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Project ECHO: Supporting Primary Care Providers to Address Complex Conditions
Better Health Conference 2019June 6, 2019
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Lise TancredeProject Manager, Qualidigm
Marlene MoraninoSenior Director of Clinical ProgramsCommunity Health Center Association of Connecticut
Presenters
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Today’s Objectives
• Understand Project ECHO® fundamentals• Raise awareness of the Benefits and Value of
Project ECHO• Gain familiarity with the regional ECHO
programs offered by CHCACT, Qualidigm and the Northern New England ECHO Network
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What is Project ECHO?
Project ECHO® is a lifelong learning and guided practice model that revolutionizes medical education and exponentially increases
workforce capacity to provide best practice specialty care and reduce health disparities through its hub-and-spoke knowledge sharing networks
People need access to specialty care for complex conditions
Not enough specialists to treat everyone,
ECHO® trains primary care clinicians to
provide specialty care services
Patients get the right care, in the right place,
at the right time.
Copyright © ECHO Institute
Extension of Community Healthcare Outcomes
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Project ECHO Mission
Project ECHO (Extension for Community Healthcare Outcomes) is a:
▪ movement to demonopolize knowledge and amplify local capacity to provide best practice care for underserved people all over the world.
▪ The ECHO model™ is committed to addressing the needs of the most vulnerable populations by equipping communities with the right knowledge, at the right place, at the right time.
▪ Goal is to touch the lives of 1 Billion people by 2025.
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The ECHO Model
Amplification – Use Technologyto leverage scarce resources
Share Best Practices to reduce disparity
Case Based Learningto master complexity
Web-based Database to Monitor Outcomes
Copyright © ECHO Institute
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HUB AND SPOKE MODEL
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Graphic and visual conceptual framework used with permission from Kent Unruh and Project ECHO.
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ECHO model is not ‘traditional telemedicine’. Treating Physician retains responsibility for managing patient.
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ECHO Creates VALUE for All Parts of the Healthcare System
• Patients• The Community• The Community Clinic• The Engaged Provider (spoke)• The Center of Excellence (hub)• The System (payers)
Copyright 2017 Project ECHO®
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Hubs in New England Community Health Center Association of CT Hub Hartford Health and Human Service Hub Weitzman Institute Hub
Connecticut
Massachusetts
UMass Memorial Medical Group Lurie Center for Autism Boston Medical Center Beacon Health Options
Vermont
University of Vermont (UVM)
New Hampshire
Dartmouth Hitchcock University of New Hampshire (UNH)
Maine MaineHealth Maine Medical Center Quality Counts, a Qualidigm Company MCD Public Health
Northern New England Network (NNE Network)
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Community Health Center
Association of CT
CHRONIC PAIN AND ADDICTIONS
Project ECHO
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Choosing the Topic: Chronic Pain and Addictions
Community Health Center Association of CT –Primary Care Association
Mission is to advance and align the work of health centers with stakeholders to improve the health and wellness of all.
Pain management in the context of the Opioid epidemic
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The Goals
▪ Increase access to evidence-based practices for diagnosis and treatment of SUDs and chronic pain.
▪ Join a community of practice to build capacity and competency for diagnosis and treatment of SUDs and chronic pain.
▪ Present de-identified individual patient cases related to the diagnosis, treatment or prevention of SUDs and chronic pain with content experts and peers.
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Our ECHO Experience▪ The “Spokes” or teams from 5 Health centers
▪ The “Hub” /subject matter Experts- included specialists in Addiction Psychiatry, Chronic Pain Management/non-opioid alternatives and Pharmacy.
▪ Determine the frequency and time- 90 minute sessions
▪ Each session begins with (15 to 20 minute) didactic presentation developed by the specialist panel on specific topics of interest.
▪ Followed by providers presenting deidentified patient cases All participants are encouraged to contribute actively to case discussions.
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CASE BASED LEARNING▪ HIPPA complaint, in-depth case-based presentations by
clinicians for feedback and recommendations
▪ Case can be a patient they are struggling with or had success with using some innovation
▪ The SMEs provide feedback and recommendations to the clinician, and the peers join in the discussion to provide any feedback or questions.
▪ This type of case-based learning enhances their ability to extend specialty care to the patients. Limits some of the patient barriers to some treatments
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Example of Case
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POWERFUL LEARNING TOOL: A mix of work and learning
▪ A group learning, best practices, guidelines and protocols reduce variation in care and improve outcomes for patients
experiencing chronic pain and SUDaccess to evidence-based educational resources, treatment guidelines,
tools, and patient resources▪ Benefit from the collective expertise of multi-disciplinary specialists experts trained in addiction psychiatry and chronic pain management experiences of other practitioners who provide direct patient care. ▪ Join a supportive network of peers▪ Build confidence in caring for complex patients and enable some treatment to be provided at the health center level.▪ FREE CMEs
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Lessons Learned
Commitment of Time▪Clinician time- Leadership buy in▪CMEs management ▪Program development and facilitation▪Case submission
FUNDING▪Grant writing and reporting
Technology- Zoom
Meeting the needs of the “Spokes”▪Added a medical research librarian▪Added a MD with medical toxicology training and FQHC experience▪Added non FQHCs clinicians
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Chronic Pain and Addictions Statistics
Total sessions - 18 ▪27 hours ▪18 didactics delivered▪1 at every session
Participants▪ 281 total participants▪ Average 15 per session
Breakdown by specialty▪10 physicians/MDs▪12 Advanced Practice▪5 Registered Nurses▪1 medical assistant▪5 mental health professional , LCSW, LPCC etc.▪Other 19- pharmacy students, other non clinical - from academic programs, project ECHO staff etc.
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Evaluation Data
Scale of 1 -5▪1 being not effective at all▪5 being highly effectiveInformation from this activity will be incorporated into my medical practice:
4-5 highly effective
Provided practical suggestions I can apply in my practice:
4 -5 highly effective
92 %
78 %
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% Patients dispensed an opioid with a toxicology screen
21.00%
27.00%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
1
% O
F M
EMBE
RS
AGGREGATE DATA ROLLING 5 MONTHS AVERAGE
non-ECHO participants ECHO Participants
Based on Medicaid claims for Health Center Members
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Patients filling Opioid Prescription above 100 MME
10.50%
7.25%
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
1
% O
F M
EMBE
RS
AGGREGATE DATA ROLLING AVERAGE 5 MONTHS
non-ECHO participants ECHO Participants
Based on Medicaid claims for Health Center Members
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Evaluation Comments
Changes in my practice I am going to make:▪Discuss attainable pain goals with patients.▪Screening and evaluate appropriate pain regimen▪Be cautious with patients with comorbid substance abuse▪Refer to NA, Al Anon, Narcanon▪Close attention to "diversion" potential must be paid ▪Consistent urine testing ▪Re-evaluate while patients are in pre-contemplation▪More motivational interviewing ▪Info on benzos with buprenorphine was helpful▪Gave real life situations to be careful of(ie pt. selling meds)▪Offer more info about alternative practices
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Evaluation Comments
Barriers to change▪Getting patients in support programs
▪Staff support for patient follow-up
▪I am a lead clinician in our Suboxone program, already implementing much of this info, however it was great re-fresh and covered info I often like to share with colleagues
▪New APRN, still learning barriers and practice standards
▪The suggestions in the presentation are inherent to my practice as a clinician and implemented regularly already
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ECHO Programming from the Project ECHO NNE Network & Qualidigm
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Network Mission▪ The mission of the Project ECHO NNE Network is to design and
implement a regional network of telehealth services using the Project ECHO model to improve access, care delivery, outcomes and health for Northern New Englanders residing in Maine, New Hampshire and Vermont. The Project ECHO NNE Network will support providers and patients to work effectively together to manage common, emerging and complex conditions safely, effectively and compassionately.
Network Shared Vision ▪ The overarching vision for the Project ECHO NNE Network is to
enhance access and improve health outcomes throughout the Northern New England region.
Project ECHO: Northern New England Network
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NNE Network & Qualidigm Program Details• Project ECHO: Capacity Building for Compassionate Tapering
o 11 sessions (10/2017- 5/2018)• Project ECHO: Clinical Peer Leadership
o 28 sessions (12/2017 -present)• Project ECHO: Continuity of Care for Substance Use and
Exposure During the Perinatal Period (Perinatal SUD)o 11 sessions (1/2017-9/2018)
• Project ECHO: Community Opioid Overdose Response (COOR)o 14 sessions (8/2018-present)
• Project ECHO: Medication Assisted Treatment (MAT)o 11 sessions (8/2018-present)
• Project ECHO: Older Adult Careo 9 sessions (10/2018-present)
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NNE Network & Qualidigm Program Participation
Across all QC and NNE Network ECHO programs, a total of 84 ECHO sessions (including orientations and Mock ECHOs) were delivered between 9/1/17-4/30/19.
o Individual attendees who participated: 434o Total attendance across all ECHO programs:
1500+ o Participant locations: Maine, New Hampshire
and Vermont
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Project ECHO: Perinatal Substance Use Disorders
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Results Summary Continued
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Steps for Implementation Timeline▪ Establishing an ECHO Hub - partnership with the ECHO
Institute™, attending Immersion Training, an onboarding Hub Technical Team (recommended 2-3 Months)
▪ ECHO Program Planning, Development, Recruitment and Training of Faculty & Participants (typically 2-3 Months)
▪ ECHO Session Program Delivery (typically 1 or 2 sessions per month)
▪ Evaluation/Reporting (1 Month)
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Program Budget ConsiderationsPersonnel for Running ECHO Sessions• IT User Support • Coordinator/Administrator • Medical Director
HUB Expert Clinical Team (4-5)
Replication Training at ECHO Institute, UNM (Albuquerque, NM) • Average per person ($1,500)
Technical Requirements • High speed internet (hard-wired recommended)• Videoconferencing software (Zoom)• ECHO Clinic Management Software (iECHO™)
Teleconferencing equipment• Dedicated room computer • Dual monitors - recommended• Speakerphone & webcam – recommended Logitech GROUP videoconferencing kit
Evaluation • Using iECHO/ other ECHO Institute tools• Survey Monkey or other on-line survey tools
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ECHO Hub Studio Setup
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Other ECHO Programs in Development
NNE Network and Qualidigm • MAT in the ED• HPV QI• Lung Cancer Screening• MAT Readiness
CHCACT• Community Health Workers (CHW)• Support Practice transformation and value based payment models• Expansion of the Transforming Clinical Practice Initiatives
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Questions?
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Contact Information
Lise Tancrede, Project Manager, Quality Counts, a Qualidigm [email protected] 207 620-8526 X1001If you would like to learn more about our ECHO programs please visit: https://mainequalitycounts.org/initiatives-resources/echo-test/If you would like to join our mailing list for upcoming opportunities please email Jonathan Church at [email protected]
Marlene Moranino, Senior Director of Clinical Programs, Community Health Center Association of CT [email protected] 860-667-7820 Website - www.CHCACT.orgIf you would like to learn more about our ECHO programs please visit:https://www.chcact.org/about/projectecho/Join us on social media: @cthealthcenters www.facebook.com/CHCACT If you would like to join our mailing list for upcoming opportunities please email:Deb Polun at [email protected]