1. 2013 Annual Meeting Year in Review

2. Why ECHO-Chicago? Demand for subspecialty services outstrips availability of subspecialists o Particularly acute where social and economic distance limit access to care o Disparities in access to care exacerbate health disparities Primary care setting is often the best place to deliver care for common, chronic diseases Launched in 2010 to address the problem of access to subspecialty care in underserved communities in our community Cook, et al, Health Affairs 2007;26(5):1459-68 Community-based primary care providers often lack the support and training to manage complex, chronic disease effectively o Training opportunities are limited, costly, and often require travel o Training is not always relevant to special populations, including underserved and minority communities

3. Purpose o Disseminate best practice management of complex, common, chronic disease in the primary care medical home o Use case-based learning; the most widespread teaching method in medicine o Leverage advanced technology to reduce cost and time constraints, and eliminate travel o Engage primary care providers in a local network to share knowledge and experience ECHO-Chicago uses case-based, iterative, telehealth curricula delivered via high-grade videoconference technology to bring advanced training and support to primary care providers in underserved communities throughout the Chicago metro area.

4. Knowledge Transfer + Technology = Force Multiplier RWJF 2011

5. ECHO-Chicago Story 2009 2010 2011 2012 Introduced Breast Cancer Survivor Care curriculum at community health center partners Completed pilot on hypertension; published results in J. Clinical Hypertension Launched ECHO-Chicago Collaboration with six community health center partners Focus on resistant hypertension Introduced Pediatric ADHD curriculum at N community health center partners 2013 Introduced Pediatric Obesity and Co-morbidities curriculum Completed study on provider response to ECHO model; published results in Partnerships in Community Health Seed Funding from Urban Health Initiative Idea formed initiated planning for ECHO-Chicago First outside funding, from Grant Healthcare Foundation

6. ECHO-Chicago Growth

7. 2013 Activities Launched new curriculum in Pediatric Obesity and Co-morbidities –Collaboration with 7 community health center partners –community provider participants Transitioned to Vidyo™; web-based videoconference technology –More user-friendly –Greater flexibility; works on PCs, MACs, tablets, and mobile devices –Better quality; lower bandwidth –Lower cost Expanded our network from two additional community partners

8. 2013 Activities # of participating health centers Total # of sessions # of unique participants Avg # of providers /session rHTN13163811 ADHD13179021 BCS610444 OBS6121813 Totals18*55136*13 *Providers may participate in more than one disease area; the total reflects the number of unique ECHO-Chicago participants.

9. 2013 Evaluation/Research Activities Study of provider feedback on the effectiveness of ECHO model, results published in Progress in Community Health Partnerships Analysis of provider survey data –baseline self-efficacy and knowledge surveys for hypertension and ADHD –pre- and post-series changes in ADHD provider surveys Launch of study to measure impact of breast cancer survivor care curriculum Preparing for analysis of Medicaid data on pre- and post-series changes in provider prescribing patterns

10. Provider Feedback on the ECHO model Our study on the effectiveness of the ECHO model was based on in-depth interviews with nine providers who participated in ECHO-Chicago sessions. Providers identified the benefits of this case-based, iterative curriculum to: Extend their current skills and knowledge in a way that is convenient (no travel, discrete time commitment) engaging in content (best practices) and format (didactic with case presentations) Model best practice protocols for their patient population through preparation, presentation, and discussion of patient cases Improve confidence to manage more complex patients without referring to subspecialists Increase job satisfaction and motivate skills enhancement Strengthen connections between University of Chicago subspecialists and community providers Build a collaborative knowledge network among peers caring for similar patient populations

11. Provider Needs Assessment: Hypertension and ADHD *Hypertension knowledge test: 26 total ; ADHD knowledge test: 18 total Analysis of baseline scores for knowledge and self-efficacy in hypertension and ADHD indicate the need for both training and support. # of providersKnowledge*SD Self-Efficacy (7-point scale)SD Hypertension5313.9 (53%)2.94.7 (67%)1 ADHD9010.6 (59%) 2.23.4 (49%) 1.1

12. Changes in ADHD Knowledge and Self-Efficacy We conducted a preliminary analysis of data from 23 providers who completed both the pre- and the post-series survey. The data show a small increase in knowledge, and a moderate increase in self-efficacy. On the 7-point scale, the 11% change points to an improvement from “slight knowledge, skills or competence” to “average among my peers” Pre-seriesSDPost-seriesSDChange Self-efficacy (7-point scale)3.4 (49%)1.24.2 (60%)0.80.8 (11%) Knowledge (18 questions)10.4 (58%)1.911.5 (64%)2.11.1 (6%)

13. Community Partners ACCESS Aunt Martha's Health Center Beloved Community Family Wellness Center Chicago Family Health Center Christian Community Health Center Erie Family Health Center Family Christian Health Center Fiedler Private Practice Friend Family Health Center Heartland Health Outreach Howard Brown Health Center La Rabida Children's Hospital Lawndale Christian Health Center Mercy Family Health Center Mile Square Health Center Mt Sinai Hospital and Health Center TCA Health, Inc. NFP University of Illinois -- Chicago

14. What’s Next Launch of curriculum in hepatitis C in 2014 Planning for launch of curriculum in Integrated Mental Health in Primary Care Continued outreach to new community partners, and new providers Continued efforts to ensure sustainability

15. George Bakris, MD Karin Vander Ploeg Booth, MD Susan Hong, MD Goutham Rao, MD (Hypertension) (ADHD) (Breast Cancer Survivorship) (Pediatric Obesity) Maureen Hyewon (Alice) Marcus B. Wolfe Chartay Robinson Timothy May Zakiya Moton Mencarini Won Daniel Johnson, MDTamara Hamlish, Ph.D

16. Thank You Chicago Glen Aduana, MD Steve Brown Andy Davis, MD Christopher Masi, MD, PhD Carmela Socolovosky Greg Van Scooter and the Multimedia Department Sanjeev Arora, MD John Brown, RN Wesley Pak, MBA South Side Healthcare Collaborative Brenda Battle Kim Hobson Participating sites and their providers New Mexico Funders Aetna Foundation American Cancer Society Baxter International Foundation CTSA – University of Chicago Grant Healthcare Foundation Northern Trust Charitable Trust UHI – University of Chicago