Project ECHO: Sharing Expertise, Building a Continuum of Care for Childhood Obesity

Helping children throughout our region to receive the right care in the right place at the right time, improving outcomes and reducing health care costs. That’s really what Children’s Hospital & Medical Center’s Project ECHO is all about.

“I knew Project ECHO would be good for Children’s and would be good for the community,” says Karla Lester, M.D., medical director of Children’s Center for the Child & Community.

A statewide learning collaborative, Children’s Project ECHO (Extension for Community Health care Outcomes) connects primary care providers across Nebraska with Children’s specialty physicians and leading national experts through biweekly, online educational sessions. There is no cost to participate.


“This type of ‘tele-mentoring” has a lot of benefits,” Dr. Lester says. “It addresses access to care issues. It’s a way to get our expertise—our mission, our specialty care and our specialists—out into the communities and build relationships with those community providers. And, it allows an opportunity for Children’s specialists to learn from the community providers as well. It’s really creating learning and knowledge networks.”

Children’s officially launched its Project ECHO program, coordinated by Children’s Center for the Child & Community in early October 2017. Sarah Hampl, M.D., a pediatrician from Children’s Mercy Kansas City, led the session with an overview of childhood obesity and introduction to clinical care. Two weeks later, Children’s Melinda Chen, M.D., a pediatric endocrinologist, presented on childhood obesity comorbidities, including prediabetes and type 2 diabetes. If you see a theme emerging, that’s not by chance. The inaugural Project ECHO curriculum, 15 sessions running through May 2018, focuses solely on issues related to childhood obesity.

“We know childhood obesity is the number one health priority for parents,” Dr. Lester says.

Nationwide, at least six percent of children are classified as severely obese. In Nebraska, one in three children is considered overweight or obese. In offering childhood obesity education to providers, Children’s hopes to change the statistics—and children’s lives—for the better.

“We know a lot of kids are slipping through the cracks as far as being assessed for comorbidities like type 2 diabetes, fatty liver disease or hypertension. Project ECHO can raise the level of assessment for those issues,” Dr. Lester explains.

Each 1.5-hour virtual session includes a 15 to 20-minute presentation by a regional or national subject matter expert. Other planned topics include causes of obesity, childhood obesity comorbidities, behavior/psychology and motivational interviewing, i.e. “how to get families to make healthy eating and active living changes,” says Dr. Lester.

To enhance interaction and provide a tangible benefit, participating community providers are encouraged to propose topics for presentation and submit cases (with no patient identification) for discussion and recommendations from specialists and presenters.

“When you look at the number of kids who are currently overweight and obese, we know we have to train up community providers on recognizing the problem, talking to the families, working up the comorbidities and getting those managed, and really addressing the issue at a best-practice level,” Dr. Lester says.

Sanjeev Arora, M.D., a liver disease doctor in Albuquerque, N.M., launched Project ECHO in 2003. The endeavor sprang from his frustration: thousands of New Mexicans with hepatitis C could not get needed treatment because there were no specialists where they lived. Dr. Arora envisioned and implemented a model that makes specialized medical knowledge more accessible. Today, Project ECHO operates with more than 130 partners in the U.S. and abroad.

Dr. Lester first learned about Project ECHO in 2015 while attending an American Academy of Pediatrics (AAP) national conference. It included a session with Dr. Arora.

“I thought Project ECHO was such an exciting concept,” she says. “At this same time, we were starting to develop the vision of the Center for the Child & Community, which we knew was going to be a statewide model. I thought Project ECHO could be a great way to deliver Children’s expertise to other communities across the state and create partnerships with providers in order to help children receive the right care in the right place at the right time.”

Children’s Center for the Child & Community, which launched in March 2016, embraces a mission to empower communities to value and support the health, safety and well-being of every child. Children’s Project ECHO helps achieve that mission.

“The Center has three overarching strategies: training and model programs, research and policy advocacy,” Dr. Lester says. “Project ECHO fits into that training and model programs strategy.”

Brad Brabec, M.D., a Lincoln pediatrician and member of Children’s Board of Directors, calls Project ECHO a “tremendous opportunity to be involved in some incredible discussion and education points for physicians in the region.”

He adds, “The more we can all hear the same information, implement those same guidelines of care and practice medicine together in a similar fashion, the better the care is going to be for children in the long run.”

The virtual, educational outreach is funded with a grant from the AAP Division of Innovation.

“It was a very competitive process,” Dr. Lester recalls. “The AAP received 24 grant applications. We were one of two projects funded from across the country.”

Implementing Project ECHO at Children’s required a period of capacity building, including the hiring of Project ECHO coordinator Jennifer Martens, MPH.

“Now that Children’s is an official ECHO replication site, we will be able to use this project to expand to many other health conditions that children are facing. That’s very exciting to me,” Martens says.

Collaboration was also a must.

“A lot of our specialists knew about Project ECHO before we were awarded the grant,” explains Dr. Lester. “We’ve had great collaboration internally among basically every division or department at Children’s. That was one thing I was very intentional about—having this be a very collaborative initiative among Children’s various departments.”

Though the team isn’t quite halfway through its inaugural Project ECHO calendar, Dr. Lester is already looking ahead to future curriculum offerings.

“There is a lot of potential to address many child health topics with Project ECHO,” she says. “The exciting thing, too, will be learning what topics community providers want to learn about—and the same thing is true for each of the specialists at Children’s. They will have their own ideas about what they are interested in.”

Beyond Project ECHO, Dr. Lester encourages community providers and agencies focused on the well-being of children to pursue partnership opportunities with Children’s Center for the Child & Community: “We are here in the community. We’re working in several areas around early childhood systems. We’re working on developing a continuum of care for obesity. We’re launching advocacy efforts and working on our next child health needs assessment in the Omaha community. We look forward to collaborative partnerships in all of those areas.”

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