RWJF Grant Supports Innovative Telehealth Model for Bringing Specialty Care to Rural and Underserved America

New Mexico's Project ECHO offers solution to health care worker shortage while improving health outcomes for poor patients with serious chronic diseases.

    • August 20, 2009

The Robert Wood Johnson Foundation (RWJF) today announced the award of a three-year, $5-million grant to Project ECHO (Extension for Community Healthcare Outcomes), a New Mexico program that uses evidence-based medicine and interactive technology to bring sorely needed specialty care to patients living in rural and underserved areas who are suffering from serious, complex chronic conditions.

Project ECHO uses a secure, Internet-based audio-visual network to connect primary care providers with medical specialists at the University of New Mexico (UNM) Health Sciences Center. Unlike most telehealth initiatives, which primarily connect patients with doctors, Project ECHO trains doctors, nurses, physician's assistants and other clinicians in rural and underserved areas to work together to manage patients, expanding the health system’s capacity to deliver high-quality chronic care to those most in need.

“Through Project ECHO, we are treating very sick people who couldn’t otherwise get care, and we are extending the capacity and reach of the health care system by engaging more colleagues in highly needed specialties,” said Sanjeev Arora, M.D., Project ECHO Director and UNMHSC Executive Vice Chairman, Department of Medicine. “We believe that this approach can help bring best practice specialty care to millions more Americans.”

The United States Department of Health and Human Services’ Health Resources and Services Administration has designated 32 of 33 counties in New Mexico as medically underserved areas and 14 as professional shortage areas. The ECHO network links the UNM medical school with more than 40 partner clinics based in public health departments, prisons, Indian Health Service sites, community health centers and rural primary care practices around the state.

In 2004, Project ECHO launched an effort to address Hepatitis C (HCV), a deadly but curable disease afflicting an estimated 32,000 New Mexicans that few providers in the state are equipped to treat. Since then, specialists at UNM have provided education on HCV to primary care physicians, nurses, physician assistants, pharmacists and community health educators in rural clinics and prisons; supplied Web-based technology necessary for training; and conducted weekly telemedicine clinics to discuss and review patient cases. The program has provided more than 4,000 consultations for patients with HCV, and clinicians in rural areas have received 3,500 hours of continuing medical education credit. Outcome studies have shown that treatment of HCV in rural areas using the ECHO model is as safe and effective as in a university-based clinic.

The RWJF grant is supporting a replication of the ECHO model, beginning with the University of Washington (UW) in Seattle, and the expansion of the model to treat other common chronic and complex diseases, including diabetes, substance abuse and mental health problems, asthma, rheumatology, chronic pain, and high-risk pregnancy.

“Millions of Americans suffer from debilitating, chronic illnesses that could be treated if resources were available,” said Nancy Barrand, special adviser for program development at RWJF. “The ECHO model teaches us that we can leverage our existing health care resources to provide safe, effective care to patients in their communities, regardless of where they are.”

In addition to RWJF, Project ECHO has received funding from the U.S. Agency for Healthcare Research and Quality, the New Mexico Legislature, the University of New Mexico, and the New Mexico State Health Department.

In 2007, Project ECHO won the Disruptive Innovations in Health and Health Care competition sponsored by RWJF and Ashoka’s Changemakers, which drew 307 applicants from 27 countries. Arora was also honored with ehealth Initiative and Computerworld awards for his creative use of technology.


Project ECHO
Project ECHO (Extension for Community Healthcare Outcomes) at the University of New Mexico, Department of Internal Medicine, uses evidence-based medicine and telehealth technology to bring specialty care for chronic complex diseases to patients in rural and underserved areas. The project builds knowledge networks based on best practice protocols and case-based learning.

Robert Wood Johnson Foundation and the Pioneer Portfolio
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. The Foundation's Pioneer Portfolio is dedicated to accelerating the trajectory of innovative ideas that may lead to breakthrough improvements in the future of health and health care. Projects in the Pioneer Portfolio are future-oriented and look beyond conventional thinking to explore solutions at the cutting edge of health and health care.