison-Based Clinicians to Improve Care for
People with Chronic Hepatitis C in New Mexico |
Project Extension for Community Healthcare Outcomes
(Project ECHO) is a telemedicine and
distance-learning program designed to improve access to quality health
care for New Mexicans with hepatitis C. Project ECHO links health-care providers from rural clinics, the Indian Health
Service, and prisons with specialists at the University of New Mexico.
At weekly clinics, partners present and discuss patients with hepatitis
C with specialists. Partners can receive continuing education credits
for participating. Since June 2003, 173 hepatitis C clinics have been
conducted with 1,843 case presentations. Partners have received 390
hours of training and 2,997 hours of continuing education credits. And
in 2006, the State Legislature approved $1.5 million in annual funding
for the project. Project ECHO has
increased access to state-of-the art hepatitis C virus care for patients
living in rural areas or prisons. Because of its success with hepatitis
C, this project is being expanded to other chronic medical conditions. (PDF)
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