Implementing Project Echo: Complex Care Management, Using Technology to Support Primary Care Nurses

Project ECHO is a telehealth model of knowledge transfer that connects expert faculty teams with primary care providers. The primary goal of Project ECHO is to improve health care outcomes through case-based learning. It aims to do so by equipping participants with the knowledge and skills needed to care for unique patient populations. While there are several established Project ECHOs specifically addressing the knowledge needs of primary care providers, Project ECHO Complex Care Management (CCM) is one of the first specifically targeting primary care nurses. It is uniquely designed to build nurse leadership and to directly support nurses as they engage in complex care management. A faculty team of multidisciplinary specialists advise the nurses on next steps to manage their patients with complex medical, psychosocial, and behavioral issues.

As part of a larger complex care management initiative at the Community Health Center, Inc. (CHCI), Project ECHO Complex Care Management (CCM) was uniquely designed to build nurse leadership skills and experience. The CHCI is one agency with 14 different integrated patient-centered primary care sites across the state of Connecticut. These sites provided care for uninsured and underinsured patients. The CHCI translated this provider-centric design using the Knowledge To Action framework to a model centered on nurses. Through twice monthly didactics and case presentations, nurses from all over CHCI's statewide network connect via videoconference to receive expert advice from a variety of specialists on how to care for their most complex patients. The faculty team is made up of a nurse practitioner and Chief Nursing Officer, a medical provider, behavioral health provider, pharmacist, registered dietician, certified diabetes educator, care management specialist and homecare nurse. The first thirty minutes of a session are focused on didactic education, and the latter 1.5 hours on case presentations by nurses. There is a standard presentation form that was designed to support nurses in organizing the case information as well as the questions they are requesting the faculty to address. Through videoconferencing and case-based learning, the faculty lends real-time support and supports nurses as they address the needs of their complex patients. Nurses are empowered to practice to the top of their license and provide patients with high quality, low cost care. Through case presentations nurses learn valuable care management skills and gain the confidence to develop their roles as leaders on health care teams.

Project ECHO CCM develops nurses as leaders and care managers in the primary care setting. It is an effective tool in training both new and experienced nurses as they transition into primary care roles that include a significant amount of care management. Project ECHO CCM is an important platform for improving nurses' knowledge and self-efficacy. Project ECHO CCM connects every nurse throughout the CHCI on a regular basis. It provides them with the chance to learn from one another, creating a knowledge network, and a stronger team dynamic. The opportunity to communicate in this way across each of the CHCI’s sites would not be possible without Project ECHO. This technology has the potential to connect nurses without regard to geography, linking teams together to learn from each other, and to share best practices.

Operational data from Project ECHO CCM further demonstrates the impact through case analysis, and also general metrics of the % of nurses who have presented, as well as the number of continuing nurse education credits granted. As of July 2016, 42 cases have been presented, representing 35 discrete patients with 66% of nurses at CHCI having had presented at least one case, and 1 nurse having presented eight cases. This number will continue to rise and more and more nurses are likely to full engage in this intervention in the coming year. Topics covered during the didactic portion of Project ECHO CCM have included chronic pain, substance abuse, diabetes, asthma, COPD, self-management goal setting, motivational interviewing and even medical nutrition therapy to name a few. This poster will be updated with the most current operational data to better describe the overall impact and global implications for Project ECHO CCM.