Selected Podcast
Project ECHO
Angela Pham, MD, discusses Project ECHO and how it incorporates IBD quality metrics to potentially improve patient outcomes. She helps us to understand how it can be utilized for patients and she explains the options and benefits Project ECHO can bring to your practice.
Featuring:
Dr. Pham is board-certified by the American Board of Internal Medicine in Medicine and the American Board of Pediatrics in General Pediatrics. She is a member of the American College of Physicians, American Academy of Pediatrics and American College of Gastroenterology. Her clinical interest include Crohn disease, gastrointestinal disorders and ulcerative colitis.
Angela Pham, MD,
Angela Pham, MD, is an assistant professor in the UF Department of Medicine's Division of Gastroenterology, Hepatology & Nutrition. She received her medical degree from Michigan State University College of Human Medicine in East Lansing, Michigan. She completed her internal medicine and pediatric residency at Grand Rapids Medical Education Partners with Michigan State University in Grand Rapids, Michigan. Dr. Pham then went on to complete her gastroenterology fellowship at the University of Florida in Gainesville, Florida.Dr. Pham is board-certified by the American Board of Internal Medicine in Medicine and the American Board of Pediatrics in General Pediatrics. She is a member of the American College of Physicians, American Academy of Pediatrics and American College of Gastroenterology. Her clinical interest include Crohn disease, gastrointestinal disorders and ulcerative colitis.
Transcription:
The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical education, ACCME, to provide continuing medical education for physicians. The University of Florida College of Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 credit. Physicians should claim only the credit commensurate with the extent of their participation in this activity.
Melanie Cole: Welcome to UF Health MedEd Cast with UF Health Shands Hospital. I'm Melanie Cole, and I invite you to listen as we discuss Project ECHO today with Dr. Angela Pham. She's an Assistant Professor in the Division of Gastroenterology, Hepatology, Nutrition at the University of Florida College of Medicine, and she practices at UF Health Shands Hospital.
Dr. Pham, it's a pleasure to have you join us. So before we get into this whole topic, I'd like you to tell us a little bit about the ECHO model itself, and then tell us what Project ECHO is.
Dr. Angela Pham: So the whole story of Project ECHO dates back all the way to the early 2000s. It was actually initiated by a hepatologist out in Arizona. And it is a rich virtual learning community by which community doctors and doctors from academic centers share knowledge. And what it stands for is Extension for Community Healthcare Outcomes. And it's been used for a variety of different disease processes after it was first used for actually hepatitis C out in Arizona by Dr. Arora.
So I'll tell you a little bit more why I decided to use this model for inflammatory bowel disease. So I am an inflammatory bowel disease specialist, and most of the patients I see that are referred to me suffer from inflammatory bowel disease and have had it for a very long time. And a lot of times, by the time they come to me, their disease course has blossomed to a point where it is much more severe than it needs to be. And my goal in starting the ECHO Project is to democratize knowledge and give access to knowledge and best practice care to community doctors that may not have access to the subspecialists that we have here at University of Florida and, therefore, improve outcomes of inflammatory bowel disease in our community of Central Florida.
Melanie Cole: Wow, what a fascinating topic this is. So tell us a little bit more about how it addresses the gaps in inflammatory bowel disease care to ensure that high quality treatment can be delivered to the underserved and geographically remote regions and how it incorporates those quality metrics to potentially improve patient outcomes. Tell us a little bit about how it works.
Dr. Angela Pham: So a lot of my patients who have inflammatory bowel disease will drive upwards of three hours, sometimes even five to six hours to come see us here in Gainesville. A lot of patients are from the Panhandle, from Southern Georgia, even South Florida. And I will say based on the data that we have, a lot of patients who have inflammatory bowel disease, upwards of 40% or more live in geographically remote isolated locations whereby they don't have access to subspecialty care. And so I would like to make sure that we can move knowledge and not people, so to speak, and give access to subspecialty care to these patients that otherwise wouldn't have access that is so very necessary to put their inflammatory bowel disease into remission.
Melanie Cole: So tell us about the benefits to a physician practice and really how it can be utilized for a physician practice and its patients.
Dr. Angela Pham: So during this whole process, I actually embarked on a journey and went to visit a lot of the referring physicians that send patients to come see me. And I heard clear and loud the fact that a lot of times these physicians don't have access to a lot of the medications that we have. For example, a lot of places don't do infusions the way that we do infusion medications here at University of Florida. And they also don't have access to a pharmacist, a specialized pharmacist, that helps them through the prior authorization and insurance approval process for these very expensive advanced therapy medications. We do have an IBD pharmacist here at University of Florida that helps us with all these medications.
And what I heard from all these physicians was that if they could simply get help with the simple tasks, that their patients would get the help that they need. And it would take just a simple meeting between physicians to hash out what it is that is a barrier to patients getting the care that they need. And rather than have a patient drive back and forth, you know, five to six hours from, you know, their hometown to University of Florida, if the physicians can share knowledge amongst themselves to get the answers that they need, that would greatly benefit the patient, improve outcomes and, ultimately, improve the care and best practices of inflammatory bowel disease.
Melanie Cole: So that's such an interesting model of care, Dr. Pham, and as you're telling us about the benefits to the community and to patients directly, tell us additionally how IBD health liaisons work with these patients as health coaches to help equip them with the skills because doctors don't always and physicians don't always have the time really, or as you said, the resources to work with those patients directly on navigating the healthcare system and managing inflammatory bowel disease, which as you said, can take many medications. I mean, it's certainly a disease situation that needs a lot of management. So speak a little bit about health liaisons and nurse navigators and the people that help along the way.
Dr. Angela Pham: Sure. Absolutely. So as you know, with any chronic condition, the needs are very, very nuanced and not all of these needs can be met by your physician during, you know, a 30-minute to one-hour appointment. And chronic conditions expand beyond the time you spend in clinic with your physician. And so these nuanced needs, I think, are best met by peer mentors or what we have termed health liaisons.
With our model, we have chosen to use health liaisons that have been touched by inflammatory bowel disease themselves. They usually have experience with the illness and so are very well-versed in the care of inflammatory bowel disease from its complications to its medications and the day-to-day life of working and going to school and living with inflammatory bowel disease. And these health liaisons can really help guide a newly diagnosed patient through the navigation of their illness from, you know, scheduling appointments to who do they actually need to see to get the help they need. For instance, if they have joint pain, they need to see a rheumatologist and that's something that's very important to bring up with your gastroenterologist. Or if they have trouble with access to certain medications, how to best collaborate with your insurance company and your doctor's office to make sure that medications are approved expediently. And then also just the administration of medications themselves. A lot of these medications are infused or injected through the skin, and that can be a very new experience for a lot of patients. And so all these little nuances, I think are best met through a peer mentor or a health liaison talking you through the process and helping you get the answers you need outside of just the appointments that you have with your physician. And so I think health liaisons will really pave the way to improving the outcomes for all these patients that don't have health liaisons or a good support network to help them through their disease process. Because sometimes, you know, friends and family don't always completely understand, or they don't have the answers needed and so a health liaison, I think, will fill that gap for patients.
Melanie Cole: Well, I think it's really important to have that sort of multidisciplinary care model. And, as you say, health advocates and health liaisons and family can't always step into that role. What is your goal for the program? Can you speak about the capacity of general gastroenterologists and clinics to empower and safely manage these underserved patients with IBD who always don't receive that subspecialty care? What goals do you have? Where do you see this going in the future?
Dr. Angela Pham: I did want to expand a little bit more on the whole idea of the ECHO Project. What it actually is, is it's a set of didactic series, usually once a month, whereby you collaborate as physicians and basically present patient cases and in real time get answers to questions you may have about patient care. It follows the philosophy of all teach, all learn. And so I think what's really important to realize is that, as gastroenterologists, we all play a different role in patient care and community gastroenterologists have a very, very important role in general GI care, including colon cancer screening and treatment of acid reflux amongst a myriad of other things. And so they are very, very busy with taking care of, you know, the high volume of colonoscopies for colon cancer screening. And so a lot of times, they just don't have the bandwidth to take care of a complex chronic condition such as inflammatory bowel disease. And that's where a place like UF Health Shands Hospital can really step in and help with the subspecialty needs of taking care of inflammatory bowel disease.
And so we hope that with Project ECHO IBD, we can collaborate with our community GI docs to really share knowledge and share all the tricks of the trade necessary to get patients the care that they need without necessarily having to move the patient from place to place, but more just, you know, democratizing knowledge and sharing our best practices amongst one another and creating this rich virtual learning community whereby we can meet on a monthly basis to really get patients the care that they need.
Melanie Cole: As we get ready to wrap up, what a great model you're discussing here today, Dr. Pham, has the ECHO model proven effective and scalable across other disciplines? Where would you see it being useful across the spectrum of the healthcare profession?
Dr. Angela Pham: Absolutely. So what's really interesting is Project ECHO has been used at University of Florida Health Shands Hospital before. So Dr. Michael Haller is a pediatric endocrinologist here at UF Health Shands hospital. And he actually is collaborating with Stanford to use Project ECHO for type 1 diabetes, and they have published several studies that have basically annotated how successful Project ECHO can be. They've improved outcomes in type 1 diabetes in both pediatric and adult patients here and in California.
And so beyond that, outside of the University of Florida, of course, Project ECHO actually has been used in 93% of countries all around the world. And there's over 3000 different Project ECHOs that have been initiated since its advent in the early 2000s. And so it's being used in conditions, such as osteoporosis, end-of-life care, type 1 diabetes, a lot of different mental health conditions, all sorts of different chronic conditions. And so it is very scalable across every different discipline across the board and worldwide.
Melanie Cole: Do you have any final thoughts you'd like to leave other physicians about Project ECHO IBD at the University of Florida College of Medicine and UF Health Shands Hospital.
Dr. Angela Pham: I would just like to let everyone know that I am open to communications to initiate new Project ECHO models across US now that we are a hub. I would like to expand Project ECHO to other GI conditions if possible. And I would really like to build on the whole idea and philosophy of the health liaison and creating a medical home for patients in general beyond Project ECHO. I think health liaisons have a very useful role in any chronic condition, not just, you know, inflammatory bowel disease. And I really encourage anybody out there who is looking at Project ECHO as a viable option for them to reach out to me and I'd be happy to get you started or collaborate in any way.
Melanie Cole: Thank you so much, Dr. Pham. Such an informative topic and what a great initiative. Thank you so much for joining us today. And to refer your patient or to listen to more podcasts from our experts, please visit ufhealth.org/medmatters. That concludes today's episode of UF Health MedEd Cast with UF Health Shands Hospital. Please also remember to subscribe, rate and review this podcast and all the other UF Health Shands Hospital podcasts. I'm Melanie Cole.
The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical education, ACCME, to provide continuing medical education for physicians. The University of Florida College of Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 credit. Physicians should claim only the credit commensurate with the extent of their participation in this activity.
Melanie Cole: Welcome to UF Health MedEd Cast with UF Health Shands Hospital. I'm Melanie Cole, and I invite you to listen as we discuss Project ECHO today with Dr. Angela Pham. She's an Assistant Professor in the Division of Gastroenterology, Hepatology, Nutrition at the University of Florida College of Medicine, and she practices at UF Health Shands Hospital.
Dr. Pham, it's a pleasure to have you join us. So before we get into this whole topic, I'd like you to tell us a little bit about the ECHO model itself, and then tell us what Project ECHO is.
Dr. Angela Pham: So the whole story of Project ECHO dates back all the way to the early 2000s. It was actually initiated by a hepatologist out in Arizona. And it is a rich virtual learning community by which community doctors and doctors from academic centers share knowledge. And what it stands for is Extension for Community Healthcare Outcomes. And it's been used for a variety of different disease processes after it was first used for actually hepatitis C out in Arizona by Dr. Arora.
So I'll tell you a little bit more why I decided to use this model for inflammatory bowel disease. So I am an inflammatory bowel disease specialist, and most of the patients I see that are referred to me suffer from inflammatory bowel disease and have had it for a very long time. And a lot of times, by the time they come to me, their disease course has blossomed to a point where it is much more severe than it needs to be. And my goal in starting the ECHO Project is to democratize knowledge and give access to knowledge and best practice care to community doctors that may not have access to the subspecialists that we have here at University of Florida and, therefore, improve outcomes of inflammatory bowel disease in our community of Central Florida.
Melanie Cole: Wow, what a fascinating topic this is. So tell us a little bit more about how it addresses the gaps in inflammatory bowel disease care to ensure that high quality treatment can be delivered to the underserved and geographically remote regions and how it incorporates those quality metrics to potentially improve patient outcomes. Tell us a little bit about how it works.
Dr. Angela Pham: So a lot of my patients who have inflammatory bowel disease will drive upwards of three hours, sometimes even five to six hours to come see us here in Gainesville. A lot of patients are from the Panhandle, from Southern Georgia, even South Florida. And I will say based on the data that we have, a lot of patients who have inflammatory bowel disease, upwards of 40% or more live in geographically remote isolated locations whereby they don't have access to subspecialty care. And so I would like to make sure that we can move knowledge and not people, so to speak, and give access to subspecialty care to these patients that otherwise wouldn't have access that is so very necessary to put their inflammatory bowel disease into remission.
Melanie Cole: So tell us about the benefits to a physician practice and really how it can be utilized for a physician practice and its patients.
Dr. Angela Pham: So during this whole process, I actually embarked on a journey and went to visit a lot of the referring physicians that send patients to come see me. And I heard clear and loud the fact that a lot of times these physicians don't have access to a lot of the medications that we have. For example, a lot of places don't do infusions the way that we do infusion medications here at University of Florida. And they also don't have access to a pharmacist, a specialized pharmacist, that helps them through the prior authorization and insurance approval process for these very expensive advanced therapy medications. We do have an IBD pharmacist here at University of Florida that helps us with all these medications.
And what I heard from all these physicians was that if they could simply get help with the simple tasks, that their patients would get the help that they need. And it would take just a simple meeting between physicians to hash out what it is that is a barrier to patients getting the care that they need. And rather than have a patient drive back and forth, you know, five to six hours from, you know, their hometown to University of Florida, if the physicians can share knowledge amongst themselves to get the answers that they need, that would greatly benefit the patient, improve outcomes and, ultimately, improve the care and best practices of inflammatory bowel disease.
Melanie Cole: So that's such an interesting model of care, Dr. Pham, and as you're telling us about the benefits to the community and to patients directly, tell us additionally how IBD health liaisons work with these patients as health coaches to help equip them with the skills because doctors don't always and physicians don't always have the time really, or as you said, the resources to work with those patients directly on navigating the healthcare system and managing inflammatory bowel disease, which as you said, can take many medications. I mean, it's certainly a disease situation that needs a lot of management. So speak a little bit about health liaisons and nurse navigators and the people that help along the way.
Dr. Angela Pham: Sure. Absolutely. So as you know, with any chronic condition, the needs are very, very nuanced and not all of these needs can be met by your physician during, you know, a 30-minute to one-hour appointment. And chronic conditions expand beyond the time you spend in clinic with your physician. And so these nuanced needs, I think, are best met by peer mentors or what we have termed health liaisons.
With our model, we have chosen to use health liaisons that have been touched by inflammatory bowel disease themselves. They usually have experience with the illness and so are very well-versed in the care of inflammatory bowel disease from its complications to its medications and the day-to-day life of working and going to school and living with inflammatory bowel disease. And these health liaisons can really help guide a newly diagnosed patient through the navigation of their illness from, you know, scheduling appointments to who do they actually need to see to get the help they need. For instance, if they have joint pain, they need to see a rheumatologist and that's something that's very important to bring up with your gastroenterologist. Or if they have trouble with access to certain medications, how to best collaborate with your insurance company and your doctor's office to make sure that medications are approved expediently. And then also just the administration of medications themselves. A lot of these medications are infused or injected through the skin, and that can be a very new experience for a lot of patients. And so all these little nuances, I think are best met through a peer mentor or a health liaison talking you through the process and helping you get the answers you need outside of just the appointments that you have with your physician. And so I think health liaisons will really pave the way to improving the outcomes for all these patients that don't have health liaisons or a good support network to help them through their disease process. Because sometimes, you know, friends and family don't always completely understand, or they don't have the answers needed and so a health liaison, I think, will fill that gap for patients.
Melanie Cole: Well, I think it's really important to have that sort of multidisciplinary care model. And, as you say, health advocates and health liaisons and family can't always step into that role. What is your goal for the program? Can you speak about the capacity of general gastroenterologists and clinics to empower and safely manage these underserved patients with IBD who always don't receive that subspecialty care? What goals do you have? Where do you see this going in the future?
Dr. Angela Pham: I did want to expand a little bit more on the whole idea of the ECHO Project. What it actually is, is it's a set of didactic series, usually once a month, whereby you collaborate as physicians and basically present patient cases and in real time get answers to questions you may have about patient care. It follows the philosophy of all teach, all learn. And so I think what's really important to realize is that, as gastroenterologists, we all play a different role in patient care and community gastroenterologists have a very, very important role in general GI care, including colon cancer screening and treatment of acid reflux amongst a myriad of other things. And so they are very, very busy with taking care of, you know, the high volume of colonoscopies for colon cancer screening. And so a lot of times, they just don't have the bandwidth to take care of a complex chronic condition such as inflammatory bowel disease. And that's where a place like UF Health Shands Hospital can really step in and help with the subspecialty needs of taking care of inflammatory bowel disease.
And so we hope that with Project ECHO IBD, we can collaborate with our community GI docs to really share knowledge and share all the tricks of the trade necessary to get patients the care that they need without necessarily having to move the patient from place to place, but more just, you know, democratizing knowledge and sharing our best practices amongst one another and creating this rich virtual learning community whereby we can meet on a monthly basis to really get patients the care that they need.
Melanie Cole: As we get ready to wrap up, what a great model you're discussing here today, Dr. Pham, has the ECHO model proven effective and scalable across other disciplines? Where would you see it being useful across the spectrum of the healthcare profession?
Dr. Angela Pham: Absolutely. So what's really interesting is Project ECHO has been used at University of Florida Health Shands Hospital before. So Dr. Michael Haller is a pediatric endocrinologist here at UF Health Shands hospital. And he actually is collaborating with Stanford to use Project ECHO for type 1 diabetes, and they have published several studies that have basically annotated how successful Project ECHO can be. They've improved outcomes in type 1 diabetes in both pediatric and adult patients here and in California.
And so beyond that, outside of the University of Florida, of course, Project ECHO actually has been used in 93% of countries all around the world. And there's over 3000 different Project ECHOs that have been initiated since its advent in the early 2000s. And so it's being used in conditions, such as osteoporosis, end-of-life care, type 1 diabetes, a lot of different mental health conditions, all sorts of different chronic conditions. And so it is very scalable across every different discipline across the board and worldwide.
Melanie Cole: Do you have any final thoughts you'd like to leave other physicians about Project ECHO IBD at the University of Florida College of Medicine and UF Health Shands Hospital.
Dr. Angela Pham: I would just like to let everyone know that I am open to communications to initiate new Project ECHO models across US now that we are a hub. I would like to expand Project ECHO to other GI conditions if possible. And I would really like to build on the whole idea and philosophy of the health liaison and creating a medical home for patients in general beyond Project ECHO. I think health liaisons have a very useful role in any chronic condition, not just, you know, inflammatory bowel disease. And I really encourage anybody out there who is looking at Project ECHO as a viable option for them to reach out to me and I'd be happy to get you started or collaborate in any way.
Melanie Cole: Thank you so much, Dr. Pham. Such an informative topic and what a great initiative. Thank you so much for joining us today. And to refer your patient or to listen to more podcasts from our experts, please visit ufhealth.org/medmatters. That concludes today's episode of UF Health MedEd Cast with UF Health Shands Hospital. Please also remember to subscribe, rate and review this podcast and all the other UF Health Shands Hospital podcasts. I'm Melanie Cole.