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Pathways to Discovery: Fall 2012

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Project ECHO Spreads Knowledge to Community Physicians in Underserved Communities

The University of Chicago (UChicago) Medicine has implemented a unique program to partner with community physicians and develop new approaches to provide underserved patients with specialized care.

Named Project ECHO (Extension for Community Healthcare Outcomes), the program calls upon teleconference technology, disease management tools, and expertise found only at an academic medical center to broaden the skills of primary care providers at Chicago community health centers.

This innovative model of medicine was developed at the University of New Mexico to serve rural populations lacking access to subspecialists. With successful results, offshoots of the program have sprung up at other institutions. UChicago Medicine is the first to apply Project ECHO in an urban setting, and also the first to apply the program toward cancer care.

“We recognize that everybody needs access to quality care. Since we can’t multiply ourselves, we are trying to provide access by educating the people who already care for these patients,” said Susan Hong, MD, MPH, associate professor of medicine, and director of UChicago Medicine’s Breast Cancer Survivorship Program.

Education Is Key
Through video-conferencing, primary care providers learn from didactic lectures about the healthcare needs and challenges faced by their breast cancer patients. The current curriculum spans over 6 months and covers a wide range of topics, including national guidelines for recommended follow-up care for breast cancer survivors, the importance of compliance to adjuvant hormone therapy, managing the long-term side effects of cancer treatment, identifying patients at risk for hereditary cancer syndromes, cancer-related resources for patients and providers, and more.

“Patients often trust their community primary care providers enough to ask them about treatment recommendations,” Dr. Hong said. “Thus, through education, community primary care providers can play an active role in ensuring treatment compliance.”

She added that community providers are often more aware of the patient’s support network and can be extremely helpful for the patient and subspecialty provider.

The Breast Cancer Survivorship Curriculum portion of Project ECHO is funded by the American Cancer Society– Illinois Division, and extends the reach of comprehensive cancer care to areas where limited access to healthcare may be partly responsible for the alarmingly large disparity in breast cancer outcomes for African American women compared to Caucasians.

The Challenges of Cancer Care
While access to care is one issue contributing to poor health outcomes for minorities, another challenge is ensuring that co-existing medical conditions are also well managed. Dr. Hong stresses the importance of involving primary care providers throughout treatment, because minority patients have higher rates of chronic health conditions, including diabetes and hypertension.

She added that doctors who are not cancer specialists may feel uncomfortable treating patients for their non-cancer related chronic health conditions, especially during active cancer treatment. This creates a greater challenge for patients with multiple medical issues already struggling to navigate the healthcare system. The goal of Project ECHO is to give doctors the skills they need to become more involved in the care of their patients.

“Although it’s too early to measure patient outcomes, we are beginning to see changes in practice patterns,” said Dr. Hong.  

Ernst Lengyel