University of Rochester

In rural areas of New York, primary care physicians (PCPs) must serve as mental health providers because of shortages in physician supply.

PCPs, however, may be inadequately equipped to manage patients with behavioral health issues: 93% of PCPs describe problematic access to and communication with mental health specialists as barriers to effective care for patients with dementia. As the State’s older population is expected to double in the next 20 years, the number of senior citizens with mental illness and dementia will also grow dramatically. The costs associated with inadequate mental health and dementia care are profound. In 2011, New York State spent $690 million on health care for patients with dementia. In response to these needs, NYHealth awarded a grant to University of Rochester Medical Center (URMC) to implement the Extension for Community Healthcare Outcomes (ECHO®) model to enhance primary care capacity in rural and underserved communities of New York State.

Under this grant, URMC worked with rural PCPs to enhance their capacity to provide geriatric mental health care to patients using Project ECHO®—an innovative model of health care education and delivery that improves the treatment of chronic and complex diseases for rural and underserved populations. Acting as an ECHO hub, URMC used Web-based videoconferencing to connect a team of its specialists from medicine, nursing, social work, psychology, and pharmacy to rural PCPs and helped them develop expertise in geriatric mental health. Through biweekly TeleECHO clinics, didactic presentations, virtual grand rounds, and case-based learning, URMC facilitated coordination between specialists and PCPs at spoke sites located in Allegany, Livingston, Monroe, Ontario, Steuben, Yates, Genesee, Seneca, Schuyler, and Wyoming counties. These spoke sites operated with increased independence and self-efficacy using Project ECHO® and became regional centers of excellence on geriatric mental health issues. An advisory committee was also be formed to examine more systemic sustainability options for future implementation of this model and build the business case for its continuation.