CEAD applies ECHO’s technology and hub-and-spoke system.

When Jessica Zwerling, MD, Director of the Montefiore Hudson Valley Center of Excellence for Alzheimer’s Disease (CEAD), heard about Project ECHO(Extension of Community Healthcare Outcomes) it was a natural fit for CEAD’s mission. “One the the goals of the State Department of Health in providing funding for CEADs is to offer training and consultation services to physicians and other clinicians who care for people with Alzheimer’s disease and related dementias,” said Dr. Zwerling. “Project ECHO gives us the structure to use technology to share our expertise so partners in remote areas or those without specialized training can serve patients and families with this disease.”

Project ECHO, described in the April 2018 MHVC Newsletter, is a “hub-and-spoke” system that uses videoconferencing to enable board-certified specialists in a central location — “a hub” — to provide their expertise to community clinicians — the “spokes”– who are not specially trained. It is different from telemedicine because it builds capacity for clinicians at the spoke sites to manage their complex cases themselves, unlike traditional telemedicine, in which the specialist directly manages the patient remotely.

“We are funded by the state and tasked with increasing Alzheimer’s diagnoses and screening in the MHVC region. To facilitate that, we want to link providers to best practices and make sure that they have access to expert consultations so they can provide state-of-the-art care,” said Steven Matthews, Project Manager for CEAD and Director of Grants Management and Communications for the Montefiore Care Management organization. “With Project ECHO, we can remotely help primary care providers (PCPs) properly diagnose difficult cases and prepare appropriate care plans. And they can get CME credits when they participate in ECHO calls.”

The Center for the Aging Brain is the “hub” for the CEAD Project ECHO model, with the CAB’s interdisciplinary team of neurologists, geriatricians, neuropsychologists and a geriatric psychiatrist available to participants at 22 spoke sites. The project will launch on October 9th, with sessions every second Tuesday of successive months from 8-9 AM. Two weeks prior to each session, providers will fill out a form describing what services they need for each case and what the challenges are. The site leader will present the case to team for discussion. “The goal is to rotate through all of the sites for the call-in so everyone has a chance to present to us,” said Dr. Zwerling. “Once we have a traditional format we will provide the sites with evidence-based literature to enhance their continued learning.

“We expect cases to range from the worried well (whether they are at risk for the disease) to atypical presentations of dementia; and from the oldest to young onset. We have a lot of patients with co-morbid risk factors that allow us to work closely with PCPs to optimize control of vascular risk factors, and also include community-based resources in our recommendations,” said Dr. Zwerling. “We can also advise providers about state of the art clinical trials.”

CEAD is funded through March 2021, and will continue with Project ECHO for the duration of CEAD. For information on how to join Project ECHO, contact Erka Amursi, eamursi@amontefiore.org.