2013 Annual Meeting

Year in Review

Why ECHO-Chicago?

• Demand for subspecialty services outstrips availability of subspecialistso Particularly acute where social and economic distance limit access to careo Disparities in access to care exacerbate health disparities

• Primary care setting is often the best place to deliver care for common, chronic diseases

Launched in 2010 to address the problem of access to subspecialty care in underserved communities in our community

Cook, et al, Health Affairs 2007;26(5):1459-68

• Community-based primary care providers often lack the support and training to manage complex, chronic disease effectively

o Training opportunities are limited, costly, and often require travel

o Training is not always relevant to special populations, including underserved and minority communities

Purpose

o Disseminate best practice management of complex, common, chronic disease in the primary care medical home

o Use case-based learning; the most widespread teaching method in medicine

o Leverage advanced technology to reduce cost and time constraints, and eliminate travel

o Engage primary care providers in a local network to share knowledge and experience

ECHO-Chicago uses case-based, iterative, telehealth curricula delivered via high-grade videoconference technology to bring advanced training and support to primary care providers in underserved communities throughout the Chicago metro area.

Knowledge Transfer + Technology = Force Multiplier

RWJF 2011

ECHO-Chicago Story

2009 2010 2011 2012

Introduced Breast Cancer Survivor Care curriculum at community health center partners

Completed pilot on hypertension; published results in J. Clinical Hypertension

Launched ECHO-Chicago•Collaboration with six community health center partners•Focus on resistant hypertension

Introduced Pediatric ADHD curriculum at N community health center partners

2013

Introduced Pediatric Obesity and Co-morbidities curriculum

Completed study on provider response to ECHO model; published results in Partnerships in Community Health

Seed Funding from Urban Health Initiative

Idea formedinitiated planning for

ECHO-Chicago

First outside funding, from Grant Healthcare Foundation

ECHO-Chicago Growth

2013 Activities• Launched new curriculum in Pediatric Obesity

and Co-morbidities– Collaboration with 7 community health center

partners– community provider participants

• Transitioned to Vidyo™; web-based videoconference technology– More user-friendly– Greater flexibility; works on PCs, MACs, tablets, and

mobile devices– Better quality; lower bandwidth– Lower cost

• Expanded our network from two additional community partners

2013 Activities

 

# of participating

health centers

Total # of sessions

# of unique participants

Avg # of providers/session

rHTN 13 16 38 11

ADHD 13 17 90 21

BCS 6 10 44 4

OBS 6 12 18 13

Totals 18* 55 136* 13

*Providers may participate in more than one disease area; the total reflects the number of unique ECHO-Chicago participants.

2013 Evaluation/Research Activities• Study of provider feedback on the effectiveness

of ECHO model, results published in Progress in Community Health Partnerships

• Analysis of provider survey data– baseline self-efficacy and knowledge surveys for

hypertension and ADHD– pre- and post-series changes in ADHD provider

surveys• Launch of study to measure impact of breast

cancer survivor care curriculum • Preparing for analysis of Medicaid data on pre-

and post-series changes in provider prescribing patterns

Provider Feedback on the ECHO modelOur study on the effectiveness of the ECHO model was based on in-depth interviews with nine providers who participated in ECHO-Chicago sessions. Providers identified the benefits of this case-based, iterative curriculum to:

• Extend their current skills and knowledge in a way that is• convenient (no travel, discrete time commitment) • engaging in content (best practices) and format (didactic with

case presentations)• Model best practice protocols for their patient population through

preparation, presentation, and discussion of patient cases• Improve confidence to manage more complex patients without

referring to subspecialists• Increase job satisfaction and motivate skills enhancement• Strengthen connections between University of Chicago

subspecialists and community providers• Build a collaborative knowledge network among peers caring for

similar patient populations

Provider Needs Assessment: Hypertension and ADHD

*Hypertension knowledge test: 26 total ; ADHD knowledge test: 18 total

Analysis of baseline scores for knowledge and self-efficacy in hypertension and ADHD indicate the need for both training and support.

 # of

providers Knowledge* SDSelf-Efficacy (7-point scale) SD

Hypertension 53 13.9 (53%) 2.9 4.7 (67%) 1

ADHD 90 10.6 (59%)  2.2 3.4 (49%)  1.1

Changes in ADHD Knowledge and Self-Efficacy

We conducted a preliminary analysis of data from 23 providers who completed both the pre- and the post-series survey. The data show a small increase in knowledge, and a moderate increase in self-efficacy. On the 7-point scale, the 11% change points to an improvement from “slight knowledge, skills or competence” to “average among my peers”

Pre-series SD Post-series SD Change

Self-efficacy (7-point scale) 3.4 (49%) 1.2 4.2 (60%) 0.8 0.8 (11%)

Knowledge(18 questions) 10.4 (58%) 1.9 11.5 (64%) 2.1 1.1 (6%)

Community Partners• ACCESS

• Aunt Martha's Health Center

• Beloved Community Family Wellness Center

• Chicago Family Health Center

• Christian Community Health Center

• Erie Family Health Center

• Family Christian Health Center

• Fiedler Private Practice

• Friend Family Health Center

• Heartland Health Outreach

• Howard Brown Health Center

• La Rabida Children's Hospital

• Lawndale Christian Health Center

• Mercy Family Health Center

• Mile Square Health Center

• Mt Sinai Hospital and Health Center

• TCA Health, Inc. NFP

• University of Illinois -- Chicago

What’s Next

• Launch of curriculum in hepatitis C in 2014• Planning for launch of curriculum in Integrated

Mental Health in Primary Care• Continued outreach to new community

partners, and new providers • Continued efforts to ensure sustainability

George Bakris, MD Karin Vander Ploeg Booth, MD Susan Hong, MD Goutham Rao, MD (Hypertension) (ADHD) (Breast Cancer Survivorship) (Pediatric Obesity)

Maureen Hyewon (Alice) Marcus B. Wolfe Chartay Robinson Timothy May Zakiya Moton Mencarini Won

Daniel Johnson, MDTamara Hamlish, Ph.D

Thank YouChicagoGlen Aduana, MDSteve BrownAndy Davis, MD Christopher Masi, MD, PhDCarmela SocolovoskyGreg Van Scooter and the

Multimedia Department

Sanjeev Arora, MDJohn Brown, RNWesley Pak, MBA

South Side Healthcare CollaborativeBrenda BattleKim Hobson Participating sites and their providers

New Mexico

FundersAetna FoundationAmerican Cancer SocietyBaxter International FoundationCTSA – University of ChicagoGrant Healthcare FoundationNorthern Trust Charitable TrustUHI – University of Chicago