Project ECHO

Initiative Type
Model of Care
Status
Sustained
Added
08 January 2019
Last updated
28 February 2019

Summary

Project ECHO® (Extension for Community Healthcare Outcomes) is an innovative model of inter-professional education and case-based learning, which aims to democratise clinical knowledge and deliver best-practice care to people in communities that lack ready access to specialists. Whether the difficulty accessing specialists is due to remoteness, poverty, cultural barriers or other factors, ECHO® helps to address inequities faced by children, young people, and their families.
Using interactive, online technology and a structured case discussion format, metropolitan Brisbane experts mentor providers from anywhere, who deliver frontline services to children and young people in need of rapid access to specialist care. Through mentoring and participation in an inter-professional community of practice, local health professionals are empowered to provide best-practice care and over time, to establish expert-level capabilities.

Project ECHO Introductory Video from Children's Health Queensland on Vimeo.

In late 2019, the Superhub operations will formally commence, which includes the delivery of training, mentorship and partner liaison to support other health services and sector organisations to become ECHO® hubs and deliver education programs on their own topics of expertise. Having an easily accessible and accredited training provider in Australia, providing Project ECHO® orientation and immersion training will accelerate uptake of the ECHO model™ in Australia and in neighbouring countries, removing the barrier of teams needing to travel to New Mexico for training.

Key dates
Jan 2016
Implementation sites
Children’s Health Queensland
Partnerships
Healthcare Improvement Unit, Brisbane North PHN, Brisbane South PHN

Aim

  • Improve health outcomes for children and young people nationally
  • Democratise clinical knowledge, empowering professionals from diverse disciplines with the knowledge to care for children with multiple complex and chronic health problems

Benefits

  • Improved knowledge and self-efficacy of care providers, in the management of complex and chronic health problems
  • Improved access to timely and high-quality healthcare locally for children and their families, resulting in a reduced burden of management for families
  • Platform for collaboration between primary, secondary and tertiary healthcare providers regardless of geographic location
  • National opportunity for collaboration between professionals from diverse sectors, including education.
  • Designation as a Superhub in late 2018 provides an opportunity for specialist teams from Australasia to be trained and mentored to establish their own ECHO® programs, and to utilise the ECHO model™ to share their knowledge with learners from diverse disciplines and sectors. This will contribute to the global community of ECHO® programs delivering whole of life support to providers working in local communities everywhere.

Background

The ECHO model™ was originally developed at the University of New Mexico, to address the unmanageable demand for treatment for patients with hepatitis C. Project ECHO® was developed so these patients could access care in a timely way, in the communities in which they lived. Since implementation of the pilot series (ADHD) in 2017, the Children’s Health Queensland ECHO® Hub has expanded rapidly to provide learning opportunities for participants from diverse disciplines and sectors, to support the enhanced delivery of quality healthcare:

  • Paediatric Overweight & Obesity (commenced February 2018, ongoing)
  • Clubfoot and other Foot Anomalies (commenced February 2018, ongoing)
  • Supporting Refugee Kids (commenced July 2018, ongoing)
  • Paediatric Persistent Pain (commenced July 2018, ongoing)
  • Kids Behavioural & Mental Health (commenced July 2018, ongoing)
  • Supporting Teams Caring for Type 1 Diabetes (commencing February 2019)

Solutions Implemented

The seven current CHQ ECHO® series are democratising clinical knowledge to build expertise in local contexts, and partnering with professionals from diverse disciplines to improve the quality and accessibility of healthcare for children and their families.

Evaluation and Results

So far, there has been steady uptake in the participation from clinicians from all over Australia, taking part in these online communities of practice to develop their knowledge, skills and confidence in delivering care to patients in their local communities.  Evaluations from these participants across the country have demonstrated high satisfaction with the ECHO model™ of free, collaborative, inter-professional education. Testimonials include:

    •  “It has been wonderful to get actual multidisciplinary teaching on this very common condition! One of the things that has really struck me is the amount allied health can really contribute to the management of ADHD… Not only have I learnt a lot about ADHD, I have also learnt so much about holistic patient care” – ADHD series participant (General Practitioner)
    • “The didactic presentations enhanced our understanding of the impact of trauma on child development and what signs would indicate that a child has trauma” – Refugee Kids series participant (Early Childhood Educator)
    • “As a rural therapist often working in isolation it can be challenging to access professional development. ECHO has provided fortnightly supervision and support from the convenience of my own office! The design of the program allows for consolidation of knowledge and expert opinion in a supportive environment. I have expanded my own reflective practice skills after being given the opportunity to present whilst also receiving direct feedback from statewide experts” – Clubfoot series participant (Physiotherapist)

    Results from the ADHD series have shown a significant improvement in GP self-efficacy (n=35, p<0.001), on multiple aspects of ADHD care, including symptom monitoring, assessment and management of co-morbidities, and referral to allied health services.
    Ethics approvals are in place for formal evaluation of each series implemented since the ADHD pilot. A current external evaluation of cost-effectiveness and implementation of the ADHD pilot is being undertaken by AusHSI. This was supported by the Clinical Excellence Division as part of the Integrated Care Innovation Fund.

Lessons Learnt

  • GPs and other primary care providers are already managing complex caseloads in the community.
  • Families are highly accepting of this model of service delivery.
  • Hospital-based specialty teams are accepting of this improved model of service delivery and capacity building.
  • Inter-agency collaboration is critical to the quality and sustainability of hub programs.
  • Economies of scale were achieved rapidly.

References

Arora et al. (2011), Outcomes of treatment for Hepatitis C virus infection by primary care providers. New England Journal of Medicine, 364 (23), 2199-2207.

Zhou et al. (2016), The impact of Project ECHO on participant and patient outcomes: A systematic review. Academic Medicine, 91 (1), 1439-1461.

Hiscock et al. (2011), Children attending paediatricians study: A national prospective audit of outpatient practice from the Australian Paediatric Research Network. Medical Journal of Australia, 194, 392-397.

Shaw et al. (2002), Attitudes and practices of general practitioners in the diagnosis and management of attention-deficit/hyperactivity disorder. Journal of Paediatric Child Health, 38, 481-486.

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Key contact

Perrin Moss
Principal Project Officer
Children’s Health Queensland
(07) 3069 7120
Perrin.Moss@health.qld.gov.au