At the time, the clinic at UNM Hospital where Arora worked was one of only two in New Mexico that offered treatment for the disease. Arora said he realized that untreated Hepatitis C was not just causing patients to develop liver cancers and cirrhosis — it was killing them.
Hepatitis C, one of the leading chronic infections that lead to death in the United States, is curable, but patients must undergo 12 to 18 rounds of difficult treatment. This, along with high costs, made this treatment unattainable for many New Mexicans, Arora said.
“There were 28,000 patients who had this disease in New Mexico at that time, and less than 5 percent of them had been treated,” Arora said.
He said that underserved communities in poor and rural areas were suffering — and dying — from Hepatitis C more often than other populations.
Arora said his frustration with the lack of access to treatment led him to create the Extension for Community Healthcare Outcomes, or Project ECHO.
Project ECHO began with three experts from UNMH, including Arora, who is a gastroenterologist and liver specialist, a pharmacist and a psychiatrist. Arora said they used teleconferencing technology to give primary care providers in underserved areas the expertise they needed to treat chronic diseases such as Hepatitis C.
“At the heart of ECHO is something called a ‘knowledge network,’ where all these primary care clinic
cians join us every Wednesday afternoon on an interactive video network,” he said.
One at a time, the practitioners presented individual cases to the specialists and each other.
“What we found is, over the course of the year, they became amazing experts,” Arora said. Project ECHO established 21 “centers of excellence” around the state. General and nurse practitioners around New Mexico now had the training to help patients in their communities that could not make 12 to 18 trips to Albuquerque for injections.
It was not the first time Arora felt compelled to save lives. He said he created Project ECHO for the same reason he went into medicine in the first place.
“I was interested in a career where I could help a lot of people,” Arora said.
He attended medical school in India, and received medical training at SUNY Buffalo and Tufts University before becoming a liver specialist at UNMH. He said it was during this training that he learned a method that would become a fundamental part of Project ECHO: case-based learning.
“I would see a patient, present them to my professor, and they would help me manage the patient,” Arora said.
He said he relied not only on the medical training principle when developing Project ECHO, but on W. Edwards Deming’s business management ideas of quality control.
“Many decades ago, W. Edwards Deming said that if you want to improve the quality of care, you want to reduce variation in practice,” Arora said.
This model of increasing quality by standardization is a key principle of Project ECHO, he said.
In 2011, these quality principles were put to the test when The New England Journal of Medicine studied the effectiveness of Hepatitis C virus treatments at ECHO sites compared with those at UNM Hospital.
“We found that treatment for HCV infection delivered with the use of the ECHO model was associated with high rates of cure,” the study stated.
The researchers attributed the model’s success to its community-based, personalized approach to chronic disease treatment. They found that disparities in Hepatitis C treatment were largely the result of geographical limitations to health care access.
“Treatment with the use of the ECHO model overcomes this barrier by bringing to the rural clinician the expertise and clinical resources that may not otherwise be available, thus positively affecting the outcomes,” the study stated.
These positive results have not gone unnoticed. Harvard, the University of Washington and the University of Chicago are among several institutions that have implemented the ECHO model in their own communities, Arora said.
“We have 43 separate hubs in the world right now connected to thousands of clinics for 26 different diseases,” Arora said.
He said that the recent implementation of the Affordable Care Act has increased the need for chronic disease treatment projects like ECHO.
“What has happened is that with the ACA, many more poor patients have received health insurance through Medicaid health plans,” he said.
Many of these patients come from the same communities that the ECHO Project was established to help in the first place. Arora said he hopes the project will continue to expand and revolutionize health care.
With millions of Americans from underserved communities entering an already overcrowded health care system, he said Project ECHO might have the potential to do just that.
“Our goal is to touch one billion lives by 2025, and we want to change the way health care is practiced all over the world,” Arora said.
Lena Guidi is a freelance reporter at the Daily Lobo. She can be contacted at firstname.lastname@example.org, or on Twitter @DailyLobo.