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Rural Health Information Hub

Project ECHO® – Extension for Community Healthcare Outcomes

Summary 
  • Need: Increase medical management knowledge for New Mexico primary care providers in order to provide care for the thousands of rural and underserved patients with hepatitis C, a chronic, complex condition that has high personal and public health costs when left untreated.
  • Intervention: Project leveraging an audiovisual platform to accomplish "moving knowledge, not patients" that used a "knowledge network learning loop" of disease-specific consultants and rural healthcare teams learning from each other and learning by providing direct patient care.
  • Results: In 18 months, the urban specialist appointment wait list decreased from 8 months to 2 weeks due to Hepatitis C patients receiving care from the project's participating primary care providers. Improved disease outcomes were demonstrated along with cost savings, including those associated with travel. The project model, now known as Project ECHO® – Extension for Community Healthcare Outcomes — has evolved into a telementoring model used world-wide.

Evidence-level

Evidence-Based (About evidence-level criteria)

Description

Project ECHO logo 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. Current UNM ECHO projects 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. Additionally, ECHO Collaboratives are open to partner participation.

Health and well-being professionals from all fields will likely find topics of interest on the project's dashboard. 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 2022, 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:

Contact Information

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

Topics
Behavioral health
Dementia
Depression
Diabetes
Health conditions
Healthcare quality
HIV and AIDS
Infectious diseases
Obesity and weight control
Substance use and misuse
Telehealth

States served
National/Multi-State, New Mexico

Date added
September 4, 2013

Date updated or reviewed
October 4, 2022

Suggested citation: Rural Health Information Hub, 2022. Project ECHO® – Extension for Community Healthcare Outcomes [online]. Rural Health Information Hub. Available at: https://www.ruralhealthinfo.org/project-examples/733 [Accessed 6 October 2022]


Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.