ECHO within a Health System

The treatment of Hepatitis C (HCV) has been changing very rapidly in recent years and looks to continue that trend. These changes have made it easier to manage at the primary care level, but the amount of change has made ECHO mentorship that much more important.

J. 1 Shofner , ECHO within a Health System 2 Box , 1 Willis , T. L. T. M. C. K. 1 2 3 Project ECHO , Department of Gastroenterology , Community Clinics University of Utah Hospital and Clinics INTRODUCTION 3 Pulgiano , 3 Evans , 3 Shutler , The University of Utah, as the only Academic Medical Center (AMC) in the state, has leveraged its traditional HCV ECHO to establish a community clinic based ECHO for the university affiliated primary care clinics spread across northern Utah communities, and other specialty facilities around the state. This has allowed for a large increase in patient screenings, a reduction in appointment wait times allowing faster care delivery, and potentially reducing costs for the patient by eliminating travel time to the University and the need to leave work. The community clinics are more flexible in scheduling around business hours for their patients. SALT LAKE VALLEY Sugar House Westridge Greenwood Stansbury South Jordan BENEFIT TO THE SYSTEM CLINIC STUDY A study conducted by the Department of Hepatology at the University of Utah found that the vast majority of referrals (~75%) for the treatment and screening of HCV came from the primary care level. Of these 139 patients, only 38(~27%) had been previously screened for HCV. Of the additional 92 that were screened in hepatology 5 were found to be positive, which is more than double the estimated 2% prevalence in the United States. This information, has helped to explain why a community clinic based HCV ECHO (CC HCV) has been so successful. The amount of patients that can now be screened increased dramatically by incorporating a larger base of referring providers at the primary care level. A tool was also developed through the electronic medical record to alert providers of at risk patients (baby boomers). Screenings have increased by 16.4% in the community clinics allowing for more patients to be identified for potential treatment of HCV. # of Unscreened % # of Screened % Primary Care Referral 139 74% 101 (79%) 72.6% 38 (62%) 27.4% Internal Referral 50 26% 27 (21%) 54% 23 (38%) 46% 189 100% 128 67.7% 61 32.2% This model still mirrors the foundation of ECHO by allowing patients to be seen by providers close to home whom they already have a relationship with. The map to the left displays five of the eleven community clinics that have been active with ECHO. Each circle encompasses the zip codes of every patient that has been presented so far and is a clear indicator of the coverage for the health system. The University Hospital now has much more exposure in the almost 550 square miles of the Salt Lake Valley and Provo (not shown, serviced by Parkway Health Center) for treating HCV. Through this area, the University of Utah will be able to screen and provide care to more people diagnosed with HCV. This will allow for more patients to be screened, treated, and cured much sooner at one of the many affiliated community clinics throughout the greater Salt Lake City region. FUTURE APPLICATION Not Pictured - Parkway Health Center in Provo, UT Total Extension for Community Healthcare Outcomes CATCHMENT AREA The treatment of Hepatitis C (HCV) has been changing very rapidly in recent years and looks to continue that trend. These changes have made it easier to manage at the primary care level, but the amount of change has made ECHO mentorship that much more important. Referral Source of Patients Descriptor # of % Patients 2 Lynch One of the biggest advantages of primary care providers within the university health system participating in ECHO has been the speed at which a patient can potentially receive care. A patient can now be seen in an average of three days (sometimes same day) instead of a wait of over 90 days to see a Hepatologist. Medication that is usually prescribed immediately after a new patient visit can now be provided almost three months sooner. In some cases a patient could potentially complete treatment before they would have been able to see a hepatologist for a new patient visit. Further more, the fact that the community clinic provider and ECHO mentor are part of the same health system allows for much greater continuity of care and sharing of resources that would not otherwise been possible. The ECHO mentor also has the added benefit of sharing an electronic medical record (EMR) with the primary care provider. All case discussions and recommendations can be included in a patient's EMR. This ensures that all providers involved with a patient's care, within the health system, are aware of treatment discussions made during an ECHO session. Finally, there is a single specialty pharmacy that is used for each patient discussed in the CC HCV. An initiative was put in place to create a central communications pool within the EMR between the pharmacy and all providers treating for HCV. This created a needed uniformity given the number of providers that are now treating HCV. The next steps will include expanding involvement to the remaining community clinics. Additionally, residents and their faculty mentors at two of the community clinics have received a grant from the Viral Hepatitis Roundtable to support the growing effort to treat HCV. We will continue to collaborate with these residents after they have left the University system creating more opportunity for the growth of Project ECHO. Days to Appointment Community Clinics 3 Hepatology 96 0 20 40 60 ACKNOWLEDGEMENTS University of Utah Health Care - • TeleHealth Services • Division of Gastroenterology/Hepatology • University of Utah Community Clinics Utah Telehealth Network University of Utah Project ECHO Staff 80 100 120