10/9/2015 PROJECT ECHO & ECHO-TYPE PROGRAMS NORTH COUNTRY HISTORY NORTH COUNTRY MISSION

Transcription

1 PROJECT ECHO & ECHO-TYPE PROGRAMS NORTH COUNTRY HISTORY Northern Arizona AHEC Flagstaff Community Free Clinic North Country HealthCare (FQHC) 1996 NORTH COUNTRY MISSION To provide accessible, affordable, comprehensive, quality primary healthcare in an atmosphere of respect, dignity and cultural sensitivity. The health and well-being of patients and community alike are promoted through direct services, training, education, outreach and advocacy. 1

2 NORTH COUNTRY SERVICES Clinical Primary Care FM, IM, OB/GYN, Peds Dental Behavioral Health Prenatal Care Breast & Cervical Cancer Screening Diabetes Management Program Integrative Medicine Pharmacy HIV/AIDS HCV (Hepatitis C) Community Health Well Woman & Fit At Fifty Health Check Programs Prenatal & Well Child Programs Diabetes Management RESEP HIV/AIDS Program NACASA Hermosa Vida Educational Youth Academic Preparedness, College Readiness, and Health Professions exploration Health Professions Student Education and Training Medical Education Health Professional Continuing Education Programs Community Health Education Research NORTH COUNTRY HEALTHCARE SERVICE AREA NORTH COUNTRY TELEHEALTH - VISION The North Country HealthCare Telehealth Program uses audiovisual technologies to link healthcare providers, patients, educators, consumers and their families to a comprehensive continuum of care and education, in order to reduce the isolation of living and working in rural communities. 2

3 HEP C - STATEMENT OF THE PROBLEM In 2011, there were more than 950 North Country patients with a Hep C diagnosis, listed within the NCH electronic health record system. Today, there are nearly 1500 patients diagnosed. EXTREMELY-LIMITED ACCESS TO CARE Almost none of these patients were receiving Hep C care, nor did they have access to Hep C care, due to the rurality of their location, and also due to the scarcity of Hep C care in their communites of residence. Patients desiring care had to drive to Phoenix, or to Flagstaff, where a one-day-per-month Hep C treatment program was available with a six month waiting list. DETERMINING THE NEED NCH determined to implement a Hep C program providing care to patients via telemedicine. Other treatment types available via telemedicine HIV/AIDS Care Behavioral Health Diabetes Care General Primary Care Teledermatology Others 3

4 NCH - HEP C PROGRAM HISTORY The NCH Hep C program started 2011 Richard Manch, MD and Ann Moore, FNP, Richard Manch, MD and Ann Moore, FNP, then employed by Banner Health/Phx, were holding monthly in-person Hep C clinics in Flagstaff IN-PERSON CARE V. TELEMEDICINE NCH asked if Manch/Moore would be willing to provide Hep C care to pts at remote NCH satellite, via telemedicine. More than 100 direct patients consults occurred in the ensuing year. In late 2012, Banner closed their liver program. After a period of time, Manch/Moore moved to St Joseph Hospital/Dignity Health. NCH Hep C program was closed in the interim, for a number of months. IMPLEMENTING THE PROJECT ECHO MODEL When resurrected, the NCH Hep C program was developed to resemble the University of New Mexcio s Project ECHO program New Mexico, being a largely rural state like Arizona, had a dearth of providers capable of providing Hep C care to patients 4

5 THE PROJECT ECHO MODEL Dr Sanjeev Arora MD, Director of Project Echo created an award-winning program where liver specialists provided Hep C care through a series of weekly care conferences, while simultaneously teaching providers how to provide Hep C care. NCH IMPLEMENTATION - ECHO MODEL At North Country, Manch and Moore no longer see Hep C patients directly, instead, they videoconference each Wednesday morning with ten North Country satellite clinics (currently) The videoconference runs 8-9am, prior to the start of the participating provider s clinical schedules. ECHO-TYPE DIDACTIC SESSIONS Cirrhosis Fatty Liver Drug Interactions HCV Complications HCV Case Studies and many more 5

6 WEEKLY CARE CONFERENCE - FORMAT Part 1: Current lab work for each patient is discussed by Manch/Moore, with current patient condition described by the patients NCH primary-care provider. Discussion ensues. Part 2: Presentation of potential new patients Part 3: Didactic presentation NCH PARTICIPATING CLINICS NCH clinics participating - present and previous: Ash Fork/Seligman Bullhead City Flagstaff Holbrook Kingman Round Valley Show Low St Johns Winslow More clinics/providers to be added in 2015, as need/interest arise. TECHNICAL CONSIDERATIONS Call is bridged by The Arizona Telemedicine Program, Pete Yonsetto, Sr Engineer Call connects at 730am for testing, event runs 8-9am Call connects at 768kbps Greg Hales, NCH Telehealth Manager, moderates the videoconference to assure technical quality Renee Zufelt, Hep C Program Coordinator attends to facilitate human-element 6

7 NCH/PROJECT ECHO PROVIDER EXPERIENCE Richard Manch, MD Ann Moore, FNP See Video Clip NCH HEP C PROGRAM - STATISTICS Weekly Videoconference Initiated: Jan 2, 2013 Weekly Hep C Clinics: 143 Attendee Hours: 2860 Patient Presentations: 1049 Physician (MD, DO): 7 Clinical Pharmacist (PharmD): 2 Average Weekly Provider/Staff Attendance: 17 NCH HEP C PROGRAM - STATISTICS Physician Assistant (PA): 7 Advanced Practice Nurse (NP, CRNA, CNM, CNS): 4 Registered Nurse: 1 Medical Assistant: 8 Other: 7 7

8 HEP C PROGRAM - STATISTICS Patients currently in treatment: Sustained Viral Responses (SVR s) Cures! Awarded 2013 AACHC Innovation Award NCH/PROJECT ECHO PROVIDER EXPERIENCE Elaine Accomando, PA-C See Video Clip NCH/PROJECT ECHO PAIN CLINIC Statement of Need Pain management is a touchy subject in primary care. It s a little bit taboo, because there s so many ramifications about how to manage pain management Prior to ECHO, many NCH providers were somewhat reticent to identify patients as pain management patients, or to manage them in any way in the primary care setting 8

9 NCH/PROJECT ECHO PAIN CLINIC Collaboration started in 2014 Current participants include Pharmacy Director Clinical Pharmacist Two DO s from NCH satellite clinics Two Pharmacy residents Three Pharmacy students NCH/PROJECT ECHO PAIN CLINIC Result of Participation NCH has completely reviewed and revised all of its pain management protocols, patient agreements, both in English and in Spanish. Have started to develop a broader scope of controlledsubstance policies for providers and patients. Providers are now more comfortable providing care, and feel more confidence, in ability to prescribe controlled substances, when needed. NCH/PROJECT ECHO PAIN CLINIC Benefit of Participation ECHO provides the opportunity to present individual patient cases, with privacy protected The opportunity to tap in to expert resources, that would not otherwise have access to in NCH rural communities. Have been able to develop collaborations with other providers: Physical therapy, chiropractic, behavioral health, surgeons and specialists in different fields. Has brought a robust amount of care to NCH patients, that would have otherwise not been available. 9

10 NCH/PROJECT ECHO PAIN CLINIC Result of Participation Program allowed provider to understand the full-range of NCH services available to the patient, which extends beyond medications to provide the opportunity to participate in their care Various modalities including Behavioral health Physical Therapy Mindfulness-Based Stress Reduction Yoga ECHO participation has given providers a clear picture of when it s appropriate to treat chronic pain patients in a primary care setting, and when it may not be. NCH/PROJECT ECHO SUCCESS STORY Kim Christoff, NCH Pharmacy Director See Video Clip IN CONCLUSION With nearly 1500 NCH patients with a Hep C Diagnosis. There truly is no way for NCH to be able to treat these patients, other than along the lines of the Project ECHO Model. The ECHO model can be used for many conditions, and in so doing, ensure patients receive care in their home communities within a medical home model 10

11 CONTACTS Greg Hales, Telehealth Program Manager Direct: Mobile: Sean Clendaniel, NAHEC Director Direct: Mobile: