A Model for Bringing Specialty Care to Underserved Areas

Jul 30, 2009, 5:24 AM, Posted by

Sanjeev Arora, M.D., is executive vice chair for the Department of Internal Medicine at the University of New Mexico Health Sciences Center and the director of Project ECHO (Extension for Community Healthcare Outcomes), which is supported by the Robert Wood Johnson Foundation’s Pioneer portfolio. He is also the principal investigator on grant funding for the project from the federal government, New Mexico Department of Health, and New Mexico Legislature.

For health reform to achieve meaningful cost savings, we must substantially change how we deliver health care.  Here in Albuquerque, we are tackling this by combining evidence-based medicine and telehealth technology to expand treatment for common, chronic, complex diseases in rural and underserved communities.

In New Mexico, an estimated 32,000 people – most of them poor and living in very remote, rural areas – suffer from Hepatitis C (HCV).  Few health care providers in the state are equipped to treat this disease.

Project ECHO, based at the University of New Mexico’s Health Sciences Center and funded by the Robert Wood Johnson Foundation’s Pioneer program, engages primary care providers in cross-disciplinary education and mentoring that makes it possible to deliver highly effective care to patients in different locations in a remarkably brief window of time.

Recently, we conducted our weekly HCV clinic with providers from a half-dozen sites, all linked to us through confidential videoconferencing or phone.  At a table in Albuquerque with me sat a pharmacologist, a mental health specialist, a nurse, an HCV outreach worker, and others.

Prior to the clinic, we had all received summaries for each case, highlighting what we needed to know to offer an informed consult.  With these summaries in hand, we listened to our remote colleagues present their cases:  A 52-year-old man needed to lose at least 40 pounds to improve his chance for a cure from HCV treatment and, if treatment failed, qualify for an eventual liver transplant. A 35-year-old woman struggling with the punishing side effects of HCV treatment needed medication to treat her depression. Thanks to real-time technology and having all the right people at the table at the same time, we worked through 20 cases in 2.5 hours.

In essence, we are providing care to very sick people who would otherwise go untreated.  At the same time we are expanding the capacity and reach of the health care system by engaging more colleagues in a highly needed specialty.  We are also using this vehicle to provide care for people dealing with substance abuse and mental health problems, rheumatology, chronic pain, asthma, and high-risk pregnancies.

We believe that this approach can help bring sorely needed specialty care to millions of Americans in rural and underserved areas without increasing costs, and we see Project ECHO as a potential model for other parts of the country.

This commentary originally appeared on the RWJF Pioneering Ideas blog.