NORTHWEST AIDS EDUCATION AND TRAINING CENTER

Introduction to NW AETC ECHO

Christian B. Ramers, MD, MPH

Presentation prepared & presented by: Christian Ramers, MD, MPH, Kent Unruh, PhD, Mary Annese, MPA, and Laurie Conratt, MBALast Updated: April 3, 2012

NW AETC ECHO Mission

NW AETC ECHO Telehealth Program

• Build capacity to maximize treatment of chronic HIV infection in underserved areas, monitoring outcomes

• Catalyze knowledge sharing between clinicians developing treatment expertise across the Pacific Northwest region

• Disseminate treatment innovations quickly across a network of clinicians

• Maximize HIV care in local communities (FQHC’s, community clinics), treating patients locally with expert knowledge

BACKGROUND

The History of Project ECHO

NW AETC ECHO Telehealth Program

2002 – Frustration

• 30,000 patients 6 month wait

2002-2008 – Roll-Out

•Ashoka Changemakers Award•AAMC Spencer Foreman Award for Outstanding Community Service

2009 – Expansion

•UW, U of Chicago, Harvard

2011 – Legitimacy

• Landmark NEJM ArticleDr. Sanjeev Arora

Evidence Supporting Project ECHO

NW AETC ECHO Telehealth Program

Arora S, et al. Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers. NEJM 2011

• Similar Hepatitis C treatment outcomes at ECHO clinics and UNM academic clinics (SVR 58.2 vs. 57.5, P = 0.89)

• Decreased professional isolation

• Increased provider knowledge & self-efficacy

SET UP

NW AETC ECHO Groundwork

NW AETC ECHO Telehealth Program

• Utilize collaborators and partner networks to recruit eligible clinic sites for participation

• Develop tools to meet AETC Telehealth program needs

• Develop web-based resources

• Identify NW AETC ECHO multidisciplinary team

• Develop curricula blocks for didactic sessions

• Conduct site visits with interested sites: - Foster buy-in with clinicians and administrators

- Baseline needs assessment

- Technology assessment

Adobe Connect Streaming Live Video

Didactic & Cases | Questions via Text

Full Live Video InteractionDidactic + Case Consultation

Tier 1

Tier 2

Tier 3

On-Demand Access to mini-Didactics Only in ECHO Archive

NW AETC ECHO Telehealth Program

Tiered Concentric Participation Model

Mechanics of Weekly Telehealth Sessions

NW AETC ECHO Telehealth Program

Mini-Didactics•Focused clinical topic•First 15 minutes of each session•Additional 5 minutes for discussion•Recorded/archived for future viewing

Case consultations•Remainder of session•Goal 3-4 cases per session•Each site should contribute at least one case per month

Resources for Participants

NW AETC ECHO Telehealth Program

• Presenting Cases!!!• Mini-Didactics (live or archived)• Availability of NW AETC ECHO Specialists 24/7• Additional resources via email

- Hot topics & Articles of interest

• Website: www.nwaetcecho.org- Streaming archive of videos (additional topics!)- Forms , Faculty & contact info- Curriculum, Upcoming session information

• CME and CNE available for participants

EVALUATION PLAN

Program Evaluation

NW AETC ECHO Telehealth Program

Clinic Level Assessment •Q12 months•Clinic goals•Standard clinical quality measures

Provider Level Assessment •Q6 months•Individual provider goals•Knowledge, Self-Efficacy, Community of Practice

Within-Session Tracking•Case presentations, Participation•Recommendations and peer-to-peer interactions

PRELIMINARY RESULTS

NW AETC ECHO Telehealth Program

ALASKAWASHINGTON

OREGON

IDAHO

MONTANA

ECHO - Chronic Pain27 sites

ECHO - Integrated Addiction and Adult Psychiatry, 42 sites

ECHO – HCV, 21 sites

NW AETC ECHO Sites

www.nwaetcecho.org

NW AETC ECHO Telehealth Program

Clinic Level Assessment •Q12 months

Specialist

Panel:

ID – Hep C

PharmD

Case Manager

ID – HIV

Psychiatry

ID – HIV

Family Medicine

Informatics

Nursing

ID - HIV

Seattle, WA

Snowmass,

CO

Anchorage, AK

Pocatello, ID

Bozeman, MT

Medford, OR

Springfield, OR

Twin Falls, ID

Spokane, WA

Barriers and Solutions

NW AETC ECHO Telehealth Program

• Provider Buy-in- Perceived need for weekly time commitment

• Administrative Buy-in- Allowing providers to participate for 1 hour every week- IT barriers

• Face-to-face site visit- Build relationships with clinic and providers – program champions- Obtain baseline assessment information- Assess clinic workflow and technology- Case review (level IV training) in clinician’s own environment

• Target Audience- Tiered participation model, recorded mini-didactics- Ensuring a diversity of content: basic cutting edge

Resources

NW AETC ECHO Telehealth Program

• www.nwaetcecho.org • Recorded Didactics• Curriculum• Staff/Faculty

• To join a session: 1. Let us know you’ll be joining:

• Christian Ramers: ramers@uw.edu• Kent Unruh: ktunruh@uw.edu

2. At 12:00 PST, log in to uwsom.adobeconnect.com/echohiv• Sign in as a ‘guest’• Provider your name & credentials

• Any further questions: ramers@uw.edu

How is this relevant to your work?

Can you envision an ECHO-like program within your training & mentoring programs?

How can ECHO foster cross-FTCC collaboration?

Questions & DiscussionQuestions & Discussion