Dr Sanjeev Arora Discusses the Specifics of Project ECHO and How Community Clinicians Benefit

The Project ECHO program helps make local community providers into experts in specialty areas in order to improve access to care for their patients, explained Sanjeev Arora, MD, FACG, MACP, director and founder of Project ECHO and a professor of medicine at University of New Mexico.

What are the specifics of Project ECHO, and what would you want a community clinician to know about it?
We started ECHO based on 4 key ideas. First, was to use technology to leverage scarce resources that only exist at the University of New Mexico or a tertiary center. And, in this case, I need a psychiatrist, a pharmacist, and, myself, a liver specialist, and it was hard enough to get these 3 together in a university—in a rural area it was impossible. So, we said we would use 1 to many video conferencing. Like Hollywood Squares. And that we would mentor primary care clinicians to provide hepatitis C care.

So, that’s the first idea, to use technology, and the second is sharing best practices. So, what we did is, we set up 21 centers of excellence for treating hepatitis C all over New Mexico. You know, 28,000 patients had already been diagnosed and less than 1500 had been treated because access to treatment was so poor. And 16 of these were in rural clinics and 5 were in the prison system. And in order to be a center of excellence you had to have a general practice clinician as the leader. So, we gave them our protocol, but nobody was willing to treat hepatitis C, and so, I asked myself, “How did I become an expert in treating hepatitis C?” I wasn’t born that way. And when I did my fellowship in Boston, I would see a patient, present to my professor, see another one, present to my professor, and then after 2 years they started calling me a gastroenterologist. So, I said, “Ah-ha, I’m going to use this model to create new hepatitis C specialists in New Mexico.”

The heart of ECHO is what is called a TeleECHO Clinic, so that all of these 20 who joined simultaneously on an interactive video conference talking to each other and to us and present cases of hepatitis C in a deidentified way. We would do this every week on Wednesday from 3 to 5 pm; we still do that. And they present cases, and as they present cases, over the course of a year, they became experts, because they were learning from us, our advice, our lectures. We would give them 15-minute lectures and discuss about 10 cases every week. And they would learn from each other, because they brought 1 patient every week, and they would learn on 10 in a week, 300 in every year.

And over time they became great experts, but mostly they became experts by doing. So, we would give them guidance, they would implement that guidance, come back next week, and we found they became such experts that after 18 months, the wait in my clinic had fallen from 8 months to 2 weeks, and everyone in New Mexico could get access to treatment within 2 weeks. And the cure rates were high, so that’s when we decided, this could be applied to many, many diseases, many problems, including cancer prevention, cancer screening, early diagnosis of cancer, helping oncologists in small towns to treat cancer better, survivorship of cancer, palliative care, and other implications of the disease. And now we operated in 33 countries, they have partnered 240 universities and not-for-profits in the world to implement Project ECHO for more than 70 healthcare conditions.
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