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AAPI - Fall Journal - Firstproof - LR ECHO PROJECT P26-28
AAPI - Fall Journal - Firstproof - LR ECHO PROJECT P26-28
ECHO PROJECT
(Extension for Community Healthcare Outcomes)
Sanjeev Arora, MD* & Nick Shroff
The Extension for Community Healthcare Outcomes By providing consultation and case-based learning using
(ECHO) Model is a platform that delivers complex an inter-disciplinary team at an AMC, this model responds
specialty medical care to underserved populations through directly to key unmet needs. The purpose of the model is
an innovative educational model that consists of team- “force multiplication” defined as a logarithmic increase in
based inter-disciplinary development. capacity of care for complex diseases in rural areas.
THE ECHO MODEL AND HOW IT WORKS: The hepatitis C team from the University of New Mexico
includes a hepatologist, a pharmacist, a psychiatrist, and a
The ECHO Model uses technology, such as webcams, nurse. These specialists do not assume the care of the patient;
custom software and clinical management tools, to train and in fact, the team from the Health Sciences Center never even
support primary care providers from underserved areas to sees the patient. Instead, through a guided practice model, the
develop knowledge and self-efficacy so they can deliver best primary care provider retains responsibility for managing the
practice care for complex health conditions. patient, operating with increasing independence as his or her
skills and self-efficacy grow.
When a new partner site--a primary care practice in
a rural area, for example--joins the network, ECHO staff Web-based disease management tools facilitate consults,
members first conduct a two-day, in-person orientation and specialists and primary care providers jointly manage
in Albuquerque. The orientation explains the hepatitis C complex chronic illness care for patients, who are treated right
treatment protocol as well as the communications technology in their home communities. A secure, centralized database
and the case-based presentation format for the weekly two- monitors patient outcomes.
hour telemedicine clinics. Next, primary care clinicians--
including physicians, nurses, and physician assistants--are The knowledge network consists of (continued on page 28)
www.aapiusa.org 27
(continued from page 27)
regularly scheduled conference calls over regular landlines in India to develop centers of excellence for prevention,
or cell phones and web cam based online clinics that bring evaluation and treating Diabetes and the metabolic syndrome.
together expert inter-disciplinary specialists from the AMC Community health workers and medical assistants will be
and multiple community-based partners. These partners learn trained to become diabetes educators so they can become
best practices through “learning loops” in which they co- a part of the disease management team at these centers of
manage diverse patients in real world situations and practice. excellence.
Over time, these learning loops create deep knowledge,
skills and self-efficacy. Provider evaluation results reported India like most developing nations lacks a fully developed
in peer-reviewed journals have shown both a positive impact infrastructure, often limited broadband connectivity between
on provider knowledge and self-efficacy while enhancing rural and urban areas. However, many towns (including
professional satisfaction and reducing professional isolation. smaller ones) have access to broadband connectivity through
Patient outcome studies have confirmed that the safety and the national telephone carrier MTNL for less than Rs 1500
efficacy of HCV care provided by primary care clinicians per (30 USD) month. Clinics will be chosen for the project
through ECHO collaboration and consultation are as good as based on availability of broadband connectivity of 512 Kbps
traditional care delivery at an AMC. per location. Project ECHO will provide the webcams and
software necessary for areas that have the required broadband
EXPANSION TO OTHER CHRONIC Internet access so that they may access the clinics via video-
DISEASES AND OTHER GEOGRAPHIES: conference.
After initial success ECHO has expanded beyond HCV As part of this process, the project will determine the
and now covers 12 additional disease areas that include resources, support, expert leadership team, partners and
chronic pain, rheumatology, pulmonary disease, high-risk sustainability plans required to bring ECHO to other areas.
PREGNANCY ()6!)$3 AND CARDIOVASCULAR RISK REDUCTION !S The proposed project will incorporate four key elements of
of September 2011, 305 partner teams across New Mexico the ECHO model:
have collaborated on more than 11,000 specialty care 1) Case-based learning and learning loops delivered through
consultations for multiple chronic diseases. The project has a knowledge network.
been successfully replicated at the University of Washington, 2) Best practice protocols for management of Diabetes,
University of Chicago and in India for treatment of HIV. Hypertension and Lipid Disorders
Over 15,000 hours of Continuing Medical Education (CME) 3) Tracking and evaluation of patient and provider outcomes
and Nursing Continuing Education Units (CEUs) have been and
issued to community-based primary care providers at no cost 4) Five types of technology that make distance learning,
to individual providers. consultation, and evaluation feasible including: a) webcams
ECHO received international recognition as one of three linked to a video conferencing bridge for consultative clinics,
winning entries out of 307 world-wide applications from 27 b) a web based electronic disease management tool (iHealth- to
countries in the 2007 Ashoka Changemaker’s competition for be developed for Diabetes by March 2011) that allows remote
Disruptive Innovations in Health and Health Care nationally entry of patient and outcome information for co-management
or globally. and outcome evaluation, c) fax machines for data exchange
where internet access is poor, e) webinar capacity to allow
THE PROPOSED PROJECT IN INDIA: delivery of didactic and interactive education to hundreds
of users simultaneously and e) a dedicated online video site
We propose a replication of the ECHO model in India (similar to “You Tube”) that allows providers to directly access
for cardiac risk reduction by setting up centers of excellence recorded educational sessions at any time.
for effective management of Diabetes, Hypertension, Lipid
Disorders, Obesity, and Smoking Effective education on diet, We will measure the number of patients treated, the
exercise, weight loss, smoking cessation and use of low cost efficacy of treatment in small towns and compare that
treatments such as insulin and oral anti diabetic medications to published literature and assess our ability to deploy
can save millions of lives. However the specialized expertise technology in India. Success of the project will demonstrate
to educate patients and treat these disorders does not exist the effectiveness of ECHO as an innovative paradigm for
in villages and many small towns of India. Primary care providing best practice care for multiple complex diseases in
physicians currently working in AAPI sponsored clinics in India.
India will collaborate with an Academic Medical Center