"AHRQ funding allowed us to create technology-supported networks of continual learning and mentorship that bring best-practice care to people in rural and underserved communities."
When he received the Heinz Award for Public Policy in 2014, Sanjeev Arora, M.D., was recognized for revolutionizing community health care by “demonopolizing” specialized medical knowledge to produce the greatest good, using basic video conferencing technology as a platform for global telementoring and collaborative care.
A liver disease specialist at the University of New Mexico Health Sciences Center (UNMHSC), Dr. Arora received the award for his AHRQ-funded work to create and expand Project ECHO (Extension for Community Healthcare Outcomes),* which brings evidence-based health care to rural and underserved patients by helping frontline providers acquire new skills and expertise via weekly virtual clinics with specialist mentors. Project ECHO exponentially expands workforce capacity by freely sharing best-practice medical knowledge with primary care providers. In this way, it has become a model for providing health care in remote areas of the United States, as well as overseas.
In July 2016, Project ECHO was selected as the basis for a new AHRQ initiative to provide treatment to Americans struggling with opioid addiction. Treatment to address this public health crisis uses innovative technology, including patient-controlled smart phone apps, remote training, and expert consultation. Several States, including Oklahoma, Colorado, and Pennsylvania, will use Project ECHO to provide urban specialists to train rural primary care doctors and for other forms of teleconsultation to improve opioid-addiction treatment.
Dr. Arora launched Project ECHO in 2003 when he realized that 28,000 people with hepatitis C in rural and underserved areas of New Mexico couldn’t get treatment for their condition. He applied for and received AHRQ health IT grant funding to help develop a solution. With AHRQ funding, Dr. Arora developed Project ECHO as a way to enable local health care providers to provide specialized treatment for hepatitis C, without having to refer patients to faraway specialists.
In Project ECHO, primary care providers—including doctors, nurses, physician assistants, nurse practitioners, and community health workers in rural and underserved areas and prisons—participate in weekly virtual clinics similar to grand rounds with multidisciplinary specialty teams located hundreds—or even thousands—of miles away. In this way, community health providers acquire the knowledge and skills they need to provide high-quality care to patients who otherwise might not be able to get it. Results have shown that patients get consistently high-quality care from these providers and that their outcomes are as good as if they had traveled hundreds of miles to the nearest specialist.
Although UNMHSC served as the first ECHO specialist "hub," Project ECHO currently operates 89 hubs in 30 States and 15 countries outside the United States, including within the Department of Defense’s Defense Health Agency and Veterans Health Administration health care systems. Other Federal Government partners include the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration.
"AHRQ funding allowed us to create technology-supported networks of continual learning and mentorship that bring best-practice care to people in rural and underserved communities," Dr. Arora said. "The AHRQ grant paved the way for expansion of the ECHO model within New Mexico. Today, Project ECHO has partners all over the United States and around the globe."
Project ECHO has expanded across other diseases and specialties, urban and rural locales, different types of delivery services, and the world. More than 40 types of clinics address conditions ranging from chronic pain to rheumatoid arthritis to HIV. One clinic, Endo ECHO, is focusing on a new, more holistic way of managing diabetes and helping patients with the disease take control of their condition. Key to the Endo ECHO and many other ECHO programs in New Mexico is the use of community health workers to provide social and emotional support to patients and help them meet everyday challenges.
The ECHO model of telementoring and collaborative practice has expanded treatment to underserved areas and helped countless people who otherwise would have suffered without medical care. And Project ECHO has set an ambitious goal for itself: to touch the lives of one billion people by the year 2025.
Principal Investigator: Sanjeev Arora, M.D., Director of Project ECHO
Institution: University of New Mexico Health Sciences Center
Grantee Since: 2008
Type of Grant: Various
Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.
To learn more about AHRQ's Research Education and Training Programs, please visit: http://www.ahrq.gov/training.
Editor’s Note: On December 14, 2016, President Obama signed the Expanding Capacity for Health Outcomes (ECHO) Act, a law that expands New Mexico’s Project ECHO as a national model for using telehealth for rural care.