ECHO-AGE: A video-consultation program to bring geriatric expertise to long-term care
Responding to the shortage of geriatricians and drawing from Project ECHO (Extension for Community Healthcare Out-comes), we started a geriatric ECHO program called ECHO-AGE*. ECHO-AGE aims to increase health security for elders in long-term care by using enhanced tele-computing technologies to co-deliver specialty care with community physicians while providing education in geriatric principals. Long-term care residents tend to be unable to travel independently and this, combined with the shortage of geriatricians, limits access to expert care. By delivering geriatric consultation and education to patients and providers in their own communities, the workforce capable of caring for elders will increase and clinical outcomes should improve at reduced cost. Methods
ECHO-AGE focuses on patients in long-term care facilities who suffer from behavioral problems due to delirium or dementia. Providers from 14 long-term care sites in MA and ME participate in every-other-week ECHO-AGE clinics. Sites present challenging cases to an expert team of geriatricians, a neurologist, a geriatrics psychiatrist, and a dementia resource expert. Input focuses on nonpharmacologic management and appropriate utilization of psychoactive medication. When not presenting, partnering sites listen and participate in management discussions.
Between June and December 2012, 13 clinics were held with 22new and 23 follow up cases. Surveys of participating sites indicate that management suggestions are helpful and applied in the majority of cases. For example, in a patient with a history of schizophrenia and advancing cognitive impairment, a slight increase in her antipsychotic dose and a positive behavior reinforcement program led to a significant reduction in agitation and hoarding behaviors. One participant wrote, “We absolutely love this forum and were raving about it to our colleagues during our weekly Clinical QI meeting today.”
Applying an established model of care to an isolated, vulnerable population, ECHO-AGE successfully utilizes tele-computing technologies to provide expert consultation to community providers. Surveys indicate improved geriatrics knowledge and possibly patient outcomes at minimal cost. If financial feasibility is proven, wide-spread dissemination is anticipated.
*Funded by the Rx Foundation
Catic, A.G., Mattison, M.L.P., Lipsitz, L. ECHO-AGE: A video-consultation program to bring geriatric expertise to long-term care. Journal of the American Geriatrics Society. 2013; 61(April SI):S108. May 2013: Annual Scientific Meeting of the American Geriatrics Society, Abstract B100.