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Bone Health TeleECHO: a Force Multiplier to Improve the Care of Skeletal Diseases in Underserved Communities

  • Quality of Care in Osteoporosis (S Silverman and J Curtis, Section Editors)
  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review describes the global development of a model of technology-enabled collaborative learning for healthcare professionals called Project ECHO (Extension for Community Healthcare Outcomes) and its applications for the management of patients with skeletal diseases.

Recent Findings

The prototype Bone Health TeleECHO was established in 2015, with others now operational in the USA and other countries, and more expected to follow soon. Each teleECHO program, in the right language and convenient time zone, provides a virtual community of practice for healthcare professionals to benefit from real-time interactive case-based learning and brief didactic presentations on topics of interest.

Summary

Bone Health TeleECHO elevates the level of knowledge of participants and improves self-confidence in managing patients with skeletal diseases. The development of many teleECHO programs worldwide serves as a force multiplier, with the potential to narrow the osteoporosis treatment gap and enhance the effectiveness of fracture liaison services.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48–58.

    PubMed  PubMed Central  Google Scholar 

  2. World Health Organisation. Global strategy on human resources for health: workforce 2030. 2016. Available from http://www.who.int/hrh/resources/global_strategy_workforce2030_14_print.pdf?ua=1. Accessed 6 Oct 2018.

  3. Herath C, Zhou Y, Gan Y, Nakandawire N, Gong Y, Lu Z. A comparative study of interprofessional education in global health care: a systematic review. Medicine (Baltimore). 2017;96(38):e7336.

    Article  Google Scholar 

  4. Health Resources & Services Administration. Telehealth programs. Available from https://www.hrsa.gov/rural-health/telehealth/index.html. Accessed 6 Oct 2018.

  5. World Health Organisation. Telehealth. Available from https://www.who.int/sustainable-development/health-sector/strategies/telehealth/en/. Accessed 22 April 2019.

  6. What is telehealth? 2018. Available from https://catalyst.nejm.org/what-is-telehealth/. Accessed 23 April 2019.

  7. Arora S, Kalishman S, Dion D, Som D, Thornton K, Bankhurst A, et al. Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care. Health Aff (Millwood). 2011;30(6):1176–84.

    Article  Google Scholar 

  8. • Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364(23):2199–207. This is the original teleECHO proof-of-concept study with hepatitis C that supported the continuing development of this model of learning.

    Article  CAS  Google Scholar 

  9. Dubin RE, Flannery J, Taenzer P, Smith A, Smith K, Fabico R, et al. ECHO Ontario chronic pain & opioid stewardship: providing access and building capacity for primary care providers in underserviced, rural, and remote communities. Stud Health Technol Inform. 2015;209:15–22.

    PubMed  Google Scholar 

  10. Kauth MR, Shipherd JC, Lindsay JA, Kirsh S, Knapp H, Matza L. Teleconsultation and training of VHA providers on transgender care: implementation of a multisite hub system. Telemed J E Health. 2015.

  11. Katzman JG, Comerci G Jr, Boyle JF, Duhigg D, Shelley B, Olivas C, et al. Innovative telementoring for pain management: project ECHO pain. J Contin Educ Health Prof. 2014;34(1):68–75.

    Article  Google Scholar 

  12. Mitruka K, Thornton K, Cusick S, Orme C, Moore A, Manch RA, et al. Expanding primary care capacity to treat hepatitis C virus infection through an evidence-based care model--Arizona and Utah, 2012-2014. MMWR Morb Mortal Wkly Rep. 2014;63(18):393–8.

    PubMed  PubMed Central  Google Scholar 

  13. Scott JD, Unruh KT, Catlin MC, Merrill JO, Tauben DJ, Rosenblatt R, et al. Project ECHO: a model for complex, chronic care in the Pacific Northwest region of the United States. J Telemed Telecare. 2012;18(8):481–4.

    Article  Google Scholar 

  14. Lewiecki EM, Bilezikian JP, Carey JJ, Dell RM, Gordon CM, Harris ST, et al. Proceedings of the 2017 Santa Fe Bone Symposium: insights and emerging concepts in the management of osteoporosis. J Clin Densitom. 2018;21(1):3–21.

    Article  Google Scholar 

  15. Bennett KA, Ong T, Verrall AM, Vitiello MV, Marcum ZA, Phelan EA. Project ECHO-geriatrics: training future primary care providers to meet the needs of older adults. J Grad Med Educ. 2018;10(3):311–5.

    Article  Google Scholar 

  16. Hager B, Hasselberg M, Arzubi E, Betlinski J, Duncan M, Richman J, et al. Leveraging behavioral health expertise: practices and potential of the project ECHO approach to virtually integrating care in underserved areas. Psychiatr Serv. 2018;69(4):366–9.

    Article  Google Scholar 

  17. Carlin L, Zhao J, Dubin R, Taenzer P, Sidrak H, Furlan A. Project ECHO telementoring intervention for managing chronic pain in primary care: insights from a qualitative study. Pain Med. 2018;19(6):1140–6.

    Article  Google Scholar 

  18. Sockalingam S, Arena A, Serhal E, Mohri L, Alloo J, Crawford A. Building provincial mental health capacity in primary care: an evaluation of a project ECHO mental health program. Acad Psychiatry. 2018;42(4):451–7.

    Article  Google Scholar 

  19. Project ECHO at University of New Mexico School of Medicine. ECHO Hubs: Global. 2019. Available from https://echo.unm.edu/locations/global. Accessed 2 May 2019.

  20. www.GovTrack.us. S. 2873 (114th): ECHO Act. (May 29, 2017). Available from https://www.govtrack.us/congress/bills/114/s2873. Accessed 3 Aug, 2017.

  21. U.S. Department of Health and Human Services. Report to Congress: Current State of Technology-Enabled Collaborative Learning and Capacity Building Models. 2019. Available from https://aspe.hhs.gov/system/files/pdf/260691/ECHOAct-ConsolidatedReportToCongress.pdf. Accessed 21 April 2019.

  22. • Lewiecki EM, Rochelle R, Bouchonville MF 2nd, Chafey DH, Olenginski TP, Arora S. Leveraging scarce resources with bone health TeleECHO to improve the care of osteoporosis. J Endocr Soc. 2017;1(12):1428–34. This first report of favorable outcomes with Bone Health TeleECHO.

    Article  Google Scholar 

  23. Introduced by Senators Schatz (D-HI) KD-V, and Murkowski (R-AK). The Expanding Capacity for Health Outcomes Act of 2019 (ECHO 2019 Act). 2019. Available from https://www.schatz.senate.gov/imo/media/doc/ECHO%202019%20Act%20One%20Pager.pdf. Accessed 31 May 2019.

  24. US Department of Health and Human Services. Bone health and osteoporosis: a report of the Surgeon General. Rockville: US Department of Health and Human Services, Office of the Surgeon General; 2004.

    Google Scholar 

  25. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007;22(3):465–75.

    Article  Google Scholar 

  26. Miller PD. Underdiagnosis and undertreatment of osteoporosis: the battle to be won. J Clin Endocrinol Metab. 2016;101(3):852–9.

    Article  CAS  Google Scholar 

  27. • Lewiecki EM, Wright NC, Curtis JR, Siris E, Gagel RF, Saag KG, et al. Hip fracture trends in the United States, 2002 to 2015. Osteoporos Int. 2018;29(3):717–22. A study finding a disturbing rate of hip fractures at levels higher than projected in the USA, highlighting the importance of the osteoporosis treatment gap.

    Article  Google Scholar 

  28. • American Society for Bone and Mineral Research. Call to action to address the crisis in the treatment of osteoporosis. 2016. Available from https://www.asbmr.org/call-to-action.aspx. Accessed 11 Jan 2017. This is a call to action to urgently initiate measures to address the crisis in osteoporosis care and reduce the burden of osteoporotic fractures.

  29. Lewiecki EM, Boyle JF, Arora S, Bouchonville MF 2nd, Chafey DH. Telementoring: a novel approach to reducing the osteoporosis treatment gap. Osteoporos Int. 2017;28(1):407–11.

    Article  CAS  Google Scholar 

  30. Lewiecki EM. Bone Health TeleECHO for orthopedists and rheumatologists. Ortho Rheum Open Access. 2017;7(4):555716.

    Google Scholar 

  31. Lewiecki EM, Bouchonville MF 2nd, Chafey DH, Bankhurst A, Arora S. Bone Health ECHO: telementoring to improve osteoporosis care. Womens Health (Lond Engl). 2016;12(1):79–81.

    Article  CAS  Google Scholar 

  32. Zoom. The Cloud Meeting Company. 2018. Available from https://operative.zoom.us/. Accessed 27 Oct 2018.

  33. Osteoporosis Foundation of New Mexico, Project ECHO. Start Your Own Bone Health TeleECHO. YouTube Video. 2018. Available from https://www.youtube.com/watch?v=pgyZ8sxiFq0. Accessed 10 May 2019.

  34. Osteoporosis Foundation of New Mexico, Project ECHO. Join Bone Health TeleECHO. YouTube Video. 2018. Available from https://vimeo.com/246121236/76efb37b39. Accessed 10 May 2019.

  35. Osteoporosis Foundation of New Mexico, Project ECHO. Fracture Liaison Service. YouTube Video. 2019. Available from https://youtu.be/NeC27qXt_Vg. Accessed 10 May 2019.

  36. Conway R, Kavanagh R, Coughlan RJ, Carey JJ. Expanding access to rheumatology care: the rheumatology general practice toolbox. Ir Med J. 2015;108(2):48–50.

    CAS  PubMed  Google Scholar 

  37. University of New Mexico. Start an ECHO. 2019. Available from https://echo.unm.edu/join-the-movement/start-an-echo. Accessed 5 June 2019.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to E. Michael Lewiecki.

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Conflict of Interest

In the past year, E. Michael Lewiecki has received no direct income from potentially conflicting entities. His employer, New Mexico Clinical Research & Osteoporosis Center, has received research grants from Radius, Amgen, Mereo, Bindex; income for service on scientific advisory boards or consulting for Amgen, Radius, Alexion, Sandoz, Samsung Bioepis; service on speakers’ bureaus for Radius, Alexion; project development for University of New Mexico; and royalties from UpToDate for sections on DXA, fracture risk assessment, and prevention of osteoporosis. He is a board member of the National Osteoporosis Foundation, International Society for Clinical Densitometry, and Osteoporosis Foundation of New Mexico.

Avery Jackson is a consultant and speaker for Medtronic.

Anne F. Lake is a consultant and advisor for Radius Health on Fracture Liasion Services.

John J. Carey has received speaker fees from Eli Lilly, Amgen, Pfizer, UCB Ireland and Europe, Pfizer Canada, Brazil and Europe, Hospira UK, Europe, and Canada, and Celltrion USA and Europe. He has received consulting fees from Hospira UK, Canada, and Europe, and UCB Europe. He has received grant and educational support from Amgen Ireland, UCB. Europe, Eli Lilly Ireland, Abbvie, MSD Ireland, and the Irish Society for Rheumatology. He has gotten travel support from Roche, Amgen, Eli Lilly, MSD, and UCB Ireland with meals and educational programs from MSD and Pfizer Ireland. He has also served on several committees for, and as President, of the International Society for Clinical Densitometry, is a member of the Committee for Scientific affairs for the International Osteoporosis Foundation, and is a founding member of, and current president, of the Irish DXA Society.

Zhanna Belaya, Galina A. Melnichenko, and Rachelle Rochelle have nothing to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Addendum

Since the original submission of this manuscript, Own the Bone Orthopaedic Bone Health TeleECHO and Rare Bone Disease TeleECHO have both become operational, with ongoing monthly case-based interactive videoconferences.

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This article is part of the Topical Collection on Quality of Care in Osteoporosis

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Lewiecki, E.M., Jackson, A., Lake, A.F. et al. Bone Health TeleECHO: a Force Multiplier to Improve the Care of Skeletal Diseases in Underserved Communities. Curr Osteoporos Rep 17, 474–482 (2019). https://doi.org/10.1007/s11914-019-00543-9

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