Virtual specialist experience linked to better survival in PCP-treated liver disease
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When primary care physicians interact with virtual specialists in hepatology, more of their patients have improved survival rate beyond the initial consultation, according to a presenter at The Liver Meeting Digital Experience.
The Extension of Community Healthcare Outcomes (ECHO) care model is a fully virtual consultation modality in which PCPs and specialists communicate directly on a case-by-case basis, according to the abstract.
In 2011, the Veterans Health Administration adapted ECHO into the Specialty Care Access Network (SCAN)-ECHO for specialty care for chronic diseases, Ponni Perumalswami, MD, MsCR, of Ann Arbor Veterans Affairs Healthcare System, said in her presentation.
“Our group has previously demonstrated that liver SCAN-ECHO visits were associated with improved survival, with a 46% decreased likelihood of dying compared with matched patients who had no visit during the same time period,” Perumalswami said. “This prior study found similar survival in matched patients with ECHO visits and face-to-face visits.”
In the present study, Perumalswami and colleagues asked if there was an improvement for the PCP’s patients beyond the initial case discussed with a SCAN-ECHO provider. The researchers assessed all-cause mortality among 77,597 veterans (median age, 58 years; 71.5% white; 95.7% men) with liver disease diagnosis (cirrhosis, 11%) between 2008 and 2017 registered in the Veterans Integrated Service Network 10. The researchers determined 14,675 veterans saw a PCP experienced with SCAN-ECHO during the study period, and after excluding veterans whose relationship with SCAN-ECHO providers ended after the first ECHO participation, the study included 11,080 veterans treated by a SCAN-ECHO provider.
Propensity-adjusted Cox proportional hazard assessment of 8,017 cohort cases matched 1:1 with controls showed that patients who saw a SCAN-ECHO PCP had higher survival rates (crude HR = 0.687; 95% CI, 0.648-0.73).
Perumalswami and associates noted that more patients living in rural areas saw a SCAN-ECHO PCP compared to the entire study population (51% vs. 33%).
Limitations included study design, potentially missing or incorrect data, variability of patient-PCP relationship, when ICD codes were assigned and ongoing research on liver disease etiology.
“Some key takeaways here are a potential signal with survival benefit in patients cared for by SCAN-ECHO providers,” Perumalswami said. “Additional analysis is ongoing to confirm these findings, and we plan to perform a sensitivity analysis to determine if a dose response with participation in ECHO is present.”
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Perumalswami P. The SCAN-ECHO force multiplier effect builds primary care provider capacity through virtual consultations to improve survival for veterans living with liver disease. Presented at: The Liver Meeting Digital Experience; Nov. 12-15, 2021 (virtual meeting).
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