Skip to main content

Advertisement

SpringerLink
Log in

Specialty Care Access Network-Extension of Community Healthcare Outcomes Model Program for Liver Disease Improves Specialty Care Access

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aims

To improve subspecialty access, VA Ann Arbor Healthcare System (VAAAHS) implemented the first Specialty Care Access Network (SCAN)-Extension of Community Healthcare Outcomes (ECHO) in chronic liver disease. SCAN-ECHO Liver links primary care providers (PCPs) to hepatologists via secure video-teleconferencing. We aim to describe characteristics of participants (PCPs) and patients (clinical question and diagnosis) in SCAN-ECHO Liver.

Methods

This is a prospective study of the VAAAHS SCAN-ECHO Liver (June 10, 2011–March 31, 2015). This evaluation was carried out as a non-research activity under the guidance furnished by VHA Handbook 1058.05. It was approved through the Medicine Service at VAAAHS as noted in the attestation document which serves as documentation of approved non-research, quality improvement activities in VHA.

Results

In total, 106 PCPs from 23 sites participated. A total of 155 SCAN-ECHO sessions discussed 519 new and 49 return patients. 29.4% of Liver Clinic requests were completed in SCAN-ECHO Liver. SCAN-ECHO Liver consults were completed an average of 10 days sooner than in conventional clinic. Potential travel saving was 250 miles round-trip (median 255 (IQR 142–316) per patient.

Conclusion

SCAN-ECHO Liver provided specialty care with increased efficiency and convenience for chronic liver disease patients. One of three of Liver Clinic consults was diverted to SCAN-ECHO Liver, reducing consult completion time by 20%.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

VHAAAHS:

VA Ann Arbor Healthcare System

SCAN-ECHO:

Specialty Care Access Network-Extension of Community Healthcare Outcomes

VHA:

Veterans Health Administration

PCP:

Primary care providers

NAFLD:

Nonalcoholic fatty liver disease

CHC:

Chronic hepatitis C

VISN:

Veterans Integrated Service Network

References

  1. Younossi ZM, Kanwal F, Saab S, et al. The impact of hepatitis C burden: an evidence-based approach. Aliment Pharmacol Ther. 2014;39:518–531.

    Article  CAS  PubMed  Google Scholar 

  2. Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA. 2015;313:2263–2273.

    Article  CAS  PubMed  Google Scholar 

  3. Arora S, Kalishman S, Thornton K, et al. Expanding access to hepatitis C virus treatment–Extension for Community Healthcare Outcomes (ECHO) project: disruptive innovation in specialty care. Hepatology. 2010;52:1124–1133.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364:2199–2207.

    Article  CAS  PubMed  Google Scholar 

  5. Beste LA, Glorioso TJ, Ho PM, et al. Telemedicine specialty support promotes hepatitis C treatment by primary care providers in the department of veterans affairs. AJM. 2017;130:432–438.

    Article  Google Scholar 

  6. Said A, Gagovic V, Malecki K, et al. Primary care practitioners survey of nonalcoholic fatty liver disease. Ann Hepatol. 2013;12:758–765.

    PubMed  Google Scholar 

  7. Blais P, Husain N, Kramer J, Kowalkowski M, El-Serag HB, Kanwal F. Nonalcoholic fatty liver disease is underrecognized in the primary care setting. Am J Gastroenterol. 2015;110:10–14.

    Article  CAS  PubMed  Google Scholar 

  8. Davis RS, Bukstein DA, Luskin AT, et al. Changing physician prescribing patterns through problem-based learning: an interactive, teleconference case-based education program and review of problem-based learning. Ann Allergy Asthma Immunol. 2004;93:237–242.

    Article  PubMed  Google Scholar 

  9. Frank JW, Carey EP, Fagan KM, et al. Evaluation of a telementoring intervention for pain management in the Veterans Health Administration. Pain Medicine. 2015;16:1090–1100.

    Article  PubMed  Google Scholar 

  10. Salgia RJ, Mullan PB, McCurdy H, et al. The educational impact of the specialty care access network- extension of community healthcare outcomes program. Telemed E Health. 2014;20:1004–1007.

    Article  Google Scholar 

  11. Goldberg DS, French B, Forde KA, et al. Association of distance from a transplant center with access to waitlist placement, receipt of transplantation, and survival among US veterans. JAMA. 2014;311:1234–1243.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Axelrod DA, Guidinger MK, Finlayson A, et al. Rates of solid-organ wait-listing, transplantation, and survival among residents of rural and urban areas. JAMA. 2008;299:202–207.

    Article  CAS  PubMed  Google Scholar 

  13. Hassan A, Pearce NJ, Mathers J, et al. The effect of place of residence on access to invasive cardiac services following acute myocardial infarction. Can J Cardiol. 2009;25:207–212.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Friedman SA, Frayne SM, Berg E, et al. Travel time and attrition from VHA care among women veterans: how far is too far? Med Care. 2015;53:S15–S22.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Neuhausen K, Grumback K, Bazemore A, et al. Integrating community health centers into organized delivery systems can improve access to subspecialty care. Health Aff. 2012;31:1708–1716.

    Article  Google Scholar 

  16. Cook NL, Hicks LS, O’Malley AJ, et al. Access to specialty care and medical services in community health centers. Health Aff. 2007;26:1459–1468.

    Article  Google Scholar 

Download references

Acknowledgments

Dr. Waljee’s research is funded by a Career Development Award (CDA 11-217) from the (US Department of Veterans Affairs Health Services Research and Development Service. The contents do not represent the views of the US Department of Veterans Affairs or the US Government.

Author information

Authors and Affiliations

  1. VA Ann Arbor Healthcare System, Internal Medicine, Gastroenterology 111D, 2215 Fuller Road, Ann Arbor, MI, 48105, USA

    Lisa M. Glass, Akbar K. Waljee, Heather McCurdy & Grace L. Su

  2. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA

    Lisa M. Glass & Grace L. Su

  3. VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA

    Akbar K. Waljee & Anne Sales

  4. Department of Statistics, University of Michigan, Ann Arbor, MI, USA

    Akbar K. Waljee

  5. Department of Learning Health Sciences, Medical School, University of Michigan, Ann Arbor, MI, USA

    Anne Sales

Authors
  1. Lisa M. Glass
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akbar K. Waljee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heather McCurdy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Grace L. Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anne Sales
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LMG contributed to study concept and design, acquisition of data, analysis and interpretation of the data, statistical analysis, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. AKW helped in study concept and design, statistical analysis, and critical revision of the manuscript for important intellectual content. HM contributed to acquisition of data, critical revision of the manuscript for important intellectual content. GLS contributed to study concept and design, statistical analysis, analysis and interpretation of the data, and critical revision of the manuscript for important intellectual content. AS helped in study concept and design, analysis and interpretation of the data, and critical revision of the manuscript for important intellectual content, study supervision.

Corresponding author

Correspondence to Lisa M. Glass.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Appendix

Appendix

Liver-related didactic topics presented in SCAN-ECHO Liver Clinic.

  1. 1.

    Chronic Hepatitis C Virus Infection: Epidemiology and Natural History

  2. 2.

    Chronic Hepatitis C Virus: Treatment of Genotype 2 and 3 Infection

  3. 3.

    Approach to the patient with abnormal liver function tests: Part I

  4. 4.

    Approach to the patient with abnormal liver Function Tests Part II:

  5. 5.

    Diagnosis and Management of Ascites

  6. 6.

    Interpretation of Hepatitis B Testing

  7. 7.

    Liver Transplantation: Why, When and How Part I

  8. 8.

    Liver Transplantation: Why, When and How Part II

  9. 9.

    Interpretation of Hepatitis B Testing

  10. 10.

    Chronic Hepatitis C: Treatment of Genotype I Infection, Treatment Naïve

  11. 11.

    Chronic Hepatitis C: Treatment of Genotype I Infection, Treatment-experienced

  12. 12.

    Diagnosis of Hepatocellular Carcinoma

  13. 13.

    Hepatocellular Carcinoma: Management and Treatment

  14. 14.

    Nonalcoholic fatty liver disease: diagnosis

  15. 15.

    Nonalcoholic fatty liver disease: management

  16. 16.

    Diagnosis of Management of Hepatic Encephalopathy

  17. 17.

    Approach to Liver Mass

  18. 18.

    Alcoholic Hepatitis: Diagnosis and Management

  19. 19.

    Autoimmune Liver Disease

  20. 20.

    Statins and Liver Disease

  21. 21.

    Approach to the patient with cirrhosis

  22. 22.

    Management of side effects HCV treatment: Dermatologic

  23. 23.

    Management and side effect of Sorafenib treatment

  24. 24.

    Medical care of the patient with a liver transplant: Part I

  25. 25.

    Medical care of the patient with a liver transplant: Part II

  26. 26.

    Hematological Abnormalities in Cirrhosis

  27. 27.

    Diagnosis and Management of Esophageal Varices

  28. 28.

    Optimizing Renal Function in Cirrhosis: an Act of balancing

  29. 29.

    Management of side effects of HCV treatment: Bone Marrow Effects

  30. 30.

    Hepatorenal Syndrome

  31. 31.

    HIV/HCV Treatment Genotype I Protocol

  32. 32.

    Hereditary Liver Disease

  33. 33.

    Paracentesis

  34. 34.

    Liver Biopsy

  35. 35.

    Pain Management in Patients with Liver Disease

  36. 36.

    Liver Transplantation and Hepatocellular Carcinoma

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Glass, L.M., Waljee, A.K., McCurdy, H. et al. Specialty Care Access Network-Extension of Community Healthcare Outcomes Model Program for Liver Disease Improves Specialty Care Access. Dig Dis Sci 62, 3344–3349 (2017). https://doi.org/10.1007/s10620-017-4789-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-017-4789-2

Keywords

Search

Navigation