SCAN-ECHO Improves Care for VA Liver Disease Patients

by U.S. Medicine

August 3, 2018

ANN ARBOR, MI — While specialty care has been associated with improved survival in patients with liver disease, convenient access to specialists isn’t available to all patients.

One way the lack of feasibility of universal access to specialty care has been addressed is virtual modalities, including the SCAN‐ECHO Specialty Access Network, according to a report in the journal Hepatology.1

The telehealth program was implemented by the VHA to address that need, but a study team led by researchers from the Ann Arbor, MI, VAMC and the University of Michigan noted that limited data are available on patient outcomes.

The researchers evaluated the efficacy of a SCAN‐ECHO visit, looking at a regional cohort of 62,237 patients with liver disease in the VHA following implementation of the Ann Arbor SCAN‐ECHO Liver Clinic in June 2011 to March 2015.

The study compared the effect of a SCAN‐ECHO visit on all‐cause mortality to patients with no liver clinic visit. To adjust for the differences among patients who had a SCAN‐ECHO visit vs. those were no visit, the researchers performed propensity score matching on factors which affect the likelihood of a SCAN‐ECHO visit: demographics, geographic location, liver disease diagnosis, severity and comorbidities.

During the study period, 513 patients who had a liver SCAN‐ECHO visit were found within the cohort, the article stated. Patients who had completed a virtual SCAN‐ECHO visit were more likely younger, rural, with more significant liver disease, and evidence for cirrhosis.

In terms of results, propensity adjusted mortality rates using Cox Proportional Hazard Model showed that a SCAN‐ECHO visit was associated with a hazard ratio of 0.54 (95% CI 0.36‐0.81, p = 0.003) compared to no visit.

“Improved survival in patients seen via SCAN‐ECHO suggests that this novel approach may be an effective method to improve access for selected patients with liver disease, particularly in rural and underserved populations where access to specialty care is limited,” study authors concluded.

Project ECHO was developed at the University of New Mexico’s School of Medicine. VA’s Specialty Care Services adopted and expanded this program to transform the delivery of specialty care throughout VA. SCAN-ECHO extends the reach of specialty services and coordinates with the Veteran’s Patient Aligned Care Team (PACT).

1Su GL, Glass L, Tapper EB, Van T, Waljee AK, Sales AE. Virtual Consultations through the Veterans Administration SCAN-ECHO Project Improves Survival for Veterans with Liver Disease. Hepatology. 2018 May 5. doi: 10.1002/hep.30074. [Epub ahead of print] PubMed PMID: 29729194.

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