Paper: Leveling the Ground for Access to Best Practice Specialty Care in Rural Communities (Sigma Theta Tau International's 21st International Nursing Research Congress)

Tuesday, 13 July 2010

Jeanne Boyle, BSN
Department of Internal Medicine, Project ECHO, University of New Mexico Health Sciences Center, Abuquerque, NM
Sanjeev Arora, MD
Department of Internal Medicine, Project ECHO, University of New Mexico, Albuquerque, NM
Connie Fassler, BS
Internal Medicine,Project ECHO, University of New Mexico Hospital, Albuquerque, NM
Joanna Katzman, MD, MPH
Department of Neurology; Department of Anesthesiology; Project ECHO, University of New Mexico School of Medicine, Albuquerque, NM

Learning Objective 1: identify how the model, Project ECHO, brings evidence-based specialty care to rural New Mexico.

Learning Objective 2: verbalize how a similar model can safely and effectively improve access to overall specialty care in their region.

The mission of Project ECHO is to safely, effectively treat chronic, common, complex diseases in rural, underserved areas and monitor outcomes. Providing such care in NM is challenging. Of 1.83 million people, 22% lack health insurance, over 52% are non-white Hispanic or Native American living in rural or frontier regions, served by fewer than 20% of clinicians. Technology leverages scarce healthcare resources. Sharing best practices via case based learning, rural primary care NPs, and MDs present cases to a chronic pain multidisciplinary team at the UNM, Project ECHO. Unlike traditional telemedicine, ECHO provides specialist guidance to rural providers without direct patient care. In 2003, Hepatitis C was the first disease approached utilizing the ECHO model. In 2009, six other diseases were targeted based on the successes of Hep C*. This presentation focuses on one of the six targets: chronic pain. The Chronic Pain Team is multidisciplinary. Tele-ECHO clinic meets weekly during which clinicians around the state phone in or utilize a video web bridge. Rural providers present cases. Written recommendations equip rural clinicians with case-based, evidence-based best practice specialty care. Advantages are many: Primary care follows their own patients, patients stay in their own communities with their own trusted providers, and specialty care is provided promptly and at no cost. Monitoring outcomes is an essential part of our mission. *Hep C ECHO data demonstrate this model provides care and treatment to the rural patient equal to that received from a hepatologist. The Chronic Pain Team is currently measuring provider empathy, self efficacy, and knowledge of pain treatment modalities in a controlled trial protocol. Patient pain levels and quality of life measures will be studied in 2010. With these data, we hope to show the ECHO model superior to the current model of referring pain patients away from their own communities.

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