Mission Project ECHO New Mexico Michelle Iandiorio, MD Medical Director, HIV ECHO Associate Professor, UNM DOIM, Div ID Democratize medical knowledge and get best practice care to underserved people all over the world. Expand workforce capacity Expand access to primary & specialty care Utilize multidisciplinary approach Disseminate best practices Engaging learners in continuous learning system & partnering them with specialist mentors Supported by New Mexico Department of Health, Agency for Health Research and Quality, New Mexico Legislature, the Robert Wood Johnson Foundation, the GE Foundation and Helmsley Trust Goal Improve the lives of 1 billion people by 2025. http://echo.unm.edu TedX Talk: https://youtu.be/ly5nljxac0g https://youtu.be/h3qy3b4ymam Moving Knowledge Instead of Patients 1
Methods TeleECHO Clinic Use Technology to leverage scarce resources Sharing best practices to reduce disparities Case based learning to master complexity Web-based database to monitor outcomes Arora S, Geppert CM, Kalishman S, et al: Acad Med. 2007 Feb;82(2): 154-60. Copyright 2015 Project ECHO ECHO vs. Telemedicine Project ECHO -NMAETC HIV TeleECHO Clinic ECHO Telehealth Traditional Telemedicine ECHO Supports Community Based Primary Care Teams Specialist Manages Patient Remotely Patients reached with specialty knowledge & expertise Started in 2009 (Project ECHO started in 2003) Weekly sessions: Tuesday 12-1pm MT Short didactic presented by AETC faculty Case presentations by participating providers (spokes) Discussion among group & recommendations from interprofessional experts from around the state Builds community of practice Capacity building & mentorship 2
Successful Expansion Benefits to Participants Hepatitis C (2003) Complex Care HIV Geriatrics Endocrinology Palliative Care Bone Health Tuberculosis Chronic Pain CHW Specialist Integrated Addictions & Psychiatry Prison Peer Educator Women s Health & Genomics No cost CME, Pharmacy CE, Nursing CEU Professional interaction with colleagues with similar interests Less isolation with improved recruitment & retention A mix of work and learning Access to specialty consultation with HIV experts, pharmacists, mental health providers, case management, etc Benefits to Hub Increase impact Reduce wait times Improve appropriateness of referrals Improve relationship with community Work with interprofessional team Learn from community of practice/collaborative Community of Practice (Social Network) Joy of Work Mentor/Mentee Relationship What Makes ECHO Work? Team Based Care Technology Force Multiplication Demonopolizing Knowledge Knowledge Expansion Movement Building vs. Organization Building Copyright 2015 Project ECHO Task Shifting Interprofessional Consultation Guided Practice 3
Join the ECHO Movement Renita Madu, PA https://www.youtube.com/w atch?v=3fane_ud0xe&list=p LoL7mi3iOLMLO3BC_2M- ZkDgDYhLOW0Pn&index=11 ECHO Immersion Training 3-day training echoreplication@salud.un m.edu Overview of Project ECHO Nevada Chris Marchand, MPH Office of Statewide Initiatives, University of Nevada School of Medicine June 10 th, 2016 Project ECHO Nevada Background Planning began in late 2010 Rural road trips/site visits/needs assessment during July and August 2011 First clinic launched April 2012 Diabetes ECHO 4
Project ECHO Nevada Clinics Project ECHO Nevada Clinics For Primary Care Providers Sports Medicine Gastroenterology Public Health Behavioral Health in Primary Care Pain Management Diabetes/General Endocrine Antibiotic Stewardship Rheumatology Hepatitis C Geriatrics For Behavioral Health Providers Mental Health Professional Development Group (Junior Clinicians) Mental Health Professional Development Group (Experienced Clinicians) Psychology Internship Supervision Group Marriage and Family Therapist Internship Supervision Group ECHO Clinics in Development Juvenile Justice Wilderness Medicine Nurse Practitioner Supervision Nevada Interscholastic Activities Association ECHO-Nevada Collaborations Nevada Rural Opioid Overdose Reversal (NROOR) Program HealthInsight Behavioral Health Initiative Project ECHO New Mexico Substance Abuse Expansion (MAT Training) Nevada Antibiotic Stewardship Program Challenges in Nevada Vickie Boll, PA-C 1) Not enough primary care doctors 2) Not enough specialty doctors 3) Maldistribution of physician workforce 4) Geographic isolation of health care facilities Diane McGinnis, APRN 5
Table 4.49: Population Residing in Health Professional Shortage Areas (HPSAs) in Nevada 2015 Population Residing in Health Professional Shortage Areas (HPSAs) Region/County Primary Medical Care HPSAs Dental HPSAs Mental HPSAs Population Number Percent of Population Number Percent of Population Number Percent of Population Rural and Frontier Churchill County 1,412 5.5 1,412 5.5 25,665 100.0 25,665 Douglas County 7,536 15.7 0 0.0 48,003 100.0 48,003 Elko County 3,520 6.4 10,779 19.6 54,993 100.0 54,993 Esmeralda County 959 100.0 959 100.0 959 100.0 959 Eureka County 2,069 100.0 0 0.0 2,069 100.0 2,069 Humboldt County 712 3.9 0 0.0 18,248 100.0 18,248 Lander County 6,708 100.0 6,708 100.0 6,708 100.0 6,708 Lincoln County 5,117 100.0 5,117 100.0 5,117 100.0 5,117 Lyon County 53,639 100.0 53,639 100.0 53,639 100.0 53,639 Mineral County 4,356 100.0 4,356 100.0 4,356 100.0 4,356 Nye County 45,081 100.0 45,071 100.0 45,081 100.0 45,081 Pershing County 7,031 100.0 7,031 100.0 7,031 100.0 7,031 Storey County 4,037 100.0 0 0.0 4,037 100.0 4,037 White Pine County 30 2.9 10,345 100.0 10,345 100.0 10,345 Region Subtotal 142,476 50.6 145,426 51.4 286,251 100.0 286,251 Urban Source: Nevada Rural and Frontier Health Data Book, 7 th Edition. University of Nevada School of Medicine (2015). Carson City 51,186 92.9 0 0.0 55,098 100.0 55,098 Clark County 612,710 29.6 612,710 29.6 736,908 35.6 2,069,967 Washoe County 151,761 34.2 145,105 32.7 443,745 100.0 443,745 Region Subtotal 815,657 31.8 757,815 29.5 1,235,751 31.1 2,568,810 Nevada Total 962,156 33.7 903,241 31.7 1,522,002 38.1 2,855,061 Sources: Health Resources and Services Administration (2015). Nevada State Demographer s Office (2014a). Impact and Outcomes of Project ECHO Nevada Build the capacity of rural and frontier primary care workforce Reduce professional isolation and improve primary care recruitment and retention FREE CME and nursing CEU credits for rural physicians, P.A.s, nurses, and pharmacists Improve reimbursement to participating rural hospitals, clinics, and providers Rural Provider Feedback on Barriers Primary Care providers don t have enough time Sparse mental health and substance abuse resources in rural Nevada put extra strain on their time Rural providers lack access to urban specialists Technology issues dissuade providers from participating more than once 6
Chris Marchand, MPH Project ECHO Nevada Program Coordinator Office of Statewide Initiatives University of Nevada School of Medicine (775) 682-8476 cmarchand@medicine.nevada.edu http://medicine.nevada.edu/echo Hawaii ECHO Logistics: Behavioral Health 1 hour, once a week, noon to 1 Pulse didactic Case presentations Use ECHO PPT resources 1 year schedule Hawaii:Behavioral Health ECHO Started 1/19/2016 Session Date Attendees Sites # Islands 1/19 33 15 3 1/26 29 16 3 2/2 22 13 4 2/9 26 16 4 2/16 28 17 4 2/23 27 18 4 3/1 18 13 4 3/8 24 13 4 3/15 17 14 4 3/22 17 13 4 3/29 19 13 4 4/5 18 12 3 4/12 22 14 3 7
8
Costs? Coordinator Hub experts CME costs Minimal equipment, connectivity Cost Per year Comments Hub experts $20,000 per year per $100 per hour for clinic specialists Equipment $240 4 webcams, 1 mic, purchasing fancy camera for $400 CME $10,000/yr $10 per person per session Coordinator $50,000+ Estimated $53K/yr Banner $240 2 banners Where does the money come from? Department of Health, different departments ($54K to date) CME and personnel-form AHEC ($40,000) Hawaii State Rural Health Association-applying for grants from local healthcare foundations Private insurance company-wellcare $7,000 Challenges Time consuming Recruitment of spoke participants Getting cases out of people Arranging speakers Make sure you eat if it is a lunch session Connectivity (actually rarely a problem) Consistency New topics Endocrine (12 weeks starting 2/ 19) Integration of Primary Care and Behavioral Health monthly Geriatrics once a month CHW training on dementia once month Pediatrics Subspecialties Homelessness Eradication School Health a 9
Suggestions Multiple computers (one for PPT, one for chat) Have extra hub members in case of vacations Difficult finding a time to meet Incentives for presenting Teaching self muting and chat pays off How to break into PPT for chat questions Texting with coordinator initially Case in PPT Follow up? Questions or Comments? New Mexico: http://echo.unm.edu/ Hawaii: echohawaii.org Kelley Withy Withy@hawaii.edu 10