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ECHO Intestinal Failure Network
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Introducing an Innovative Model for Education and Patient Care 

Marion Winkler, PhD, RD; Kelly Tappenden, PhD, RD; Kishore Iyer, MD

 
ECHO trains non-specialists to provide specialty care
services, so more people can get the care they need.
 

               Intestinal failure (IF) is a rare, chronic, debilitating disease defined as the reduction of intestinal function below the minimum necessary for the absorption of nutrients and water. Management of IF often involves parenteral nutrition (PN), with the ability to provide IV nutrients, calories, vitamins, trace elements, and minerals to maintain health and/or support growth. Although considered a life-saving therapy, PN may be associated with life-threatening complications of liver disease or recurrent central line–associated bloodstream infections.
 

               Intestinal rehabilitation programs offer multidisciplinary management of IF with the goal of restoring enteral autonomy and reducing the need for PN support, and, sometimes, liver and/or intestinal transplantation or referral for such transplant. Access to specialized intestinal care and expert PN management may be challenging for patients who do not live close to intestinal rehabilitation programs. Novel approaches to provide specialized care for IF are necessary. The Expanding Community Healthcare Outcomes (ECHO®) model may be an innovative way to expand and support such expertise.


 

Project ECHO

               Project ECHO® is a movement started by Dr. Sanjeev Arora from University of New Mexico to improve the lives of people all over the world. Simply, ECHO aims to provide the “right knowledge at the right place and the right time.” The ECHO model has four key pillars:

1. move knowledge by using technology to leverage scarce resources

2. share best medical and health practices

3. apply case-based learning to master complex care

4. evaluate and monitor health-care outcomes

               Dr. Kishore Iyer, Director of the Intestinal Rehabilitation and Transplant Program at Mount Sinai Hospital (New York, New York), is organizing the LIFT-ECHO (“Learn Intestinal Failure Tele-ECHO”). This intestinal failure ECHO is a collaboration among experts in nutrition, gastroenterology, surgery/transplant, patient advocacy, and insurers (see table 1); and the ECHO Institute (University of New Mexico, Albuquerque); with the American Society for Parenteral and Enteral Nutrition (ASPEN) as a continuing medical education (CME) provider.

               LIFT-ECHO aims to provide a virtual multidisciplinary “consult” service to physicians and other health-care providers who manage and care for IF patients. A virtual, multidisciplinary hub of experts will provide education and support to non-specialist clinicians caring for patients with IF, through case-based tele-learning in regularly scheduled tele-ECHO clinics. Target “learners” will be nutritionists, nurses, pharmacists, physician assistants, primary care physicians, gastroenterologists, surgeons, and any other clinician having to care for a complicated IF patient, far removed from a multidisciplinary specialty center.

               Clinicians may present anonymous patient cases, covering a broad range of topics in IF, short bowel syndrome, dysmotility syndromes, PN, and so on, utilizing a structured template with moderated case discussions. A summary of recommendations by the experts will be provided to clinicians regarding the cases they present.

               A separate but complementary research project is planned to evaluate patient-reported quality of life among IF patients receiving standard of care at major specialty centers compared to patients receiving care from non-specialists participating in LIFT-ECHO clinics.

Role for the Patient/Consumer

               Patients are not directly involved in the LIFT-ECHO clinic, because this is treated as a confidential, academic setting; however, Oley consumers are invited to share the information about the LIFT-ECHO clinic with their clinicians and encourage their participation. By participating, clinicians may receive expert consultation and continuing education that may benefit the clinicians themselves, but it will also benefit individual patient care. The establishment of a LIFT-ECHO network, based on the ECHO model of care to share “right knowledge at the right place and right time,” is expected to improve management of complex IF in the United States.

               Tell your clinicians who are attending ASPEN19 Nutrition Science & Practice Conference about the opening keynote address, where Dr. Sanjeev Arora, Director and Founder of Project ECHO, will highlight how this model enhances access to treatment for patients in rural and urban areas, improves management of chronic and complex diseases, and helps clinicians gain competency and expertise in the delivery of specialized complex care.

               The anticipated launch date for LIFT-ECHO is May 1, 2019. Watch for more information on the Oley website.

               More information about the ECHO model is available at https://echo.unm.edu.

ACTION ITEMS

Consumers/Caregivers: Share the information about the LIFT-ECHO clinic with your clinicians and encourage their participation.

Clinicians: Share your difficult cases, and gain expertise and help while getting continuing medical education (CME) credits for free. Get your colleagues involved, too.

 

 

Table 1. ECHO Intestinal Failure Network Advisory Board


LIFT-ECHO’s board reflects the collaboration among experts in nutrition, gastroenterology, surgery/transplant, patient advocacy, and insurers.

Joan Bishop, The Oley Foundation, Albany, NY

Anthony Bonagura, MD, Optum Health, Minneapolis, MN

John K. DiBaise, MD, Mayo Clinic, Scottsdale, AZ

David Gutierrez, Mount Sinai Medical Center, New York, NY

Kishore Iyer, MD, Mount Sinai Medical Center, New York, NY

Lisa Metzger, The Oley Foundation, Albany, NY

Marjorie Nisenholtz, Mount Sinai Medical Center, NY

Ron Potts, MD, Kaiser Permanente National Transplant Services, Portland, OR

Douglas Seidner, MD, Vanderbilt University Medical Center, Nashville, TN

Michelle Spangenburg, MS, RD, American Society for Parenteral and Enteral Nutrition (ASPEN), Silver Spring, MD

Kelly A. Tappenden, PhD, RD, University of Illinois, Chicago, IL

Marion Winkler, PhD, RD, Rhode Island Hospital/Brown University, Providence, RI

 

LifelineLetter, January/February 2019

more Calendar

6/21/2019 » 6/24/2019
2019 Oley/UI Health Combined Conference

6/22/2019 » 6/23/2019
Virtual 2019 Oley Conference

This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.

 

Updated in 2015 with a generous grant from Shire, Inc. 

 

This website was updated in 2015 with a generous grant from Shire, Inc. This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.
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