Innovative telementoring for pain management: project ECHO pain.

INTRODUCTION: Project ECHO Pain, the innovative telementoring program for health professionals, was developed in 2009 at the University Of New Mexico Health Sciences Center to fill considerable gaps in pain management expertise. Substantive continuing education for clinicians who practice in rural and underserved communities convenes weekly by means of telehealth technology. Case-based learning, demonstrations, and didactics are incorporated into the interprofessional program that helps to improve pain management in the primary care setting. METHOD: Three different approaches were used to evaluate the program over a 3-year period: (1) evaluation of all weekly continuing medical education surveys; (2) aggregation of annual clinic data; and (3) assessment of practice change in clinicians who joined Project ECHO Pain for at least 1 year. RESULTS: Between January 2010 and December 2012, 136 Project ECHO Pain clinics were held, with 3835 total instances of participation, representing 763 unique individuals from 191 different sites. Sixty percent self-identified as advanced practice or other nonphysician health professional. Statistically significant improvements in participant self-reported knowledge, skills, and practice were demonstrated. Focus group analyses of 9 subjects detailed specific practice improvements. DISCUSSION: Project ECHO Pain is a successful continuing professional development program. The telementoring model closes the large knowledge gap in pain education seen in primary care and other settings. Expertise is delivered by implementing effective, evidence-based, and work-based education for diverse health professionals. Project ECHO Pain serves as a model for interprofessional collaborative practice.

Building capacity to reduce disparities in diabetes: training community health workers using an integrated distance learning model.

PURPOSE: The purpose of this study is to determine whether an innovative interactive distance training program is an effective modality to train community health workers (CHWs) to become members of the diabetes health care team. The University of New Mexico Health Sciences Center has developed a rigorous diabetes training program for CHWs involving both distance and hands-on learning as part of Project ECHO™ (Extension for Community Healthcare Outcomes). METHODS: Twenty-three diverse CHW participants from across New Mexico were enrolled in the first training session. Participants completed surveys at baseline and at the end of the program. They attended a 3-day hands-on training session, followed by weekly participation in tele/video conferences for 6 months. Wilcoxon signed-rank statistics were used to compare pre- and posttest results. RESULTS: Participants demonstrated significant improvements in diabetes knowledge (P = .002), diabetes attitudes (P = .04) and confidence in both clinical and nonclinical skills (P < .001 and P = .04, respectively). Additionally, during focus group discussions, participants reported numerous benefits from participation in the program. CONCLUSIONS: Community health worker participation in the Project ECHO diabetes training program resulted in significant increases in knowledge, confidence, and attitudes in providing care to patients with diabetes. Studies are ongoing to determine whether the training has a positive impact on patient outcomes.

Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care.

Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need because of various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technology and case-based learning, Project ECHO enables specialists at the University of New Mexico Health Sciences Center to partner with primary care clinicians in underserved areas to deliver complex specialty care to patients with hepatitis C, asthma, diabetes, HIV/AIDS, pediatric obesity, chronic pain, substance use disorders, rheumatoid arthritis, cardiovascular conditions, and mental illness. As of March 2011, 298 Project ECHO teams across New Mexico have collaborated on more than 10,000 specialty care consultations for hepatitis C and other chronic diseases.

Neonatal hypoglycemia in term, nondiabetic pregnancies.

OBJECTIVE: To define the incidence of hypoglycemia and identify risk factors in neonates from term, singleton, nondiabetic pregnancies. STUDY DESIGN: We conducted a matched case-control study of term, singleton infants weighing more than 2500 g in nondiabetic pregnancies. Cases with hypoglycemia (glucose < 50 mg/dL) were identified by International Classification of Diseases, ninth revision, codes. Two controls per case were matched on race, maternal age, and birthweight. Conditional logistic regression analyses were performed. RESULTS: There were 116 cases and 232 controls studied. The incidence density of neonatal hypoglycemia was 24.7 per 1000 infant-days at risk. Hypoglycemia was less commonly associated with later gestational age (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.53-0.85 per week of gestation). Maternal fever during labor was more common with hypoglycemia (OR, 4.08; 95% CI, 1.39-11.79). Public insurance was more than twice as common with hypoglycemia compared with those privately insured (OR, 2.31; 95% CI, 1.17-4.58). CONCLUSION: Neonatal hypoglycemia was associated with earlier gestational age, intrapartum fever, and public insurance.