Oregon ECHO: Meeting Primary Care Community’s Urgent Need for COVID-19 Guidance
A week after Oregon reported its first coronavirus patient on Feb. 28, Gov. Kate Brown declared a state of emergency. Although attention focused initially on efforts in cities to address COVID-19, rural communities — with their older populations, higher chronic disease burdens, and fewer health care resources — urgently needed to prepare.
Fortunately, Oregon ECHO was already well established, having provided a range of telementoring programs to clinicians across the state since 2016.
Leaders at the Oregon ECHO Network, the statewide public utility that oversees Oregon ECHO, approached the governor’s office with an offer to support the pandemic response. A few days later, they received a reply, asking them to work with the Oregon Health Authority to create a COVID-19 Response ECHO in less than a week.
When the new program launched on March 19, the high demand for guidance on how to respond to the novel coronavirus became clear. Some 730 medical professionals from 35 of the state’s 36 counties participated in the first session.
“Clamoring” for Information
The chat box “just exploded” with questions, said Ron Stock, M.D., clinical innovation advisor to the Oregon ECHO Network, which is housed within the Oregon Rural Practice-based Research Network and has had more than 1,100 clinicians at 400-plus practices and organizations participate in at least one ECHO program.
“People were clamoring for information,” Stock said. “Everything from who should be staying home to guidance around wearing masks to redeploying staff and office visits to how to manage chronic care patients. The number of questions was unbelievable.”
The chat box function proved critical. Because participation in the COVID-19 sessions was so high, presenters could not conduct the verbal Q&As with attendees that are so popular in non-COVID-19 ECHO programs. The chat box became the place where participants not only asked questions but shared experiences, resources and lessons from the field. It also became an essential planning tool; Stock and his team culled through the questions and comments for direction on how to structure subsequent sessions.
“We knew we needed to spend the first few sessions getting answers to people’s questions,” Stock said. Each session chat box produced 15 to 20 pages of text. Working with faculty and medical students at Oregon Health & Sciences University OHSU to research and verify those answers, the ECHO team produced a document of 300 questions and answers from the COVID-19 sessions.
Between March and June, Oregon ECHO Network held weekly COVID-19 response sessions in collaboration with the Oregon Health Authority. Stock served as the moderator; presenters included health authority officials and staff from federally qualified health centers in the state, as well as public health officials, OHSU infectious disease and virology faculty, and mental health providers. Mean attendance was 718 in the first four sessions and 560 for the entire 11 session program. More than two-thirds of participants were clinicians, two-thirds of whom were primary care physicians. About 80% had never participated in an ECHO before.
A Feeling of Community Amid a Pandemic
Response to the COVID-19 ECHO program was overwhelmingly positive.
Rural providers said they valued connecting with fellow health providers from around the state and learning from shared experiences. “There is a feeling of community you get, working with people who are wrestling with the same difficult problems you are,” said Brandon Lynch, M.D., an addiction treatment provider who transitioned to working full-time via telemedicine about a year ago.
They also appreciated getting up-to-date information that was relevant to their practices. “Things are developing so rapidly,” said Lynch, who is also on the faculty of the Substance Use Disorders in Ambulatory Care ECHO. “Over the course of a week, there’s a whole new body of information that people need to catch up on and having an hourlong session over lunch is a real efficient way to do that.”
He noted that COVID-19 has become part of everything that ECHO is teaching in Oregon. For example, the ambulatory substance use treatment ECHO recently hosted a presentation on how to treat opioid use disorder amid the pandemic. And a 12-session ECHO series on treating substance use disorder during COVID-19 pandemic has launched.
Stock said he’s received requests for more COVID-related ECHOs in areas like inpatient management and COVID-19 management in long-term care facilities.
Meanwhile, a second phase of COVID-19 Response ECHO launched in June, a 12-session series focused on the state of science in treatment and prevention of COVID-19, offering guidance to practices around necessary system change. Stock says he envisions this series has shifted “more toward community and practice presentations, both of personal experiences and professional experiences with patients and families.”
Stock notes that, in the midst of a public health crisis — especially one with so many unknowns, like the coronavirus pandemic — the need for best available information as it develops is critical. “That’s why Project ECHO is so important,” Stock says. “We can stand up a new program almost immediately, and because clinicians have this huge and evolving need for information, they will come.”
