Patients of doctors who participated in a Veteran Affairs-run telemedicine consultation program were 54 percent more likely to survive chronic liver disease than a matched cohort of patients of non-participating doctors, according to a new retrospective study from the University of Michigan.
“It seems that primary care providers who participated in [the program] were more likely to follow the guidelines for cirrhosis and perform the screening for esophageal varicose veins and liver cancer in the patients who need it,” lead author and University of Michigan gastroenterologist Dr. Grace L. Sue . “I think it is the behavior of the provider that’s the reason patients lived longer.”
The study looked at Specialty Care Access Network — Extension for Community Healthcare Outcomes (SCAN-ECHO), a rural telehealth consultation launched by the Department of Veterans Affairs in 2012 in New Mexico. The program was then rolled out nationally, including in Ann Arbor where it was used for chronic liver disease.
The model connects rural care teams to specialty clinics for weekly consultations where the rural physicians can learn how to better treat their patients and apply that knowledge to specific cases.
“It is one thing for a primary care provider to read or learn about a disease, but another when they have a specific patient in mind. This case-based teaching magnifies the potential for learning. Creating many mini-specialists from primary care providers is the most powerful aspect of the SCAN-ECHO program,” Su explained. “It’s a medical force multiplier.”
According to VA records, out of 62,237 veterans with chronic liver disease in the region, just 513 had a primary care physician who had a remote consultation about their case via SCAN-ECHO. Su and her team compared mortality between these 513 and a matched cohort from among the other 61,724 patients, taking into account demographics, geographic location, liver disease diagnosis, severity, and comorbidities.
They found that the SCAN-ECHO cohort was 54 percent more likely to survive than the other matched cohort.
“Primary care providers really want to do the right thing, but they may not have all the necessary tools,” Su said. “This research shows an excellent way to impart specialty knowledge to them."