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Project ECHO: An Effective Means of Increasing Palliative Care Capacity
Sanjeev Arora, MD; Tracy Smith, BS; Jennifer Snead, PhD; Sarah Zalud-Cerrato, MPH; Lisa Marr, MD; Max Watson, MBChB; Sriram Yennu, MD; Amy Bruce, MPP; Chris Piromalli, DO; Stacy Kelley, MPH; Nandini V
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Project ECHO: An Effective Means of Increasing Palliative Care Capacity

Sanjeev Arora, MD; Tracy Smith, BS; Jennifer Snead, PhD; Sarah Zalud-Cerrato, MPH; Lisa Marr, MD; Max Watson, MBChB; Sriram Yennu, MD; Amy Bruce, MPP; Chris Piromalli, DO; Stacy Kelley, MPH; Nandini V
This article provides insight on the work of 7 of Project ECHO’s replicating partners from around the world who are implementing the ECHO model to address the knowledge gap that underlies integrated palliative care crisis.
The UNM Experience
The UNM Hospital started the first palliative care teleECHO clinic in 2011. Pre- and post-surveys of participants have demonstrated improved self-efficacy (P = .0073) and greater knowledge of pain and non-pain symptom management with participation (P = .0156).22 In the fall of 2017, a new session of the UNM Palliative Care ECHO will begin, this time with a focus on primary palliative care for non-specialists of all disciplines. In preparation for this next phase, members of the teleECHO clinic specialist team are traveling around the state to conduct needs assessments and discuss potential benefits of this clinic with nonspecialists.

Northern Ireland Hospice
Northern Ireland Hospice first implemented ECHO for palliative care in 2014 under the leadership of medical director Max Watson, MD. Community hospice nurses (CHNs) who were employed reported that ECHO created a safe space for those working in isolation to talk about and learn from failures and successes in their own work, and to support each other. The original 6-month pilot was evaluated using a mixed-methods prospective longitudinal cohort study involving 28 CHNs. Mean knowledge scores improved significantly, as did overall self-efficacy scores. Seventy percent of CHNs reported that the technology used in ECHO had given them access to education that would have been hard to access due to geography. The study provided evidence for Project ECHO-connected networks of CHNs as an affordable solution to the United Kingdom’s growing need for hospice and palliative care. The Northern Ireland Hospice has become an ECHO superhub, and in partnership with the Health and Social Care Board of Northern Ireland, has launched 19 different teleECHO clinics, many of which address integrated palliative care.

Northern California-based ResolutionCare launched a palliative- care-to-primary-care teleECHO pilot program in September 2015. Working with Partnership HealthPlan of California, a non-profit healthcare organization contracted with the State of California to administer Medi-Cal benefits, ResolutionCare implemented the ECHO model to provide hospice and palliative medicine training to primary care teams at 10 federally qualified health centers throughout Northern California.23 In addition to using ECHO for developing palliative care curricula and networking community partners with physicians and other healthcare professionals, ResolutionCare’s pilot explores value-based systems of payment. After April 2017, when California Senate Bill 1004 on Palliative Care goes into effect, standardizing value-based systems statewide, the ResolutionCare’s pilot program will become an ongoing initiative to address California’s exploding demand for palliative care.24

The palliative care service of Montevideo’s Hospital Maciel in partnership with Universidad de la República, started a palliative care teleECHO clinic in August 2015. Prior to this, the ECHO model had been implemented to train hepatitis C providers in Uruguay. The palliative care teleECHO clinic for adults created an interdisciplinary network of health professionals who assist patients in advanced or terminal stage of their disease throughout the country. Multidisciplinary specialist teams collaborate with providers in comprehensive patient and family assistance, collective decision-making, and a holistic, QOL approach to patient care. Watson, of ECHO Northern Ireland, traveled to Uruguay during the initiative’s planning stages to engage local providers, share best practices for utilizing the ECHO model for hospice and palliative care, and learn about how palliative care is practiced in Latin America. Watson’s mentorship at the beginning of the teleECHO palliative care clinic in Uruguay further demonstrates the collaborative potential of the global ECHO network.25

MD Anderson Cancer Center
In May of 2016, the Department of Palliative Care, Rehabilitation, and Integrative Medicine at the University of Texas MD Anderson Cancer Center launched its Palliative Care ECHO Telementoring Program (ECHO PACA) in collaboration with clinicians in South Africa, Zambia, Kenya, Nigeria, Ghana, Brazil, and Mozambique. ECHO PACA’s goal is to build a network of palliative care experts in Africa, connecting experts and providers through the ECHO model to provide increased access and quality palliative care for patients with life-limiting cancer diagnoses.26

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