Project MS E.C.H.O - Outcomes of an Innovative Pilot to Improve Access to Care in Underserved Areas

Background: Barriers to accessing MS specialty care include geographic disparities between rural and metropolitan regions. MS Project ECHO (Extension for Community Healthcare Outcomes) is a videoconference-based education and case consultation program developed to improve care delivery to MS patients in underserved communities. This program is an MS-focused adaptation of the existing Project ECHO, which has successfully improved disparities in care for patients with Hepatitis C and HIV.

Objectives: Goals of this pilot were to establish feasibility of the ECHO model for the MS population and to assess impact on MS care by community providers.

Methods: MS Project ECHO involved weekly CME-accredited video conferencing between a multidisciplinary team of MS clinicians from the University of Washington, National MS Society staff, and community participants from Alaska, Idaho, Montana and Washington. Participants included neurologists, physiatrists, internists, family practitioners, nurse practitioners, and naturopaths.  Each session (N=41)included a brief MS-related didactic followed by cases presented by participants. Participants were invited to participate in a qualitative interview upon completion of the program to assess: impact on provider confidence related to their own MS practice parameters; changes in provider practice habits  related to the case consultations; and whether patients had increased connection to information and resources of the National MS Society.

Results: Of 26 participants, 15 were available for exit interviews. Improvement in confidence of MS care delivery was rated at 4.53 (5 point Likert scale) with a bias toward lower ratings from less engaged participants; 11 used Society resources. Barriers to participation included time commitment and the specific time of the sessions. Four themes emerged reflecting impact on provider practices related to the case consultations: direct changes in patient care; improved confidence in existing treatment decisions; changes in general MS practice habits; and improved perception of patient confidence in their MS-related care.

Conclusions: MS Project ECHO has potential to be an efficient, replicable method of training and education with the potential of reducing the care disparity existing in underserved rural populations. This pilot demonstrated the feasibility of MS Project ECHO while suggesting positive impact on the MS-related care provided by the community participants in their rural communities.