March 30, 2017
By Greg Peters
|Matt Sharpe and Dave Burnett|
An interprofessional team of health care professionals from the University of Kansas Medical Center is creating a virtual community to share the latest in asthma management and treatment with their peers throughout the state and as far away as the West African nation of Ghana thanks to technology provided by Project ECHO (Extension for Community Healthcare Outcomes).
In February, health care professionals from the University of Kansas Asthma Center, the KU Department of Respiratory Care Education, the KU Department of Internal Medicine's Division of Pulmonary Diseases and Critical Care Medicine, and the KU Office of Rural Medicine Education presented a series of four one-hour interactive teaching teleconferences titled "Project ECHO Asthma" designed to build a community of doctors, nurses, school nurses, social workers and other health-care colleagues from throughout Kansas who work with asthma patients.
By taking advantage of the benefits of the latest in online communications, organizers can bring the program to the participants in their home locations, reducing the time, travel and expense involved in providing the best care possible for asthma patients across the Sunflower State and beyond. More than anything, their goal is to build a community of people that work with asthma patients, so that they can learn from one another and reduce the disparities in patient care.
"I believe we have much to learn from our rural community health partners, school nurses, physicians, and patients," said David Burnett, Ph.D., RRT, AE-C, co-director of the KU Asthma Center. "The asthma TeleECHO project will allow us to better understand the needs of all asthma stakeholders. Hopefully, we'll be able to create useful interventions to improve the burden of asthma, especially in underserved areas."
About Project ECHO
Project ECHO, which is offered through the KU Center for Telemedicine and Telehealth (KUCTT), was founded at the University of New Mexico in the early 2000s as a way to give providers working on the front lines of health care easy access to ongoing education. Representatives from KU Medical Center were at an ECHO training event in 2014 at the University of New Mexico, and saw the potential that two-way conversations via the internet could have, especially for practitioners in isolated rural settings.
By staying true to its credo of "moving knowledge, not patients" ECHO allows participants to manage and treat their patients with common, complex conditions such as asthma within their own communities, instead of having to refer them to a specialist in another location. The technology links expert specialists at a "hub" institution with health care providers at "spoke" sites in local communities. This can be especially helpful in rural areas in Kansas where there can be a considerable distance between a primary care physician and a specialist.
"At its core, ECHO uses a tele-mentoring approach, so that participants from across wide geographic spaces can work together to create evidence-based approaches for the best management of chronic conditions," said Eve-Lynn Nelson, Ph.D., director of ECHO replication at KU Medical Center and professor in the KU School of Medicine, who played a key role in ECHO coming to KU.
So in 2015, KU Medical Center joined forces with Children's Mercy Hospital for the first local Project ECHO - a bi-state campaign funded by the American Academy of Pediatrics, focusing on the treatment of epilepsy. The asthma program is the fourth ECHO so far for KU Medical Center, with a behavioral health ADHD ECHO scheduled for April and more to follow.
To be part of the an ECHO program, all a participant needs is access to the internet through a device such as a desktop computer, tablet or smart phone, equipped with a video camera, speakers and a microphone to communicate. Project ECHO participants log into a proprietary meeting website (Zoom), which has been screened to meet medical security requirements such as the Health Insurance Portability and Accountability Act. In most cases, organizers allow between 15 and 20 participants to make logistics more manageable.
On the KU Medical Center side of the conversation, the Project ECHO team uses high-definition video equipment with high bandwidth access to the internet to allow greater amounts of data to be shared in the videoconferencing system. ECHO participants join a community where the team members work together to find solutions with the help of expert advice.
Building a community
During the asthma ECHO campaign in February, each session followed a similar pattern. The leader presented an overview of the topic that would be discussed. Then a case involving an unidentified patient, submitted by the participants prior to the meeting and elected on the basis of each week's focus area, was presented and the participants worked together to devise a course of treatment or management.
Matt Sharpe, M.D., co-director and co-founder of the KU Asthma Center, led the first session which reached participating locations, ranging from Sharon in the south, Lakin in the west, Marysville in the north and Pittsburg in the east. "One of the great things about ECHO is that our partners from all over the state can connect with each other and feel less isolated," said Carla Deckert, director of Project ECHO at KU Medical Center. "But I always tell people, if you've seen one ECHO, then you've seen one ECHO. Each one has its own characteristics."
Sharpe explained to participants how important it is to use a variety of tests in order to best diagnose and treat a patient suffering from asthma. He discussed the standards of care for asthma patients, including identifying the severity of the illness based on severity of symptoms and pulmonary function; the use of inhaled corticosteroid for controlling asthma; and creating an action plan for the treatment of asthma.
Mike Lewis, M.D., assistant professor in the KU Department of Pediatrics, discussed the care and treatment of asthma among children and teens during the second session, paying particular attention to both the behavior and adherence to treatments.
Michael Kennedy, M.D., associate dean for rural health education and an associate professor in the KU Department of Family Medicine, led the third session, which outlined the benefits of office-based spirometry and other pulmonary/asthma status measurements. The group discussed the advantages and disadvantages of using symptom scores versus more objective ways of assessing asthma patients. This was capped off by a conversation about the psychosocial needs of asthma patients, which is a huge aspect of treating patients with chronic illnesses, especially in children.
"The beauty of ECHO is that it helps educate doctors, so that they can they can treat their patients in their home communities," Kennedy said. "ECHO helps the rural-practicing physician gain the knowledge needed to provide the highest level of care."