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In Geriatric Mental Health (ECHO® GEMH)

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In Geriatric Mental Health (ECHO® GEMH) Extension for Community Healthcare Outcomes in Geriatric Mental Health (ECHO® GEMH) Michael Hasselberg, PhD, NPP-BC Assistant Professor of Psychiatry Director of Project ECHO® Director of Telepsychiatry UR OARHS Office for Aging Research and Health Services Disclosures I have no financial relationships with a commercial entity producing health- care related products and/or services to the content I am presenting 2 OARHS Acknowledgements . Supported by funding from o The New York State Health Foundation o The Health Foundation of Central and Western New York o Greater Rochester Health Foundation . Infrastructure support from ® o Project ECHO , University of New Mexico (UNM) (Slides adapted from those of Sanjeev Arora, MD, UNM Professor) 3 OARHS Growing Need . Aging and disease impact in New York State (NYS) o Population age ≥ 65 years will rise from 2.5 to 4 million by the year 2030 o Elderly with mental illness will rise from 495,000 to 772,000 by the year 2030 . Costs of inadequate care in NYS o In 2011, health care costs for elderly with dementia alone was $690 million • Value of unpaid care exceeded $13 billion New York State Office of Mental Health, 2013; Alzheimer’s Association, 2012 OARHS Alliance for Aging Research, 2002 OARHS Geriatric Psychiatry Shortage • Only 1,596 physicians are currently certified in geriatric psychiatry • One for every 11,372 older Americans • By 2030 that total is predicted to rise to only 1,659, which would then be only one for every 20,195 older Americans (ADGAP, 2007b). • Half of fellowship positions go unfilled nationwide • General psychiatry is a partial solution • 71% feel very prepared to dx and treat delirium • 96% to dx and treat major depression • 56% to diagnose and treat dementia. Retooling for an Aging America: Building the Health Care Workforce http://www.nap.edu/catalog/12089.htm 6 OARHS One solution: Project ECHO® The mission of Project ECHO® is to expand the capacity to provide best practice care for common and complex diseases in rural and underserved areas and to monitor outcomes. Goal is to touch the lives of 1 billion people by 2025 Supported by New Mexico Department of Health, Agency for Health Research and Quality, New Mexico Legislature, the Robert Wood Johnson Foundation and the GE Foundation. OARHS Project ECHO® Hepatitis C (HCV) . In 2004 less than 5% of patients with HCV in New Mexico had been treated o Estimated 28,000 people with HCV in New Mexico o No Primary Care Physicians treating HCV in New Mexico Good news … o Curable in 70% of cases Bad news … o Severe side effects: . anemia (100%) . neutropenia >35% . depression >25% OARHS Methods of Project ECHO® . Use Technology (multipoint videoconferencing and Internet) .Disease Management Model focused on reducing variation in processes of care and sharing “best practices” . Case based learning: Co-management of patients . HIPAA compliant web-based database to monitor outcomes Arora (2013); Supported by N.M. Dept. of Health, Agency for Health Research and Quality HIT Grant 1 UC1 HS015135-04, New Mexico Legislature, and the Robert Wood Johnson Foundation. 9 OARHS OARHS Project ECHO® HCV Outcomes Sustained Viral Response (SVR): no detectable virus 6 months after completion of treatment 11 OARHS 12 OARHS Project ECHO® in New Mexico 13 OARHS ECHO® Replication in United States • University of Washington (HCV, Chronic Pain, HIV, Multiple Sclerosis) – Seattle, WA • University of Chicago (Hypertension, Breast Cancer Survivorship/Women’s Health, Pediatric ADHD, Childhood Obesity, HCV) – Chicago, IL • University of Nevada (Antibiotic Stewardship, Autism (closed group, by invitation only), Diabetes/General Endocrinology, Gastroenterology, Rheumatology, Sports Medicine, Mental Health: Professional Development Groups (closed groups, by invitation only), Mental Health Clinic Director’s Group (closed groups, by invitation only), Marriage & Family Therapy Intern Supervision Clinic (closed groups, by invitation only) – Reno, NV • University of Utah (HCV, Advanced Liver Care, Chronic Pain) – Salt Lake City, UT • Florida/Caribbean AIDS Education and Training Center, University of South Florida (General HIV, Adolescents/Pediatrics HIV, HCV/HIV Co-Infection, Psychiatry & HIV, Spanish Language HIV) – Tampa, FL • Harvard/Beth Israel Deaconess Medical Center (HCV, Gerontology – ECHO AGE) – Boston, MA • St. Joseph’s Hospital & Medical Center (HCV) – Phoenix, AZ • Community Health Center, Inc. (HIV, HCV, Chronic Pain, Opioid Addiction – Buprenorphine, Coaches International—supporting Quality Improvement and Specialists) – Middletown, CT • LA Net (AAPA Preventive Care, Nephrology, Adult Psychiatry) – Los Angeles, California • UNM: Center for Development and Disability (Autism) – Albuquerque, NM • UNM: Envision NM (Childhood Overweight Medical Management, Pediatric Nutrition, Psychiatry, Asthma/Pulmonary) – Albuquerque, NM • CHI St. Luke’s Health (HCV, HBV, Infectious Disease) – Houston, TX • University of California Davis (Pain Management) – Davis, CA • University of Wyoming, Wyoming Institute for Disabilities (Assistive Technologies) – Laramie, Wyoming • Ochsner Health System (Liver Care) – New Orleans, LA • University of Texas MD Anderson Cancer Center (Cervical Cancer Prevention) – Houston, TX • Oregon Health and Science University/Health Share of Oregon (Psychiatric Medication Management) – Portland, OR • University of Rochester Medical Center (Geriatric Mental Health) – Rochester, New York • Visiting Nurses Association Health Group (Care Transition) – Red Bank, New Jersey • Missouri Telehealth Network/University of Missouri (Autism) – Columbia, MS • University of Colorado School of Public Health (Children and Youth with Epilepsy) – Denver, CO 14 OARHS 15 OARHS ECHO® Replication Worldwide National AIDS Control Organization and Maulana Azad (HIV) – New Delhi, India Institute of Liver and Biliary Sciences (HCV) – New Delhi, India Universidad de la República (Liver Disease) – Montevideo, Uruguay West/North West Hospitals Group (Diabetes) – Galway, Ireland ECHO Ontario (Chronic Pain) – Queens University & University of Toronto Ontario, Canada Northern Ireland Hospice (Hospice Care) – Belfast, NI National Institute for Mental Health Services (NIMHANS) (Mental Health and Drug Addiction) – Bangalore, India B.J. Medical College (HIV) – Ahmedabad, India Vietnam National Lung Hospital (TB) – Hanoi, Vietnam Hospital Italiano (HCV) – Buenos Aires, Argentina PUCRS Brazil-( Depression and Dementia) 16 OARHS Geriatric Mental Health & Memory Care 17 OARHS Project ECHO® GEMH Goal To support the delivery . by primary care practices (PCPs) in underserved and rural areas of New York State (NYS) . of expert care . to older adults with dementia or mental disorders. OARHS Project ECHO® GEMH PC PC PC Practice Practice Practice PC PC Practice Practice URMC Hub Site • Geriatric psychiatry • Geriatric medicine • Geriatric psychology • Social work PC PC • Pharmacy Practice Practice 19 OARHS 20 OARHS Current Participants . Primary Care Practices o Hospital system affiliated o Accountable care affiliated o Provider owned group . Federally Qualified Health Centers . Health Service Corporations . County Department of Aging Centers 21 OARHS Workforce Development . UR School of Medicine . UR School of Nursing o Medical School Program o Undergraduate Nursing Program o Family Medicine Residency Program o Family Nurse Practitioner Program o Psychiatry Residency Program o Adult Nurse Practitioner Program o Geriatric Psychiatry Fellowship o Psychiatric Nurse Practitioner Program o Interdisciplinary Geriatric o Graduate Nurse Leadership Program Medicine Fellowship o Clinical Psychology Fellowship . St. John Fisher Collage of Pharmacy . Niagara Falls Medical Center Family Practice Residency Program 22 OARHS UR Medicine Project ECHO® Hub Site Health System Affiliated Primary Care Site Primary Care Practice Group Site Federally Qualified Health Center Site Health Care Service Corporation Site County Department of Aging Site OARHS Program Evaluation First TeleECHO™ clinic was held on September 18, 2014 To Date: 24 TeleECHO™ clinics 546 participants 181 Continuing Medical Education (CME) credits 49 patient case presentations 24 OARHS Preliminary Outcomes CME Survey Results: Overall Rating/Content Poor Fair Good Very Good Excellent How well were objectives met 0% 0% 2% 19% 79% Objective/evidence-based content 0% 0% 2% 17% 81% Opportunities to ask questions 0% 1% 7% 17% 75% Appropriate pace 0% 0% 4% 29% 67% Organization of presentation 0% 0% 1% 16% 83% Presenter clearly communicated 0% 0% 1% 13% 86% Relevance of presentation 0% 1% 0% 13% 86% n = 181 25 OARHS Preliminary Outcomes Participant Qualitative Interviews: . Most feel clinics are useful, some do not . Of those who could implement suggestions, they often saw results . Most feel that they will use learnings in future work . Clinics are considered particularly useful for complex cases, poly pharmacy, reducing reliance on antipsychotics . Clinics can be perceived as validating for participants in that cases are complex and it’s normal to struggle with them . Major value – access to specialists otherwise unavailable 26 OARHS Sustainability . External cost evaluation being conducted by the New York Academy of Medicine . Collaboration with Excellus BCBS o Practice level claims data Fee-for-service versus Accountable Care 27 OARHS Accountable Care An accountable care organization or network is a healthcare organization characterized by a payment and care delivery model that ties provider reimbursements to quality metrics and reductions
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