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Royal Commission into Victoria’s Mental Health System

Case study:

Project ECHO

Project ECHO (Extension for Community Healthcare Outcomes) is a guided practice model that was developed in 2003 at the University of New Mexico in the United States. It aims to extend capacity in rural and regional areas to manage chronic disease in primary care settings.

Project ECHO increases access to best‑practice care and reduces geographical health disparities through hub and spoke networks that facilitate the sharing of knowledge, experience and expertise. Project ECHO connects community providers (‘spokes’) with teams of specialists at centres of excellence (‘hubs’) in regular real‑time collaborative sessions. A brief lecture, followed by online case‑based discussion, provides a platform to come together as a learning community.

The model enables clinicians and other providers in primary care to develop skills and knowledge in best practice in the care of people with complex needs. The primary care clinician retains responsibility for managing the patient with input from other participants.

Project ECHO now operates in 400 locations across the world in numerous medical fields. A 2016 review found that ‘Project ECHO is an effective and potentially cost‑saving model that increases participant knowledge and patient access to healthcare in remote locations’.

The researchers suggested that a number of factors explain its success, including the development of a ‘community of practice’ resulting in change in participants’ behaviour; its cost‑effectiveness; and improvement in patient care. This is achieved through its ability to use technology to leverage scarce specialist and academic resources, to share knowledge with primary care clinicians to help master complexity and reduce disparity. Each Project ECHO hub in turn is supported by a dedicated account representative from the ECHO Institute at the University of New Mexico.

Project ECHO can increase the quality of care and number of patients being seen in primary settings, reducing the need for patients to access resource‑intensive tertiary services. The model promotes a system of care across primary, secondary and tertiary settings. In addition to capacity building, it builds relationships at local levels between clinicians, which assists with warm referrals (referrals where services support the person to connect to another service), and reduces the need for patients having to retell their story.

Goulburn Valley Health Joint Addiction and Mental Health ECHO

The Joint Addiction and Mental Health (JAMH) ECHO is an initiative led by Goulburn Valley Health’s two divisions, Goulburn Valley Alcohol and Drug Service and Goulburn Valley area mental health service, supported by the ECHO Institute at the University of New Mexico.

Primary and secondary care services in the Goulburn Valley area, including community health service providers, GPs, medical specialists, alcohol and other drug clinicians, and maternal and child health practitioners, access an interdisciplinary panel of experts from across the state. This program supports workforce development and the learning needs of trainee doctors, nurses and allied health students in the local tertiary mental health, and drug and alcohol services.

JAMH ECHO sessions are held weekly. While these sessions are not formal secondary consultations, they provide an opportunity for participants to discuss cases with peers and experts in a tertiary specialist centre, much like ‘hallway discussions’, but over videoconference.

Lisa Pearson, coordinator of the JAMH ECHO, noted the benefits of Project ECHO in sharing scarce specialist resources in a collegial manner.

It comes from a position of de‑monopolising healthcare, about trying to access the scarce specialist resources and amplify them using a philosophy of ‘all teach, all learn’.

Ms Pearson described how Project ECHO can improve care and treatment provided to the consumer.

You have a network of health professionals from different disciplines meeting together to provide the best care around a particular client. The approach opens up new referral pathways and builds health professionals’ confidence and competencies in mental health, and alcohol and drugs. People shouldn’t have to wait for two years to get specialist input into their care. If they have a primary carer who is affiliated with JAMH ECHO, they can bring that case and have an entire community to assist with that case within a matter of weeks.

Ms Pearson said that since beginning in July 2020, they have grown to more than 100 members, with around 30 participants attending each week.

We are doing a lot of work in the background to increase the representation and discipline diversity of service providers. We would also like to see Goulburn Valley Health’s Project ECHO platform support more clinics using this model of care, whether that is in mental health and addiction, or mental health and other areas, for example, women and babies, or we could go in multiple directions. We will also be evaluating the efficacy of the JAMH ECHO in changing participants’ behaviours and patient outcomes.

Source: RCVMHS, Interview with Lisa Pearson, September 2020; RCVMHS, Inpatient Consultation Liaison Services Expert Roundtable: Record of Proceedings, 2020.; Carrol Zhou and others, ‘The Impact of Project ECHO on Participant and Patient Outcomes: A Systematic Review’, Academic Medicine, 91.10 (2016), 1439–1461; Goulburn Valley Health, ‘Joint Addiction and Mental Health’ [accessed 25 September 2020].