Delaware Telehealth ConferenceProject ECHO Update

(Extension for Community Health Care Outcomes) March 25, 2014

Meeting the Challenge of Pain Management and Opioid Addiction in Primary Care

Using Videoconferencing to Link Specialists and Primary Care Health Providers

Presentation By: J. Kevin Massey Delaware, Division of Public Health

Prescription Drug Action Committee Co-ChairsKaryl Rattay, MD, MS, Director, Delaware Division of

Public HealthRandeep Kahlon, MD, Past President of the Medical

Society of Delaware

Why Project ECHO? Prescription Drug Abuse and Misuse in Delaware

• Delaware: 9th highest drug overdose death rate (2009)– DE average deaths per 100,000 population: 12.6– National average deaths per 100,000: 12.0– Drug overdose death rate increased 142% (1999-2009)

• More Delaware residents 12 and older report using non-medical use of opioid pain relievers– DE average: 5.6%– National average: 4.8%

• Substance abuse treatment admission rates for opioids increased over 2,750% (1999-2010)

• Delaware 5th highest for opioid sales (2010)– DE average: 10.2 KG per 100,000 population– National average: 7.1 KG per 100,000 population

Why Project ECHO? A Coordinated Team Approach to Action

– The Prescription Drug Action

Committee, PDAC History

Established in February 2012. Focused on coordinating public, private and community

efforts under the leadership of the Division of Public Health and the Medical Society of Delaware.

The PDAC has a broad and diverse membership. To date, has conducted 18 full committee public

meetings and over 50 sub committee meetings. The PDAC has developed a comprehensive set of

recommendations to combat drug abuse, misuse and diversion statewide. Implementation of these recommendations is ongoing.

You can access our PDAC report on our website address: http://dhss.delaware.gov/dhss/dph/pdachome.html

PDAC Leadership – Co-Chairs & Sub-Committee Chairs

PDAC Co-Chairs Karyl Rattay, MD, MS, Director

of Delaware Division of Public Health

Randeep Kahlon, MD, Past President of the Medical Society of Delaware

Staff Support: J. Kevin Massey, Delaware, Division of Public Health

Next public meeting is on Monday, April 28, 2014 at the Medical Society of Delaware.

PDAC Sub-Committee Chairs (A.C.E) Access to Treatment:

Marc Richman, PhD Assistant Director for Delaware Substance Abuse & Mental Health

Control: John Goodill, MD Delaware Pain Initiative

Education: Sandra Retzky, MD., RPh., MPH, MBA Healthcare Fellow Office of US Senator Christopher A. Coons

Project ECHO – Expanding Access to Treatment and Education

“The mission of Project ECHO (Extension for Community Health Care Outcomes) is to develop the capacity to safely and effectively treat chronic, common and complex diseases in rural and underserved areas and to monitor outcomes.” Dr. Sanjeev Arora, University of New Mexico – Founder, Project ECHO.

HEALTHCARE DILEMMA• How can a specialist better manage thousands of patients who live a long

distance from his or her office?• How can specialty care reach underserved populations?• How can this be accomplished without adding to the workforce?• How can this be accomplished with the existing infrastructure? CONCLUSIONS AND OUTCOMES• Replicated world wide i.e. Department of Defense; Harvard Medical Center; India,

New Delhi, The Community Healthcare Center, Inc., Veterans Administration, etc. • Proven to significantly increase knowledge, skills and abilities. Leads to improved

patient experience and outcomes. • Reduces cost of care

Goals and Methods of Delaware Project ECHOGoals• Develop the capacity to safely and effectively treat related opioid and addiction

diseases in all areas in Delaware and monitor outcomes• Develop a model to safely treat complex diseases especially in rural locations in

the state.Methods• Use cost effective technology (Vidyo videoconferencing) to leverage scarce

healthcare resources.• Disease management model focus on improving outcomes by reducing variation

in processes of care and sharing best practices.• Cased based and interactive learning between specialists and primary care

providers.Benefits to Clinicians No cost CME’s and CEUs Professional interaction with colleagues with similar interests i.e. physicians, nurse

practioners, physician assistants, etc. A mix of work and learning. Access to specialty consultation in pain management and medication assisted

treatment i.e. Buprenorphine. Others are available.

Delaware Project ECHO Steps for Pain Management and Opioid Addiction

Treatment Education

• 2 hour weekly or bi monthly sessions, depending upon the topic

• Case submission form• Expert specialty team located anywhere in the world• Local Delaware and Remote Project ECHO manager• 15-20 minute didactic presentation• Deidentified case presentation (2-10)• Primary care providers can join from anywhere in the

world using a desktop or mobile device. No expensive hardware or software. Ease set up.

• Access to a dedicated Project ECHO secure website to reference materials

Disease Selection in Delaware: Pain Management and Opioid Addiction Treatment

• Management is complex• Evolving treatments and medicines• High societal impact (health and economic)• Serious outcomes of untreated disease• Improved outcomes with disease management• Other commons diseases are available.Potential Benefits of ECHO model to Health System• Quality and safety• Rapid learning and best practice dissemination• Expand access to care and reduce variations in care• Improve professional satisfaction/retention• Cost effective care (avoid excessive testing and travel)• Supports the Medical Home ModelCurrent Delaware ECHO Projects and Participants • Westside Family Healthcare – Pain Management• University of Delaware, Nurse Managed Health Center – Pain Management, Summer 2014• Brandywine Counseling – Buprenorphine, Medication Assisted Treatment• Connections – Buprenorphine, Medication Assisted Treatment• Horizon House – Buprenorphine, Medication Assisted Treatment• Kent Sussex Counseling Services – Buprenorphine, Medication Assisted Treatment• Thresholds, Inc. – Buprenorphine, Medication Assisted TreatmentDelaware Executive Sponsors and Education Partners• The Community Health Center, Inc. of Connecticut (FQHC)• The State of Delaware, Department of Health and Social Services• The Delaware Telehealth Coalition• The Prescription Drug Action Committee (PDAC)

Contact Me:Jonathan Kevin Massey

Jonathan.massey@state.de.us

302.744.4919

PDAChttp://dhss.delaware.gov/dhss/dph/pdachome.html