Project ECHO provides small towns with specialty knowledge

For the physicians in Pennsylvania small towns who are the first level of care for opioid use disorder, Project ECHO at Penn State College of Medicine offers a unique learning experience and support network. ECHO, which stands for Extension for Community Healthcare Outcomes, gives primary care physicians the tools they need and a professional network to treat patients in regions with little or no access to specialists.

The concept comes the University of New Mexico. Now, more than 220 institutions around the world use Project ECHO for at least 90 disease topics. The program is part of Penn State Clinical and Translational Science Institute, which provides the tools and resources to move research from the science laboratories more efficiently to healthcare settings. The institute provides not only office space for the program, but important infrastructure. It is that infrastructure that is unique from many other ECHO hub locations and will allow Penn State to deliver expertise in several specialties across the state. The program uses what is called a hub and spoke model, with an academic health center as the hub that delivers education to the primary care physicians who make up the spokes.

While the ECHO concept has grown in use, little research has been completed on the effects of the program – something Penn State researchers plan to change.

“Research evaluating the project hasn’t kept pace with growth of the movement in clinics,” Dr. Jennifer Kraschnewski, director of Project ECHO at Penn State College of Medicine and a researcher of community health interventions, said. “It is our goal to create an evidence base to support the model and its ability to mentor primary care providers outside of urban academic hubs. We also aim to learn how to best grow and use Project ECHO as an intervention.”

Penn State expert clinicians have just launched their second cohort of the Opioid Use Disorder Project ECHO, funded by a grant from the Substance Abuse and Mental Health Services Administration.

“What most excites me is that Project ECHO gets to the heart of the challenges of treating some of a physician’s toughest patients,” Dr. Sarah Kawasaki, director of the Opioid Use Disorder Project ECHO at the College of Medicine, said. “We’re creating a community to support and educate physicians and improve the chances that they can provide the care their patients need, rather than sending them to a specialist for first-line treatment.”

In the Opioid Use Disorder Project ECHO, up to 20 clinicians attend 12 sessions with Kawasaki and her specialist team. The Penn State team is comprised of addiction medicine experts from the College of Medicine and partner organizations. At each session, a complex patient case – presented with no identifying patient information – from a participating clinician is discussed, followed by a short lecture. The project rolls from one group to the next, growing a network of specially trained physicians. In time, it should exponentially build the state’s ability to bring best-practice care to all patients.

“Project ECHO takes the education outside of Penn State and puts it into the state of Pennsylvania,” Kawasaki said. “It reduces physician burn-out by giving them the tools and support they need to be effective. It broadens the reach of addiction-related knowledge and fights the opioid problem in a meaningful way.”

Penn State’s ECHO currently includes the opioid use group and a BSA (formerly Boy Scouts of America) project to help summer camps improve healthy eating options. Other topics are being explored, including adult autism.

The continued success of Project ECHO depends on grant money. The team has applied for a $100 million grant. If they succeed, the grant would support Project ECHO in 15 counties for three years.

“We need to get specialty knowledge out to the places where it doesn’t currently exist,” Kraschnewski said. “Our goal is to educate the clinic spokes so that more communities have physicians who can treat opioid use disorder, just like they have for diabetes or high blood pressure.”

This story was modified from an article that first appeared on Penn State Medicine by Katherine Brind’Amour. Read that version here.

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