Introduction to NW AETC ECHO

1. Introduction to NW AETC ECHO Christian B. Ramers, MD, MPH Presentation prepared & presented by: Christian Ramers, MD, MPH, Kent Unruh, PhD, Mary Annese, MPA, and Laurie Conratt, MBA Last Updated: April 3, 2012

2. NW AETC ECHO Telehealth Program NW AETC ECHO Mission • Build capacity to maximize treatment of chronic HIV infection in underserved areas, monitoring outcomes • Catalyze knowledge sharing between clinicians developing treatment expertise across the Pacific Northwest region • Disseminate treatment innovations quickly across a network of clinicians • Maximize HIV care in local communities (FQHC’s, community clinics), treating patients locally with expert knowledge

3. Background

4. NW AETC ECHO Telehealth Program The History of Project ECHO 2002 – Frustration • 30,000 patients  6 month wait 2002-2008 – Roll-Out • AshokaChangemakers Award • AAMC Spencer Foreman Award for Outstanding Community Service 2009 – Expansion • UW, U of Chicago, Harvard 2011 – Legitimacy • Landmark NEJM Article Dr. Sanjeev Arora

5. NW AETC ECHO Telehealth Program Evidence Supporting Project ECHO • Similar Hepatitis C treatment outcomes at ECHO clinics and UNM academic clinics (SVR 58.2 vs. 57.5, P = 0.89) • Decreased professional isolation • Increased provider knowledge & self-efficacy Arora S, et al. Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers. NEJM 2011

6. Set Up

7. NW AETC ECHO Telehealth Program NW AETC ECHO Groundwork • Utilize collaborators and partner networks to recruit eligible clinic sites for participation • Develop tools to meet AETC Telehealth program needs • Develop web-based resources • Identify NW AETC ECHO multidisciplinary team • Develop curricula blocks for didactic sessions • Conduct site visits with interested sites: • Foster buy-in with clinicians and administrators • Baseline needs assessment • Technology assessment

8. NW AETC ECHO Telehealth Program On-Demand Access to mini-Didactics Only in ECHO Archive Adobe Connect Streaming Live Video Didactic & Cases | Questions via Text Full Live Video Interaction Didactic + Case Consultation Tier 1 Tiered Concentric Participation Model Tier 2 Tier 3

9. NW AETC ECHO Telehealth Program Mechanics of Weekly Telehealth Sessions Mini-Didactics • Focused clinical topic • First 15 minutes of each session • Additional 5 minutes for discussion • Recorded/archived for future viewing Case consultations • Remainder of session • Goal 3-4 cases per session • Each site should contribute at least one case per month 12 9 3 6

10. NW AETC ECHO Telehealth Program Resources for Participants • Presenting Cases!!! • Mini-Didactics (live or archived) • Availability of NW AETC ECHO Specialists 24/7 • Additional resources via email • Hot topics & Articles of interest • Website: www.nwaetcecho.org • Streaming archive of videos (additional topics!) • Forms , Faculty & contact info • Curriculum, Upcoming session information • CME and CNE available for participants

11. Evaluation Plan

12. NW AETC ECHO Telehealth Program Program Evaluation Clinic Level Assessment • Q12 months • Clinic goals • Standard clinical quality measures Provider Level Assessment • Q6 months • Individual provider goals • Knowledge, Self-Efficacy, Community of Practice Within-Session Tracking • Case presentations, Participation • Recommendations and peer-to-peer interactions

13. Preliminary Results

14. NW AETC ECHO Telehealth Program NW AETC ECHO Sites ALASKA Bellingham, WA WASHINGTON MONTANA Everett, WA Kalispell, MT Bremerton, WA Spokane, WA Missoula, MT Anchorage, AK Yakima, WA Butte, MT Vancouver, WA Bozeman, MT Billings, MT Portland, OR Hermiston, OR IDAHO ECHO - Chronic Pain 27 sites OREGON Eugene, OR ECHO - Integrated Addiction and Adult Psychiatry, 42 sites Springfield, OR Boise, ID Twin Falls, ID ECHO – HCV, 21 sites Pocatello, ID Medford, OR

15. NW AETC ECHO Telehealth Program www.nwaetcecho.org Clinic Level Assessment • Q12 months

16. Specialist Panel: ID – Hep C PharmD Case Manager ID – HIV Psychiatry ID – HIV Family Medicine Informatics Nursing ID - HIV

17. Seattle, WA Snowmass, CO Anchorage, AK Pocatello, ID Bozeman, MT Medford, OR Springfield, OR Twin Falls, ID Spokane, WA

18. NW AETC ECHO Telehealth Program Barriers and Solutions • Provider Buy-in • Perceived need for weekly time commitment • Administrative Buy-in • Allowing providers to participate for 1 hour every week • IT barriers • Face-to-face site visit • Build relationships with clinic and providers – program champions • Obtain baseline assessment information • Assess clinic workflow and technology • Case review (level IV training) in clinician’s own environment • Target Audience • Tiered participation model, recorded mini-didactics • Ensuring a diversity of content: basic  cutting edge

19. NW AETC ECHO Telehealth Program Resources • www.nwaetcecho.org • Recorded Didactics • Curriculum • Staff/Faculty • To join a session: 1. Let us know you’ll be joining: • Christian Ramers: ramers@uw.edu • Kent Unruh: ktunruh@uw.edu 2. At 12:00 PST, log in to uwsom.adobeconnect.com/echohiv • Sign in as a ‘guest’ • Provider your name & credentials • Any further questions: ramers@uw.edu

20. Questions & Discussion How is this relevant to your work?Can you envision an ECHO-like program within your training & mentoring programs?How can ECHO foster cross-FTCC collaboration?