Leveraging Scarce Resources With Bone Health TeleECHO to Improve the Care of Osteoporosis

Abstract

Osteoporosis is a common condition with serious consequences because of fractures. Despite availability of treatments to reduce fracture risk, there is a large osteoporosis treatment gap that has reached crisis proportions. There are too few specialists to provide services for patients who need them. Bone Health Extension for Community Health Care Outcomes (TeleECHO) is a strategy using real-time ongoing videoconferencing technology to mentor health care professionals in rural and underserved communities to achieve an advanced level of knowledge for the care of patients with skeletal diseases. Over the first 21 months of weekly Bone Health TeleECHO programs, there were 263 registered health care professionals in the United States and several other countries, with 221 attending at least 1 online clinic and typically 35 to 40 attendees at each session at the end of the reported period. Assessment of self-confidence in 20 domains of osteoporosis care showed substantial improvement with the ECHO intervention (P = 0.005). Bone Health TeleECHO can contribute to mitigating the crisis in osteoporosis care by leveraging scarce resources, providing motivated practitioners with skills to provide better skeletal health care, closer to home, with greater convenience, and lower cost than referral to a specialty center. Bone Health TeleECHO can be replicated in any location worldwide to reach anyone with Internet access, allowing access in local time zones and languages. The ECHO model of learning can be applied to other aspects of bone care, including the education of fracture liaison service coordinators, residents and fellows, and physicians with an interest in rare bone diseases.

Keywords: ECHO Act; Project ECHO; osteoporosis; telehealth; telemedicine; treatment gap.

Figure 1.

United States map of Bone Health TeleECHO “hub and spoke” network (21 months’ data). The ECHO hub in Albuquerque links to faculty to learners and learners to other learners through collaborative, ongoing, real-time case-based medical education. Participants were located in 34 states and the District of Columbia. Participants in other countries are not shown on this map.

Figure 2.

Bone Health TeleECHO outcomes. Learners with direct patient care responsibilities who attended more than 10 TeleECHO clinics (n = 10) were evaluated for self-confidence in managing osteoporosis patients in 20 different domains of care. There was a very large effect size [13] (P = 0.005) after the ECHO intervention compared with before the intervention.