Joining the Movement: Replication Hubs in Maine - Maine Quality ...
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Joining the Movement: Replication Hubs in Maine
Continuing Medical
Education (CME)
• Disclosure: Today’s speakers do not have any relevant financial
relationships with the manufacturers(s) of any commercial products(s)
and/or provider of commercial services discussed in this CME activity.
• CME will be available for today’s conference.
• Please complete the CME evaluation survey via Survey Monkey within 1
week.
• A CME certificate will be emailed within 1 month of completion of the
survey. Please contact Jackie Tiner (jtiner@mainequalitycounts.org) with
questions.
ECHO Replication: Secrets for Success
Erika Harding, MA
Chief Replication Officer
Project ECHO/The ECHO Institute
UNM Health Sciences Center
Email: eharding@salud.unm.edu
ECHO Secrets of Success:
#1 Pick the Right Topic
Community needs/gaps in care
Availability/interest of hub team members
Fits the interests of community providers/spoke champions
More or less protocol-driven?
External motivators: chronic pain, HCV, rheumatology, HIV
Some diseases/topics find more traction
Not too broad, not too narrow
ECHO Secrets of Success:
#2 Pick the Right Champions/Facilitators
Transformational Learning REQUIRES
Transformational Leadership: choose your mentors
carefully
ECHO Secrets of Success:
#3 Get good help and Train them well!
Multi-disciplinary hub team members:
Specialist(s) (.1 up to .5 if they serve as project director)
Pharmacist (.1 or .2)
Psychologist, Psychiatrist or Social Worker (.1 or .2)
Others, depending on disease (.1 or .2)
Hub staff to run the teleECHOclinics:
Clinic coordinator or Administrative assistant (.5 or 1.0)
IT User Support (.5)
RN (.5) whenever possible
ECHO Secrets of Success:
#4 Always focus on the needs of your learners/participants
The objective of the ECHO model is to create
workforce multiplication and capacity building,
with all team members working at the top of
their game and the height of their scope of
practice.
Steps for Replication Orientation is just the beginning… Next you sign partnership documents Begin planning budget and seek funding Design the project (target audience, curriculum, resources, community needs, evaluation strategy and tools …) Develop your team – experts and staff Bring a team for full training (3 days – Immersion) Continue to develop curriculum, begin to recruit spokes/participants Build organizational buy-in Practice before you launch – get feedback Launch! Continue to seek input and reflection, constant QI Publicize your success – money follows successful ECHOs (not the other way around)
Maine Dermatology ECHO
Our ECHO:
The Who, What, Where, Why, and How
Dr. Jill Colvin, Co-Founder Maine Derm ECHO
MDFMR Dermatology Services
Dr. Jonathan Karnes, Co-Founder Maine Derm ECHO
MDFMR Dermatology Services
Dr. James deKay, Team Member Maine Derm ECHO
Maine General Pathology
Disclosure
I have no actual or potential conflict of interest
related to the content of this presentation.
Jill Colvin, MD
James deKay, MD
Jon Karnes, MDMaine Derm ECHO
Founded by: Dartmouth Family Medicine Residency
Dermatology Services
Medical and Surgical Dermatology Practice
– Two locations: Augusta and Waterville
– Phototherapy suites: Augusta and Waterville
– Fotofinder total body photography: Augusta
Clinicians
– General Dermatology: 5 Providers
• Maine Derm ECHO Co-Founders: Dr. Jill Colvin, Dr. Jonathan Karnes
– Mohs / Procedural Dermatology: 2 Providers joining this year
– Dermatopathologist: 1 Provider (Maine General Pathology)
• Maine Derm ECHO Team Member: Maine Derm ECHO Dr. James deKay
Support Staff
– Registered Nurses
• Maine Derm ECHO Team Member: Krista Knowles, RN
– Administrative Professionals
– Medical Assistants
– Front Desk StaffMDFMR Dermatology Services
Medical and Surgical Dermatology Practice
– Augusta, Maine
– Second location in Waterville, Maine opens 4/2018
– Large catchment area with no limits or quotas on insurance or ability to pay
Clinicians
– 2012 Founded by Dr. Jonathan Karnes
• Completed family medicine residency at Maine Dartmouth and subsequent completion of a two year
dermatology fellowship at the UT Health Sciences Center at San Antonio
– 2015 Dr. Jill Colvin joins practice
• Completed dermatology residency at the University Hospital Cincinnati in 2000
– 2016 Dr. James deKay, Dermatopathologist, joins Maine General Pathology
• Competed fellowship in dermatopathology at the University of Vermont in 2016.
– 6/2017 Dr. Joshua Sparling joins practice
• Completed dermatology residency at Walter Reid Army Hospital in 2006
– 8/2017 Dr. Maulik Dhanda joins the practice
• Completed dermatology residency at St. Louis University in 2017.
– 4/2018 Dr. Robert Kenney joins the practice
• Completed dermatology residency at Walter Reid Army Hospital in 1981
– 4/2018 Dr. Brian O’Donnell joins ME General - Dermatology Surgery
• Completed dermatology surgery fellowship at NY Presbyterian Medical Center in 1999
– Anticipated 8/2018 Dr. Dan Filitis joins ME General – Dermatology Surgery
• Anticipated completion of Mohs/procedural dermatology fellowship at Columbia Univ, NY in 2018
JK, JDMaine Dartmouth Family Medicine Residency
Dermatology Services
Our practice is unique:
• We are dermatology specialists employed by a family
medicine residency.
Dual Mission:
• Improving patient access to dermatology care.
• Improving access to dermatology education within primary
care.
Day to Day:
• We provide patient care in our dermatology clinics.
• We teach medical students, family medicine residents, and
primary care providers.
• We pursue academic projects that align with our missions.
JMaine Dartmouth Family Medicine Residency
Dermatology Services
• Ballard Center, 6 S Chestnut Street, Augusta, Maine
– (2.9 miles south of the Augusta Civic Center)
• Second location 4/2018: Thayer Center for Health, Waterville, Maine
Dr. deKay, Maine General Pathology
• Maine General Medical Center
Augusta, Maine
JK/
JDMaine Derm ECHO
Challenges = Opportunities =
Our missions! MDFMR SUPPORT!
• Improve patient access to • MDFMR shares our missions.
dermatology care. • MDFMR supported our proposal
– High volume of referrals to launch an ECHO.
– Rural/underserved demographics • MDFMR funded travel for ECHO
• Improve access to dermatology immersion training.
education within primary care. • MDFMR employment values
– Local clinicians and resident dedicated academic time.
physicians requesting such
educationSteps for Maine Derm ECHO Implementation
• 2015 – LEARNED OF Project ECHO at a Kennebec Regional Health Alliance (KRHA) meeting.
• 2/2016 –ATTEND ECHO Introduction and the only Derm ECHO in the USA via ZOOM
– Dr. Karen Edison’s Show-Me Derm ECHO, U of Missouri and ECHO
• 2016 –GAIN APPROVAL for Project ECHO Immersion Training from key MDFMR administrators:
– Dr. Harry Colt (Residency Dir.), Dr. Greg Feero (Research Dir.), Michelle Bragg (Admin. Dir.), Nancy Fisher (Ed. Admin.)
• 11/2016 – RECRUITMENT of 16 primary care providers (PCPs) to attend Maine Derm ECHO 2017
– From referral base and KRHA; MDFMR Dermatology RNs and MAs commit to attend
– Family Medicine: DO x 4, MD x 1, PA x 4, NP x 6; Pediatrics: MD x 1
• 1/26,27/2017 –ECHO Immersion TRAINING at the University of Chicago
• 2/2017 – NETWORK with Dr. Karen Edison’s Show-Me Derm ECHO
– Re. format of sessions, pre and post self-efficacy surveys for attendees, form for case submissions
• 2/2017 – DEVELOP curriculum and learning objectives; APPROVED for CME credits by AAFP
• 2/2017 – PRACTICE ECHO session with attendees
• 2/2017 – PUBLISH Website – Maine Derm ECHO
• 3/2017 – LAUNCH! Maine Derm ECHO
• 9/2017 – COMPLETED six months of ECHO sessionsECHO Immersion Training :
University of Chicago
1/26,27/2017
• ECHO Chicago’s 1st Immersion Training
– Daniel Johnson, MD – Director of ECHO-Chicago
– Dana Sohmer, MA (now former) Project Coordinator
– Tracy Smith, BA Program Planning Manager, ECHO Institute, UNM
• Attendees
– Maine Derm ECHO, Dr. Jill Colvin
– Team from Great Lakes Practice Transformation Network (IL, IN, KY, MI, OH)
• ECHO Clinic Observations and Debrief with ECHO Teams
– Complex Pediatric Asthma, Hepatitis C
• Didactic Sessions
– Intro to ECHO-Chicago, MetaECHO, and Project ECHO Replication
– Planning: Your Hub’s Vision
– Outreach and Recruitment of Spokes (Participants)
– Budgets and Evaluation
– Tech Overview
– Anatomy of a Clinic Session and Fundamentals of Facilitation
– Curriculum and Case Form Development
– ECHO Team Roles: TeleECHO Director, Manager, Coordinatior, IT support
– Strategic PlanningOur ECHO!
Register on line for sessions
Jhttps://dermecho.weebly.com/
Curriculum based on:
American Academy of Dermatology: Basic Dermatology Curriculum
- Free on-line resource
- https://www.aad.org/education/basic-derm-curriculum
Jhttps://dermecho.weebly.com/
https://dermecho.weebly.com/
Details on claiming CME credits. Call out for cases presentations!
Link for accessing Zoom.
JMaine Derm ECHO: post-series recap
Successes: Challenges:
– Collegiality – We had none.
– Positive feedback from attendees
– No coordinator, manager, or tech
– Networking support.
– Drs. Colvin, Karnes, and deKay did it
– Case presentations all.
– Grew PCP Knowledge: AAD Basic
Dermatology Curriculum
– Regular attendance of PCPs
– Finding scheduled time for ECHO
– ECHO Revolution: Increasing access
sessions that works for most and is
to best-practice specialty care and
reducing health disparities protected from clinical duties
– ECHO ethos: Demonopolizing
medical knowledgeMaine Derm ECHO Launch
• MDFMR support
– Our employer shared our Maine Derm ECHO vision
• Community support
– KRHA, Maine General, Maine General Pathology, PCPs
• Project ECHO support
– Immersion training
• University of Chicago
– Collegiality, Sharing of resources and best practices
• Dr. Edison’s Derm Show-Me ECHO – Univ. of Missouri
• ECHO web-based resources
• Zoom Video Conferencing Platform
– Free!, Easy to use!
• Curriculum
– American Academy of Dermatology: Basic Dermatology Curriculum
• Free, On-line access to all
• Engaged learners
– PCPs, Our clinic staff: RNs, MAsMaine Derm ECHO:
Vision for Future
GOAL:
• Conduct on-going series of weekly or biweekly teleconference sessions for a dedicated group of 10 – 15
PCPs per series.
NEEDS:
– Recruits participants
• Ideally 10 – 15 PCP participants dedicated to attend a session
– Supports participants: regarding logistics, technology, and CME
• Emails reminders, and invitation to participants before each session
• Emails other communications to participants as requested by the MD ECHO Staff
• Emails pre and post series surveys; compiles data from the surveys
– Tech Support: on-site for each teleconference
• Duties: sets up, records session, manages participants, and troubleshoots teleconference technology
– Maintains website
• Updates dates and topics; uploads recordings after each session
– Manages iECHO
– Administrative support: for grant writing and fund raising.
• Facility:
– Conference room set-up with dual monitors, camera, and microphone for Zoom teleconferencing.
– Background sign for teleconference with our name and ECHO designation
• Continuing Ed for ECHO team
– Funds for travel and housing for select staff and/or MD to annually attend an ECHO conference and/or site visits
with other Derm ECHOs.
– Funds for Facilitator to attend an ECHO replication event for full understanding of Facilitator duties.Thank you for attending this session.
Our Maine Derm ECHO Hub and Spokes,
Successfully completed an inaugural series and…
We aim for the FUTURE!
Photo credit: Jill ColvinProject ECHO MaineHealth Center for Health Improvement April 4, 2018
Here’s a story….
…of an Endocrinologist named Dr. Brodsky
Who was trying, like so many providers, to solve the
great challenge of…
28Striking a balance
Endo/Diabetes
Primary Care
Center
29MaineHealth’s Project EndoECHO
Background
• 6 “teleclinics” to date
• Hub Site: MMP Endocrinology and
Diabetes Center
- 10 presenters
• Spoke Sites: Primary Care
- 8 regions
- Avg of 14 participants per call
(mostly MDs and NPs)
• Second Tuesday of every month at
7:30am – 1 hour
• Agenda: Didactic and case review
30Evaluation – successes
100% of responses indicate participants…
• Plan on attending next call
• Would recommend participating in an ECHO project to a colleague
• Believe that EndoECHO improves coordination and comprehensive care
of patients*
*52/53 indicated a positive response
31Evaluation – confidence
Self-reported confidence in ability to manage the care for the case(s)/condition(s)
presented :
Extremely confident
Fairly confident
Before
Somewhat confident After
Not at all confident
0 5 10 15 20 25 30
Participant responses indicating they were Fairly or Extremely Confident in managing the
cases presented increased from 58% to 87% after the Project ECHO Endo teleclinic*
*Note: Total responses = 54 and are combined for 5 sessions
32What are the primary reasons you participate in this
EndoECHO?
- “I want to increase my knowledge regarding diabetes care to improve management of my
patients with this condition”
- “Primarily interested in the topic. Also interested in the format as a tool for future
educational efforts across MaineHealth”
- “I have a lot of questions and little access to endocrinologist”
- “Great info from specialist first hand”
- “Better understanding of primary care for endocrine pts vs. need for referral”
33How is ECHO helping to address the need for access to
endo/diabetes expertise?
- “No local endocrinologist in our area, these presentations are very helpful increase PCP
knowledge to reduce burden on patient to travel to endocrinologist”
- “Making appropriate referrals”
- “Ability to present our challenging cases to the specialists”
- “Provides resources that are not available locally”
34Evaluation - opportunities
• Technology hiccups at hub and local
sites (most resolved)
• Improve the “flow” (time of didactic
presentations, format for Q&A)
• Increase the number of cases
submitted by spoke sites
• Participation – timing won’t work for
everyone
35Takeaways
• ECHO provides an opportunity for education and NETWORKING
• Clinical champion and SUPPORT team are critical
• Time permitting, allow for FLEXIBILITY of communication during the
session (impromptu questions, cases, etc.)
• Don’t underestimate personal CONNECTION
• PRACTICE still makes perfect! There’s no such thing as too many run-throughs
36For more information
Joan Ingram Jasmine Kurywczak
Diabetes Program Manager Telehealth Program Manager
jingram@mainehealth.org jkurywczak@mainehealth.org
662-1548 661-7699
37Continuity of Care For
Substance Use and Exposure
During the Perinatal Period
Project ECHO: Maine Quality Counts
Project ECHO: Maine Quality CountsDisclosures and Funder Acknowledgement
▪ I have no conflicts of interest with commercial products in
this program.
.
▪ Funding for this program is provided by the Harvard Pilgrim
Health Care Quality Grants Program 2017.
Project ECHO: Maine Quality Counts
39Immersion Training
Project ECHO: Maine Quality Counts
40Learning Objectives
▪ Establish cultural changes to reduce stigma of mental health
and substance use disorders;
▪ Explore the importance of screening for mental health
concerns with underlying opioid use, defining why behavioral
health conditions are important to identify and address;
▪ Build competencies to deliver trauma-informed care and
integrated behavioral health treatment;
▪ Implement medication assisted therapies and models of care
for SUD;
Project ECHO: Maine Quality Counts
41Learning Objectives
▪ Bolster skills to appropriately identify and treat substance use
disorders in the course of opioid and other medication
tapering;
▪ Develop models for team based addiction treatment through
relationships with integrated behavioral health clinicians,
addiction specialists and providers of alternative treatment in
the medical neighborhood; and
▪ Build individual and organizational resilience to support
complex presentations and improvement technologies.
Project ECHO: Maine Quality Counts
42Didactic Curriculum
▪ Session 1: Building culture and reducing stigma, ▪ Session 6: Pain on the Brain overview- a
role of integrated behavioral health, in addressing tool developed to find ways to join with
patients with OUDs patients to learn to control pain as well as
to help them take ownership of the very
▪ Session 2: Increase confidence and competency to real risk of addiction and other problems
address trauma and mental health conditions that which are, by definition, part of opiate
underlie and are intertwined with chronic pain and interactions with the body.
▪ Session 3: Communicating with patients: having ▪ Session 7: Resilience: Taking Care While
difficult conversations about tapering and Caring for Others and Surviving in Rapidly
treatment options for SUD, including MAT. Changing Environments; Organizational
Strategies for Addressing Secondary Trauma
and Sustaining Providers in Changing
▪ Session 4: Identifying and addressing physical Environments.
dependence and addiction, when to refer for
addiction treatment and how to implement MAT
Models of Care for SUD. ▪ Session 8: Practice and community
resources and building workflows strategies
for integrating behavioral health clinicians
▪ Session 5: Opioid tapering and changing practice into practices.
culture to support compassionate tapering,
including when and how to taper from MAT,
opioids, and benzodiazepines.
Project ECHO: Maine Quality Counts
43Monthly TeleECHO Sessions
▪ The virtual meetings, referred to as TeleECHO Sessions, last 1 hour, and
are scheduled on the 3rd Thursday of each month, starting in September
2017, and ending in May, 2018.
▪ Each TeleECHO session consists of a short, expert-led didactic, followed by
a patient case presentation and discussion.
Project ECHO: Maine Quality CountsProgram Faculty
Kate Chichester, MSN, APRN, BC Noah Nesin, MD
Faculty Lead
Eric Haram, LADC Lisa Letourneau, MD, MPH
Faculty Lead
Project ECHO: Maine Quality CountsProgram Faculty
Jesse Higgins, RN, MSN, PMHN Jennifer McCarthy, L.C.P.C.
Eva Quirion, FNP Jesse Harvey, CIPSS
Stephanie Nichols, Pharm.D., BCPS, BCPP
Project ECHO: Maine Quality CountsProgram Participants: Spokes
A cohort of integrated behavioral health clinicians and affiliated
primary care practice teams located in across Maine in communities
where PCMH primary care practices are active in their medical
neighborhoods to improve their collective response to SUD.
▪ Participants
– Average 23 spoke participants during ECHO sessions, representing 22 Sites
– 19 attended orientation
▪ Faculty:
– Average 8.7 faculty members per ECHO session
▪ Staff:
– Average 4 hub staff per ECHO Session
Project ECHO: Maine Quality Counts
47Evaluation
The preliminary findings from the pilot program are very
promising, with enrolled participants appreciative of its
benefits. According to provider survey results,
–Over 86% of participants reported enhanced competence
and the value of the case-based discussions as being good
or excellent.
–86% of the participants indicated that what they learned
during the monthly sessions is influencing their practice
–Almost 70% reported a positive impact on their patient
outcomes.
Project ECHO: Maine Quality Counts
48Evaluation
When asked if they learned something during the sessions that
will be useful in caring for their patients, the participants
responded:
– “I think my awareness of addiction behavior and how I speak about it
was enhanced.”
–“It helped me have greater empathy for both patients struggling with
opiate use and for those providing services to them.”
–“I have greater insight into the need for collaborative care between
providers”.
– After the conclusion of a cased-based discussion, another presenter
expressed, “I already feel less isolated having presented this case to
the group.”
Project ECHO: Maine Quality Counts
49Challenges
▪ To maximize participation, monthly sessions were scheduled
during the noon hour and limited to one-hour in duration.
▪ This schedule required extremely efficient facilitation and
management of each monthly session, and also limited the
number of potential cases that can be presented to only 8
overall – one case per session.
▪ Additionally, the one-hour sessions don’t allow for much
networking and development of the learning community
cohort.
Project ECHO: Maine Quality Counts
50Quality Improvement
▪ Improvements generally are focused on maximizing the
efficiency of each session, given the one-hour format, and on
internal project team management of the solicitation and
finalization of case presentations for each session.
▪ The ECHO Institute provided a two hour customized virtual
facilitation training for our faculty by one of the most highly
regarded facilitation trainers in the Meta ECHO community.
This was an incredible opportunity to receive personalized
support and feedback to the faculty in order to create a safe,
structured and supportive environment for the presentation
and discussion of challenging cases.
Project ECHO: Maine Quality Counts
51Lesson Learned
▪ Utilize support from the ECHO Institute and your Partner
Liaison.
▪ Don’t be shy about reaching out to other ECHO programs and
Hub teams.
▪ Practice, practice, practice.
▪ Have a back up case handy and be ready to adjust on the fly.
Project ECHO: Maine Quality Counts
52Q&A
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