Knowledge Networks for Treating Complex Diseases in Remote, Rural, and Underserved Communities

  • Sanjeev Arora
  • Summers Kalishman
  • Denise Dion
  • Karla Thornton
  • Glen Murata
  • Connie Fassler
  • Steven M. Jenkusky
  • Brooke Parish
  • Miriam Komaromy
  • Wesley Pak
  • John Brown
Chapter
Part of the Innovation and Change in Professional Education book series (ICPE, volume 7)

Abstract

Project ECHO (Extension for Community Healthcare Outcomes) is an innovative healthcare program developed to address the treatment of patients with chronic and complex diseases in rural and underserved areas of New Mexico. Through the use of technology and iterative, case-based discussion with ongoing support, the model used in Project ECHO bridges the gap between academic healthcare specialists and providers in rural and underserved settings. Its prime foci are the provision of workplace learning, evidence-based practices, and the delivery of best quality care to patients with chronic diseases. Collaboration between academic specialists and community-based providers enables patients to receive state-of-the-art healthcare from the professionals they know and trust in their own communities.  For local providers, co-management of the often lengthy and involved treatments gives them additional expertise in competencies associated with chronic disease and involves them in continuing communication and patient management. As they learn more about specific chronic diseases, the community-based providers become engaged with expanded networks of providers and organizations, become more satisfied in their work, and experience less professional isolation.  With continued involvement, community-based providers become highly skilled in the treatment of these chronic and complex diseases, thus creating centers of excellence in their own communities. This chapter describes the activities and outcomes associated with the collaborative, iterative, and workplace-focused care of patients with Hepatitis C, the first chronic disease to be addressed, and how new modes of collaboration were forged between specialists in academic settings and community-based primary care providers in rural and underserved communities. Work on other chronic diseases is now being organized using a similar approach to developing expanded expertise in rural and underserved areas of the state.

References

  1. Arora, S., Geppert, C. M. A., Kalishman, S., Dion, D., Pullara, F., Bjeletich, B., et al. (2007, February). Academic Health Center Management of chronic diseases through knowledge networks: Project ECHO. Academic Medicine, 82(2).Google Scholar
  2. Arora, S., Kalishman, S., Thornton, K., Dion, D., Murata, G., Deming, P., et al. (2010, September). Expanding access to hepatitis C virus treatment – Extension for Community Healthcare Outcomes (ECHO) project: Disruptive innovation in specialty care. Hepatology , 52(3), 1124–1133.CrossRefGoogle Scholar
  3. Arora, S., Thornton, K., Jenkusky, S. M., Parish, B., & Scaletti, J. V. (2007). Project ECHO: Linking University specialists with rural and prison-based clinicians to improve care for people with chronic hepatitis C in New Mexico. Public Health Reports. 122(Supplement 2), 74–77.Google Scholar
  4. Arora, S., Thornton, K., Murata, G., Deming, P., Kalishman, S., Dion, D., et al. (2011, June 9). Outcomes of treatment for hepatitis C virus infection by primary care providers. New England Journal of Medicine, 364(23), 2199–2207. Epub 2011 Jun 1.CrossRefGoogle Scholar
  5. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  6. Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Process, 50(2), 248–287.CrossRefGoogle Scholar
  7. Bereiter, C. (1997). Situated cognition and how to overcome it. Situated cognition: Social, semiotic, and psychological perspectives (pp. 281–300). Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
  8. Bransford, J. D., Vye, N. J, Stevens, R., Kuhl, P., Schwartz, D., Bell, P., et al. (2006). Learning theories and education: Toward a decade of synergy. In P. Alexander & P. Winne (Eds.), Handbook of educational psychology (2, 209–244). Mahwah, NJ: Erlbaum.Google Scholar
  9. Centers for Disease Control and Prevention (2009). Retrieved January 6, 2009, from http://www.cdc.gov/
  10. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd edn). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  11. Crabtree, B. F., & Miller, W. L. (1992). A template approach to text analysis: Developing and using codebooks. In B. F. Crabtree & W. F. Miller (Eds.), Doing qualitative research (pp. 93–109). Newbury Park: Sage.Google Scholar
  12. Darling-Hammond, L., & Bransford, J. D. (2005). Preparing teachers for a changing world: What teachers should learn and be able to do. San Francisco, CA: Jossey-Bass.Google Scholar
  13. Ericsson, K. A. (2008). Deliberate practice and acquisition of expert performance: A general overview. Academic Emergency Medicine, 15, 988–994.CrossRefGoogle Scholar
  14. Health Professional Shortages Area at U.S. (2008). Department of Health and Human Resources, Health Resources and Services Administration. http://www.hrsa.gov/
  15. Institute of Medicine of the National Academies. State of U.S.A. (2008). Health indicators. Washington, DC: The National Academies Press.Google Scholar
  16. Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge, MA: Cambridge University Press.Google Scholar
  17. Mylopoulos, M., & Scardamilia, M. (2008). Doctors’ perspectives on their innovations in daily practice: Implications for knowledge building in health care. Medical Education, 42, 975–981.CrossRefGoogle Scholar
  18. New Mexico Department of Health. (2009). Retrieved January 6, 2009, from http://www.health.state.nm.us/
  19. Parboosingh, J. T. (2002). Physician communities of practice: Where learning and practice are inseparable. The Journal of Continuing Education in the Health Professions, 22, 230–236.CrossRefGoogle Scholar
  20. Project ECHO Annual Meeting Report. (2006). Internal report based on survey and discussion groups.Google Scholar
  21. Project ECHO Annual Meeting Report. (2007). Internal report based on survey and discussion groups.Google Scholar
  22. Project ECHO Annual Meeting Report. (2008). Internal report based on survey and discussion groups.Google Scholar
  23. Project ECHO Hepatitis C Six Month HCV. (2006–2008). Report based on survey of ECHO HCV providers.Google Scholar
  24. Schwartz, D. L, Bransford, J. D, & Sears, D. (2005). Efficiency and innovation in transfer. In J. Mestre (Ed.), Transfer of learning: Research and perspectives. Greenwich, CT: Information Age Publishing.Google Scholar
  25. Soubhi, H. (2007). Toward an ecosystemic approach to chronic care design and practice in primary care. Annals of Family Medicine, 5, 264–269.CrossRefGoogle Scholar
  26. United States Department of Agriculture, Economic Research Service (2008). Retrieved January 11, 2008, from http://www.ers.usda.gov/StateFacts/NM.HTM
  27. University of New Mexico, Bureau of Business and Economic Research (2009). Retrieved January 6, 2009, from http://www.unm.edu/~bber/
  28. U.S. Census Bureau: State and County QuickFacts. Last Revised: Friday, 03-Jun-2011 15:23:14 EDT.Google Scholar
  29. U.S. Department Health and Human Services, Human Resources and Services Administration. (2008). Retrieved December 27, 2008, from http://www.hhs.gov/
  30. Varkey, A. B, Manwell, L. B, Williams, E. S, Ibrahim, S. A, Brown, R. L, Bobula, J. A, et al. (2009). Separate and unequal: Clinics where minority and nonminority patients receive primary care. Archives of Internal Medicine, 169(3), 243–250.CrossRefGoogle Scholar
  31. Vygotsky, L. S. (1978). Mind and society: The development of higher mental processes. Cambridge, MA: Harvard University Press.Google Scholar
  32. Wenger, E. (1998). Communities of practice: Learning, meaning and identity. New York: Cambridge University Press.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Sanjeev Arora
    • 1
  • Summers Kalishman
    • 1
  • Denise Dion
    • 1
  • Karla Thornton
    • 1
  • Glen Murata
    • 1
  • Connie Fassler
    • 1
  • Steven M. Jenkusky
    • 1
  • Brooke Parish
    • 1
  • Miriam Komaromy
    • 1
  • Wesley Pak
    • 1
  • John Brown
    • 1
  1. 1.University of New Mexico School of MedicineAlbuquerqueUSA

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