Category: Clinical Issues

15 - Progress Report for 15 Months of Bone Health TeleECHO Clinic: A Strategy to Improve Osteoporosis Care in Underserved Areas

Background: Bone Health TeleECHO Clinic was developed at the University of New Mexico Health Sciences Center through collaboration of the ECHO Institute and the Osteoporosis Foundation of New Mexico. It is a strategy for telementoring healthcare professionals in underserved communities to achieve advanced levels of knowledge in the care of skeletal diseases. ECHO uses videoconferencing technology for case-based interactive learning, with brief didactic presentations on topics of interest. The ECHO model of learning aims to transform the care of osteoporosis and reduce the osteoporosis treatment gap. This is a progress report of Bone Health TeleECHO Clinic since its launch in 2015.


Methods:
Registration for Bone Health TeleECHO Clinic is submitted online or by fax, then processed at the ECHO Institute. Demographic information of learners is collected. Participation is logged for each session attended. Electronic queries recorded anticipated changes in clinical practice and generated monthly feedback reports. A self-efficacy assessment questionnaire retrospectively evaluated the effect of the ECHO intervention for confidence in managing patients with osteoporosis.


Results:
Bone Health TeleECHO Clinic videoconferencing sessions have been held weekly since October 6, 2015. Over the first 15 months, 166 individuals registered, with 124 attending at least 1 TeleECHO clinic. Of those who attended at least once, 65 (52.4%) were classified as physicians (MD, DO, DC), 30 (24.1%) “advanced practice providers” (PA, CNP, RN, CNM, etc.), 15 (12.1%) other (PT, OT, PhD, etc.), and 14 (11.3%) unknown. Number of TeleECHO clinics attended ranged from 1 to 52, with a mean of 9.1. There were 19 learners (faculty excluded) who attended more than 20 TeleECHO clinics and 10 who attended more than 30. Attendees were located in 33 US states plus 4 other countries. The self-efficacy questionnaire was administered online in August 2016, after 10 months of Bone Health TeleECHO Clinics. There were 16 responders, 10 of whom attended more than 10 clinics and had patient care responsibilities. In this group, there was a statistically significant overall improvement in confidence of caring for osteoporosis patients, with an “effect size” of 1.18 (p = 0.005).


Conclusion:
Bone Health TeleECHO Clinic improves self-confidence of healthcare professionals in caring for patients with osteoporosis. The provides an opportunity for patients to receive better care, closer to home, with greater convenience, and lower cost than referral to a specialty center. Replication of Bone Health TeleECHO Clinic in other US states and other countries may serve as a force multiplier to improve osteoporosis care and reduce the osteoporosis treatment gap.

Sanjeev Arora

Faculty
UNM
Albuquerque, New Mexico

Matthew Bouchonville

Faculty
UNM
Albuquerque, New Mexico

David Chafey

Faculty
UNM
Albuquerque, New Mexico

Natalie Weiss

Student
UNM
Albuquerque, New Mexico

E. Michael Lewiecki

Director
New Mexico Clinical Research & Osteoporosis Center
Albuquerque, New Mexico

E. Michael Lewiecki, MD, is Clinical Assistant Professor of Medicine at University of New Mexico School of Medicine and Director of New Mexico Clinical Research & Osteoporosis Center. His is a consultant in osteoporosis and metabolic bone disease, supervisor of bone densitometry at his center, and an educator with a special interest in the management of osteoporosis and metabolic bone disease. He is principal investigator for the center’s osteoporosis clinical trials and author of numerous scientific publications on osteoporosis and bone densitometry.

Dr. Lewiecki is past-president of the International Society for Clinical Densitometry (ISCD), member of the ISCD Board of Directors, and chair of the ISCD International Relations Council. He is a member of the Board of Trustees of the National Osteoporosis Foundation and a member of the Committee of Scientific Advisors of the International Osteoporosis Foundation. Dr. Lewiecki is a faculty member for the IOF/ISCD educational programs for osteoporosis and bone densitometry. He is founder and Director of Bone Health ECHO (Extension for Community Healthcare Outcomes), a telementoring program for osteoporosis and metabolic bone disease developed through collaboration of Project ECHO at the University of New Mexico Health Sciences Center and the Osteoporosis Foundation of New Mexico. Dr. Lewiecki holds editorial positions with many peer-reviewed journals. He has received national and international awards, including “Physician of the Year” by the ISCD in 2002, the ISCD “Paul D. Miller Service Award” in 2006, and the “Laureate Award” of the New Mexico Chapter of the American College of Physicians in 2006.

He is a fellow of the American College of Physicians and the American College of Endocrinology. Dr. Lewiecki is president and founder of the Osteoporosis Foundation of New Mexico and director of its educational activities. He established and is program director of the annual Santa Fe Bone Symposium.