Academic health center management of chronic diseases through knowledge networks: Project ECHO

Sanjeev Arora, Cynthia M A Geppert, Summers Kalishman, Denise Dion, Frank Pullara, Barbara Bjeletich, Gary Simpson, Dale C Alverson, Lori B Moore, Dave Kuhl, Joseph V Scaletti, Sanjeev Arora, Cynthia M A Geppert, Summers Kalishman, Denise Dion, Frank Pullara, Barbara Bjeletich, Gary Simpson, Dale C Alverson, Lori B Moore, Dave Kuhl, Joseph V Scaletti

Abstract

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 comanage 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 comanaging 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.

Figures

Figure 1
Figure 1
Project ECHO video teleconferencing implementation. Project ECHO is based at the University of New Mexico, Albuquerque, NM, and was implemented in June 2003.
Figure 2
Figure 2
Project ECHO care manager implementation. Project ECHO is based at the University of New Mexico, Albuquerque, NM, and was implemented in June 2003.
Figure 3
Figure 3
The role of expanding knowledge in caring for underserved populations.

References

    1. Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services. Healthy People 2010. [October 16, 2006]; Available at: ( )
    1. Petit P. Continuing education. Closing the performance gap. HealthAction. 1994 Mar-May;(8):4–5.
    1. Sylvestre DL, Loftis JM, Hauser P, et al. Co-occurring hepatitis C, substance use, and psychiatric illness: treatment issues and developing integrated models of care. J Urban Health. 2004;81:719–734.
    1. United States Census Bureau. The Hispanic Population: Census 2000 Brief. Washington, DC: United States Census Bureau; 2001.
    1. Alter MJ, Kruszon-Moran D, Nainan OV, et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med. 1999;341:556–562.
    1. New Mexico Department of Health. New Mexico Hepline: Hepatitis C Resource for Clinicians and the General Public. [October 16, 2006]; Available at: ( )
    1. New Mexico Department of Health. Health Behaviors and Conditions of New Mexicans: Results from the New Mexico Risk Factor Surveiliance System. Santa Fe, NM: New Mexico Department of Health; 2002.
    1. Wong JB, McQuillan GM, McHutchison JG, Poynard T. Estimating future hepatitis C morbidity, mortality, and costs in the United States. Am J Public Health. 2000;90:1562–1569.
    1. Poynard T, McHutchison J, Manns M, et al. Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C. Gastroenterology. 2002;122:1303–1313.
    1. Fried MW. Side effects of therapy of hepatitis C and their management. Hepatology. 2002;36(5 suppl 1):S237–S244.
    1. Kraus MR, Schafer A, Faller H, Csef H, Scheurlen M. Psychiatric symptoms in patients with chronic hepatitis C receiving interferon alfa-2b therapy. J Clin Psychiatry. 2003;64:708–714.
    1. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. 1998;47:1–39.
    1. Cassano P, Fava M. Depression and public health: an overview. J Psychosom Res. 2002;53:849–857.
    1. Reid CM, Thrift AG. Hypertension 2020: confronting tomorrow’s problem today. Clin Exp Pharmacol Physiol. 2005;32:374–376.
    1. Dansky KH, Dirani R. The use of health care services by people with diabetes in rural areas. J Rural Health. 1998;14:129–137.
    1. United States Department of Health and Human Services and Centers for Disease Control and Prevention. Chronic Diseases and Their Risk Factors: The Nation’s Leading Causes of Death: A Report with Expanded State-by-State Information. Atlanta, Ga: United States Department of Health and Human Services and Centers for Disease Control and Prevention; 1998.
    1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet. 1997;349:1498–1504.
    1. Villagra VG, Ahmed T. Effectiveness of a disease management program for patients with diabetes. Health Aff (Millwood) 2004;23:255–266.
    1. Dimmick SL, Burgiss SG, Robbins S, Black D, Jarnagin B, Anders M. Outcomes of an integrated telehealth network demonstration project. Telemed J E Health. 2003;9:13–23.
    1. Institute of Medicine Committee on Evaluating Clinical Applications of Telemedicine. Telemedicine: A Guide to Assessing Telecommunications in Health Care. Washington, DC: National Academy Press; 1996.
    1. Darkins A. Telemedicine: What Do We Know and What Do We Need to Know? Forum. VA Health Services Research and Development. 2001
    1. Hyler SE, Gangure DP. Legal and ethical challenges in telepsychiatry. J Psychiatr Pract. 2004;10:272–276.
    1. Rosenblatt RA. A view from the periphery - health care in rural America. N Engl J Med. 2004;351:1049–1051.
    1. Morrow CB, Epling JW, Teran S, Sutphen SM, Novick LF. Future applications of case-basedteaching in population-based prevention. Am J Prev Med. 2003;24(4 suppl):166–169.
    1. Davis RS, Bukstein DA, Luskin AT, Kailin JA, Goodenow G. Changing physician prescribing patterns through problem-based learning: an interactive, teleconference case-based education program and review of problem-based learning. Ann Allergy Asthma Immunol. 2004;93:237–242.
    1. Norris T, Hart L, Larson E. Low-Bandwidth, Low-Cost Telemedicine Consultations Between Rural Family Physicians and Academic Medical Center Specialists: A Multifacted Satisfaction Study. Seattle: Wash: WWAMI Rural Health Research; 2001. WWAMI Rural Health Research Group Working Paper 63.
    1. Hoyal FM. Skills and topics in continuing medical education for rural doctors. J Contin Educ Health Prof. 2000;20:13–19.
    1. Nordin I. Expert and non-expert knowledge in medical practice. Med Health Care Philos. 2000;3:297–304.
    1. Bruce ML, Ten Have TR, Reynolds CF, 3rd, et al. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA. 2004;291:1081–1091.
    1. Hecht FM, Wilson IB, Wu AW, Cook RL, Turner BJ. Optimizing care for persons with HIV infection. Society of General Internal Medicine AIDS Task Force. Ann Intern Med. 1999;131:136–143.
    1. Agency for Healthcare Research and Quality. National Healthcare Disparities. Rockville, Md: Department of Health and Human Services; 2003.
    1. Institute of Medicine. Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st Century. Washington, DC: Institute of Medicine; 2002.
    1. Institute of Medicine. Quality through Collaboration: the Future of Rural Health: Building 21st Century Community Health Care System in Rural America. Washington, DC: Institute of Medicine; 2004.
    1. Shannon GW, Bashshur R, Kratochwill E, DeWitt J. Telemedicine and the academic health center: the University of Michigan health system model. Telemed J E Health. 2005;11:530–541.
    1. Pellegrino ED. Academic health centers and society: an ethical reflection. Acad Med. 1999;74(8 suppl):S21–S26.
    1. Carey TS, Howard DL, Goldmon M, Roberson JT, Godley PA, Ammerman A. Developing effective interuniversity partnerships and community-based research to address health disparities. Acad Med. 2005;80:1039–1045.

Source: PubMed

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