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Importantly, Project ECHO has been shown to be as safe and effective as in-person specialty care at an academic medical center for the care of hepatitis C. This approach may be the only way that high-quality treatments for many disorders can be delivered to rural residents. These new local experts offer state-of-the-art care in geographic areas that lack specialty physicians, thereby increasing access without having to recruit, retain, and fund additional clinicians. Over time, these learning loops result in deep knowledge, skills, and self-efficacy among participating clinicians.
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Community clinicians learn best practices in chronic disease management through “learning loops,” in which they longitudinally co-manage patients with expert specialists and expand their knowledge through case-based learning. 6 It operates regularly scheduled telehealth clinics that function as “knowledge networks” by bringing together expert interdisciplinary specialists from academic medical centers and community-based primary-care clinicians. Project ECHO in Washington State started with hepatitis C in 2008 and has expanded to other conditions, such as HIV/AIDS, addictions, and psychiatry. 5 The four pillars of Project ECHO are 1) videoconferencing, to leverage scarce health-care resources 2) sharing best practices, to reduce variability in care and innovate quickly 3) using case-based learning, to maximize learning efficiency and 4) monitoring outcomes through a Web-based database. Project ECHO improves the capacity to treat common, complex chronic diseases and monitor outcomes in rural and underserved areas. The National Multiple Sclerosis Society (New York, NY) identified the Project Extension for Community Healthcare Outcomes (ECHO) model to address gaps in MS care in collaboration with the University of Washington (UW) (Seattle, WA). 2 Individuals with MS living in rural areas have reported lower levels of perceived quality of routine health care, MS-specific care, neurologist-provided care, mental health care, and home health care compared with their urban counterparts. 1 Accessing MS care is especially challenging for people living in rural areas. Multiple sclerosis (MS) requires a comprehensive approach to care and is limited by the shortage of MS-trained clinicians.