NEJM: PCPs treat hepatitis C as effectively as specialists through new delivery model

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http://www.eurekalert.org/pub_releases/2011-06/bc-npt060211.php

Public release date: 2-Jun-2011

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NEJM: PCPs treat hepatitis C as effectively as specialists through new delivery

model

University of New Mexico's Project ECHO poised to spread best practices,

eliminate barriers to treatment and improve health care quality across the

United States

Albuquerque, NM – Under a completely new way of providing health care, primary

care clinicians in remote villages, prisons and poor urban neighborhoods who

were trained to treat patients with hepatitis C achieved excellent results

identical to those of specialists at a university medical center.

These findings, from an evaluation of Project ECHO (Extension for Community

Healthcare Outcomes), were published today online by the New England Journal of

Medicine and will appear in the June 9 print edition. They demonstrate that

primary care providers anywhere can be trained via videoconferencing technology

to manage complex chronic conditions formerly outside their expertise, thus

expanding their ability to treat very sick patients. Project ECHO is based at

the University of New Mexico Health Sciences Center (UNMHSC) in Albuquerque.

" By producing what we call a 'force multiplier effect,' Project ECHO transforms

the dynamics – and the capacity – for health care delivery and spread of best

practices, " said Sanjeev Arora, M.D., the hepatologist at UNMHSC who created

Project ECHO. " This model empowers primary care clinicians to provide

high-quality specialty care locally, and holds promise for dramatically changing

clinical practice and medical education nationally. "

Using real-time videoconferencing technology and best-practice medicine, Project

ECHO teams primary care clinicians with specialists at academic medical centers,

who train them in new areas of care delivery and co-manage patients with them.

Project ECHO is not traditional telemedicine that facilitates a one-to-one

remote connection between a doctor and a patient. In fact, no patient is ever

seen during an ECHO teleclinic. Instead, through Project ECHO, primary care

providers can treat many more patients with serious illnesses right in their

communities.

Although the findings from the NEJM evaluation focus exclusively on treatment of

hepatitis C, the Project ECHO model is being used to train primary care

clinicians to locally treat patients with a dozen other chronic conditions.

Risa Lavizzo-Mourey, M.D., president of the Wood Foundation

(RWJF), which has provided a three-year, $5 million grant to Project ECHO,

called the ECHO model " the future of health care for those who aspire to

excellence. " The ECHO model, she said, " demonstrates how health care providers

everywhere can – and should – work collaboratively to provide better care. "

" Project ECHO has the potential to transform health care as we know it, "

Lavizzo-Mourey said. " What began as a truly disruptive innovation in New Mexico

for treatment of hepatitis C has the capacity to re-engineer health care

delivery and training across the health care system. "

RWJF's funding aims to bring the ECHO model to " industrial strength " within New

Mexico and spread it to health care providers nationwide. Replications are

underway in Washington state and Chicago, and other potential sites are actively

exploring the model. Several government agencies have expressed strong interest

in ECHO as well.

The NEJM evaluation assessed cure rates among 407 patients with hepatitis C who

had received no previous treatment for infection. Project ECHO enrolled 261

patients and UNMHSC enrolled 146. Cure rates were 58.2 percent for patients

treated through Project ECHO and 57.5 percent for the group treated at UNMHSC.

Results for both groups were significantly higher than cure rates achieved in

previous community-based treatment studies for hepatitis C. The evaluation also

showed that the ECHO model can reduce – and even eliminate – racial and ethnic

disparities in treatment outcomes by bringing more services to minority

communities.

In an editorial accompanying the evaluation, D. Sequist, M.D., associate

professor of medicine and of health care policy at Harvard Medical School and

Brigham and Women's Hospital, called Project ECHO a " promising step " toward

overcoming barriers to health care delivery and encouraged " expanding such

innovative care models throughout the U.S. health care system. "

" The key to this study is that technology helped local physicians and other

providers deliver safe, high-quality care within their own – in most cases,

underserved – communities, " said Carolyn M. Clancy, M.D., director of the

federal Agency for Health Care Quality and Research (AHRQ), which funded the

evaluation. " We've known that geography can play a role in timely and

appropriate treatment, especially managing complex conditions such as hepatitis

C. However, it doesn't have to mean destiny. "

Hepatitis C a Launching Pad for Other Treatment Clinics

Dr. Arora created Project ECHO to combat hepatitis C in New Mexico, which has

very high rates of hepatitis C. As a specialist, Dr. Arora could only treat 70

to 90 patients a year in his clinic, yet more than 30,000 New Mexicans had the

disease.

At the time, few physicians in New Mexico were trained to treat hepatitis C. For

patients who don't have access to a specialist where they live, it can be

extremely difficult – if not impossible – to get the specialty care they need.

The treatment regimen is grueling and requires 12 to 18 visits a year to a

specialist. Yet, contrary to popular belief, hepatitis C can be cured.

Under the ECHO model, primary care clinicians—including physicians, nurses,

physician assistants and community health workers—are organized into knowledge

networks that meet weekly via videoconference to present patient cases. These

" virtual grand rounds " are led by UNMHSC specialists who review and discuss the

cases with primary care providers and also share best practices with them.

Web-based disease management tools facilitate consults, and specialists and

primary care providers jointly manage complex chronic illness care for patients.

Primary care providers then treat patients in their own communities.

Project ECHO launched its hepatitis C clinic in 2003. Today, Project ECHO's

videoconferencing clinics address asthma, mental illness, chronic pain, diabetes

and cardiovascular risk reduction, hepatitis C, high-risk pregnancy, HIV/AIDS,

pediatric obesity, rheumatology and substance abuse.

Within New Mexico, more than 1,000 doctors, nurses, nurse practitioners,

physician assistants and community health workers have participated in Project

ECHO's clinics and trainings, and Project ECHO has performed more than 10,000

case consultations through its knowledge networks. In this way, many thousands

of patients in New Mexico have received much-needed specialty care.

###

In addition to funding from RWJF's Pioneer Portfolio and AHRQ, Project ECHO

enjoys strong support from the New Mexico Legislature, the University of New

Mexico and the New Mexico Department of Health.

The Wood Foundation focuses on the pressing health and health

care issues facing our country. As the nation's largest philanthropy devoted

exclusively to improving the health and health care of all Americans, the

Foundation works with a diverse group of organizations and individuals to

identify solutions and achieve comprehensive, meaningful and timely change.

Projects in the Pioneer Portfolio are future-oriented and look beyond

conventional thinking to explore solutions at the cutting edge of health and

health care. For more information, visit our website at www.rwjf.org/pioneer.