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UCSF Medical Center Project ECHO FAQ

What is ECHO?

Project ECHO (Extension for Community Healthcare Outcomes) is a collaborative model of medical education and care management that empowers clinicians everywhere to provide better care to more people, right where they live.

The ECHO model™ does not actually “provide” care to patients. Instead, it dramatically increases access to specialty treatment in underserved and rural areas by providing front-line clinicians with the knowledge and support they need to manage patients with complex conditions such as hepatitis C, rheumatoid arthritis, chronic pain and behavioral health disorders, among many others.

As the ECHO model expands, it is helping to address some of the health care system’s most intractable problems, including inadequate or disparities in access to care, rising costs, systemic inefficiencies and unequal or slow diffusion of best practices. Across the United States and globally, policymakers are recognizing the potential of ECHO to exponentially expand workforce capacity to treat more patients sooner, using existing resources. At a time when the health care system is under mounting pressure to do more without spending more, this is critical.

How will ECHO be used at UCSF?

Our Hepatitis C ECHO Program allows a multi-disciplinary team of specialists to partner with health care providers in underserved communities to provide education and guidance on the treatment of patients with hepatitis C. This partnership enables specialists to co-manage patients and monitor outcomes through web-based technology, reducing variations in care and allowing more patients to be served in their own communities at a lower cost.

Our goals are to:
1. Increase HCV screening by primary care physicians in underserved communities and areas with a high burden of HCV
2. Increase access to specialty care in underserved communities
3. Increase knowledge around treatment of HCV amongst primary care providers

UCSF provides educational support to participating primary care providers. This includes live online training, mentoring, case consultation and peer-to-peer technical assistance to increase participating clinicians’ confidence to implement HCV screening and treatment guidelines.

Tele-ECHO sessions will consist of biweekly virtual clinics with brief didactics and case presentations and discussions.

Research has consistently shown the benefits of remote training, in which academic medical specialists provide instruction, mentoring and technical assistance to rural and other isolated primary care providers via regular video-based case conferences, brief teachings and ongoing clinical consultation.

Remote training can greatly increase providers’ ability to effectively screen for and manage HIV, HCV and other complex conditions in their own communities, while reducing access barriers and cost for patients.

Why focus on hepatitis C?

HCV infection is the most common blood-borne disease in the United States and the leading cause of liver disease, cirrhosis and liver cancer. National estimates suggest that around 5.1 million people are living with HCV in the United States, with 750,000 of those residing in California. Annual deaths related to HCV now surpass those due to HIV, and death rates are highest among 45- to 64-year-olds.

HCV-related hospitalization charges in Calif. totaled more than $2.3 billion in 2010. Early detection and treatment can prevent or mitigate these costs and complications.

In 2012, the Centers for Disease Control and Prevention recommended one-time HCV screening for those born between 1945 and 1965 (i.e., “baby boomers”) to identify the majority of people living with chronic HCV who remain unaware of their infection.

In 2013, the U.S. Preventive Services Task Force issued a “B” rating to HCV screening for baby boomers and others at risk. However, a recent California Academy of Family Physicians membership survey found that 60 percent of respondents did not routinely screen baby boomers for HCV and 84 percent did not feel competent to treat HCV infection.

Respondents cited a need for more education about HCV screening, diagnosis and treatment. Meanwhile, a California Association of Rural Health Clinics membership survey found that nearly half (47 percent) of responding clinics reported needing help serving their HCV-infected clients, specifically specialty consultation.

At a statewide forum on HCV screening and treatment in 2013, more than 60 representatives from payers, providers and medical associations in Calif. agreed that “worries about treatment are the biggest barrier to HCV screening.”

How do I participate in UCSF’s Hepatitis C ECHO Program?

To learn more about our program, please send email to HCVECHO@ucsf.edu

ECHO was created at the University of New Mexico. Click here for more information.