ECHO Care: Providing Multidisciplinary Specialty Expertise to Support the Care of Complex Patients
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Grayken Center for Addiction Boston Medical Center, Boston University, 801 Massachusetts Ave, #1039, Boston, MA 02118, USA; 2Department of Internal Medicine, Division of General Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA; 3University of New Mexico Health Sciences Center, ECHO Institute™, Albuquerque, NM, USA.
BACKGROUND: Programs for high-need, high-cost (HNHC) patients can improve care and reduce costs. However, it may be challenging to implement these programs in rural and underserved areas, in part due to limited access to specialty consultation. AIM: Evaluate the feasibility of using the Extension for Community Health Outcomes (ECHO) model to provide specialist input to outpatient intensivist teams (OITs) dedicated to caring for HNHC patients. SETTING: Weekly group videoconferencing sessions that connect multidisciplinary specialists with OITs. PARTICIPANTS: Six OITs across New Mexico, typically consisting of a nurse practitioner or physician assistant, a registered nurse, a counselor or social worker, and at least one community health worker. PROGRAM DESCRIPTION: OITs and specialists participated in weekly teleECHO sessions focused on providing the OITs with case-based mentoring and support. PROGRAM EVALUATION: OITs and specialists discussed 427 highly complex patient cases, many of which had social or behavioral health components to address. In 70% of presented cases, the teams changed their care plan for the patient, and 87% reported that they applied what they learned in hearing case presentations to other HNHC patients. DISCUSSION: Pairing the ECHO model with intensive outpatient care is a feasible strategy to support OITs to provide high-quality care for HNHC patients. KEY WORDS: ECHO model; continuing medical education; case-based learning; complex care; high-need, high-cost patients.
J Gen Intern Med DOI: 10.1007/s11606-019-05205-1 © Society of General Internal Medicine 2019
INTRODUCTION
High-need, high-cost (HNHC) Medicaid patients struggle with multiple medical and behavioral health conditions that are frequently paired with functional limitations and difficulties overcoming social barriers to care.1,2 Traditional primary care services are often ill-prepared to address these patients’ complex needs, and sometimes overlook the social issues that prevent engagement in effective primary care.3 Addressing the needs of this population using innovative complex care models in the primary care setting could translate into more effective and efficient care. Several complex care models exist that connect HNHC Medicaid patients to appropriate care.4 Models vary widely with respect to intensity and setting; elements of successful models include intensive care coordination, team-based care, integration of medical and behavioral health services, and attention to social barriers.5 Preparing primary healthcare teams to use these approaches is important, and common obstacles include insufficient clinical support, ineffective communication with specialists that can lead
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