Improving Access To Best Practice Health Care In Underserved Communities

Curricula

BHI – Common Psych Issues in Primary Care

The ECHO-Chicago Behavioral Health Integration: Management of Common Psychiatric Issues in Primary Care series is designed to expand primary care capacity in better meeting the behavioral and mental health needs of patients. An estimated 25-30% adults in the United States have a mental illness; with higher rates among those who are publicly insured and racial/ethnic minorities. In the U.S., the primary health care system often functions as the mental health provider for many patients with common conditions like anxiety and depression. In Chicago and across much of the U.S., shortages of psychiatric providers has led to a severe lack of access of services and primary care providers are increasingly faced with the challenge of caring for patients with complex mental health needs without the adequate training and skills to do so. ECHO-Chicago training provides primary care providers with the knowledge to identify and assess persons who may be in need of mental health services and the confidence to appropriately treat patients in house, triage while waiting access to psychiatry, and refer when necessary.

BHI – Systems Collaborative Care

The presence of integrated mental health care in the primary care settings can be inconsistent. Patients often do not know where to go for care, are concerned about costs associated, or a fear of lack of coverage through existing health plans and social stigma. Similarly, safety net providers in the Chicago area confirm many of the challenges described above, as well as lack of training opportunities in better identification of symptoms, lack of access to behavioral health providers at their organization, and patient adherence issues. Collaborative care is a type of integrated health care that treats common mental health conditions in the primary care setting. It is a type of care that has been shown to have improved mental health symptoms over the usual care model. The primary care provider and behavioral health staff can work in conjunction to develop a shared care plan for patients, incorporating patient goals for treatment. This coordination of services can have a significant impact on the patient's quality of life, eliminating the need for separate assessments. Collaborated care also benefits the health system through increased capacity and improved quality of care. The ECHO-Chicago Behavioral Health Integration curriculum, based on the collaborative care model, will enhance access to mental health care for patients and lead to an improved patient experience through a coordinated effort between primary care providers and behavioral health providers to facilitate system changes to integrate behavioral health in primary care.

Child and Youth Epilepsy

It is estimated that more than 450,000 children living in the U.S. have epilepsy and seizure disorder. Epilepsy exists across all racial and ethnic groups, but the chances of developing epilepsy across one’s lifetime is higher for Hispanic and African American populations. Poverty further increases risk; children in families with lower socioeconomic status have shown higher rates of developing epilepsy and seizures. Access to pediatric neurology subspecialist care is limited, especially for medically underserved populations -- which may contribute to disparities in outcomes across racial and ethnic groups. The ECHO-Chicago curriculum is designed to ensure all children and youth with epilepsy have access to the medical, social and other supports and services they require to achieve optimal health outcomes and improved quality of care in their medical home.

Childhood Obesity and Comorbidities

The ECHO-Chicago curriculum on childhood obesity and comorbidities is designed in response to the growing number of children who are overweight or obese. An estimated 32% of children in the U.S. are overweight or obese, with even greater prevalence among children living below the poverty level. Childhood obesity is linked to a number of serious risks and conditions and the problem has received widespread attention in recent years. Unfortunately, effective solutions are scarce. The goal of this curriculum is to provide primary care providers with increased skills and knowledge to screen and treat children for obesity and related comorbidities and improve the long term health outcomes for Illinois children.

Complex Pediatric Asthma

In the United States 1 in 11 children is diagnosed with asthma making it the most common chronic childhood condition. High rates of emergency department visits and hospitalizations due to asthma indicate subpar management. This is particularly true in Chicago where there is double the national average of asthma mortality in children and high rates of irreversible bronchial obstruction. A disproportionate amount of urban, minority, and underserved youth are affected by asthma. Black children in Chicago have 2-3 times higher prevalence rates and are less likely to receive recommended care than whites or Hispanics. If evidence-based asthma care guidelines are routinely followed, this morbidity and mortality is preventable. The ECHO-Chicago Complex Pediatric Asthma series aims to increase the use of best practices for pediatric asthma in the community and to improve health outcomes for low-income children suffering with asthma in Chicago.

Geriatrics

Advances in medical care and a rapidly expanding aging population means more Americans are living longer, but often with multiple chronic conditions requiring providers trained to manage complex care needs. Older adults contend with elevated rates of diabetes, hypertension, respiratory disease, arthritis and other chronic conditions leading to disability, functional loss, cognitive decline, and other poor health outcomes. The South Side of Chicago is one of the nation's largest medically underserved communities and a place where the ills of a fragmented, dysfunctional, and under-resourced health care system are a daily reality for older adults. According to the University of Chicago Adult Community Needs Assessment, older adults living in the University of Chicago Medicine’s primary service area have higher prevalence of chronic conditions such as arthritis, diabetes, and hypertension compared to regional, state, or national levels. A shortage of geriatricians and limited access to care further increases the risk to older adult health. The ECHO-Chicago Geriatrics curriculum improves health outcomes for older adults by creating a robust, engaged network of interdisciplinary care providers who share resources and education to improve health for older adults on Chicago’s South Side.

Hepatitis C

The ECHO-Chicago curriculum in Hepatitis C (HCV) is designed to expand primary care capacity for HCV screening and evidenced-based care at community health centers in some of Chicago’s most underserved neighborhoods. HCV has surpassed HIV/AIDS as the leading chronic virus infection leading to death in the United States. Early detection and treatment in the primary care setting can contribute to lower rates of morbidity and mortality, reduce the risk of disease progression, and maximize the benefits of emerging treatment options. ECHO-Chicago training provides primary care providers with the knowledge to identify persons at risk for HCV and conduct risk assessments, test, diagnose, counsel, stage, monitor and treat persons with HCV.

Hepatitis C Case Management & Clinic Capacity Building

The ECHO-Chicago curriculum in Hepatitis C (HCV) Case Management & Clinic Capacity Building is designed to expand community health center capacity for managing patients with HCV. The training series provides best practice recommendations for strengthening existing HCV programming or initiating new HCV workflows. HCV has surpassed HIV/AIDS as the leading chronic virus infection leading to death in the United States. Early detection and treatment in the primary care setting can contribute to lower rates of morbidity and mortality, reduce the risk of disease progression, and maximize the benefits of emerging treatment options. The ECHO-Chicago Case Management & Clinic Capacity Building training provides health centers with a toolkit to assist in the creation of an HCV workflow individualized to each participating clinic.

Opioid Use Disorder

Opioid use disorder (OUD) has been identified nationally as an epidemic, with death from overdose now the leading cause of death in people under 50, and rates continuing to climb. Opioid addiction and overdose death has similarly risen in Cook County, and the Chicago Department of Public Health has identified OUD as a top priority. There is an urgent need to increase the number of health care providers trained in evidence based treatment options for patients with OUD. Approaches such as Medication Assisted Treatment (MAT) are highly effective in helping patients achieve long term recovery and substantially reduce the risk of harm for patients with OUD. Despite the availability of effective treatments, there remains a critical shortage of trained providers. Under the Drug Addiction Treatment Act of 2000 (DATA 2000), primary care providers including MDs, PAs and APNs are eligible to obtain DEA-waivers to prescribe buprenorphine. However, few prescribers pursue this training and fewer still prescribe after receiving their DEA waiver. ECHO-Chicago training provides primary care providers with the knowledge to provide caring for patients and communities suffering from addiction. The curriculum is designed to focus on case discussions, problem solving, peer support and mentorship for beginning MAT prescribers.

Pediatric Attention Deficit Hyperactivity Disorder

The ECHO-Chicago ADHD curriculum is designed to address one of the most common chronic childhood disorders in the U.S.. It is estimated that 9% of children ages 3—17 have a diagnosis of ADHD. Poverty further increases a child’s risk for ADHD, with greater prevalence among children living below the poverty level. Disparities in access to care for children living with ADHD are linked to race/ethnicity. African-American boys living in poverty are the most likely to be referred for mental health services and among the least likely to receive these services. ECHO-Chicago training provides primary care providers with the skills and knowledge to deliver care to children at risk for ADHD in their local community health center.

Resistant Hypertension

Our focus on hypertension is in response to a critical need for expanded access to best practice care for hypertension in our community. Hypertension is recognized as a major contributing factor to heart disease. Incidence rates of hypertension are as high as 50% among Chicago’s South Side health center adult patient populations. Project ECHO sessions address state of the art care, including proper techniques for obtaining accurate BP readings, medication management, dietary changes, and patient adherence. Sessions are designed to train and support community providers in managing the challenges of resistant hypertension.

Risk Based Approach To Women’s Healthcare

The establishment of the Public Health Service Task Force on Women’s Health in the early 1980s stimulated efforts to identify women’s health issues and raise awareness of the need for research on health issues disproportionately affecting women. While significant improvements have been made for women’s health, many disparities in women’s health remain. For example, although more men than women have heart attacks, more women than men die of heart disease. However, disparities are even greater, and a disproportionate burden of disease higher, among women who are racial or ethnic minorities or who are low-income. For example, Chicago health statistics indicate a shocking increase in disparities in breast cancer mortality between White women and Black women since the late 1990’s. Improvements in care that resulted in decreasing mortality rates among White women have had less impact on the mortality rates of Black women. Many of these disparities can be reduced through high quality, risk-based preventive care delivered in the primary care setting. A risk-based approach to women’s healthcare focuses on assessing, and managing, the multiple and often complex risk factors faced by women in vulnerable populations. The goal of this series is to provide training and support to community providers in using a risk-based approach to breast, bone, heart, and gynecological health for high risk populations, with a focus on women in underserved communities.