In 2003, Sanjeev Arora, MD, a liver disease specialist at the University of New Mexico Health Sciences Center in Albuquerque, saw that his community was in crisis. An estimated 28,000 New Mexicans desperately needed treatment for hepatitis C, but fewer than 5 percent were getting it. In fact, the state has the nation’s highest death rate from liver disease.
Treatment for hepatitis C is a complicated, chemotherapy-like regimen administered over 12 to 18 visits. In all of New Mexico, only Arora’s specialty clinic in Albuquerque treated hepatitis C. “Not a single primary doctor in the state was trained to treat the disease—just our specialists,” Arora says.
As a result, thousands of people could not get the treatment they needed —and they were suffering and dying.
Building Medical Knowledge Networks
To Arora, that was unacceptable. He created Project ECHO (Extension for Community Healthcare Outcomes) as a way to break down the knowledge wall and empower primary care providers to treat patients with hepatitis C.
Instead of confining specialized medical knowledge to institutions of higher learning, Arora developed a model to make that knowledge accessible wherever it was needed to save and improve people's lives. By teaming community-based providers with specialists at university medical centers through real-time, virtual clinics, Project ECHO both shares knowledge and expands treatment capacity —resulting in better care for more people.
Project ECHO produces what Arora calls a “force multiplier effect,” which he describes as a “logarithmic expansion” of health care system capacity. Primary care doctors and their teams —trained through Project ECHO—become new centers of excellence, dramatically increasing access to care for patients in their own communities. These medical teams are trained in best practices and are continually connected to an online learning loop, where they develop the skills and receive the support they need to provide comprehensive, complex treatment for patients with chronic diseases right where they live.
Increasing Access to Specialty Care
Today, treatment for hepatitis C is available at 21 centers of excellence across New Mexico, and more than 50 primary care teams provide treatment to 6,000-plus patients enrolled in Project ECHO’s comprehensive disease management programs.
A 2011 study published in the New England Journal of Medicine showed that the quality of hepatitis C care provided by Project ECHO-trained clinicians was equal to that of care provided by university-based specialists.
With the help of a $5 million grant from the Robert Wood Johnson Foundation, Project ECHO’s capacity has been expanded to train rural and urban health care providers in underserved communities to address hepatitis C, chronic pain, rheumatology, addictions, psychiatry, asthma and pulmonary care, cardiovascular risk reduction, high-risk pregnancy, HIV/AIDS, geriatrics, palliative care, pediatric obesity and heart failure. To date, Project ECHO has provided more than 27,000 hours of best practice dissemination to more than 300 primary care doctors and their teams in 74 communities across New Mexico.
But Project ECHO’s impact goes far beyond New Mexico. ECHO replications are underway in Washington State and Chicago; federal government agencies, academic medical centers, health care systems, health plans and others across the nation are adopting the ECHO model.
Through Project ECHO, thousands of people—many of them from poor and isolated communities—are living longer, healthier lives, with less pain and disability. Project ECHO offers what could become a new, improved norm for medical practice.