Project ECHO® (Extension for Community Health Outcomes)SanjeevArora, MD, MACP
Distinguished Professor of Medicine (Gastroenterology/Hepatology)Director of Project ECHO®
Department of MedicineUniversity of New Mexico Health Sciences Center
Tel: 505-272-2808Fax: [email protected]
@ProjectECHOUNMProjectECHO
SupportedbyNewMexicoDepartmentofHealth,AgencyforHealthResearchandQuality,NewMexicoLegislature,theRobertWoodJohnsonFoundation,theGEFoundation,HelmsleyCharitableTrust,MerckFoundation,BMSfoundation,NMMedicaid
At ECHO, our mission is to democratize medical knowledge and get best practice care to underserved people all over the
world.
Our goal is to touch the lives of 1 billion people by 2025.
Moving Knowledge Instead of Patients and Providers
3
HCV
70millionintheworldinfectedwithHCV
InNewMexicoestimatednumberwasgreaterthan28,000in2004.
In2004lessthan5%ofpatientsinNMhadbeentreated.2,300prisonerswereHCVpositive
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HCV Treatment 2004
Good news…Curablein70%ofcases
Bad news…Severesideeffects:
anemia(100%)neutropenia>35%depression>25%NoPrimaryCarePhysicianstreatingHCV
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Goals of Project ECHO
DevelopcapacitytosafelyandeffectivelytreatHCVinallareasofNewMexicoandtomonitoroutcomes.
Developamodeltotreatcomplexdiseasesinrurallocationsanddevelopingcountries.
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The ECHO Model
Amplification– UseTechnologytoleveragescarceresources
Share BestPracticestoreducedisparity
CaseBasedLearningtomastercomplexity
Web-basedDatabasetoMonitorOutcomes
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StepsTrainphysicians,physicianassistants,nursepractitioners,nurses,pharmacists,educatorsinHCV
Traintouseweb-basedsoftware— iECHO&ECHOHealth®
ConductteleECHO™clinics— “KnowledgeNetworks”
Initiatecase-basedguidedpractice— “LearningLoops”
Collectdataandmonitoroutcomescentrally
AssesscostandeffectivenessofprogramsCopyright©ECHOInstitute
Benefits to Rural Clinicians
NocostCMEsandNursingCEUs
ProfessionalinteractionwithcolleagueswithsimilarinterestLessisolationwithimprovedrecruitmentandretention
Amixofworkandlearning
AccesstospecialtyconsultationwithGI,hepatology,psychiatry,infectiousdiseases,addictionspecialist,pharmacist,patienteducator
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AroraS.,ThorntonK.,MurataG.,etal.NEngJMed.2011;364(23):2199-207.
AroraS.,KalishmanS.,ThorntonK.,etal.Hepatol.2010;52(3):1124-33.
ECHO model is not ‘traditional telemedicine’. Treating Physician retains responsibility for managing patient.
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TechnologyWebCam
VideoconferencingSoftware
VideoRecordingSystem
ECHO-PearlRepository
ECHOHealth– ElectronicClinicalManagementTool
iECHO – ElectronicTeleECHOClinicManagementSolutionCopyright©ECHOInstitute
How well has model worked?
600HCVteleECHOClinicshavebeenconducted>6,000patientsenteredHCVdiseasemanagementprogram
CME’s/CE’sissued:TotalCMEhours79000hoursatnocostforHCVand19otherdiseaseareas
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Project ECHO CliniciansHCV Knowledge Skills and Abilities (Self-Efficacy)
scale:1=noneornoskillatall7=expert-canteachothers
CommunityCliniciansN=25
BEFOREParticipationMEAN(SD)
TODAYMEAN(SD)
PairedDifference(p-value)
MEAN(SD)
EffectSizeforthechange
1.Ability toidentifysuitablecandidatesfortreatmentforHCV. 2.8(1.2) 5.6(0.8) 2.8(1.2)
(<0.0001) 2.4
2.AbilitytoassessseverityofliverdiseaseinpatientswithHCV.
3.2(1.2) 5.5(0.9) 2.3(1.1)(<0.0001) 2.1
3.AbilitytotreatHCVpatientsandmanagesideeffects. 2.0(1.1) 5.2(0.8) 3.2(1.2)
(<0.0001) 2.6
(continued)
Project ECHO CliniciansHCV Knowledge Skills and Abilities (Self-Efficacy)
CommunityCliniciansN=25
BEFOREParticipationMEAN(SD)
TODAYMEAN(SD)
PairedDifference(p-value)
MEAN(SD)
EffectSize
forthechange
4.Abilitytoassessandmanagepsychiatricco- morbiditiesinpatientswithhepatitisC.
2.6(1.2) 5.1(1.0) 2.4(1.3)(<0.0001) 1.9
5.ServeaslocalconsultantwithinmyclinicandinmyareaforHCVquestionsandissues.
2.4(1.2) 5.6(0.9) 3.3(1.2)(<0.0001)
2.8
6.AbilitytoeducateandmotivateHCVpatients.
3.0(1.1) 5.7(0.6) 2.7(1.1)(<0.0001) 2.4
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Project ECHO CliniciansHCV Knowledge Skills and Abilities (Self-Efficacy)
Cronbach’salphafortheBEFOREratings=0.92andCronbach’salphafortheTODAYratings=0.86indicatingahighdegreeof consistencyintheratingsonthe9items.
CommunityCliniciansN=25
BEFOREParticipationMEAN(SD)
TODAYMEAN(SD)
PairedDifference(p-value)
MEAN(SD)
EffectSizeforthechange
Overall Competence(average of 9 items) 2.8* (0.9) 5.5* (0.6) 2.7 (0.9)
(<0.0001) 2.9
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AroraS.,KalishmanS.,ThorntonK.,etal.Hepatol.2010;52(3):1124-33.
Clinician Benefits(Data Source; 6 month Q-5/2008)
BenefitsN=35
Not/MinorBenefits
Moderate/MajorBenefits
EnhancedknowledgeaboutmanagementandtreatmentofHCVpatients.
3%(1)
97%(34)
Beingwell-informedaboutsymptomsofHCVpatientsintreatment.
6%(2)
94%(33)
AchievingcompetenceincaringforHCVpatients.
3%(1)
98%(34)
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Project ECHOAnnual Meeting Survey
MeanScore(Range1-5)
ProjectECHO®hasdiminishedmyprofessionalisolation. 4.3
MyparticipationinProjectECHO®hasenhancedmyprofessionalsatisfaction. 4.8
CollaborationamongagenciesinProjectECHO®isabenefittomyclinic. 4.9
ProjectECHO®hasexpandedaccesstoHCVtreatmentforpatientsinourcommunity. 4.9
Access, ingeneral,tospecialistexpertiseandconsultationisamajorareaofneedforyouandyourclinic. 4.9
AccesstoHCVspecialistexpertiseandconsultationisamajorareaofneedforyouandyourclinic. 4.9
Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care
ProvidersResults of the HCV Outcomes Study
AroraS.,ThorntonK.,MurataG.,etal.NEngJMed.2011;364(23):2199-207.
Objectives
TotrainprimarycarecliniciansinruralareasandprisonstodeliverHepatitisCtreatmenttoruralpopulationsofNewMexico
Toshowthatsuchcareisassafeandeffectiveasthatgiveinauniversityclinic
ToshowthatProject ECHO improvesaccesstoHepatitisCcareforminorities
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Participants
StudysitesIntervention(ECHO)
Community-basedclinics:16
NewMexicoDepartmentofCorrections:5
Control:UniversityofNewMexico(UNM)LiverClinic
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Principle Endpoint
SustainedViralResponse(SVR):nodetectablevirus6monthsaftercompletionoftreatment
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Treatment Outcomes
Outcome ECHO UNMH p-valuen=261 n=146
Minority 68% 49% p<0.01
SVR*(Cure)Genotype1 50% 46% ns
SVR*(Cure)Genotype2/3 70% 71% ns
AroraS.,ThorntonK.,MurataG.,etal.NEngJMed.2011;364(23):2199-207.
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*SVR=sustainedviralresponse
Conclusions
RuralprimarycareCliniciansdeliverHepatitisCcareundertheaegisofProjectECHOthatisassafeandeffectiveasthatgiveninaUniversityclinic.
ProjectECHOimprovesaccesstohepatitisCcareforNewMexicominorities.
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Disease SelectionCommondiseases
Managementiscomplex
Evolvingtreatmentsandmedicines
Highsocietalimpact(healthandeconomic)
Seriousoutcomesofuntreateddisease
Improvedoutcomeswithdiseasemanagement
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Bridge BuildingPareto’sPrinciple
PrivatePractice
StateHealthDept
CommunityHealthCentersUNMHSC
ChronicPain
RheumatoidArthritis+RheumatologyConsultation
SubstanceUseandMentalHealthDisorders
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PhysicianAssistants
PrimaryCare
NursePractitionersSpecialists
ChronicPain
RheumatoidArthritis+RheumatologyConsultation
SubstanceUseandMentalHealthDisorders
Force MultiplierUseExistingCommunityClinicians
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ECHO now reaching a breadth of areas
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• AntimicrobialStewardship• Autism• BehavioralHealth• BoneHealth• Cancer• Cardiology• ChronicLungDisease• ChronicPain• CrisisIntervention• DiabetesandEndocrinology
• Education• Geriatrics• GoodHealthandWellnessinIndianCountry
• Hepatitis• High-RiskPregnancy• HIV/AIDS• InfectiousDisease• IntegratedAddictions&Psychiatry
• LaboratoryMedicine• LGBTHealth
• OpioidUseDisorder• PalliativeCare• Pediatrics• PrisonPeerEducation• QualityImprovement• Rheumatology• SexuallyTransmittedDiseases
• Trauma-InformedCare• Tuberculosis
Views of Participating Providers, Health Workers, And Educators1 = Strongly Disagree, 5 = Strongly Agree
Benefit MeanThroughtheProjectECHOtelehealthclinics,Iamlearningbest-practicecareinchronicdisease. 4.68
IamconnectedwithpeersintheECHOtelehealth clinicwhoseopinionIrespectforprofessionaladviceandconsultation. 4.55
I learnwithguidancefromProjectECHOacademicspecialistsinchronicdiseasemanagementwhoseknowledgeandskillsIrespect. 4.73
IamconnectedtoandrespectedbytheacademicspecialistsintheECHOtelehealthclinicinwhichIparticipate. 4.4
Iamdevelopingmyclinicalexpertisethroughparticipation inProjectECHO. 4.48AftergainingexpertiseintheclinicaldiseasesaddressedinProjectECHO,IamcomfortableteachingotherswhatIhavelearned. 4.33
AroraS.,KalishmanS.,DionD.,etal.HealthAff(Millwood).2011;30(6):1176-84.
Project ECHO:
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Participants’ Views of Patient Benefits1 = Strongly Disagree, 5 = Strongly Agree
PatientBenefit MeanMyparticipationinProjectECHObenefits patientsundermycare whomIco-managewithECHOspecialists. 4.45
ThepatientsundermycarewhomIco-managewithECHOspecialistsreceivebest-practicecare. 4.43
MyparticipationinProjectECHObenefitsthepatientsundermycarewhomIdonotco-managewithECHOspecialists. 4.19
I applywhatIhavelearnedaboutbestpracticesthroughProjectECHO toallofmypatientswithsimilarchronicdiseases. 4.45
I feelcomfortableapplyingtheprinciplesIlearnedfromProjectECHOtootherpatientsinmypracticewithsimilarchronicdisease,independently,withoutpresentingthemonthenetwork.
4.23
AroraS.,KalishmanS.,DionD.,etal.HealthAff(Millwood).2011;30(6):1176-84.
Project ECHO:
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VA SCAN-ECHO for Liver Disease University of Michigan
513patientswhohadaliverSCAN-ECHOvisitwerefoundwithinthecohort.PatientswhohadcompletedavirtualSCAN-ECHOvisitweremorelikelyyounger,rural,withmoresignificantliverdisease,andevidenceforcirrhosis.PropensityadjustedmortalityratesusingCoxProportionalHazardModelshowedthataSCAN-ECHOvisitwasassociatedwithahazardratioof0.54(95%CI0.36-0.81,p=0.003)comparedtonovisit.
VirtualConsultationsthroughtheVeteransAdministrationSCAN-ECHOProjectImprovesSurvivalforVeteranswithLiverDiseaseSu.GL,GlassL,etal;Hepatology .2018May5.doi:10.1002/hep.30074
Peer Reviewed Publications n=129
73
1915 13
5 5 5
0%
10%
20%
30%
40%
50%
60%
Provider Learning Quality of Care Access to Care Workforce Issues Efficiency and Cost Barriers to Adoption Implementation science
% ofpeer-reviewedpublications(N=116)
ECHO Publications by Moore’s Outcome Levels
0 10 20 30 40 50 60 70
CommunityHealth
PatientHealth
Performance
Competence
Learning
Satisfaction
Participation
ECHO Hubs and Spokes: State of New Mexico
Army and Navy Pain Management ECHO Clinics
Arizona:• NHYumaCalifornia:• NMCSD Naval Training Center• NHLemoore• NH Twentynine Palms• NH Camp Pendleton• Naval Air Facility El Centro• Naval Air Station North IslandFlorida:• Naval Hospital (NH) Jacksonville• Naval Air Station JacksonvilleMaryland:• NHC Pax RiverMissouri:• Behavioral Health Clinic (BHC) BooneNorthCarolina:• NH Camp LeJeune
«Navy ECHO Hubs: Navy Medicine East (NME)- Naval Medical Center (NMC) Portsmouth, VA | Navy Medicine West (NMW)- Naval Medical Center San Diego (NMCSD), CA
New Hampshire:• BHC Portsmouth NH• Navy Safe HarborVirginia:• NMC Portsmouth (Case
Management, Pain Clinic, Physiatry, Internal Medicine)
• BHC Oceana• TriCare Prime Clinic (TPC)
Chesapeake• TPC Virginia Beach• 633rd Medical Group-Langley
«Army ECHO Hubs: Regional Health Command-Europe (RHC-E) – Landstuhl, Germany | Regional Health Command-Central (RHC-C)-Joint Base San Antonio-Brook Army Medical Center – TX | Regional Health Command-Pacific (RHC-P)-Tripler Army Medical Center – HI | Regional Health Command-Atlantic (RHC-A) – Ft. Bragg, NC
Belgium:• Brussels• Supreme Headquarters
Allied Powers Europe (SHAPE)
Germany:• Grafenwoehr• Hohenfels• Katterbach• Landstuhl Regional Medical
Center (LRMC)/FHC• LRMC/IMC• Stuttgart• Wiesbaden• VilseckItaly:• Livorno• VicenzaJapan:• Camp Zama
South Korea:• Camp Casey• Camp Humphreys• Camp Carroll• Camp Walker • Brian Allgood Army Community
Hospital/ 121st Combat Support Hospital
Alabama:• Redstone ArsenalArizona:• Fort HuachucaCalifornia:• Fort IrwinColorado:• Colorado SpringsGeorgia:• Fort Gordon• Fort Benning• Ft. Stewart
Hawaii:• Schofield Barracks (Family
Medicine and Troop Medical Clinic)
• Adult Medicine Patient Centered Medical Home (PCMH) Tripler
• Family Medicine PCMH Tripler• Warrior Ohana PCMH• VA Pain ClinicKansas:• Fort Leavenworth• Fort RileyKentucky:• Fort Knox• Fort CampbellLouisiana:• Fort PolkMaryland:• Fort Meade
Missouri:• Fort Leonard WoodNew Mexico:• White Sands Missile RangeNew York:• Fort Drum• West PointOklahoma:• Fort SillSouth Carolina:• Fort JacksonTexas:• Fort Bliss• Fort HoodVirginia:• Joint Base Langley-Eustis• Fort LeeWashington:• Madigan Army Medical Center
ECHO Hubs and Superhubs:United States
ECHO Hubs and Superhubs: Global
ImprovingProfessionalSatisfaction/RetentionSupportingtheMedicalHomeModelCostEffectiveCare- AvoidExcessiveTestingandTravelPreventCostofUntreatedDisease(e.g.:livertransplantordialysis)IntegrationofPublicHealthintotreatmentparadigm
Potential Benefits of the ECHO Model
QualityandSafetyRapidLearningandbest-practicedisseminationReducevariationsincareAccessforRuralandUnderservedPatients,reduceddisparitiesWorkforceTrainingandForceMultiplier
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DemocratizeKnowledge
What The Mind Does Not Know The Eye Cannot See
Time
IncreasingGap
“ExpandingtheDefinitionofUnderservedPopulation”Copyright©ECHOInstitute
Cancer Incidence and Mortality Higher in Rural Areas
Mortalityrateshigherforcervical,colorectal,kidney,lung,melanomaandoropharyngealcancerBlake,K.D.,Moss,J.L.,Gaysynsky,A.,etal.CancerEpidemiolBiomarkersPrev.2017;26(7):992-7.
Nonmetropolitanruralareashaveloweraverageannualage-adjustedcancerincidenceratesforallanatomiccancersitescombinedbuthigherdeathratesthanmetropolitanareas.During2006-2015,theannualage-adjusteddeathratesforallcancersitescombineddecreasedataslowerpaceinnonmetropolitanareas(-1.0%peryear)thaninmetropolitanareas(-1.6%peryear),increasingthedifferencesintheserates.Henley,S.J.,Anderson,R.N.,Thomas,C.C.,etal.MorbMortalWklyRep.2017;66(14):1-13.
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Cancer Incidence and Mortality Higher in Rural Areas
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• Smokingcessation• HPVvaccination• HepatitisBvaccination• Sunsafety&skincancerprevention
• Communitycancerintervention&prevention
• Dermatology• Breastcancer• Cervical&colorectalcancer
• Oral&lungcancer• Pathologybestpractices• Trainingpeerandcommunityhealthadvocates
• HepatitisBandC• Pain&toxicitymanagement• TumorBoards• Cancercarenavigation• Precisionmedicine&cancergenomics
• Palliativecare• Survivorship• Clinicaltrialenrollment
Prevention Screening Treatment
echo.unm.edu/initiatives/cancer-echo/
University of Texas MD Anderson Cancer Center ECHO Superhub
• Superhub: 2017, 11 active programs serving the United States, Latin America, and Africa• Championed by Ernest Hawk, MD, MPH – VP, Cancer Prevention, OVP, Cancer Prevention & Population
Science and Kathleen Schmeler, MD – Associate Professor, Gynecologic Oncology & Reproductive Medicine • Ellen Baker, MD, MPH – Director• Melissa Lopez, MS – Program Manager
American Cancer Society ECHO
• ECHOs in design:
• Tobacco Cessation in Public Housing
• HPV Vaccination & Screening
• Lung Cancer Patient Support ECHO serving the United States• ACS Advisory Group: co-chaired by Sarah Shafir, MPH, Strategic Director of State and
National Systems, and Dawn Wiatrek, PhD, Strategic Director of Cancer Treatment Access.
Kimberley Hospital Complex ECHO• Lung Cancer & Mesothelioma ECHO serving the Norther Cape of South Africa
• Addressing the entire Continuum of Care: Prevention, Screening, Diagnosis, Treatment, Survivorship and End of Life Care
• Led by Daniel Osei-Fofie, MD – Medical Director and Brenda Masuabi, Oncology Specialist Nurse – Program Manager and Facilitator
National Cancer Institute –Center for Global Health ECHO
Active Programs: Participation from ministries of health, NGOs, UICC, WHO, CDC, AORTIC, international foundations, cancer centers.• Asia-Pacific Economic Cooperation (APEC) ECHO: Cancer Control Planning ECHO with work in
Cervical Cancer Implementation of evidence based practices
• Participants from China, Malaysia, Peru, Papua New Guinea, Thailand, Vietnam, Canada and the United States
• Africa ECHO: Cancer Control Planning ECHO• Participants from Botswana, Ethiopia, Kenya, Malawi, Namibia, Nigeria, Rwanda, Swaziland,
Tanzania, Uganda, Zambia and Zimbabwe
Cohort Program• Caribbean ECHO: Cancer Control Planning specific to Cervical Cancer Caribbean ECHO Asian Pacific
Economic Cooperation ECHO• Participants from Suriname, Jamaica, Trinidad and Tobago, Grenada, Barbados, Dominican
Republic and Dominica
National Institute of Cancer Prevention and Research (NICPR), Noida, India• Goal: to build capacity in the area of cancer screening services among health care providers which
will empower them to carry out screening independently, thereby enabling their services to be accessible to every eligible citizen in India.
• Cancer screening pilot project with Community Health Workers in 2016 led to two publications in the Journal of Global Oncology.
• Currently running Oral Cancer Screening and Tobacco Cessation ECHO for Dentists.
Palliative Care Programs in India
1. Trivandrum Institute of Palliative Sciences, Thiruvananthapuram, India• Palliative care program launched January 2017 with 20-25 spokes per session.
2. Pain Relief and Palliative Care Society – Hyderabad, India• “No Pain Too Small” ECHO launched March 2018, connecting experts in pediatric palliative care
with health care workers caring for children with life-limiting conditions across South Asia.
Tata Memorial Hospital, Mumbai, India
• Virtual Tumour Board ECHO launched December 2016 including 100+ spokes from 20+ centers of excellence from the National Cancer Grid
• Currently running three Virtual Tumour Board ECHO programs with 30+ centers of excellence.
Courtesy Swasth India & Dr. C S Pramesh, TMH
Cancer ECHO Replication Sites in the United States
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• AlaskaNativeHealthConsortium– Anchorage,AK• PalliativeCarewithCommunityHealthAides
• AmericanAcademyofPediatrics– Itasca,IL• HPVScreeningandQualityImprovement
• AmericanCancerSociety,Inc.– Atlanta,GA• LungCancerPatientSupport
• CenterforAsianHealthEquity– Chicago,IL• ColorectalCancerScreening
• CharlestonAreaMedicalCenter– Charleston,WV• BreastCancerSurvivorship
• FourSeasonsCompassionforLife– FlatRock,NC• PalliativeCare
• InternationalGynecologicCancerSociety– Louisville,KY• ManagementofGynecologicCancers(Belarus),
ManagementofGynecologicCancers(Vietnam),ManagementofGynecologicCancers(Kenya),ManagementofGynecologicCancers(Ethiopia),ManagementofGynecologicCancers(Mozambique),ManagementofGynecologicCancers(Kazakhstan),ManagementofGynecologicCancers(Caribbean),
• MissouriTelehealthNetwork– Columbia,MO• Dermatology&SkinCancerPreventionforPCPs
• NationalCancerInstitute– CenterforGlobalHealth–Bethesda,MD• CancerControlPlanning&CervicalCancer(APEC),
CancerControlPlanning(Africa)• UniversityofColoradoSchoolofPublicHealth– Aurora,
CO• CancerSurvivorship
• UniversityofRochesterMedicalCenter– Rochester,NY• PalliativeCare
Cancer ECHO Replication Sites in the United States
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• UniversityofTexasMDAnderson:Superhub – Houston,TX• CervicalCancerPreventionintheRioGrandeValley• CommunityCancerSurvivorshipforCHWs• EarlyDiagnosisofMelanomaUsingDermoscopy• SurvivorshipTrainingforFamilyMedicineResidents• TobaccoEducationandCessationintheHealthSystem(TEACH)• PalliativeCareinAfrica(PACA)• CervicalCancerManagement(LatinAmerica)• Pathology(Zambia)• Pharmacy(Zambia,Tanzania)• Radiation(Zambia)• Mozambique:BreastCancerManagement,CervicalCancerManagement,CancerHematology,CervicalCancerManagement,Head&NeckCancerManagement
Cancer ECHO Replication Sites Worldwide
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• HighlandHospice– Inverness,Scotland• CommunityPharmacists,NurseSpecialists,EmergencyPractitioners,RuralGeneralPractitioners
• HospiceUK– KingsCross,England• CareHomesandPalliativeCare
• Instituto deOncología Ángel H.Roffo – BuenosAires,Argentina• Head&NeckCancer
• Instituto AlexanderFleming– BuenosAires,Argentina• ColorectalCancerVirtualTumor Boards
• KimberleyHospital– NorthernCape,SouthAfrica• LungCancer&Mesothelioma
• NationalInstituteforMentalHealthandNeurosciences– Bengaluru,India• TobaccoCessation
• NationalInstituteofCancerPrevention&Research– NewDelhi,India• Oral,BreastandCervicalCancerPreventionandScreening,VirtualAdvancedCancerScreeningTrainingProgramforDentists
Cancer ECHO Replication Sites Worldwide
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• NorthernIrelandHospice– Newtownabbey,NorthernIreland• NursingHomeNIReach&PalliativeCare
• PainReliefandPalliativeCareSociety– Hyderabad,India• PalliativeCare
• TataMemorialCentre– Mumbai,India• VirtualTumorBoards
• TheHospitalforSickChildren– Toronto,Canada• PediatricPalliativeCare
• TrivandrumInstituteofPalliativeSciences– Thiruvananthapuram,India• PalliativeCare,ChronicPain
• UniversidaddelaRepública – Montevideo,Uruguay• CervicalCancer,VirusdelPapilomaHumano(HPV),CuidadosPaliativosPediatricos(Pediatric
PalliativeCare),CuidadosPaliativosdeAdultos(AdultPalliativeCare)
The “ECHO Act”(Expanding Capacity for Health Outcomes Act)Passed House/Senate by unanimous vote, November-December 2016
Signed into law by President Barack Obama, December 2016
AskstheSecretaryofHealthandHumanServicestostudytheimpactofProjectECHOon:
Mentalandsubstanceusedisorders,chronicdiseasesandconditions,prenatalandmaternalhealth,pediatriccare,painmanagement,andpalliativecare
Conditions
Workforce
PublicHealth
RuralandUnderservedPopulations
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Healthcareworkforceissues,suchasspecialtycareshortagesandprimarycareworkforcerecruitment,retention,andsupportforlifelonglearning
Implementationofpublichealthprograms,includingthoserelatedtodiseaseprevention,infectiousdiseaseoutbreaks,andpublichealthsurveillance
Deliveryofhealthcareservicesinruralareas,frontierareas,healthprofessionalshortageareas,andmedicallyunderservedareas,andtomedicallyunderservedpopulationsandNativeAmericans
Co-sponsorsUtahHatch(R)
HawaiiSchatz(D)
TexasBurgess(R)
CaliforniaMatsui(D)
WashingtonSen.MariaCantwell(D)Sen.PattyMurray(D)
WyomingSen.JohnBarrasso(R)
MontanaSen.SteveDaines(R)Sen.JonTester(D)
LouisianaSen.BillCassidy(R)
MassachusettsSen.ElizabethWarren(D)
MississippiSen.RogerWicker(R)
MinnesotaSen.AlFranken(D)
NewMexicoSen.MartinHeinrich(D)Sen.TomUdall(D)Rep.MichelleLujanGrisham(D)
TexasSen.JohnCornyn(R)Rep.KayGranger(R)
TennesseeSen.LamarAlexander(R)
VirginiaSen.MarkWarner(D)
OklahomaSen.JamesInhofe(R)
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The ECHO Team
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What Makes ECHO Work?
TaskShifting
GuidedPractice
JoyofWork
Technology
ForceMultiplication
De-monopolizingKnowledge
AllTeachAllLearn
MovementBuildingVs.OrganizationBuilding
Mentor/MenteeRelationship
CommunityofPractice(SocialNetwork)
InterprofessionalConsultation
TeamBasedCare
Thanks to our supporters