The hub-and-spoke model that transformed aviation is being applied to the continuing education of primary care physicians with the aim of enabling access to hard-to-find specialty care in remote areas. In this case, the “hub” is the team of academic subspecialty experts who make themselves available to primary care physicians—the “spokes”—through Web-enabled videoconferencing sessions. They cover dozens of conditions such as chronic pain, HIV, hepatitis C, endocrinology, dementia, autism, addiction and diabetes.

Extremely long waits for hepatitis C care in New Mexico gave birth to the effort, known as Project Extension for Community Healthcare Outcomes (ECHO), at the University of New Mexico School of Medicine. More than 90 hubs now participate, offering subspecialist guidance to primary care physicians, nurses and other clinicians across the U.S. and in 12 other countries.

The 90-minute Project ECHO sessions, available for free and eligible for continuing medical education (CME) credits, are organized by disease- or topic-specific case and feature presentations made by physicians seeking guidance. The doctors are provided examples and templates on how to present case information so that the subspecialty experts have the information they need to offer meaningful advice.

The project goes beyond typical CME offerings by giving primary care doctors a way to present their most complex cases to expert teams and to learn by managing their own patients with interactive guidance from subspecialists.

University of Missouri, Columbia, pediatrician Bernie Eskridge, MD, takes part in Project ECHO sessions on autism. It takes between six and 18 months to confirm an autism diagnosis, and Dr. Eskridge wanted to learn more about how to help address these patients’ comorbidities and symptoms during that time. Dr. Eskridge takes part in four Project ECHO sessions each month, and he has learned how to address patients’ immediate needs and how to talk with parents during the long process of awaiting diagnostic confirmation.

Ob-gyn Rose Gowen, MD, practices in Brownsville, Texas, and frequently had to refer patients with abnormal Pap smear results to a specialist with an office more than an hour away and who was available once a month to provide follow-up care. Dr. Gowen was able to obtain in-person training on colposcopy, and now takes part in the MD Anderson ECHO for Cervical Cancer Prevention. She credits her office’s involvement with an uptick in the number of women who get Pap smears in the clinic and a decrease in the number referred for cone biopsy. Dr. Gowen also says participation in the Project ECHO sessions has led to greater adherence to updated cervical cancer screening guidelines.

While Project ECHO was launched with an aim toward helping primary care physicians in rural areas, it is now being used in urban settings too. For example, the University of Chicago is using the Project ECHO model to connect doctors in their affiliated clinics in the Windy City and throughout Illinois with specialists. Their focus topics include resistant hypertension, geriatric medicine and childhood obesity.

An AMA STEPS Forward™ module on Project ECHO outlines seven things physicians can do to integrate the program into their practices:

  • Learn more about the Project ECHO model, which aims to improve clinician satisfaction, knowledge and self-efficacy while achieving better patient satisfaction and outcomes. The project’s director, Sanjeev Arora, MD, details the effort in this 12-minute TEDx talk, “Changing the World, Fast.”
  • Identify topic areas where there is a need for increased access to specialty care or areas in which the physician is particularly interested in gaining deeper learning or specialization. In a larger practice, a multidisciplinary planning committee should meet for one hour a month for two to three months to help determine educational needs. In a smaller practice, physicians should pursue ECHO sessions of personal interest and see how they like it.
  • Connect with Project ECHO hubs that offer training in the clinical area of interest. More information about Project ECHO sessions is available by email.
  • Join a Project ECHO session in the clinical area of interest to observe the format firsthand and learn from the didactic presentations. Participants get CME credits for the total time spent on the activity, including time spent on didactics and patient case presentations.
  • Present patient cases in a Project ECHO clinic session. Broadband Internet access is required to take part in the sessions, which happen about once a week. Health professionals other than physicians can take part and see a benefit, including nurse practitioners, psychiatrists, social workers and pharmacists.
  • Apply what has been learned to treat patients in practice. A few sessions should provide participants the knowledge to provide direct care to patients or determine when a referral is prudent. The ECHO hub partner will also provide access to specialists in a physician’s region.
  • Continue to participate in Project ECHO clinic sessions to refine skills, presenting patient cases as needed. The self-paced learning model means some physicians may learn what they need about a given topic in just a few sessions, then move to another topic of interest. Some doctors passionate about a clinical topic opt to attend sessions in that area for years, becoming experts and receiving referrals through Project ECHO.
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