181943 New Mexico Project ECHO

Monday, October 27, 2008: 9:15 AM

Sanjeev Arora, MD , Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
Alfredo Vigil, MD , Secretary of Health, New Mexico Department of Health, Santa Fe, NM
Ray Stewart, MA , Public Health Region 5, New Mexico Department of Health, Las Cruces, NM
Project ECHO (Extension for Community Healthcare Outcomes) is a collaborative partnership of the University of New Mexico School of Medicine in Albuquerque, the New Mexico Department of Health and the State Department of Corrections that treats complex diseases in remote, rural parts of the state. It has been a pioneer in teleheath consulting between university specialists and community physicians treating Hepatitis C patients and is now being extended as a successful model for treating other common chronic illnesses or conditions, such as HIV, addictions, and mental health disorders, in underserved areas statewide.

New Mexico leads the nation in the death rate from chronic liver disease and cirrhosis. Since its inception in June 2004, Project ECHO has established 21 HCV treatment centers among FQHC facilities and at 8 prisons around the state, resulting in more than doubling the number of rural and border patients receiving HCV disease management or treatment. Over 70% of these patients are minorities and 40% lack health insurance.

The key component of the ECHO model is a "disruptive innovation" called the Knowledge Network, in which the expertise of a single specialist in an urban tertiary medical center is shared with multiple primary healthcare providers in dispersed locales as the virtual telehealth team connects via videoconferencing and the Internet. Together they co-manage patients with case reviews and participate in continuing education opportunities. A multi-disciplinary team of Public Health professionals in the southwestern section of the state carries out focused case surveillance for field follow-up while maintaining strong outreach and referral connections with local providers to support Project ECHO.

To date results of Project ECHO have been noteworthy for consumers, providers, and taxpayers. Outcome studies of patients comparing successful treatment completion and serious adverse events have demonstrated that the care provided in rural areas and prisons under the remote supervision of UNM specialists is as safe and effective as that provided in a university-based clinic. In ongoing surveys of participating ECHO providers they have expressed statistically significant improvements in professional competence and satisfaction. On the financial side the State appropriations for this hepatitis C initiative have been exceeded by laboratory and pharmaceutical in-kind support from private companies to the UNMHSC.

In September 2007 Project ECHO won the Changemakers award in an international competition from the Robert Wood Johnson Foundation for this “disruptive innovation" which may change the paradigm of how medicine is practiced in New Mexico and globally.

Learning Objectives:
A) Participants will be able to describe and discuss a new model of care (Extension for Healthcare Outcomes- ECHO) that improves healthcare access and infrastructure and addresses health disparities for a major public health problem in a border state by: 1) integrating care between the Public Health Department and the therapeutic arm of the healthcare system. 2) using technology to develop knowledge networks in which specialists from an academic medical center co-manage patients with primary care providers in rural areas and correctional facilities. 3) providing best practice care for chronic, common and complex diseases to rural and under served populations. 4) enhancing primary care provider knowledge and self efficacy for managing chronic complex diseases in the local continuum of care. B) Participants will be able to assess the applicability of the ECHO model for their local areas or jurisdictions by: 1) recognizing the critical success factors for public and private nonprofit organizations implementing special projects or initiatives with limited / minimal new resources to better serve low income and under/uninsured residents. 2) understanding how to establish operational bridges among infectious and chronic diseases with behavioral disorders for program or project progress in rural and border areas. 3) identifying opportunities to improve inter-agency, multi-disciplinary collaboratives on a state or regional scope for the health and healthcare of minority or border populations. 4) analyzing the challenges and options of integrating public health programs for STD, HIV and TB with Viral Hepatitis.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Work experience in city/county, state and federal public health services for approximately 30 years; Region 5 is the first and only public health partner in Project ECHO.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.