The University of New Mexico Health Sciences Center’s Project ECHO, funded in part by the Robert Wood Johnson Foundation, is already a nationally recognized model that links community-based clinicians with specialists at university medical centers to help patients in rural and underserved areas manage chronic, common, and complex conditions such as diabetes.
But with a recent $6.4 million grant from the Leona M. and Harry B. Helmsley Charitable Trust, Project ECHO will expand this work to a pilot program called Endocrinology teleECHO (Endo ECHO), the starting point for a national model that could help provide care for the more than 25 million Americans living with diabetes and other hormonal disorders.
Endo ECHO will apply the proven methodology of Project ECHO to train and support clinicians and their teams to provide access to care for patients in rural and underserved areas of New Mexico who are combating Type 1 and complex Type 2 diabetes and other hormonal disorders. Endo ECHO is the first program to provide support for multiple endocrine disorders, such as thyroid, pituitary, and adrenal diseases.
As the sole funder of Endo ECHO, the Helmsley Charitable Trust’s Type 1 Diabetes Program is interested in the pilot program’s impact on the quality of care for those living with diabetes and other endocrinologic disorders.
“In the diabetes community, we know there are challenges facing endocrinology as a medical specialty. Especially in rural, sparsely populated areas, an endocrinologist shortage means patients with Type 1 and other complex diabetes conditions rely on undertrained primary care providers, often resulting in poor outcomes,” said Eliot Brenner, program director for the Helmsley Charitable Trust’s Type 1 Diabetes program, in a press release.
By starting with the pilot program in New Mexico, the Helmsley Charitable Trust hopes to apply the proven ECHO model to improve the treatment of Type 1 and other complex diabetes and endocrine disorders—regardless of a patient’s insurance coverage or socioeconomic status—and to increase the capacity of nonspecialized clinicians in underserved and rural areas, said Lydia Guterman, program officer for its Type 1 Diabetes program.
“We share a common mission [with the funder] of improving access to [high-] quality care in underserved areas,” said Matthew Bouchonville, medical director for Endo ECHO and assistant professor of endocrinology at the University of New Mexico School of Medicine.
New Mexico Pilot Program
Although the initial pilot program consists of eight endocrine centers located in Albuquerque and surrounding rural areas, Bouchonville said, with the three-year grant, Endo ECHO is hoping to replicate the model in rural and urban areas across other states. Each center will include a primary care clinician, whom Bouchonville referred to as an “endocrine champion,” and a community health worker (CHW), who will work alongside the primary care clinician and assist with diabetes management.
While the clinician will treat patients for all types of endocrinology disorders, the CHW’s prime focus will be on helping diabetes patients overcome cultural and social barriers to managing their condition. Speaking from experience as an endocrinologist, Bouchonville said that without a patient’s engagement, it’s hard to achieve progress because diabetes is a largely self-managed disease.
Clinicians and CHWs will be undergoing weekly telementoring training at the new Endocrinology teleECHO clinic. Such training, in which expert endocrinologists and other specialists use video-conferencing equipment to consult on case presentations with primary care providers, will continue throughout the three-year grant. Bouchonville said the official launch date of the pilot program will be in a few months.
Replicating the ECHO Model Across States
The grant not only supports the pilot program in New Mexico, but also funds capacity building (actions that improve nonprofit effectiveness) for Project ECHO overall, quality assurance efforts, and replication planning and support, said Guterman. Specifically, the grant will enable the Center for Health Care Strategies (a nonprofit health policy resource center based in New Jersey) to develop a multistate learning collaborative for Medicaid agencies that want to implement the ECHO model in general in their state.
Having other states adopt the work that the Helmsley Charitable Trust is funding is part of a broader focus at that foundation, said Guterman.
In addition, through separate funding to New York University’s Robert F. Wagner Graduate School of Public Service, the Helmsley Charitable Trust will provide support for health policy analysts to conduct an evaluation of Endo ECHO, by looking at clinical outcomes, cost-effectiveness, utilization of services, preventable hospitalizations, and impact of care.
The Leona M. and Harry B. Helmsley Charitable Trust supports nonprofits and other mission-aligned organizations in the United States and around the world in health, selected place-based initiatives, and education and human services.
This foundation notes on its website that it does not accept unsolicited grant proposals. Through its Type 1 Diabetes program, the Helmsley Charitable Trust is the largest private foundation funder of Type 1 diabetes–related research, treatment, and support services in the United States.