Access to Health Services in the Northwest Territories: Project ECHO and Tele-Medicine Expansion

Regions: North Slave Region

Tags: health, social sciences, health care evaluation, Telecommunications

Principal Investigator: Goldman, Michelle L (1)
Licence Number: 16195
Organization: Princeton University
Licensed Year(s): 2017
Issued: Dec 14, 2017
Project Team: Michelle Goldman (Principal Investigator, Princeton University), Joseph Amon (Advisor, Princeton University)

Objective(s): To address “inadequate or disparities in access to care, rising costs, systemic inefficiencies, and unequal or slow diffusion of best practices,” and is designed to use existing resources to reach patients in remote areas.

Project Description: The objective of this research is to analyze existing cases of Project ECHO (Extension for Community Healthcare Outcomes) implementation, pinpointing previous challenges and accomplishments in order to adapt this model within a Northern context. The Project ECHO model seeks to address “inadequate or disparities in access to care, rising costs, systemic inefficiencies, and unequal or slow diffusion of best practices,” and is designed to use existing resources to reach patients in remote areas, like many communities in the Northwest Territories, thus better reaching patients’ needs while remaining cost-efficient ( Since ECHO hub teams are designed to meet the specific needs of the regions they serve, a hub that serves the Northwest Territories would incorporate Aboriginal health and wellness specialists so as to ensure traditional knowledge remains a central consideration in health care delivery.

In preparation for this project, the research team has been in contact with several professionals working on Project ECHO. The Principal Investigator (PI) plans to reach out to additional hub professionals, including members of the ECHO Ontario Mental Health and Addictions team. The PI particularly interested in speaking with the co-Chair of ECHO Ontario Mental Health, whose work is partly based out of Nunavut, and who works currently with Inuit Tapiriit Kanatami and the Mental Health Commission of Canada towards the creation of a Canadian National Inuit Suicide Prevention Strategy. Because many ECHO sites have recently formed, and thus have not yet been systematically evaluated, these conversations will shed light on previous implementation challenges that can be better addressed in new sites, as well as individual successes that can inform future implementation.

This project will combine qualitative and quantitative methods. For the qualitative portion, the PI will interview up to ten healthcare practitioners (both those that work in Yellowknife, and Yellowknife-based practitioners that work/have worked in smaller communities) as well as between 5-10 policymakers, regarding the potential for Project ECHO expansion in the Northwest Territories in various specialties.

The PI has spent time during the summer of 2017 in Yellowknife, Norman Wells, and Fort Good Hope, where they had met leaders from Fort Good Hope, Norman Wells, and Colville Lake, as well as Minister of Health, Aurora College Ethics Review Committee member, and the Chairman of the Northwest Territories Health and Social Services Board. This experience further developed the knowledge and interest around researching health system innovation. Based on that interest, and through interviews, the PI will aim to identify an overview of health specialty areas that require improved services, and then focus on one or two of these specialties, such as mental health or addictions. In this project the PI will bring in other models of tele-health that can be used to inform Project ECHO implementation.

For the quantitative portion of the, the PI would like to analyze current publicly available health care expenditure information in the Northwest Territories to better understand areas in which Project ECHO might reduce health care costs. Additionally, quantitative analysis of publicly available information regarding medical travel, health services available in smaller communities, and evidence of significant health status disparities will help identify potential application of the Project ECHO model for improving access to services. Furthermore, quantitative analysis of previous Project ECHO cases, including implementation costs, will better inform how this model can work in the Northwest Territories.

This research aims to pinpoint a means of improving access to health services across the Northwest Territories, in both Yellowknife and larger towns, as well as small communities. Project ECHO, a successful model of tele-medicine, is designed to use existing resources to reach patients in remote and/or underserved areas, thus addressing disparities in health care access, as well as high medical costs and inefficiencies in health care delivery. This research will evaluate the potential for cutting system-wide costs and increasing specialty knowledge in individual communities (thus potentially reducing the need for medical travel). Because Project ECHO works to create a "continuous learning system," this type of program would work to ensure medical knowledge stays within the system and is gained more efficiently. Through this research, individual, NWT-specific concerns can be heard, and thus this model can be effectively adapted to address the needs of NWT residents.

The PI will send the final results/thesis to the GNWT Health and Social Services Authority, as well as to healthcare practitioners and policymakers. The PI will also plan to make the results available to smaller communities through community leaders.

The fieldwork for this study will be conducted from December 14, 2017 to December 31, 2017.