2013 Annual Meeting
Year in Review
Why ECHO-Chicago?
Launched in 2010 to address the problem of access to
subspecialty care in underserved communities in our community
• Demand for subspecialty services outstrips availability of subspecialists
o Particularly acute where social and economic distance limit access to care
o Disparities in access to care exacerbate health disparities
• Primary care setting is often the best place to deliver care for common,
chronic diseases
• Community-based primary care providers often
lack the support and training to manage
complex, chronic disease effectively
o Training opportunities are limited, costly, and
often require travel
o Training is not always relevant to special
populations, including underserved and
minority communities
Cook, et al, Health Affairs 2007;26(5):1459-68
Purpose
ECHO-Chicago uses case-based, iterative, telehealth curricula
delivered via high-grade videoconference technology to bring
advanced training and support to primary care providers in
underserved communities throughout the Chicago metro area.
o Disseminate best practice management of complex, common,
chronic disease in the primary care medical home
o Use case-based learning; the most widespread teaching method in
medicine
o Leverage advanced technology to reduce cost and time constraints,
and eliminate travel
o Engage primary care providers in a local network to share
knowledge and experience
Knowledge Transfer + Technology =
Force Multiplier
RWJF 2011
ECHO-Chicago Story
Introduced Pediatric
Obesity and Co-morbidities
curriculum
Idea formed
initiated planning for
ECHO-Chicago
Seed Funding
from Urban
Health Initiative
2009
2010
Introduced Pediatric ADHD
curriculum at N community
health center partners
2011
2012
First outside funding, from
Grant Healthcare Foundation
Launched ECHO-Chicago
• Collaboration with six community
health center partners
• Focus on resistant hypertension
Completed study on provider
response to ECHO model;
published results in Partnerships
in Community Health
2013
Introduced Breast Cancer
Survivor Care curriculum
at community health
center partners
Completed pilot on hypertension; published
results in J. Clinical Hypertension
ECHO-Chicago Growth
Number of sessions
60
50
40
30
20
10
0
2010
2011
2012
2013
2013 Activities
• Launched new curriculum in Pediatric Obesity
and Co-morbidities
– Collaboration with 7 community health center
partners
– community provider participants
• Transitioned to Vidyo™; web-based
videoconference technology
– More user-friendly
– Greater flexibility; works on PCs, MACs, tablets, and
mobile devices
– Better quality; lower bandwidth
– Lower cost
• Expanded our network from two additional
community partners
2013 Activities
rHTN
# of
participating
health
centers
13
ADHD
BCS
OBS
Totals
13
6
6
18*
Avg # of
Total # of # of unique providers
sessions participants /session
16
38
11
17
10
12
55
90
44
18
136*
21
4
13
13
*Providers may participate in more than one disease area; the total
reflects the number of unique ECHO-Chicago participants.
2013 Evaluation/Research Activities
• Study of provider feedback on the effectiveness
of ECHO model, results published in Progress in
Community Health Partnerships
• Analysis of provider survey data
– baseline self-efficacy and knowledge surveys for
hypertension and ADHD
– pre- and post-series changes in ADHD provider
surveys
• Launch of study to measure impact of breast
cancer survivor care curriculum
• Preparing for analysis of Medicaid data on preand post-series changes in provider prescribing
patterns
Provider Feedback on the ECHO model
Our study on the effectiveness of the ECHO model was based on in-depth
interviews with nine providers who participated in ECHO-Chicago
sessions. Providers identified the benefits of this case-based, iterative
curriculum to:
• Extend their current skills and knowledge in a way that is
• convenient (no travel, discrete time commitment)
• engaging in content (best practices) and format (didactic with
case presentations)
• Model best practice protocols for their patient population through
preparation, presentation, and discussion of patient cases
• Improve confidence to manage more complex patients without
referring to subspecialists
• Increase job satisfaction and motivate skills enhancement
• Strengthen connections between University of Chicago
subspecialists and community providers
• Build a collaborative knowledge network among peers caring for
similar patient populations
Provider Needs Assessment:
Hypertension and ADHD
Analysis of baseline scores for knowledge and self-efficacy
in hypertension and ADHD indicate the need for both
training and support.
# of
Self-Efficacy
providers Knowledge* SD (7-point scale) SD
Hypertension
53
13.9 (53%)
2.9
4.7 (67%)
1
ADHD
90
10.6 (59%)
2.2
3.4 (49%)
1.1
*Hypertension knowledge test: 26 total ; ADHD knowledge test: 18 total
Changes in ADHD
Knowledge and Self-Efficacy
We conducted a preliminary analysis of data from 23 providers
who completed both the pre- and the post-series survey. The
data show a small increase in knowledge, and a moderate
increase in self-efficacy. On the 7-point scale, the 11% change
points to an improvement from “slight knowledge, skills or
competence” to “average among my peers”
Pre-series SD
Post-series
SD
Change
Self-efficacy
(7-point scale)
3.4 (49%)
1.2
4.2 (60%)
0.8
0.8 (11%)
Knowledge
(18 questions)
10.4 (58%) 1.9
11.5 (64%)
2.1
1.1 (6%)
Community Partners
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ACCESS
Aunt Martha's Health Center
Beloved Community Family Wellness Center
Chicago Family Health Center
Christian Community Health Center
Erie Family Health Center
Family Christian Health Center
Fiedler Private Practice
Friend Family Health Center
Heartland Health Outreach
Howard Brown Health Center
La Rabida Children's Hospital
Lawndale Christian Health Center
Mercy Family Health Center
Mile Square Health Center
Mt Sinai Hospital and Health Center
TCA Health, Inc. NFP
University of Illinois -- Chicago
What’s Next
• Launch of curriculum in hepatitis C in 2014
• Planning for launch of curriculum in
Integrated Mental Health in Primary Care
• Continued outreach to new community
partners, and new providers
• Continued efforts to ensure sustainability
George Bakris, MD
Karin Vander Ploeg Booth, MD
(Hypertension)
(ADHD)
Tamara Hamlish, Ph.D
Maureen
Mencarini
Hyewon (Alice)
Won
Susan Hong, MD
(Breast Cancer Survivorship)
Goutham Rao, MD
(Pediatric Obesity)
Daniel Johnson, MD
Marcus B. Wolfe Chartay Robinson Timothy May
Zakiya Moton
Thank You
Chicago
Glen Aduana, MD
Steve Brown
Andy Davis, MD
Christopher Masi, MD, PhD
Carmela Socolovosky
Greg Van Scooter and the
Multimedia Department
New Mexico
Sanjeev Arora, MD
John Brown, RN
Wesley Pak, MBA
South Side Healthcare
Collaborative
Brenda Battle
Kim Hobson
Participating sites and their
providers
Funders
Aetna Foundation
American Cancer Society
Baxter International Foundation
CTSA – University of Chicago
Grant Healthcare Foundation
Northern Trust Charitable Trust
UHI – University of Chicago