Project ECHO Hepatitis C Ambulatory Care Quality Improvement in New Mexico throug

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DESCRIPTION (provided by applicant): This project is specifically focused on the following Health Information Technology (HIT) research area of interest: to improve healthcare decision making via the use of integrated data and knowledge management. Project ECHO (Extension for Community Healthcare Outcomes) is an innovative model for treating complex chronic diseases in rural and underserved areas of New Mexico. The Project trains rural healthcare professionals to provide the same level of care to rural patients as they would receive at an academic health center. The approach is based upon case-based learning delivered through a telemedicine infrastructure and Internet-based technologies to co-manage patients in community-based practices. With the support of the AHRQ (1 UC1 HS015135, PI: S. Arora, MD), Project ECHO has successfully bridged the gap in access to and outcomes of treatment for Hepatitis C virus (HCV) between urban and rural settings, thus paving the way for an ongoing State-funded program. As part of this effort, we have already deployed a prototype of an Internet based electronic treatment record called iHealth that is used to collect data and generate reports. Funding of this new application will allow us to program iHealth with additional features that support standardized data entry, improve treatment safety through warnings and automated treatment algorithms, provide practice support, facilitate extraction of aggregate data, and allow automatic data transfers between Project ECHO and its community laboratory partners. We further propose to make these functionalities available through a web portal. Thus, both the educational and treatment components of our HCV program will be based upon widely available technologies and therefore easily replicated by other institutions. We will promote the adoption of iHealth by identifying user needs and soliciting feedback; using clinical champions and other organizational strategies; using Project ECHO's distant learning model for iHealth training; and demonstrating that iHealth improves outcomes through structured management and reduces workload through practice support. The evaluation will be driven by theories describing the diffusion of innovation (Rogers and Orlandi) and focus on utilization, provider attitudes and beliefs, and changes in processes and outcomes. iHealth has significant potential to support Project ECHO's mission to improve health care quality and safety for rural populations and can readily be adopted to other chronic diseases.