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"Arora, Sanjeev"
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Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers
In this study of patients with hepatitis C virus infection residing in rural areas or prisons in New Mexico, treatment by primary care physicians (PCPs) trained and supported by university specialists through videoconferencing resulted in high rates of sustained virologic response.
The Extension for Community Healthcare Outcomes (ECHO) model was developed by the University of New Mexico (UNM) Health Sciences Center as a platform for both delivery of services and outcomes research.
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The objectives of the ECHO program are to improve the access of minorities and other underserved populations to best-practice care for hepatitis C virus (HCV) infection, to determine the safety and efficacy of treatment for HCV infection based on the ECHO model in rural communities, and to compare the effectiveness of the ECHO model with that of university-based clinic treatment. The ECHO program increases the accessibility of populations . . .
Journal Article
Ledipasvir and Sofosbuvir for Previously Treated HCV Genotype 1 Infection
In this study in patients with HCV genotype 1 infection and prior treatment failure, those assigned to 12 weeks or 24 weeks of treatment with ledipasvir and sofosbuvir, with or without ribavirin, had high rates of sustained response (94 to 99% in all groups).
Among the estimated 170 million people in the world who have chronic hepatitis C virus (HCV) infection, approximately 60% have the genotype 1 strain of the virus.
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The treatment of patients infected with HCV genotype 1 is evolving rapidly.
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At the end of 2013, the Food and Drug Administration (FDA) approved two new direct-acting antiviral agents for the treatment of HCV infection: the nucleotide polymerase inhibitor sofosbuvir (Gilead Sciences) and the protease inhibitor simeprevir (Janssen Therapeutics).
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Among the regimens that have been approved by the FDA for patients with HCV genotype 1 infection who have not had a . . .
Journal Article
ECHO Care: Providing Multidisciplinary Specialty Expertise to Support the Care of Complex Patients
BackgroundPrograms for high-need, high-cost (HNHC) patients can improve care and reduce costs. However, it may be challenging to implement these programs in rural and underserved areas, in part due to limited access to specialty consultation.AimEvaluate the feasibility of using the Extension for Community Health Outcomes (ECHO) model to provide specialist input to outpatient intensivist teams (OITs) dedicated to caring for HNHC patients.SettingWeekly group videoconferencing sessions that connect multidisciplinary specialists with OITs.ParticipantsSix OITs across New Mexico, typically consisting of a nurse practitioner or physician assistant, a registered nurse, a counselor or social worker, and at least one community health worker.Program DescriptionOITs and specialists participated in weekly teleECHO sessions focused on providing the OITs with case-based mentoring and support.Program EvaluationOITs and specialists discussed 427 highly complex patient cases, many of which had social or behavioral health components to address. In 70% of presented cases, the teams changed their care plan for the patient, and 87% reported that they applied what they learned in hearing case presentations to other HNHC patients.DiscussionPairing the ECHO model with intensive outpatient care is a feasible strategy to support OITs to provide high-quality care for HNHC patients.
Journal Article
Omentum Mimicking as a Vaginal Prolapse in a Delayed Vaginal Cuff Dehiscence
A rare consequence of hysterectomy is vaginal vault dehiscence, which commonly occurs five to seven weeks after the procedure. Its frequency ranges from 0% to 7.5%. The incidence of delayed dehiscence is rare. The small bowel is the organ that prolapses most frequently, but other organs and multi-organ prolapses have also been documented. Due to potential catastrophes such as intestinal ischemia, blockage, and perforation, transvaginal protrusion of abdominal viscera is an emergency. A laparoscopic approach facilitates a thorough evaluation of the abdominal contents and provides assistance in challenging circumstances where the contents are not reducible.
Journal Article
A Novel Intervention for High-Need, High-Cost Medicaid Patients: a Study of ECHO Care
BackgroundA small number of high-need patients account for a disproportionate amount of Medicaid spending, yet typically engage little in outpatient care and have poor outcomes.ObjectiveTo address this issue, we developed ECHO (Extension for Community Health Outcomes) Care™, a complex care intervention in which outpatient intensivist teams (OITs) provided care to high-need high-cost (HNHC) Medicaid patients. Teams were supported using the ECHO model™, a continuing medical education approach that connects specialists with primary care providers for case-based mentoring to treat complex diseases.DesignUsing an interrupted time series analysis of Medicaid claims data, we measured healthcare utilization and expenditures before and after ECHO Care.ParticipantsECHO Care served 770 patients in New Mexico between September 2013 and June 2016. Nearly all had a chronic mental illness, and over three-quarters had a chronic substance use disorder.InterventionECHO Care patients received care from an OIT, which typically included a nurse practitioner or physician assistant, a registered nurse, a licensed mental health provider, and at least one community health worker. Teams focused on addressing patients’ physical, behavioral, and social issues.Main MeasuresWe assessed the effect of ECHO Care on Medicaid costs and utilization (inpatient admissions, emergency department (ED) visits, other outpatient visits, and dispensed prescriptions.Key ResultsECHO Care was associated with significant changes in patients’ use of the healthcare system. At 12 months post-enrollment, the odds of a patient having an inpatient admission and an ED visit were each reduced by approximately 50%, while outpatient visits and prescriptions increased by 23% and 8%, respectively. We found no significant change in overall Medicaid costs associated with ECHO Care.ConclusionsECHO Care shifts healthcare utilization from inpatient to outpatient settings, which suggests decreased patient suffering and greater access to care, including more effective prevention and early intervention for chronic conditions.
Journal Article
Educating Community Health Professionals About the Health-Related Effects of Climate Change Through ECHO Telementoring
Introduction:
Climate change is a global public health emergency causing extensive morbidity and mortality worldwide. Although most large medical organizations endorse the need to train health care professionals in climate change, such trainings are not readily available.
Methods:
This article describes the results of an 8-week, 75-min per week, Climate Change and Human Health ECHO (CCHH ECHO) synchronous telementoring course for post-licensure health professionals. The primary goals were: to increase knowledge, self-efficacy, and communication skills. Participants were eligible to receive up to 10 h of no-cost continuing education credits and a certificate for completing the program.
Results:
The 8-week course included 625 unique participants from 25 countries. An interprofessional group of clinicians, health professionals, and educators included: 130/28% PhD, 92/20% MD/DO, 52/12% RN/NP/PA, 50/11% MPH. The prospective survey demonstrated a significant improvement in knowledge, confidence, attitudes (P < .001) and communication skills (P = .029) at 3 months post course.
Conclusions:
The climate crisis is a public health emergency, and health professionals worldwide are considered the most trusted source of health information. Training current and future health professionals regarding the health-related effects of global warming is vital. The CCHH ECHO may be a successful model to facilitate knowledge transfer and promote communication skills between subject matter experts and course participants.
Journal Article
Euclidean distortion and the sparsest cut
We prove that every nn-point metric space of negative type (and, in particular, every nn-point subset of L1L_1) embeds into a Euclidean space with distortion O(logn⋅loglogn)O(\\sqrt {\\log n} \\cdot \\log \\log n), a result which is tight up to the iterated logarithm factor. As a consequence, we obtain the best known polynomial-time approximation algorithm for the Sparsest Cut problem with general demands. If the demand is supported on a subset of size kk, we achieve an approximation ratio of O(logk⋅loglogk)O(\\sqrt {\\log k}\\cdot \\log \\log k).
Journal Article
Project ECHO Cancer Initiative: a Tool to Improve Care and Increase Capacity Along the Continuum of Cancer Care
Solving health problems requires not only the development of new medical knowledge but also its dissemination, particularly to underserved communities. The barriers to effective dissemination also contribute to the disparities in cancer care experienced most everywhere. This concern is particularly acute in low and middle-income countries which already bear a disproportionate burden of cancer, a situation that is projected to worsen. Project ECHO (Extension for Community Healthcare Outcomes) is a knowledge dissemination platform that can increase workforce capacity across many fields, including cancer care by scaling best practices. Here we describe how Project ECHO works and illustrate this with existing programs that span the cancer care continuum and the globe. The examples provided combined with the explanation of how to build effective Project ECHO communities provide an accessible guide on how this education strategy can be integrated into existing work to help respond to the challenge of cancer.
Journal Article