The authors describe an innovative academic health center (AHC)-led program of health care delivery and clinical education for the management of complex, common, and chronic diseases in underserved areas, using hepatitis C virus (HCV) as a model. The program, based at the University of New Mexico School of Medicine, represents a paradigm shift in thinking and funding for the threefold mission of AHCs, moving from traditional fee-for-service models to public health funding of knowledge networks. This program, Project Extension for Community Health care Outcomes (ECHO), involves a partnership of academic medicine, public health offices, corrections departments, and rural community clinics dedicated to providing best practices and protocol-driven health care in rural areas. Telemedicine and Internet connections enable specialists in the program to comanage patients with complex diseases, using case-based knowledge networks and learning loops. Project ECHO partners (nurse practitioners, primary care physicians, physician assistants, and pharmacists) present HCV-positive patients during weekly two-hour telemedicine clinics using a standardized, case-based format that includes discussion of history, physical examination, test results, treatment complications, and psychiatric, medical, and substance abuse issues. In these case-based learning clinics, partners rapidly gain deep domain expertise in HCV as they collaborate with university specialists in hepatology, infectious disease, psychiatry, and substance abuse in comanaging their patients. Systematic monitoring of treatment outcomes is an integral aspect of the project. The authors believe this methodology will be generalizable to other complex and chronic conditions in a wide variety of underserved areas to improve disease outcomes, and it offers an opportunity for AHCs to enhance and expand their traditional mission of teaching, patient care, and research.
Dr. Arora is professor and executive vice-chair, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Dr. Geppert is chief consultation–liaison, Psychiatry and Ethics, New Mexico Veterans Affairs Health Care System, and assistant professor, Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Dr. Kalishman is director, Office of Program Evaluation, Education and Research, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Dr. Dion is research scientist, Office of Program Evaluation, Education and Research, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Dr. Pullara is health services director, New Mexico Corrections Department, Santa Fe, New Mexico.
Ms. Bjeletich is nurse practitioner, Health Centers of Northern New Mexico, Espanola, New Mexico.
Dr. Simpson is medical director, Infectious Diseases, New Mexico Department of Health, Santa Fe, New Mexico.
Dr. Alverson is professor of pediatrics and regents’ professor, and medical director, Center for Telehealth and Cybermedicine Research, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
Dr. Moore is a pharmacist, Indian Health Service, Santa Fe, New Mexico.
Dr. Kuhl is a pharmacist, Indian Health Service, Santa Fe, New Mexico.
Dr. Scaletti is emeritus professor, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
Please see the end of this article for information about the authors.
Correspondence should be addressed to Dr. Arora, Internal Medicine, MSC10 5550, Ambulatory Care Center 5th Floor, 1 University of New Mexico, Albuquerque, NM 87131-0001; e-mail: (SArora@salud.unm.edu).