Implementation of the first department of Veterans Affairs specialty care access network-extension of community healthcare outcomes (SCAN-ECHO) program for chronic liver disease

Document Type


Publication Date



BACKGROUND: Chronic liver disease continues to be a major problem, with the number of veterans carrying the diagnosis of HCV cirrhosis doubling over the last decade. Primary care providers have limited access to specialists in liver disease, yet are faced with the burden of care for these complicated patients. With the goal of improving access to specialty care, particularly from rural and underserved areas, the VA Ann Arbor Healthcare System, as part of the national Specialty Care Transformation Initiatives, implemented the first SCAN-ECHO program in chronic liver disease. We modified the method used by Project ECHO, merging case-based distance learning with co-management of care for delivery within the VA health system.

METHODS: Using the electronic consult system, we re-routed cases submitted to the general Liver clinic to Liver SCAN-ECHO clinics after obtaining permission from primary care providers. The Liver SCAN-ECHO clinic occurred via dedicated video-teleconferencing with multiple site participation and consisted of both case-based learning, in which primary care providers interacted with the specialists and received immediate consultation for the patients, as well as a short didactic session on a liver specific topic. The entire clinic was eligible for continuing medical education credit. Data from these clinics were prospectively collected. RESULTS: From the period of June 2011 to May 2012, 36 clinics were held. 153patients were “seen” in this manner with 136 “new” patients and 17 “return” patients. 43 primary care providers participated from 16 sites. These included 4 VA medical centers and their community based outpatient clinics (CBOC). The most common diagnoses were chronic hepatitis C infection, nonalcoholic fatty liver disease, and cirrhosis. The average patient would have traveled 187 miles round-trip (range 14 - 484miles) to Liver clinic. As a result of the SCAN-ECHO clinic,28,597 miles of patient travel were saved. Post session evaluations by primary care providers rated the conference. On a scale of 1 to 4 where 1 was “not at all” and 4 was “very much”, primary care providers rated the question of whether the conference addressed “how to implement ideas” at a mean of 3.93 and whether the conference was “relevant to my practice” at a mean of 3.93 (n= 83 evaluations).

CONCLUSION: In summary, we demonstrated the feasibility of implementing this innovative model of care for patients with chronic liver dis-ease within the VA health system. In our preliminary assessment, this appears to be a highly effective method to decrease veteran travel and increase provider competency.