Technology, expert training and real-time feedback improves Hepatitis C outcomes

Widely-available technology, expert training and real-time feedback helped ensure that patients treated for Hepatitis C in local communities did as well as patients treated at a university-based medical center, results of a new study funded by HHS' Agency for Healthcare Research and Quality show. The study is published in the June 2 online issue of the New England Journal of Medicine and in the June 9 print edition.

To bring effective treatment to persons with the Hepatitis C virus (HCV) infection in underserved areas, researchers at the University of New Mexico Health Sciences Center (UNMHSC) developed a model called Extension for Community Healthcare Outcomes, or ECHO, that brings state-of-the-art medical knowledge to primary care providers and nurses.

Using videoconference or teleconference lines, community-based medical teams, including physicians and nurses, take part in weekly clinics with specialists. Together, they discuss patients' medical history, review lab results and other key findings and collaborate on treatment plans using evidence-based treatment approaches.

Study authors examined outcomes for 407 patients undergoing treatment for HCV infection at 21 community settings, including five prisons, and at a UNMHSC-affiliated clinic in Albuquerque. They found that the HCV infection was cured at a similar rate for patients who were treated at these community-based settings as patients who were treated at the university clinic (58.2 percent vs. 57.5 percent).

"The key to this study is that technology helped local physicians and other providers deliver safe, high-quality care within their own - in most cases, underserved - communities," said AHRQ Director Carolyn M. Clancy, M.D. "We've known that geography can play a role in timely and appropriate treatment, especially in managing complex conditions such as Hepatitis C; however, it doesn't have to mean destiny."

Approximately 3.2 million Americans are chronically infected with HCV, which causes 12,000 deaths per year. It is the leading cause of liver transplantation. Although treatment is available and effective, it can cause serious side effects and, therefore, must be carefully managed by a medical team. Typically, such care and treatment is not available outside of university medical centers.

"Project ECHO demonstrates that we can solve the problems of underserved communities by empowering primary care clinicians to provide high-quality specialty care locally," said Sanjeev Arora, M.D., the liver disease specialist at UNMHSC who created Project ECHO. "This empowerment - what we call a 'force multiplier effect'- holds promise for reforming health care delivery nationally."

Because a majority of patients at the community setting were Hispanic, the study also achieved a related goal of increasing treatment for underserved and minority patients. AHRQ's 2010 National Healthcare Quality Report released in February found that Hispanics had worse access to care than non-Hispanics for five of six measures of ability to obtain health services. For more on the National Healthcare Quality Report and the National Healthcare Disparities Report, go to http://www.ahrq.gov/qual/qrdr10.htm. The U.S. Department of Health and Human Services also recently launched its action plan to prevent and treat viral hepatitis. To read the plan, go to http://www.hhs.gov/ash/initiatives/hepatitis.