Department of Internal Medicine, University of New Mexico, Albuquerque, USA.
N Engl J Med. 2011 Jun 9;364(23):2199-207. doi: 10.1056/NEJMoa1009370. Epub 2011 Jun 1.
The Extension for Community Healthcare Outcomes (ECHO) model was developed to improve access to care for underserved populations with complex health problems such as hepatitis C virus (HCV) infection. With the use of video-conferencing technology, the ECHO program trains primary care providers to treat complex diseases.
We conducted a prospective cohort study comparing treatment for HCV infection at the University of New Mexico (UNM) HCV clinic with treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 patients with chronic HCV infection who had received no previous treatment for the infection were enrolled. The primary end point was a sustained virologic response.
A total of 57.5% of the patients treated at the UNM HCV clinic (84 of 146 patients) and 58.2% of those treated at ECHO sites (152 of 261 patients) had a sustained viral response (difference in rates between sites, 0.7 percentage points; 95% confidence interval, -9.2 to 10.7; P=0.89). Among patients with HCV genotype 1 infection, the rate of sustained viral response was 45.8% (38 of 83 patients) at the UNM HCV clinic and 49.7% (73 of 147 patients) at ECHO sites (P=0.57). Serious adverse events occurred in 13.7% of the patients at the UNM HCV clinic and in 6.9% of the patients at ECHO sites.
The results of this study show that the ECHO model is an effective way to treat HCV infection in underserved communities. Implementation of this model would allow other states and nations to treat a greater number of patients infected with HCV than they are currently able to treat. (Funded by the Agency for Healthcare Research and Quality and others.).
扩展社区医疗服务成果（ECHO）模式旨在改善医疗服务不足人群获得医疗服务的机会，这些人群患有复杂的健康问题，如丙型肝炎病毒（HCV）感染。通过使用视频会议技术，ECHO 项目培训初级保健提供者治疗复杂疾病。
我们进行了一项前瞻性队列研究，比较了新墨西哥大学（UNM）HCV 诊所对 HCV 感染的治疗与新墨西哥州农村地区和监狱的 21 个 ECHO 站点的初级保健临床医生的治疗。共有 407 名患有慢性 HCV 感染且未接受过该感染治疗的患者入组。主要终点是持续病毒学应答。
在 UNM HCV 诊所治疗的患者（146 例中的 84 例）中有 57.5%和在 ECHO 站点治疗的患者（261 例中的 152 例）中有 58.2%的患者获得持续病毒学应答（站点间差异为 0.7 个百分点；95%置信区间，-9.2 至 10.7；P=0.89）。在 HCV 基因型 1 感染的患者中，UNM HCV 诊所的持续病毒学应答率为 45.8%（83 例中的 38 例），ECHO 站点的持续病毒学应答率为 49.7%（147 例中的 73 例）（P=0.57）。UNM HCV 诊所的患者中有 13.7%发生严重不良事件，ECHO 站点的患者中有 6.9%发生严重不良事件。
这项研究的结果表明，ECHO 模式是治疗医疗服务不足社区 HCV 感染的有效方法。实施这种模式将使其他州和国家能够治疗比目前更多的 HCV 感染患者。（由医疗保健研究和质量局等资助）。
