This project is supported in part by funds from the Health Resources and Services Administration (HRSA)’s Advanced Nursing Education Grants D09HP28670-01-00 Grant PI Brenda Zierler.

Authors:

Presentation Date:

October 2, 2017

Erin Blakeney, PhD, RN Megan Miller, MEd

Northwest Heart Failure Collaborative: Project ECHO—A new model of interprofessional continuing education for primary care providers in the WWAMI region

™

Learning Objectives

1) Describe the Northwest Heart Failure Collaborative: Project ECHO™ model

2) Assess pilot program challenges versus benefits gained in interprofessional learner outcomes

IOM, 2015

Year All CVD* Hypertension CHD Heart Failure

Stroke Hypertension as Risk Factor†

2010 $272.5 $69.9 $35.7 $24.7 $28.3 $130.7

2015 $358.0 $91.4 $46.8 $32.4 $38.0 $170.4

2020 $470.3 $119.1 $61.4 $42.9 $51.3 $222.5

2025 $621.6 $155.0 $81.1 $57.5 $70.0 $293.6

2030 $818.1 $200.3 $106.4 $77.7 $95.6 $389.0

% Change 200 186 198 215 238 198

Table 2. Projected Direct (Medical) Costs of CVD, 2010–2030 (in Billions 2008$) USA Un

Circulation. 2011 Mar 1;123(8):933-44.

Scope of Heart Failure

Scope of Heart Failure

Circulation. 2013 Jan 1;127(15) Circ Heart Fail. 2013 May;6(3):606-19

Approach: Bimonthly webinar series hosted by interprofessional heart failure (HF) specialists

Goal: To improve standards of practice

Model: Project ECHO™ (Extension for Community Healthcare Outcomes)

Northwest Heart Failure Collaborative: Project ECHO™

Started at University of New Mexico in 2003 (Hepatitis-C ECHO) o Positive outcomes o Reasonable cost o Reaches a widespread geographic area

UW Project ECHO™ Hub: Telepain, HIV/AIDS, Hep-C, MS, HF, etc.

Project ECHO™ Model

When: 1st & 3rd Wednesdays @ NOON PST

Target Audience: Community providers (MD/DO, ARNP/PA, RN, PharmD, Social Work & Allied Health) and health science students

Cost: FREE to participate

CME (optional): CME Accreditation for up to 24.0 AMA PRA Category 1 Credits™ per year ($25 - $45/year)

Cases: 1-page case review form

Northwest Heart Failure Collaborative: Project ECHO™

Session Agenda

HF didactic

Discussion

Case 1

Case 2

Case 3

12:15pm

12:20pm

12:46pm

12pm (PT)

12:33pm

Past & Future Didactic Topics

28 Webinar sessions as of Sept 8th, 2017

131 Unique Participants from 6 states

55% have HF patients make up at least half of their clinic’s patient population

60% rate confidence in their knowledge as

low to moderate

Webinar Attendance

RN ARNP/PA

MD/DO PharmD

Other 25%

14%

6%

10%

Webinar Attendance by Profession

45%

Post Session Surveys

Panel Modeled Interprofessional Practice %

Yes 97.1 Somewhat 2.1

No 0.7 I Intend to Make Changes %

Yes 71.3 Somewhat 20.6

No 2.1 Not Sure 5.7

Quality of Session: 5=High; 1=Low Didactic

presentation 4.6 Case discussions 4.4

Session facilitation 4.6

14-question online survey sent approximately 6 months after program implementation

Open dates: Nov. 23 – Dec. 16, 2016

109 registered participants

26 responded (23.9%)

Retention & Satisfaction Survey

Participants like & recommend format (didactic, cases, interprofessional) o Would like to be able to ask shorter questions without submitting a

whole case

Interest in email, text, &/or calendar invites/reminders

Would like to know schedule of topics further in advance Timing is a challenge Interest in recorded webinars

o Keep informing that these are available

Retention Survey: Key Points

0%

20%

40%

60%

Improve understanding Implement team-based care Seek peer community Seek advice CE Credit

Reasons for Attending:

0%

10%

20%

30%

40%

50%

No Barriers Timing Clinic duties Technical Issues Don't know how

Barriers to Participation: I have not encountered any barriers (4, 15.4%), Timing- Wednesdays at noon never work for me (12, 46.2%), I intended to participate, but clinical demands that day of prevented me from doing so (5, 19.2%), I'm having technical issues with Zoom/don’t have required technology (2, 7.6%), I'm not sure how to participate- I would like an orientation (1, 3.8%),

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Text reminders Email reminders Calendar invites Orientation/site visit Other

Suggestions to Encourage Participation

Text reminders (5, 23.8%), Email reminders (13, 61.9%), Calendar invites (e.g. in outlook) (9, 42.9%), Opportunities to get together in person/Orientation on how to participate (4, 19.0%), Other (2, 9.5%)

Participant Suggestions Implemented

“Maybe a blog for questions instead of microphone”

“Is it possible to present several cases… often a brief questions may be all we need advice on”

“I'm glad that previous presentations are now available to review and revisit”

Participant Suggestions Implemented

“Thoroughly enjoyed the first session! I can see how this

program will certainly enhance the work that I do as a CHF case

manager”

Preliminary Outcomes: Positive Feedback From Participants

“very challenging case presentation, nicely done.”

“Enjoy these sessions so much. It is refreshing to share info about

patients and see how professionals in other facilities deal with issues, emphasizes that we are working

off the same template.”

“Very informative, unbiased in use of profession, and relevant to everyday

use.”

Youtube channel live in March 2017

Outreach to local &

regional healthcare systems o Billings Clinic Site Visit Feb

2017 o Exploring local partners

Next Steps

Total Views 563

Watch Time (mins) 1,95

7

Next Case Conference: Wednesday Oct 4, 2017 (12-1 PM PDT)

Topic: Heart Failure and Adult Congenital Heart Disease

Presenter: Karen Stout, MD

Learn More About the NWHFC!

For more information or to view previous webinars: NWHFC.org OR NWHFC@uw.edu

The NWHFC program is supported in part by funds from the Division of Nursing (DN), Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under grant number DH09HP286700100 and title “Education-Practice Partnership to Improve Advanced Heart Failure (AHF) Training and Outcomes for Rural and Underserved Populations.”

Acknowledgements

Debra Liner Amanda Moore Brenda Zierler (PI) Megan Miller Todd Dardas Alice Cheng Claudius Mahr Kevin O’Brien John Scott

Kristin Scott-Tillery Billings Clinic

Greg Gipson Beatrice Wong Andrea Miura Lynda Tanagi Liz Brule Nanci Murphy

Thanks! • Jennifer Beckman • Susan Pambianco • Carrie Boom • Tracy Fowler • Todd Ray • Heidi Kresken • Darla Fagan

Upon completion of this activity, participants should be able to use evidence-based strategies to: 1. Assess patients at high risk for HF 2. Diagnose patients with HF 3. Recommend appropriate lab tests prior to initiating treatment 4. Select treatment regimens consistent with national recommendations or document the

rationale for divergence 5. Monitor chronic HF and understand intervention strategies 6. Assess social support and provide patient education regarding treatment risks and

benefits to help them prepare for the realities of treatment 7. Perform best practices for treating HF in a primary care setting

Overall Learning Objectives

Copyright: University of Washington, 2016

0%

10%

20%

30%

40%

50%

1 2 3 4 5

N = 120

Confidence in HF Knowledge

Where: 1 = Not at all confident - 5 = Very Confident