- Primary care providers in Florida and California will soon be using telemedicine to improve care management and coordination for patients with Type 1 diabetes.
Armed with a $1.6 million grant from the Leona M. and Harry B. Helmsley Charitable Trust, the University of Florida Diabetes Institute will use the nationally recognized Project ECHO (Extension for Community Healthcare Outcomes) telemedicine platform in an 18-month pilot to counsel providers across the state on how to treat patients with the chronic condition.
The goal of a program like ECHO is to empower primary care doctors to treat patients on their own, rather than sending those patients to specialist care, which is often hard to access, time-consuming and expensive.
"Our hope is to reach adult and pediatric type 1 diabetes patients who may not see an endocrinologist for routine care but who could really benefit from the expertise of those specialists,” Ashby Walker, PhD, director of health quality initiatives at the UF Diabetes Institute, said in a release issued by the Helmsley Trust.
“It’s an opportunity to provide better care for patients living with a chronic disease that requires 24/7 management,” Dr. Michael Haller, a professor and chief of pediatric endocrinology at the UF College of Medicine, told the Independent Florida Alligator. “Type 1 diabetes is tough even for the patients who have great access to great care.
“Some patients, particularly lower income urban and rural residents, may lack optimal access to endocrinologists and other healthcare specialists,” he added in the Helmsley release. “In those cases, patients may be getting insulin from their family doctor but doing little or nothing else to manage their diabetes.”
Developed and launched in 2003 at the University of New Mexico School of Medicine to help rural and remote doctors treat patients with hepatitis C, ECHO programs are now in place throughout the country, focusing on issues like HIV/AIDS, pediatric health, substance abuse, chronic pain management and autism.
The latest application of the telementoring program is for diabetes care, which Stanford University is spearheading. Stanford is collaborating with the UF Diabetes Institute on the ECHO program, the goal being to create statewide hub-and-spoke telemedicine networks that will allow doctors to work with and learn from diabetes experts.
Researchers chose Florida and California because of their large and diverse underserved populations of people with Type 1 diabetes.
“The idea of an ECHO is places with expertise, like us, serve as a hub,” Haller told the Alligator. “If we can prove that this works, theoretically, this would be something that would be sued nationwide.”
“Many people are living with very bare bones support for their diabetes management,” he added. “We want to see if we can empower primary care doctors to provide more meaningful diabetes care for their patients. Given the shortage of endocrinologists and the need to increase access, the ultimate goal of this effort is to ensure better access to diabetes care for everyone living with type 1 diabetes.”
Collaborating on the project from Stanford are David Maahs, MD, PhD, a professor and chief of pediatric endocrinology and Nicolas Cuttriss, MD, an assistant clinical professor in the division of endocrinology and diabetes. Cuttriss previously served as the pediatric endocrinologist for the Endocrinology Project ECHO at the University of New Mexico.
This isn’t the first Helmsley-funded ECHO project targeting diabetes care.
In 2014, the foundation issued a $6.2 million grant to the University of New Mexico Health Sciences Center’s Project ECHO to create an “Endo ECHO” pilot, targeting primary care providers and their patients with diabetes in New Mexico.
The foundation also announced a separate award to New York University’s Robert F. Wagner Graduate School of Public Service to support an evaluation of Endo ECHO, “assessing the pilot clinic’s impact on patient outcomes, utilization of services and health-related expenditures in New Mexico.” The Endo ECHO grant will also support the Center for Health Care Strategies in developing “a multi-state learning collaborative for Medicaid agencies interested in implementing the model in other states.”
“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 under-trained primary care providers, often resulting in poor outcomes,” Eliot Brenner, former Program Director for the Helmsley Charitable Trust’s Type 1 Diabetes Program, said in a release announcing that program. “Endo ECHO is a workforce expansion opportunity that can bolster existing medical support by teaching primary care clinicians and community health workers on the ground to successfully treat the serious conditions they were not formally trained to manage.”