Project ECHO® – Extension for Community Healthcare Outcomes

Evidence-level

Evidence-Based (About evidence-level criteria)

Description

Rural healthcare providers who care for patients with chronic complex conditions are often challenged because of their own knowledge limitations. Additionally, their patients — because of either long specialty appointment wait-times or travel burden — are unable to access urban specialty medical care.

In 2003, Dr. Sanjeev Arora, a liver specialist at the University of New Mexico (UNM) in Albuquerque, saw the direct impact of limited treatment capacity with respect to hepatitis C, especially increased rates of liver cancer in patients with untreated disease.

To remedy the situation, Arora drew on the basics of his own medical training: medical education's iterative guided learning, also referred to as case-based learning. He created a "hub-and-spoke" telementoring model by leveraging internet connections and using webcams. He described the model as one that "moved knowledge, not patients."

In the model, called Project ECHO® – or Extension for Community Healthcare Outcomes — disease-specific consultants and rural healthcare teams met regularly, were able to learn from each other, and also learned by providing direct patient care. This created a "knowledge network learning loop." Hepatitis C management capacity within the state increased dramatically, due to what Arora terms was the project's "force multiplier" effect. In 18 months, Arora's hepatitis C clinic wait list had decreased from 8 months to 2 weeks reflecting that the project's participating primary care providers' ability to provide the required care had been impacted.

With publication of the initial project outcomes in a 2011 New England Journal of Medicine article, Project ECHO® became a landmark model of telementoring. Also referred to as "technology-enabled mentoring", due to hundreds of research papers supporting the project's scalability, the model has proven its effectiveness in the management of many medical conditions.

In 2012, a trademark was obtained. In 2016, Congress passed Public Law 114-270, "the ECHO Act," a public policy that made Project ECHO® a national model for healthcare collaboration in rural and underserved areas.

As of 2022, the Project is still managed by the University of New Mexico. It has experienced major expansion using a partnership model that is based on 4 key principles:

• Amplification: Leveraging scarce resources with technology and resulting in force multiplication that increases disease treatment capacity
• Disparities reduction: Using best practices
• Promotion of understanding and management of complex medical conditions: Using case-based learning
• Outcome monitoring: Using data collection to increase impact by monitoring project programs and results

Over the last several decades, the model has engaged partners which serve as experts in hubs and superhubs and offer expertise on multiple medical conditions. Superhub status is conferred after sustained activity as a hub.

Project ECHO partners also now use iECHO, a "web-based partner relations management tool" that allows for data collection, ECHO session management, and the provision of online resources. ECHO IT is another offering for the navigating the nuances of the project's audiovisual technology platform.

New medical condition topics are selectively added to the ECHO model if the disease is common, has complex management options with outcomes being improved with an evolving set of treatment options and new medications, and has high societal personal and financial costs. include topics ranging from bone health to first responder training.

Although Project ECHO's main focus has been health, recent global events due to COVID-19 have allowed expansion in New Mexico to the education and public service arenas. Project ECHO is improving education disparities by connecting teachers and principals with experts in order to meet a specific school's needs, culture, and students.

Additionally, public service professionals can also benefit from Project ECHO's platform. The Albuquerque police department has become the first of its profession to use the ECHO model to educate its officers on topics associated with crisis intervention.

At its inception, support for Project ECHO® was provided by the New Mexico Department of Public Health, the New Mexico legislature, and the University of New Mexico. Continuing to operate as a non-profit organization, the project had also received grants from the Robert Wood Johnson Foundation, Agency for Healthcare Research and Quality (AHRQ) and its Minority Research Infrastructure Support Program (MRISP), the GE Foundation, and the Leona M. & Harry B. Helmsley Charitable Trust.

See the Robert Wood Johnson Foundation's early overview of Project ECHO in this 5-minute video:

Services offered

As a telementoring model, Project ECHO® offers its services through the hub-and-spoke activities of its partner hubs and superhubs, the latter gaining designation after gaining experience as an ECHO hub. A superhub is then able to provide training and technical assistance to new hubs.

Health and well-being professionals from all fields will likely find topics of interest by using the project's contact email. Needed equipment for participation is an internet connection, computer or mobile device, and a webcam.

An individual or organization interested in joining an existing ECHO project can find specific contact information and participation guidelines by emailing Project ECHO's replication staff. Often, participation in a series of learning sessions is recommended.

An ECHO meeting follows this framework:

• Duration: 75-120 minutes of recorded audiovisual interaction
  • 20-30 minute PowerPoint presentation on a pre-determined aspect of the medical condition
• 1-2 case templated presentations by participants (no patients participate)
• Community of practice discussion
• Moderation by a trained facilitator

Results

In a recent video, Project ECHO: Origin Story, Arora lists ECHO's benefits for rural providers and those they care for:

• Decreased disparities due to increased access to care in rural, remote, and underserved areas, demonstrating the force multiplier effect
• Decreased healthcare costs associated with:
  • Improved outcomes due to management and treatment interventions
  • Decreased healthcare testing
  • Decreased travel
• Improved patient care quality and safety
• Lessened perception of isolation
• Increased provider satisfaction
• Improved rural provider recruitment and retention
• Support for Patient-centered Medical Home (PCMH) models
• Fostering a culture of collaboration
• Creation of a mixed professional environment of work and learning

Also available through the project is:

• No-cost certified medical education units(CME)/certified education units (CEU)
• Specialty consultation access
• Rapid learning environment

The project maintains a digital biography of research associated with the program.

Replication

Due to substantial expansion within the U.S. — and across the globe — the ECHO model's replication process has been modified over the years. As of 2024, several partnerships offerings are available.

Organizations wanting to join as a new partner should:

• Consider the following:
  • Does the medical condition or topic have a current topic-related ECHO in existence?
  • Is there a condition with need for increasing treatment capacity or training gaps that require an iterative guided practice and ongoing mentoring?
  • Multiple ECHO programs addressing the same topic can exist in same geographic area
• If connecting with Project ECHO® to explore a new partnership, these steps should be followed:
  • Register for dedicated email series
  • Review the 30-minute potential partner video, Project ECHO Introduction

Contact Information

Ben Cloutier, Director of Communications, Marketing and Outreach
Project ECHO
505.750.3246
echoreplication@salud.unm.edu