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EP-110 - Dermatology ECHO: An Evaluation of Physician Learning Using a Guided Practice Model

Tuesday, May 1
11:55 AM - 12:10 PM
Location: Education Zone, Booth 2416, Screen 1

Introduction:

Primary care providers (PCPs) in rural and isolated areas face unique challenges in keeping up with evidence-based guidelines, which would require them to spend 600 hours each month evaluating the current literature (Alper, et al., 2004). Extension for Community Healthcare Outcomes (ECHO) Project utilizes telemedicine technologies to deliver education and mentoring to PCPs practicing in rural and other medically underserved areas. The Missouri Telehealth Network at the University of Missouri spearheads the Show-Me ECHO Project, which consists of several different specialties - dermatology, pediatric asthma, hepatitis C, autism, and healthcare ethics, among others. The goal of Show-Me ECHO is to provide participating PCPs with live-interactive video case-based mentoring in order to increase their capacity to care for patients with complex and chronic diseases.
The objective of our study was to evaluate the specific dermatologic conditions presented at Dermatology ECHO by participating providers, and examine the accuracy of diagnoses. Our goal was to understand if attending Dermatology ECHO sessions improves the diagnostic ability and accuracy for participating providers.

Materials and Methods:

Dermatology ECHO sessions are offered every Friday, from 12:00- 1:00 pm, throughout the year. Participating PCPs from rural and isolated areas of Missouri join via Zoom to present de-identified cases for targeted education and mentoring. In addition, each Dermatology ECHO includes a continuing medical education (CME)-approved didactic presentation. The de-identified cases are reviewed and discussed with the Dermatology ECHO specialty hub team, which includes general dermatologists, pediatric dermatologists, a dermatopathologist, and a clinical psychologist, who mentor them regarding clinical diagnosis, treatment, and management.

Data from the presenting PCPs (patient demographics and provisional diagnosis), as well as the data from Dermatology ECHO specialty hub team (final diagnosis and treatment options) were collected via standardized Dermatology ECHO case forms.

There were 141 unique, de-identified patient cases presented from November 2015 to July 2017 during the 62 Dermatology ECHO sessions. Of the 141 cases, we analyzed 122 case presentations, which had complete and accessible data regarding provisional and final diagnoses.

Results:

PCPs most frequently presented cases categorized as dermatitis, hypersensitivity, psoriasis or scaling disorders, as well as almost equal numbers of focal and diffuse dermatologic disorders (48% and 52% of cases, respectively). Seventy four percent (74%) of provisional diagnoses were in the same category as the final diagnoses, and 61.5% of cases had provisional diagnoses that exactly matched the final diagnoses. The percentage of cases with exact matching diagnoses improved significantly from 2016 to 2017 (48.9% to 68.9%, p-value = 0.034).

Conclusion:

Our findings suggest that Dermatology ECHO is an excellent option for successful telementoring of PCPs practicing in rural and isolated areas. It provides telementoring in diagnosis and treatment of complex dermatologic disorders, increasing their capacity to care for patients that would not otherwise have access to specialty care. PCPs showed significant improvement in diagnostic accuracy after attending Dermatology ECHO sessions. Dermatology ECHO may also improve the health and quality of life of patients in rural and underserved Missouri.

Learning Objectives:

Calli Morris

Medical Student
University of Missouri School of Medicine

Calli Morris is a second year medical student at the University of Missouri School of Medicine. She is originally from St. Charles, Missouri and completed her undergraduate studies at the University of South Carolina. She is potentially interested in going into dermatology and has thoroughly enjoyed learning more about telemedicine through her participation in and research on the success of the Dermatology ECHO clinics spearheaded by the Missouri Telehealth Network at the University of Missouri.

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