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Mattox EA, Yantsides KE, Germani MW, Parsons EC. Utilizing the RE-AIM framework for a multispecialty Veterans Affairs Extension for Community Healthcare Outcomes (VA-ECHO) program 2018-2022. FRONTIERS IN HEALTH SERVICES 2023; 3:1217172. [PMID: 37780401 PMCID: PMC10533985 DOI: 10.3389/frhs.2023.1217172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/16/2023] [Indexed: 10/03/2023]
Abstract
VA-ECHO (Veterans Affairs -Extension for Community Healthcare Outcomes) provides live, synchronous, continuing education accredited, case-based learning. Sessions deliver up-to-date, evidence-based, practice-relevant, Veteran-focused learning to healthcare team members. The primary goal of VA-ECHO is to increase Veterans' access to high quality care by improving knowledge and skills among VA care providers. Utilizing the RE-AIM framework, descriptive statistics for 23 VA-ECHO programs regarding program effectiveness, adoption, implementation, and maintenance during a five-year period (2018-2022) are reported. VA-ECHO offered 1,462 sessions and 157,238 contact hours, engaging 17,642 participants from 837 VA-based sites (20% rural-based sites). Effectiveness includes information on number and diversity of programs, as well as reported impact on participants' practice. Adoption includes descriptive statistics, including comparison of growth and change compared to prior years. Implementation describes change in the program over time, including the number of specialties offered, and types of continuing education offered. Maintenance includes a narrative regarding sustainability. The discussion focuses on implementation and maintenance strategies the program has used to address participant and VA needs within the RE-AIM framework, including adjustments to the program, iterative qualitative improvement, sustainment strategies, and opportunities for future evaluation.
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Affiliation(s)
- Elizabeth A. Mattox
- Pulmonary, Critical Care and Sleep Medicine Section, Hospital and Specialty Medicine Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Konstantina E. Yantsides
- Health Services Research and Development Center for Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Maureen Wylie Germani
- Health Services Research and Development Center for Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Elizabeth C. Parsons
- Pulmonary, Critical Care and Sleep Medicine Section, Hospital and Specialty Medicine Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington Medical Center, Seattle, WA, United States
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Corcorran MA, Thornton K, Struminger B, Easterbrook P, Scott JD. Training the healthcare workforce: the global experience with telementorship for hepatitis B and hepatitis C. BMC Health Serv Res 2023; 23:824. [PMID: 37533025 PMCID: PMC10394928 DOI: 10.1186/s12913-023-09849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Telementorship has emerged as an innovative strategy to decentralise medical knowledge and increase healthcare capacity across a wide range of disease processes. We report the global experience with telementorship to support healthcare workers delivering hepatitis B virus (HBV) and hepatitis C virus (HCV) care and treatment. METHODS In early 2020, we conducted a survey of HBV and HCV telementorship programmes, followed by an in-depth interview with programme leads. Programmes were eligible to participate if they were located outside of the United States (U.S.), focused on support to healthcare workers in management of HBV and/or HCV, and were affiliated with or maintained adherence to the Project ECHO model, a telementorship programme pioneered at the University of New Mexico. One programme in the U.S., focused on HCV treatment in the Native American community, was purposively sampled and invited to participate. Surveys were administered online, and all qualitative interviews were performed remotely. Descriptive statistics were calculated for survey responses, and qualitative interviews were assessed for major themes. RESULTS Eleven of 18 eligible programmes completed the survey and follow up interview. Sixty-four percent of programmes were located at regional academic medical centers. The majority of programmes (64%) were led by hepatologists. Most programmes (82%) addressed both HBV and HCV, and the remainder focused on HCV only. The median number of participating clinical spoke sites per programme was 22, and most spoke site participants were primary care providers. Most ECHO sessions were held monthly (36%) or bimonthly (27%), with sessions ranging from 45 min to 2 h in length. Programme leaders identified collective learning, empowerment and collaboration to be key strengths of their telementorship programme, while insufficient funding and a lack of protected time for telementorship leaders and participants were identified as major barriers to success. CONCLUSION The Project ECHO model for telementorship can be successfully implemented across high and low-and-middle-income countries to improve provider knowledge and experience in management of viral hepatitis. There is a tremendous opportunity to further expand upon the existing experience with telementorship to support non-specialist healthcare workers and promote elimination of viral hepatitis.
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Affiliation(s)
- Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 9th Ave, Box 359782, Seattle, WA, 98104, USA.
| | - Karla Thornton
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Project ECHO, University of New Mexico, Albuquerque, NM, USA
| | - Bruce Struminger
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Project ECHO, University of New Mexico, Albuquerque, NM, USA
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - John D Scott
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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Crawford A, Sockalingam S, Serhal E, Zhou C, Gambin A, de Oliveira C, Iwajomo T, Kurdyak P. Using "Big Data" to Provide Insights into Early Adopters of Continuing Professional Development: An Example from Project ECHO. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; Publish Ahead of Print:00005141-990000000-00066. [PMID: 37053580 DOI: 10.1097/ceh.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Mental health care is often managed in primary care with limited specialist support, particularly in rural and remote communities. Continuing professional development programs (CPD) can offer a potential solution to further mental health training; however, engaging primary care organizations (PCOs) can be challenging. The use of "big data" to identify factors influencing engagement in CPD programs has not been well studied. Therefore, the aim of this project was to use administrative health data from Ontario, Canada to identify characteristics of PCOs associated with early engagement in a virtual CPD program, Project Extension for Community Healthcare Outcomes (ECHO) Ontario Mental Health (ECHO ONMH). METHODS Ontario health administrative data for fiscal year 2014 was used to compare the characteristics of ECHO ONMH-adopting PCOs, and their patients, to nonadopter organizations (N = 280 vs. N = 273 physicians). RESULTS ECHO-adopting PCOs did not differ with respect to physician age or years of practice, although PCOs with more female physicians were somewhat more likely to participate. ECHO ONMH adoption was more likely in regions with lower psychiatrist supply, among PCOs using partial salary payment models, and those with a greater interprofessional complement. Patients of ECHO-adopters did not differ on the basis of gender or health care utilization (physical or mental health); however, ECHO-adopting PCOs tended to have patients with less psychiatric comorbidity. CONCLUSION Models such as Project ECHO, which deliver CPD to primary care, are advanced to address lack of access to specialist health care. These findings support the use of administrative health data to assess the implementation, spread, and impact of CPD.
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Affiliation(s)
- Allison Crawford
- Allison Crawford, MD, FRCPC, PhD: Medical Director, Outreach and Virtual Care; Chief Medical Officer, Canada Suicide Prevention Service, Co-Chair ECHO Ontario Superhub and ECHO Ontario Mental Health, Clinician Scientist, Centre for Addiction and Mental Health, and Associate Professor, Department of Psychiatry, University of Toronto, Toronto, ON; Sanjeev Sockalingam, MD, MHPE, FRCPC, FACLP: VP, Education at the Centre for Addiction and Mental Health, CAMH Clinician Scientist; Professor of Psychiatry, University of Toronto, Toronto, ON; Eva Serhal, MBA, PhD: Senior Director of Virtual Mental Health, ECHO Ontario Mental Health, and Canadian Suicide Prevention Service, Centre for Addiction and Mental Health, Toronto, ON; Carrol Zhou, MD, FRCPC: Lecturer and Staff Psychiatrist, University of Toronto, Toronto, ON; Amanda Gambin, PhD: Research Coordinator, Virtual Mental Health, ECHO Ontario Mental Health, and Canadian Suicide Prevention Service, Centre for Addiction and Mental Health, Toronto, ON; Claire de Oliveira, PhD: Independent Scientist and Senior Health Economist, Centre for Addiction and Mental Health, and Associate Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; Tomisin Iwajomo, MPH: Research Coordinator, Institute for Mental Health Policy Research (CAMH), and Appointed Analyst, Mental Health and Addictions Research Program at the Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; and Paul Kurdyak, MD, PhD: Director of Health Outcomes and Performance Evaluation, Institute for Mental Health Policy Research, Medical Director of Performance Improvement at CAMH, Lead of the Mental Health and Addictions Research Program at the Institute for Clinical Evaluative Sciences (ICES), and Associate Professor, Department of Psychiatry, University of Toronto, Toronto, ON
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Mattox EA, Yantsides KE, Borgerding J, Beste LA, Parsons EC, Fleet M, Palen BN, O'Hearn D, Germani MW, Chang MF. Participant Characteristics and Attendance Patterns for a Multispecialty Veterans Affairs ECHO Program 2012-2018. Telemed J E Health 2022; 28:1633-1641. [PMID: 35325561 DOI: 10.1089/tmj.2021.0626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The Veteran Integrated Service Network (VISN) 20 Veterans Affairs-Extension for Community Healthcare Outcomes (VA-ECHO) program connects specialty and primary care providers (PCPs) across large geographic areas, utilizing video-teleconferencing with the intention of increasing access to care among underserved and isolated populations. No previously published work describes participation patterns of a multispecialty ECHO program. We describe the development of VISN 20 VA-ECHO program to inform the design and evaluation of ECHO programs. Methods: The participant cohort included VA-affiliated licensed health care professionals, including trainees, who attended at least one VISN 20 VA-ECHO session between April 2012 and December 2018. Participant characteristics reported include gender, clinical location, clinical specialty, discipline, and rurality. Results: Over the 6-year time frame, VISN 20 VA-ECHO offered 945 sessions in 14 clinical specialties and recorded 17,893 hours of attendance. The cohort included 1,346 participants, 74.3% of whom were female, 85.2% employed in medical centers, and 40.7% affiliated with primary care. Most participants (62.3%) attended one specialty exclusively; among all participants, 40% attended five or more sessions. Discussion: Although VA-ECHO was implemented to develop single specialty expertise among PCPs, our participant cohort represented a more diverse audience from a range of disciplines and specialties. Our experience may be valuable to other teams implementing ECHO programs. Conclusions: Through adaptability and strategies that actively promoted inclusion of a diverse audience, VISN 20 VA-ECHO expanded to include multiple clinical specialties and successfully engaged an audience across a large geographic area and beyond PCPs.
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Affiliation(s)
- Elizabeth A Mattox
- Pulmonary and Critical Care Section, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Konstantina E Yantsides
- Health Services Research and Development Center for Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Joleen Borgerding
- Health Services Research and Development Center for Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Lauren A Beste
- Health Services Research and Development Center for Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- General Medicine Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Division of General Internal Medicine, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Elizabeth C Parsons
- Pulmonary and Critical Care Section, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Margaret Fleet
- Nephrology Section, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Brian N Palen
- Pulmonary and Critical Care Section, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Daniel O'Hearn
- Pulmonary and Critical Care Section, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Maureen Wylie Germani
- Health Services Research and Development Center for Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Michael F Chang
- Gastroenterology and Hepatology Service, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Gastroenterology and Hepatology Division, Oregon Health & Sciences University, Portland, Oregon, USA
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Stanley K, Bowie BH. Comparison of hepatitis C treatment outcomes between primary care and specialty care. J Am Assoc Nurse Pract 2021; 34:292-297. [PMID: 34115717 DOI: 10.1097/jxx.0000000000000621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infections have increased significantly in the United States recently, having tripled by 2014. Seventy-five percent of those with HCV are aging baby boomers, which places increased pressure on the medical system to provide treatment. There are not enough specialists available to treat everyone infected with HCV. PURPOSE The aim of this research was to determine whether treatment of hepatitis C with new direct-acting antivirals in primary care settings resulted in equivalent cure rates when compared with those patients treated by specialists. METHODOLOGY A retrospective cohort design was used. Participants were those treated for hepatitis C in specialty care at large public hospitals by gastroenterologists and/or hepatologists and those treated in two primary care community health centers in Seattle. Multivariate logistic regression was used to determine differences of sustained virologic response between those treated in primary care and those treated in specialty care. Treatment failure and those lost to follow-up were combined into one category. RESULTS Failure rates were only 4% in primary care and 1.1% in specialty care. After adjustment, patients treated in primary care were statistically significantly less likely to have failure/lost to follow-up than those treated in specialty care. Hepatitis C treatment can be successfully provided in primary care with equivalent treatment outcomes. IMPLICATIONS FOR PRACTICE Primary care advanced practice nurses are in a good position to identify and treat hepatitis C. In addition, as patients are typically more engaged with their primary care provider, follow-up rates may be better versus referring these patients to a specialty provider.
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Affiliation(s)
- Kate Stanley
- Integrated Health Services, Colorado Coalition for the Homeless, Denver, Colorado
| | - Bonnie H Bowie
- Seattle University College of Nursing, Seattle, Washington
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Agley J, Henderson C, Adams Z, Hulvershorn L. Provider engagement in Indiana's opioid use disorder ECHO programme: there is a will but not always a way. BMJ Open Qual 2021; 10:bmjoq-2020-001170. [PMID: 33849905 PMCID: PMC8051380 DOI: 10.1136/bmjoq-2020-001170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/24/2021] [Accepted: 04/03/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jon Agley
- Prevention Insights, Department of Applied Health Science, Indiana University Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Cris Henderson
- Prevention Insights, Department of Applied Health Science, Indiana University Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Zachary Adams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leslie Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Schreiber MJ, Chatoth DK, Salenger P. Challenges and Opportunities in Expanding Home Hemodialysis for 2025. Adv Chronic Kidney Dis 2021; 28:129-135. [PMID: 34717858 DOI: 10.1053/j.ackd.2021.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Advancing American Kidney Health Initiative has set an aggressive target for home dialysis growth in the United States, and expanding both peritoneal dialysis and home hemodialysis (HHD) will be required. While there has been a growth in HHD across the United States in the last decade, its value in controlling specific risk factors has been underappreciated and as such its appropriate utilization has lagged. Repositioning how nephrologists incorporate HHD as a critical renal replacement therapy will require overcoming a number of barriers. Advancing education of both nephrology trainees and nephrologists in practice, along with increasing patient and family education on the benefits and requirements for HHD, is essential. Implementation of a transitional care unit design coupled with an intensive patient curriculum will increase patient awareness and comfort for HHD; patients on peritoneal dialysis reaching a modality transition point will benefit from Experience the Difference programs acclimating them to HHD. In addition, the potential link between HHD program size and patient outcomes will necessitate an increase in the size of the average HHD program to more consistently deliver quality dialysis results. Addressing the implications of the nursing shortage and need for designing in scope staffing models are necessary to safeguard HHD growth. Seemingly, certain government payment policy changes and physician documentation requirements deserve further examination. Future HHD innovations must result in decreasing the burden of care for HHD patients, optimize the level of device and biometric data flow, facilitate a more functional centralized patient management care approach, and leverage computerized clinical decision support for modality assignment.
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Belcher JM. The Role of Telenephrology in the Management of CKD. KIDNEY360 2020; 1:1310-1315. [PMID: 35372872 PMCID: PMC8815503 DOI: 10.34067/kid.0000802019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 09/21/2020] [Indexed: 06/01/2023]
Affiliation(s)
- Justin M. Belcher
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
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Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review. J Gen Intern Med 2019; 34:2842-2857. [PMID: 31485970 PMCID: PMC6854140 DOI: 10.1007/s11606-019-05291-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/31/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Extension for Community Healthcare Outcomes (ECHO) and related models of medical tele-education are rapidly expanding; however, their effectiveness remains unclear. This systematic review examines the effectiveness of ECHO and ECHO-like medical tele-education models of healthcare delivery in terms of improved provider- and patient-related outcomes. METHODS We searched English-language studies in PubMed, Embase, and PsycINFO databases from 1 January 2007 to 1 December 2018 as well as bibliography review. Two reviewers independently screened citations for peer-reviewed publications reporting provider- and/or patient-related outcomes of technology-enabled collaborative learning models that satisfied six criteria of the ECHO framework. Reviewers then independently abstracted data, assessed study quality, and rated strength of evidence (SOE) based on Cochrane GRADE criteria. RESULTS Data from 52 peer-reviewed articles were included. Forty-three reported provider-related outcomes; 15 reported patient-related outcomes. Studies on provider-related outcomes suggested favorable results across three domains: satisfaction, increased knowledge, and increased clinical confidence. However, SOE was low, relying primarily on self-reports and surveys with low response rates. One randomized trial has been conducted. For patient-related outcomes, 11 of 15 studies incorporated a comparison group; none involved randomization. Four studies reported care outcomes, while 11 reported changes in care processes. Evidence suggested effectiveness at improving outcomes for patients with hepatitis C, chronic pain, dementia, and type 2 diabetes. Evidence is generally low-quality, retrospective, non-experimental, and subject to social desirability bias and low survey response rates. DISCUSSION The number of studies examining ECHO and ECHO-like models of medical tele-education has been modest compared with the scope and scale of implementation throughout the USA and internationally. Given the potential of ECHO to broaden access to healthcare in rural, remote, and underserved communities, more studies are needed to evaluate effectiveness. This need for evidence follows similar patterns to other service delivery models in the literature.
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Su GL. Electronic Consultations: Delivering Specialty Care Anywhere. Hepatol Commun 2019; 3:1171-1173. [PMID: 31497737 PMCID: PMC6719737 DOI: 10.1002/hep4.1409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 07/02/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Grace L. Su
- Medicine ServiceVA Ann Arbor Healthcare System and University of Michigan Medical SchoolAnn ArborMI
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Query LA, Olson KR, Meyer MT, Drendel AL. Minding the Gap: A Qualitative Study of Provider Experience to Optimize Care for Critically Ill Children in General Emergency Departments. Acad Emerg Med 2019; 26:803-813. [PMID: 30267596 DOI: 10.1111/acem.13624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pediatric emergency care provision in the United States is uneven. Institutional barriers to readiness in the general emergency department (GED) are known, but little is understood about the frontline providers. Our objective was to explore the lived experiences of emergency medicine (EM) providers caring for acutely ill children in the GED and identify opportunities to optimize their pediatric practice. METHODS This grounded theory study used theoretical sampling with snowball recruitment to enroll EM physicians and advanced practice providers from 25 Wisconsin GEDs. Participants completed one-on-one, semistructured interviews. Audio recordings were transcribed and coded by a multi-investigator team drawing on theory produced from comparative analysis. RESULTS We reached theoretical saturation with 18 participants. The data suggested that providers felt competent managing routine pediatric care, but critically ill children outstripped their resources and expertise. They recognized environmental constraints on the care they could safely provide, which were intensified by unanticipated knowledge gaps and lack of awareness regarding pediatric practice guidelines. A fragmented medical network to support their pediatric practice was identified as a challenge to their care provision at critical junctures. Due to lack of guidance and feedback, providers internalized their experience with critically ill children with uncertainty, which limited learning and practice change. They benefited from meaningful relationships with pediatricians and pediatric subspecialists, targeted education, timely consults, and looped feedback about care provided and patient outcomes. CONCLUSIONS General ED providers struggled with critically ill children because they could not anticipate their pediatric-specific knowledge gaps and only realized them at critical junctures. EM providers were isolated and frustrated when seeking help; without guidance and feedback they internalized their experience with uncertainty and were left underprepared for subsequent encounters. The data suggested the need for provider-focused interventions to address gaps in pediatric-specific continuing medical education, just-in-time assistance, and knowledge transfer.
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Affiliation(s)
- Lindsey A. Query
- Department of Pediatrics Medical College of Wisconsin Milwaukee WI
- Division of Emergency Medicine Medical College of Wisconsin Milwaukee WI
| | - Krisjon R. Olson
- Department of Pediatrics Medical College of Wisconsin Milwaukee WI
- Division of Critical Care Medical College of Wisconsin Milwaukee WI
| | - Michael T. Meyer
- Department of Pediatrics Medical College of Wisconsin Milwaukee WI
- Division of Critical Care Medical College of Wisconsin Milwaukee WI
| | - Amy L. Drendel
- Department of Pediatrics Medical College of Wisconsin Milwaukee WI
- Division of Emergency Medicine Medical College of Wisconsin Milwaukee WI
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Giachetto G, Casuriaga AL, Santoro A, Kanopa V, Garrido G, Fernández J, Cohen H, Sohl K. Extension for Community Healthcare Outcomes Uruguay: A New Strategy to Promote Best Primary Care Practice for Autism. Glob Pediatr Health 2019; 6:2333794X19833734. [PMID: 31044151 PMCID: PMC6446250 DOI: 10.1177/2333794x19833734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/23/2018] [Accepted: 01/26/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction. In Uruguay, the special care required for children with neurodevelopmental disorders presents difficulties including lack of access to specialists and rehabilitation services. Project ECHO (Extension for Community Healthcare Outcomes) connects primary care clinicians from remote areas to specialists to enable them to treat complex conditions through ongoing education and mentoring. Objective. To share the experience of the ECHO Autism program during the first 2 years of implementation. Methods. Analysis of ECHO Autism clinics from June 2015 to June 2017 including clinical cases presented participants' self-perception of changes in skills and competences. Results. Twenty clinical cases were presented: mean age 4.5 years; 15 were males; and 17 with medical and psychiatric comorbidities. After ECHO Autism implementation, a statistically significant improvement in participants' self-perception of skills and competences was observed. Conclusions. ECHO Autism in Uruguay is a meaningful approach to autism care and offers improved access to best practice care.
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Affiliation(s)
| | | | | | | | | | - José Fernández
- Universidad de la Republica Uruguay, Montevideo, Uruguay
| | - Henry Cohen
- Universidad de la Republica Uruguay, Montevideo, Uruguay
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Ball S, Wilson B, Ober S, Mchaourab A. SCAN-ECHO for Pain Management: Implementing a Regional Telementoring Training for Primary Care Providers. PAIN MEDICINE 2019; 19:262-268. [PMID: 28525633 DOI: 10.1093/pm/pnx122] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective The Specialty Care Access Network-Extension for Community Health Outcomes (SCAN-ECHO) is a video teleconferencing-based training program where primary care providers are trained by a specialty care team to provide specialty care. A multidisciplinary team of pain management specialists at the Cleveland Veterans Affairs Medical Center established such a program for pain management; a description and preliminary effectiveness assessment of this training program is presented. Design Primary care provider participants in the Specialty Care Access Network program in pain management completed pre- and post-training questionnaires. A subset of these participants also participated in a group session semistructured interview. Subjects Twenty-four primary care providers from Cleveland, South Texas, or Wisconsin Veterans Affairs Medical Centers who regularly attended pain management SCAN-ECHO sessions during 2011, 2012, 2013, or 2014 completed pre- and post-training questionnaires. Methods Pre- and post-training questionnaires were conducted to measure confidence in treating and knowledge of pain management. Questionnaire responses were tested for significance using R. Qualitative data were analyzed using inductive coding and content analysis. Results Statistically significant increases in confidence ratings and scores on knowledge questionnaires were noted from pre- to post-pain management SCAN-ECHO training. Program participants felt more knowledgeable and reported improved communication between specialty and primary care providers. Conclusions This pilot study reveals positive outcomes in terms of primary care providers' confidence and knowledge in treating patients with chronic pain. Results suggest that involving primary care providers in a one-year academic project such as this can improve their knowledge and skills and has the potential to influence their opioid prescribing practices.
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Affiliation(s)
| | | | - Scott Ober
- Primary Care, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Ali Mchaourab
- Pain Medicine Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.,Department of Anesthesiology, Case Western Reserve University, Cleveland, Ohio, USA
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Mc Veigh C, Reid J, Carvalho P. Healthcare professionals' views of palliative care for American war veterans with non-malignant respiratory disease living in a rural area: a qualitative study. BMC Palliat Care 2019; 18:22. [PMID: 30813937 PMCID: PMC6394001 DOI: 10.1186/s12904-019-0408-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic lung diseases, such as COPD, are a growing health concern within the veteran population. Palliative care programs have mainly focused on the needs of people with malignant disease in the past, however the majority of those worldwide needing palliative care have a non-malignant diagnosis. Additionally, palliative care provision can often be fragmented and varied dependent upon a patient's geographical location. This study aimed to explore palliative care provision for veterans with non-malignant respiratory disease, and their family carers, living in a rural area of America. METHODS Qualitative study involving a convenience sample of 16 healthcare professionals from a large veteran hospital in Boise, Idaho. Data collection consisted of 5 focus groups which were transcribed verbatim and analysed using thematic analysis. RESULTS Healthcare professionals perceived that a lack of education regarding disease progression enhanced feelings of anxiety amongst veterans with NMRD, and their family carers. Additionally, the uncertain disease trajectory impeded referral to palliative and hospice services due to healthcare professionals own ambiguity regarding the veteran's prognosis. A particular barrier also related to this particular patient population, was a perceived lack of ability to afford relevant services and a lack of local palliative service provision. Healthcare professionals expressed that a compounding factor to palliative care uptake was the perceptions held by the veteran population. Healthcare professionals expressed that alongside aligning palliative care with dying, veterans also viewed accepting palliative care as 'surrendering' to their disease. Findings indicated that telemedicine may be a beneficial platform to which palliative care can be provided to veterans with NMRD, and their family carers, in rural areas using a digital platform. CONCLUSION Non-malignant respiratory disease is a life limiting condition commonly experienced within the veteran population. A new model of palliative care utilising a dynamic digital platform for this particular veteran population may provide an optimal way of providing efficient holistic care to areas with limited palliative services.
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Affiliation(s)
- Clare Mc Veigh
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Paula Carvalho
- Pulmonary and MICU, Boise VA Medical Centre, Boise, USA.,Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, USA
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15
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Su GL, Glass L, Tapper EB, Van T, Waljee AK, Sales AE. Virtual Consultations Through the Veterans Administration SCAN-ECHO Project Improves Survival for Veterans With Liver Disease. Hepatology 2018; 68:2317-2324. [PMID: 29729194 DOI: 10.1002/hep.30074] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/30/2018] [Indexed: 12/22/2022]
Abstract
Access to specialty care has been associated with improved survival in patients with liver disease but universal access is not always feasible. Methods of care delivery using virtual modalities including the SCAN-ECHO (Specialty Access Network-Extension of Community Healthcare Outcome) program were implemented by the Veterans Health Administration (VHA) to address this need but limited data are available on patient outcomes. We sought to evaluate the efficacy of a SCAN-ECHO visit within the context of a regional cohort of patients with liver disease in the VHA (n = 62,237) following implementation in the Ann Arbor SCAN-ECHO Liver Clinic from June 1, 2011, to March 31, 2015. The effect of a SCAN-ECHO visit on all-cause mortality was compared with patients with no liver clinic visit. To adjust for the differences among patients who had a SCAN-ECHO visit versus those with no visit, propensity score matching was performed on condition factors that affect the likelihood of a SCAN-ECHO visit: demographics, geographic location, liver disease diagnosis, severity, and comorbidities. During the study period, 513 patients who had a liver SCAN-ECHO visit were found within the cohort. Patients who had completed a virtual SCAN-ECHO visit were more likely younger, rural, with more significant liver disease, and evidence for cirrhosis. Propensity-adjusted mortality rates using the Cox Proportional Hazard Model showed that a SCAN-ECHO visit was associated with a hazard ratio of 0.54 (95% confidence interval 0.36-0.81, P = 0.003) compared with no visit. Conclusion: Improved survival in patients using SCAN-ECHO suggests that this approach may be an effective method to improve access for selected patients with liver disease, particularly in rural and underserved populations where access to specialty care is limited.
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Affiliation(s)
- Grace L Su
- Medicine Service, VA Ann Arbor Healthcare System, Ann Harbor, Michigan.,University of Michigan Medical School, Ann Arbor, Michigan
| | - Lisa Glass
- Medicine Service, VA Ann Arbor Healthcare System, Ann Harbor, Michigan.,University of Michigan Medical School, Ann Arbor, Michigan
| | - Elliot B Tapper
- Medicine Service, VA Ann Arbor Healthcare System, Ann Harbor, Michigan.,University of Michigan Medical School, Ann Arbor, Michigan
| | - Tony Van
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Akbar K Waljee
- Medicine Service, VA Ann Arbor Healthcare System, Ann Harbor, Michigan.,University of Michigan Medical School, Ann Arbor, Michigan.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, Michigan
| | - Anne E Sales
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Department of Learning Health Science, University of Michigan, Ann Arbor, Michigan
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16
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A pilot study using telehealth to implement antimicrobial stewardship at two rural Veterans Affairs medical centers. Infect Control Hosp Epidemiol 2018; 39:1163-1169. [PMID: 30185238 DOI: 10.1017/ice.2018.197] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To test the feasibility of using telehealth to support antimicrobial stewardship at Veterans Affairs medical centers (VAMCs) that have limited access to infectious disease-trained specialists. DESIGN A prospective quasi-experimental pilot study. SETTING Two rural VAMCs with acute-care and long-term care units.InterventionAt each intervention site, medical providers, pharmacists, infection preventionists, staff nurses, and off-site infectious disease physicians formed a videoconference antimicrobial stewardship team (VAST) that met weekly to discuss cases and antimicrobial stewardship-related education. METHODS Descriptive measures included fidelity of implementation, number of cases discussed, infectious syndromes, types of recommendations, and acceptance rate of recommendations made by the VAST. Qualitative results stemmed from semi-structured interviews with VAST participants at the intervention sites. RESULTS Each site adapted the VAST to suit their local needs. On average, sites A and B discussed 3.5 and 3.1 cases per session, respectively. At site A, 98 of 140 cases (70%) were from the acute-care units; at site B, 59 of 119 cases (50%) were from the acute-care units. The most common clinical syndrome discussed was pneumonia or respiratory syndrome (41% and 35% for sites A and B, respectively). Providers implemented most VAST recommendations, with an acceptance rate of 73% (186 of 256 recommendations) and 65% (99 of 153 recommendations) at sites A and B, respectively. Qualitative results based on 24 interviews revealed that participants valued the multidisciplinary aspects of the VAST sessions and felt that it improved their antimicrobial stewardship efforts and patient care. CONCLUSIONS This pilot study has successfully demonstrated the feasibility of using telehealth to support antimicrobial stewardship at rural VAMCs with limited access to local infectious disease expertise.
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17
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De Witt Jansen B, Brazil K, Passmore P, Buchanan H, Maxwell D, McIlfatrick SJ, Morgan SM, Watson M, Parsons C. Evaluation of the impact of telementoring using ECHO© technology on healthcare professionals' knowledge and self-efficacy in assessing and managing pain for people with advanced dementia nearing the end of life. BMC Health Serv Res 2018; 18:228. [PMID: 29606132 PMCID: PMC5879835 DOI: 10.1186/s12913-018-3032-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/16/2018] [Indexed: 11/16/2022] Open
Abstract
Background Pain assessment and management in advanced and end-stage dementia are challenging; patients are at risk of under-diagnosis, under-assessment and under-treatment. Previous research has highlighted the importance of needs-driven training and development in this area for physicians, nurses and healthcare assistants (HCAs) across specialties, disciplines and care settings. This study used teleconferencing technology to connect healthcare professionals across multiple settings and disciplines in real-time clinics, based on the Project ECHO© model. This paper reports the evaluation of the clinics by physicians, nurses and HCAs, including their knowledge and self-efficacy in pain assessment and management for patients with advanced and end-stage dementia. Methods A mixed method evaluation comprising quantitative survey of self-reported knowledge and self-efficacy pre- and post-ECHO clinic participation, and qualitative exploration of experiences of the clinics using focus group interviews. A census approach to sampling was undertaken. Pre- and post-ECHO evaluations were administered electronically using Survey Monkey software. Mann-Whitney U tests were used to explore differences in knowledge and self-efficacy scores pre- and post-ECHO clinic participation. Statistical significance was set a-priori at p = 0.05. Focus groups were video- and audio-recorded, transcribed verbatim and analysed using Braun & Clarke’s model of thematic analysis. Results Eighteen healthcare professionals [HCPs] (physicians [n = 7], nurses [n = 10], HCA [n = 1]) and twenty HCPs (physicians [n = 10], nurses [n = 10]) completed pre- and post-ECHO evaluations respectively, reporting improvements in knowledge and self-efficacy on participation in ECHO clinics and perceived utility of the clinics. Seven HCPs (physicians [n = 2], nurses [n = 5]) participated in two focus groups. Four themes emerged: knowledge and skills development and dissemination; protected time; areas for improvement; and the future of ECHO. Conclusions Telementoring clinics for HCP education and training in pain assessment and management in advanced and end-stage dementia demonstrate a positive impact on knowledge and self-efficacy of HCPs and highlight the value of a cross-specialty network of practice which spans across disciplines/HCP types, care settings and geographical areas. Further development of ECHO services in this and in other clinical areas, shows significant potential to support delivery of high-quality care to complex patient populations. Electronic supplementary material The online version of this article (10.1186/s12913-018-3032-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bannin De Witt Jansen
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Peter Passmore
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Hilary Buchanan
- Patient and Public Involvement Representative, Carer for a person living with dementia, Belfast, UK
| | | | - Sonja J McIlfatrick
- Institute of Nursing and Health Research, Ulster University, Coleraine, UK.,All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Dublin, Ireland
| | | | | | - Carole Parsons
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
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18
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Development of a Sleep Telementorship Program for Rural Department of Veterans Affairs Primary Care Providers: Sleep Veterans Affairs Extension for Community Healthcare Outcomes. Ann Am Thorac Soc 2018; 14:267-274. [PMID: 27977293 DOI: 10.1513/annalsats.201605-361bc] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Primary care providers (PCPs) frequently encounter sleep complaints, especially in regions with limited specialty care access. OBJECTIVES The U.S. Department of Veterans Affairs Extension for Community Healthcare Outcomes (VA-ECHO) program (based on Project ECHO) has successfully provided rural PCP education in subspecialty areas, including hepatitis C. We describe the feasibility of an ECHO program for sleep medicine. METHODS ECHO creates a virtual learning community through video-teleconferencing, combining didactics with individualized clinical case review. We invited multidisciplinary providers to attend up to 10 stand-alone, 1-hour sessions. Invitees completed a needs assessment, which guided curriculum development. After program completion, we examined participant characteristics and self-reported changes in practice and comfort with managing sleep complaints. We surveyed participation barriers among invitees with low/no attendance. MEASUREMENTS AND MAIN RESULTS Of the 39 program participants, 38% worked in rural healthcare. Participants included nurse practitioners (26%), registered nurses (21%), and physicians (15%). Seventeen (44%) completed the summative program evaluation. Respondents anticipated practice change from the program, especially in patient education about sleep disorders (93% of respondents). Respondents reported improved comfort managing sleep complaints, especially sleep-disordered breathing, insomnia, and sleep in post-traumatic stress disorder (80% of respondents each). A follow-up survey of program invitees who attended zero to two sessions reported scheduling conflicts (62%) and lack of protected time (52%) as major participation barriers. CONCLUSIONS Participants in a pilot sleep medicine VA-ECHO program report practice change and increased comfort managing common sleep complaints. Future work is needed to identify objective measures of return on investment and address participation barriers.
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19
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Glass LM, Waljee AK, McCurdy H, Su GL, Sales A. Specialty Care Access Network-Extension of Community Healthcare Outcomes Model Program for Liver Disease Improves Specialty Care Access. Dig Dis Sci 2017; 62:3344-3349. [PMID: 29043594 DOI: 10.1007/s10620-017-4789-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/19/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS To improve subspecialty access, VA Ann Arbor Healthcare System (VAAAHS) implemented the first Specialty Care Access Network (SCAN)-Extension of Community Healthcare Outcomes (ECHO) in chronic liver disease. SCAN-ECHO Liver links primary care providers (PCPs) to hepatologists via secure video-teleconferencing. We aim to describe characteristics of participants (PCPs) and patients (clinical question and diagnosis) in SCAN-ECHO Liver. METHODS This is a prospective study of the VAAAHS SCAN-ECHO Liver (June 10, 2011-March 31, 2015). This evaluation was carried out as a non-research activity under the guidance furnished by VHA Handbook 1058.05. It was approved through the Medicine Service at VAAAHS as noted in the attestation document which serves as documentation of approved non-research, quality improvement activities in VHA. RESULTS In total, 106 PCPs from 23 sites participated. A total of 155 SCAN-ECHO sessions discussed 519 new and 49 return patients. 29.4% of Liver Clinic requests were completed in SCAN-ECHO Liver. SCAN-ECHO Liver consults were completed an average of 10 days sooner than in conventional clinic. Potential travel saving was 250 miles round-trip (median 255 (IQR 142-316) per patient. CONCLUSION SCAN-ECHO Liver provided specialty care with increased efficiency and convenience for chronic liver disease patients. One of three of Liver Clinic consults was diverted to SCAN-ECHO Liver, reducing consult completion time by 20%.
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Affiliation(s)
- Lisa M Glass
- VA Ann Arbor Healthcare System, Internal Medicine, Gastroenterology 111D, 2215 Fuller Road, Ann Arbor, MI, 48105, USA. .,Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Akbar K Waljee
- VA Ann Arbor Healthcare System, Internal Medicine, Gastroenterology 111D, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Heather McCurdy
- VA Ann Arbor Healthcare System, Internal Medicine, Gastroenterology 111D, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Grace L Su
- VA Ann Arbor Healthcare System, Internal Medicine, Gastroenterology 111D, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anne Sales
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Learning Health Sciences, Medical School, University of Michigan, Ann Arbor, MI, USA
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20
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Ness TE, Annese MF, Martinez-Paz N, Unruh KT, Scott JD, Wood BR. Using an Innovative Telehealth Model to Support Community Providers Who Deliver Perinatal HIV Care. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:516-526. [PMID: 29283274 DOI: 10.1521/aeap.2017.29.6.516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mountain West AETC (AIDS Education and Training Center) ECHO (Extension for Community Healthcare Outcomes), a longitudinal HIV telemen-toring program, connects community providers and a multidisciplinary specialist team at the University of Washington. The program employs focused lectures and real-time case discussions to educate and support providers in low-resource and rural settings. We assessed the impact of the program on management of perinatal HIV through surveying community providers who participate, and reviewing cases presented by providers for consultation. One hundred percent of providers who presented a perinatal HIV case for ECHO consultation reported that presentation "very much" impacted management of the case, and 93% of survey respondents reported that ECHO participation helped them stay up to date on national perinatal HIV guidelines. All 13 cases had the successful outcome of prevention of mother-to-child transmission of HIV. The ECHO model can effectively support and educate community providers who care for HIV-infected pregnant women.
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Affiliation(s)
- Tara E Ness
- University of Washington, Seattle, Washington
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Mary F Annese
- University of Washington, Seattle, Washington
- Mountain West AIDS Education and Training Center, Seattle, Washington
| | - Natalia Martinez-Paz
- University of Washington, Seattle, Washington
- Mountain West AIDS Education and Training Center, Seattle, Washington
| | - Kenton T Unruh
- University of Washington, Seattle, Washington
- Mountain West AIDS Education and Training Center, Seattle, Washington
| | | | - Brian R Wood
- University of Washington, Seattle, Washington
- Mountain West AIDS Education and Training Center, Seattle, Washington
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21
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Scallan E, Davis S, Thomas F, Cook C, Thomas K, Valverde P, Kazanjian M, Byers T. Supporting Peer Learning Networks for Case-Based Learning in Public Health: Experience of the Rocky Mountain Public Health Training Center With the ECHO Training Model. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2373379917697066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Extension for Community Healthcare Outcomes (ECHO) is a model for professional training and support now being used widely in clinical health care. ECHO provides training for health care professionals in their own communities by creating peer learning groups connected by live bidirectional video communications. Topic experts lead the sessions, but most of the learning occurs through case presentations and consultations. Although similar to telemedicine, ECHO differs in that the responsibility for patient care remains with the primary care learners. The Rocky Mountain Public Health Training Center—which supports training for the public health workforce in the six-state region of Colorado, Utah, Wyoming, Montana, and North and South Dakota—has adapted the ECHO health care model for public health training, using the ECHO learning principles of creating and supporting peer learning networks connected by live bidirectional video, and employing a case-based learning approach. The public health ECHO trainings are facilitated by subject matter experts, focus on real-life public health challenges, and use programs or scenarios within communities as “cases.” This article looks at early success in using the ECHO model for public health training on topics such as local public health agency quality improvement, patient navigation, food safety, tobacco control, obesity prevention, tuberculosis management, and HIV prevention. The Rocky Mountain Public Health Training Center continues to refine its implementation of the ECHO learning model across a wide range of public health and population health topics and shows great promise as a framework for regional public health training.
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Affiliation(s)
| | | | - Fred Thomas
- University of Colorado, Aurora, CO, USA
- Children’s Hospital Colorado in Aurora, CO, USA
| | | | | | | | | | - Tim Byers
- University of Colorado, Aurora, CO, USA
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22
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Zhou C, Crawford A, Serhal E, Kurdyak P, Sockalingam S. The Impact of Project ECHO on Participant and Patient Outcomes: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1439-1461. [PMID: 27489018 DOI: 10.1097/acm.0000000000001328] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE Project Extension for Community Healthcare Outcomes (ECHO) uses tele-education to bridge knowledge gaps between specialists at academic health centers and primary care providers from remote areas. It has been implemented to address multiple medical conditions. The authors examined evidence of the impact of all Project ECHO programs on participant and patient outcomes. METHOD The authors searched PubMed, MEDLINE, EMBASE, PsycINFO, and ProQuest from January 2000 to August 2015 and the reference lists of identified reviews. Included studies were limited to those published in English, peer-reviewed articles or indexed abstracts, and those that primarily focused on Project ECHO. Editorials, commentaries, gray literature, and non-peer-reviewed articles were excluded. The authors used Moore's evaluation framework to organize study outcomes for quality assessment. RESULTS The authors identified 39 studies describing Project ECHO's involvement in addressing 17 medical conditions. Evaluations of Project ECHO programs generally were limited to outcomes from Levels 1 (number of participants) to 4 (providers' competence) of Moore's framework (n = 22 studies, with some containing data from multiple levels). Studies also suggested that Project ECHO changed provider behavior (n = 1), changed patient outcomes (n = 6), and can be cost-effective (n = 2). CONCLUSIONS Project ECHO is an effective and potentially cost-saving model that increases participant knowledge and patient access to health care in remote locations, but further research examining its efficacy is needed. Identifying and addressing potential barriers to Project ECHO's implementation will support the dissemination of this model as an education and practice improvement initiative.
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Affiliation(s)
- Carrol Zhou
- C. Zhou is a psychiatry resident, Department of Psychiatry, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.A. Crawford is assistant professor, Department of Psychiatry, University of Toronto, Faculty of Medicine, and director of psychiatry outreach and telepsychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.E. Serhal is manager, ECHO Ontario Mental Health Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.P. Kurdyak is associate professor, Department of Psychiatry, University of Toronto, Faculty of Medicine, medical director, Performance Improvement, Centre for Addiction and Mental Health, and assistant professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.S. Sockalingam is associate professor, Department of Psychiatry, University of Toronto, Faculty of Medicine, and deputy psychiatrist-in-chief, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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23
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Videoconferencing and telementoring about dementia care: evaluation of a pilot model for sharing scarce old age psychiatry resources. Int Psychogeriatr 2016; 28:1567-74. [PMID: 27189501 DOI: 10.1017/s1041610216000740] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND While videoconferencing, telementoring, and peer support have been shown to enhance services in some instances, there has been no research investigating the use of these technologies in supporting professionals managing clients with dementia. The objective of this research was to evaluate expansion of an old age psychiatry consultation service and pilot test a model to improve medical supervision and clinical governance for staff within regional and remote areas using remote information technology. METHODS The design was a mixed methods (qualitative and quantitative) evaluation using before, mid-point and post-implementation semi-structured interviews and questionnaires to examine orientation, acceptance, and impact underpinned by theoretical approaches to evaluation. Education evaluations used a Likert style response template. Participants were 18 dementia service staff, including staff from linked services and old age psychiatrists. Qualitative interviews addressed the pilot implementation including: expectations, experiences, strategies for improving the pilot, and perceived impact on work practice and professional development opportunities. RESULTS There was high satisfaction with the program. The case conference process contributed to perceived improved outcomes for clients, family, and staff. Clinicians perceived improvement in family carer and staff carer stress and their confidence in managing clients with behavioral and psychological symptoms of dementia (BPSD). Thematic analysis indicated that the pilot enhanced professional development, decreased travel time, and improved team cohesion. CONCLUSIONS Given the increasing aging population in regional, rural, and remote areas, initiatives using videoconferencing and telementoring will help to develop a confident and skilled workforce. This pilot program was found to be acceptable and feasible. Potential benefits for clients and family carers should be examined in future resesarch.
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24
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Wood BR, Unruh KT, Martinez-Paz N, Annese M, Ramers CB, Harrington RD, Dhanireddy S, Kimmerly L, Scott JD, Spach DH. Impact of a Telehealth Program That Delivers Remote Consultation and Longitudinal Mentorship to Community HIV Providers. Open Forum Infect Dis 2016; 3:ofw123. [PMID: 27703991 PMCID: PMC5047402 DOI: 10.1093/ofid/ofw123] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/14/2016] [Indexed: 01/09/2023] Open
Abstract
Background. To increase human immunodeficiency virus (HIV) care capacity in our region, we designed a distance mentorship and consultation program based on the Project ECHO (Extension for Community Healthcare Outcomes) model, which uses real-time interactive video to regularly connect community providers with a multidisciplinary team of academic specialists. This analysis will (1) describe key components of our program, (2) report types of clinical problems for which providers requested remote consultation over the first 3.5 years of the program, and (3) evaluate changes in participants' self-assessed HIV care confidence and knowledge over the study period. Methods. We prospectively tracked types of clinical problems for which providers sought consultation. At baseline and regular intervals, providers completed self-efficacy assessments. We compared means using paired-samples t test and examined the statistical relationship between each survey item and level of participation using analysis of variance. Results. Providers most frequently sought consultation for changing antiretroviral therapy, evaluating acute symptomatology, and managing mental health issues. Forty-five clinicians completed a baseline and at least 1 repeat assessment. Results demonstrated significant increase (P < .05) in participants' self-reported confidence to provide a number of essential elements of HIV care. Significant increases were also reported in feeling part of an HIV community of practice and feeling professionally connected to academic faculty, which correlated with level of program engagement. Conclusions. Community HIV practitioners frequently sought support on clinical issues for which no strict guidelines exist. Telehealth innovation increased providers' self-efficacy and knowledge while decreasing professional isolation. The ECHO model creates a virtual network for peer-to-peer support and longitudinal mentorship, thus strengthening capacity of the HIV workforce.
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Affiliation(s)
- Brian R Wood
- University of Washington,; Mountain West AIDS Education and Training Center, Seattle, Washington
| | - Kenton T Unruh
- University of Washington,; Mountain West AIDS Education and Training Center, Seattle, Washington
| | - Natalia Martinez-Paz
- University of Washington,; Mountain West AIDS Education and Training Center, Seattle, Washington
| | - Mary Annese
- University of Washington,; Mountain West AIDS Education and Training Center, Seattle, Washington
| | | | | | | | | | | | - David H Spach
- University of Washington,; Mountain West AIDS Education and Training Center, Seattle, Washington
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25
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Beste LA, Mattox EA, Pichler R, Young BA, Au DH, Kirsh SF, Germani MW, Hedeen A, Harp BK, Chang MF. Primary Care Team Members Report Greater Individual Benefits from Long- Versus Short-Term Specialty Telemedicine Mentorship. Telemed J E Health 2016; 22:699-706. [PMID: 26959098 DOI: 10.1089/tmj.2015.0185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary care providers who participate in structured specialty telemedicine mentorship report improvements in clinical content mastery, professional satisfaction, and specialist communication. INTRODUCTION Although these programs require investments of infrastructure resources and time, the duration of participation required to accrue optimal benefits is not known. We aimed to assess whether duration of participation is related to improved benefits of a longitudinal telemedicine-based mentorship program, specifically regarding perceived specialty care access, acquisition of new knowledge and skills, team integration, and overall job satisfaction. MATERIALS AND METHODS We conducted an e-mail survey of Veterans Affairs-based primary care team members in the United States' Pacific Northwest region who engaged in a longitudinal telemedicine mentorship program (n = 78). RESULTS After adjustment for potential confounding factors, respondents who engaged in telemedicine mentorship for ≥1 year were significantly more likely to strongly agree that telemedicine mentorship improved patient access to specialty care (adjusted odds ratio [AOR] = 9.3, p < 0.005) and was useful in treating other patients on their panels (AOR = 3.7, p = 0.04). Participation ≥1 year was also associated with higher self-reported knowledge and competencies (AOR = 4.0, p = 0.03) and with perception of integration into a clinical team (AOR = 5.6, p = 0.01), but not with overall job satisfaction. CONCLUSION Telemedicine-based specialty mentorship programs are highly valued by primary care-based participants, and self-reported benefits accumulate beyond 1 year of participation.
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Affiliation(s)
- Lauren A Beste
- 1 General Medicine Service, VA Puget Sound Health Care System , Seattle, Washington.,2 Health Services Research and Development Center for Innovation , VA Puget Sound Health Care System, Seattle, Washington.,3 Division of General Internal Medicine, University of Washington , Seattle, Washington
| | - Elizabeth A Mattox
- 4 Pulmonary and Critical Care Section, Hospital and Specialty Medicine , VA Puget Sound Health Care System, Seattle, Washington
| | - Raimund Pichler
- 5 Nephrology Section, Hospital and Specialty Medicine , VA Puget Sound Health Care System, Seattle, Washington.,6 Division of Nephrology and Kidney Research Institute, University of Washington , Seattle, Washington
| | - Bessie A Young
- 2 Health Services Research and Development Center for Innovation , VA Puget Sound Health Care System, Seattle, Washington.,5 Nephrology Section, Hospital and Specialty Medicine , VA Puget Sound Health Care System, Seattle, Washington.,6 Division of Nephrology and Kidney Research Institute, University of Washington , Seattle, Washington
| | - David H Au
- 2 Health Services Research and Development Center for Innovation , VA Puget Sound Health Care System, Seattle, Washington.,4 Pulmonary and Critical Care Section, Hospital and Specialty Medicine , VA Puget Sound Health Care System, Seattle, Washington.,7 Division of Pulmonary and Critical Care, University of Washington , Seattle, Washington
| | - Susan F Kirsh
- 8 Office of Specialty Care Services , Patient Care Services, Department of Veterans Health Administration, Washington, District of Columbia.,9 Louis Stokes Cleveland VA Medical Center , Cleveland, Ohio.,10 Case Western Reserve University School of Medicine , Cleveland, Ohio
| | - Maureen W Germani
- 2 Health Services Research and Development Center for Innovation , VA Puget Sound Health Care System, Seattle, Washington
| | - Ashley Hedeen
- 2 Health Services Research and Development Center for Innovation , VA Puget Sound Health Care System, Seattle, Washington
| | - Bonnie K Harp
- 2 Health Services Research and Development Center for Innovation , VA Puget Sound Health Care System, Seattle, Washington.,6 Division of Nephrology and Kidney Research Institute, University of Washington , Seattle, Washington
| | - Michael F Chang
- 11 Gastroenterology and Hepatology Service , VA Portland Health Care System, Portland, Oregon.,12 Gastroenterology and Hepatology Division, Oregon Health & Sciences University , Portland, Oregon
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Carey EP, Frank JW, Kerns RD, Ho PM, Kirsh SR. Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis. ACTA ACUST UNITED AC 2016; 53:147-56. [DOI: 10.1682/jrrd.2014.10.0247] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 09/11/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Evan P. Carey
- Department of Veterans Affairs (VA) Eastern Colorado Health Care System, Denver, CODepartment of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Joseph W. Frank
- Department of Veterans Affairs (VA) Eastern Colorado Health Care System, Denver, CODivision of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Robert D. Kerns
- VA Connecticut Healthcare System, West Haven, CT, and Yale School of Medicine, New Haven, CT
| | - P. Michael Ho
- Department of Veterans Affairs (VA) Eastern Colorado Health Care System, Denver, CODepartment of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Susan R. Kirsh
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, and Office of Specialty Care, Veterans Health Administration, Washington, DC
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27
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Daniel H, Sulmasy LS. Policy recommendations to guide the use of telemedicine in primary care settings: an American College of Physicians position paper. Ann Intern Med 2015; 163:787-9. [PMID: 26344925 DOI: 10.7326/m15-0498] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Telemedicine-the use of technology to deliver care at a distance-is rapidly growing and can potentially expand access for patients, enhance patient-physician collaboration, improve health outcomes, and reduce medical costs. However, the potential benefits of telemedicine must be measured against the risks and challenges associated with its use, including the absence of the physical examination, variation in state practice and licensing regulations, and issues surrounding the establishment of the patient-physician relationship. This paper offers policy recommendations for the practice and use of telemedicine in primary care and reimbursement policies associated with telemedicine use. The positions put forward by the American College of Physicians highlight a meaningful approach to telemedicine policies and regulations that will have lasting positive effects for patients and physicians.
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Affiliation(s)
- Hilary Daniel
- From American College of Physicians, Washington, DC, and Philadelphia, Pennsylvania
| | - Lois Snyder Sulmasy
- From American College of Physicians, Washington, DC, and Philadelphia, Pennsylvania
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