Whether they were finding funding for telecom systems, reaching out to build the program's network, or helping providers navigate new technology, one of the hurdles that Project ECHO Nevada faced before Zoom became a household name was how to connect health care providers in rural communities to the telementoring program.

Then, the COVID-19 pandemic accelerated the adoption of digital learning methods and created an environment that broke down virtual connection barriers amid social distancing measures and stay-at-home mandates.

We were always a virtual telehealth platform, Mordechai Lavi, M.D., medical director of Project ECHO Nevada, said. We connect and create virtual communities of learning where we amplify best practices and share knowledge. These types of communities can helpespecially in rural communities.

In Nevada, where more than two out of three people live in a primary care Health Professional Shortage Area (HPSA), according to the Physician Workforce in Nevada: A Chartbook, providing educational and support resources in rural areas is critical.

Through telementoring, rural clinicians can stay updated with the latest medical practices and treatments, which can directly translate into improved patient care and outcomes. This is especially vital for rural communities where accessing specialized medical training and resources may otherwise require extensive travel or be entirely out of reach.

As ECHO expands primary care physicians' knowledge base, patients benefit by reducing health care-related travel, long waits and costs. They receive quality care within their own communities when physicians can work together to solve medical problems.

In the years following the onset of the COVID-19 pandemic, Project ECHO continues to serve some of the most rural communities in the Silver State and demonstrate the value of its outreach. Rural health care and public health professional participation in the program grew by more than 26% from 2019 to 2022. During the same time, participation from all state organizations grew by 180%. And in 2023, the program experienced a 98% increase of case reviews conducted across all ECHO sessions from pre-COVID operations.

One of the cornerstone programs of Project ECHO is teleECHO programs, during which health care professionals across the state review patient cases with a multidisciplinary team of subject matter experts to collaborate on treatment using multi-point video technology. The case review process increases the impact of a session by providing the reviewing provider with recommendations about their case and offering other participants new skills and training.

A physician in Ely may have had a similar experience as a physician in Yerington and be able to share advice or recommend resources, Dr. Lavi said.

With interdisciplinary teams and shared experiences, ECHO sessions become a community of learning. Issues sometimes relate to navigating the vast health care system network, like prior authorization, income barriers or functional deficits, affecting whether a patient gets the care they need.

We can create that community of learning that Project ECHO is known for, Dr. Lavi said. It helps us connect so we can learn from each other.

In this way, the ECHO model is not traditional telemedicine where the specialist assumes patient care but instead a guided practice model where the primary care provider retains responsibility for managing the patient.

Providers practicing in rural areas have similar workforce shortages and fewer resources, such as social workers or therapists, and these sessions have allowed for innovative solutions, Troy Jorgensen, senior program manager for Project ECHO Nevada, said.

By enabling specialists to serve as mentors and train community providers in clinical areas previously outside their expertise, primary care providers can operate with increased independence as their skills and self-efficacy grow.

According to post-session evaluations since 2017, 91.9 percent of ECHO participants either strongly agree or agree that their participation has decreased their sense of professional isolation.

These sessions can help providers feel not so alone in what can be a really lonely environment, Dr. Lavi said. It lets them know other people are dealing with the same challenges in other communities.

Housed within the Office of Statewide Initiatives, Project ECHO Nevada connects everyone that works in health care from primary care providers and specialists to community health workers and administrative partners. Dr. Lavi said the program is proving particularly impactful in rural areas.

The University of Nevada, Reno School of Medicine (UNR Med) proactively addresses these health care challenges by retaining medical school graduates and recruiting medical residents to work in Nevada. Among the initiatives aimed at filling the health care void is Project ECHO.

ECHO is giving physicians and other providers direct access and support to a specialist where they can consult on cases and feel connected to a larger community, Dr. Lavi said.

Thats the vision that Sanjeev Arora, M.D., founded the virtual program on nearly 20 years ago. Now Project ECHO director at the University of New Mexico, Dr. Arora would see patients from rural areas, some suffering from diseases in advanced stages that could have been treated sooner.

These experiences led Dr. Arora to develop Project ECHO. The virtual program adheres to four guiding principles:

As physicians and other providers participate in ECHO, they get feedback and reinforcement about their practice, Dr. Lavi said. These are conversations physicians often dont get to have after residency due to time, workload or proximity to other health care providers.

As Project ECHO continues to grow and evolve, UNR Med remains committed to improving access to health care and enhancing the quality of life for individuals in rural Nevada. In 2024, the program plans to add more learning sessions on topics such as diabetes, pediatrics and rheumatology and increase its outreach and impact.

Ultimately, we're really trying to make improve health at the population level, meaning patients health is improving, Dr. Lavi said. That takes changing providers practices, and ECHO is the force multiplier that we can use to make those changes.

Learn more about Project Echo

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Project ECHOs digital prescription for rural health disparities - University of Nevada, Reno