Project Echo: Delivering advanced dementia care to rural communities


In this article:

  • Health inequities can impact many different populations – rural communities, marginalized groups, minorities, income levels and older adults.
  • Residents in Alaska enjoy its diverse landscapes, wildlife and people, but they can face challenges accessing quality, specialty care.
  • Project ECHO connects specialists in Alzheimer’s disease and dementia with local providers, resources, and care sites to share insight and advance dementia care available in Alaska.
  • Access to specialty care removes barriers and reduces the need to travel to clinics for care.

Alaska is known for its breathtaking landscapes, stunning vistas and rich wildlife. It’s also known for its rural (and remote) communities and diverse population. Consider this:

  • Alaska has the 11th most diverse population in the United States.
  • 16% of the total population is Alaska Native or American Indian
  • 75% of its cities (including Juneau) are not connected by a road system
  • Some residents must travel over 1,000 miles to access basic healthcare
  • 31.8% of Alaska Native people live below poverty thresholds
  • The median age of residents is rising, largely due to its baby boomer population


While Alaska is a beautiful place to live – and one that many are proud to call home – these factors do create significant barriers that can impact residents’ access to healthcare and, ultimately, their overall health. Research has shown that marginalized groups, minorities, those living in rural communities, and those living below the federal poverty level are:

  • Less likely to seek healthcare due to transportation, financial issues and distrust of the medical community
  • More likely to have complex chronic conditions, such as diabetes, heart disease or neurological conditions
  • More likely to have a lower life expectancy

Many healthcare organizations around the country are actively researching and rolling out programs that help address this healthcare inequity – including Providence and Swedish.

“We are constantly on the lookout for innovative and effective programs that will help break down the barriers that patients in all our communities face,” explains Nancy Isenberg, MD MPH, medical director of the Center for Healthy Aging, Providence Swedish Neuroscience Institute and Providence Health and Services. “One such approach is Project ECHO.”

‘Moving knowledge, not people’

Project ECHO, developed at the University of New Mexico, is a hub and spoke approach to specialty healthcare. Imagine a wheel: A hub is at the center with spokes coming out all around that hub. In Project ECHO, specialty medical providers are in the hub. They amplify knowledge about a specific disease or condition.

Physicians, advanced practice providers, nurses and staff at local doctor’s offices, clinics and hospitals are the spokes. They are at the receiving end of the specialty training, but also can share their own insights back to the hub about their specific patients and community needs. Together, this creates a learning loop that benefits everyone.

“The ECHO program brings medical knowledge to rural and underserved communities, empowering providers to access expert knowledge and thereby improve the health of their communities all while supporting and learning from one another,” says Dr. Isenberg.


Improving access to dementia care

In Alaska, one Project ECHO is focused on Alzheimer’s disease and dementia. The Alzheimer’s Association estimates that 12.7 million people age 65 and older will have Alzheimer’s dementia by 2050 – nearly twice as many as today. The biggest burden will likely fall on our communities of color, according to the Centers for Disease Control and Prevention (CDC).

Alzheimer’s disease is just one of the complex diseases expected to increase as the population ages. Diabetes, heart disease and cancer will also likely grow at a fast rate. This creates a serious burden for rural healthcare providers. They must stay up to date on the latest research in many conditions – or their patients will have to seek specialty care far from home or go without.

Dementia-related care can be particularly difficult for several reasons:

  • Person- and family-centered Dementia care is complex and takes times.
  • Recommendations to maximize risk reduction and early detection and maximize quality care and support are being constantly updated.
  • There is no single diagnostic test for dementia or Alzheimer’s disease. Physicians must be comfortable in diagnosing the condition based on medical history, physical exam, a brief objective assessment of symptoms, and function and lab tests.
  • People with Alzheimer’s and conditions that cause dementia can exhibit slightly different symptoms, making it even more difficult to diagnose and manage.

Additionally, 55% of primary care providers say there are not enough dementia care specialists in their communities.

“Physicians and staff in rural communities wear many different hats,” says Dr. Isenberg. “It’s very challenging for them to stay up to date on the latest research on dementia or Alzheimer’s. With a program like Project ECHO Dementia, we can bring together their knowledge of the community and their patients with dementia specialists who can share their experience and support providers.”

In Alaska, participants in Project ECHO Dementia include physicians, nurse practitioners, physician's assistants, therapists or any staff member interested at a local doctor’s office, clinic or hospital. Twice a month, they meet with specialists from Alaska and Washington, including:

  • Neurologists
  • Neuropsychologists
  • Geriatricians
  • Palliative care providers
  • Primary care providers throughout the state
  • Social workers
  • Pharmacists
  • Cross-cultural community psychologists
  • Care partners
  • Community health educators

The sessions, which last about 60 minutes give providers and specialists the opportunity to have a two-way conversation – rather than a one-way dialogue. After a 15-minute didactic (teaching) lesson, there is a case-based review where everyone at the table is a teacher and learner.

This approach helps local providers deliver Alzheimer’s and dementia care to their patients. And for their patients, the benefit is clear: They can get the care they need with the care providers who know them and without the burden of extensive, complicated travel.

“We first launched this program in Washington State in June of 2020,” shares Dr. Isenberg. “After its success, it was clear that Alaska would be a perfect fit for the program because of its unique geography and population. Given the prevalence of dementia in the communities we care for, there is a significant need for person- and family-centered dementia care. Project ECHO is an effective way to meet that need.”

A better approach for better outcomes

Project ECHO Dementia is a win-win-win for clinics, providers and patients:

  • Clinics improve workflow, charge capture and efficiency. Simply put, they are better able to deliver efficient, reimbursable care to patients.
  • Providers master complexity, benefit from peer engagement and earn up to 30 CMEs. They receive and share knowledge on diagnosing and treating complex diseases and build relationships while advancing their own career.
  • Patients receive improved access to expert care locally and avoid costly trips to specialists.

Specifically, the project:

  • Increases providers’ understanding of and ability to manage mid-life risk factors to help prevent or delay cognitive impairment and dementia
  • Trains providers on how to identify early signs of dementia
  • Provides resources to help providers feel confident caring for patients with dementia
  • Coaching providers on how to have difficult conversations with patients and their families
  • Create a referral stream for patients who need more involved care
  • Fills a gap for local dementia care

“Our goal is to keep patients in their communities, with the doctors and providers they feel comfortable seeing,” explains Dr. Isenberg. “Project ECHO puts the knowledge, tools and support right in the hands of local providers and clinics so that they can deliver comprehensive, culturally competent dementia care to underserved communities.”


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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

About the Author

Neuroscience is super complex, and the Providence Brain & Spine Team taps into the many decades of expertise to provide useful and helpful advice and tips on non-surgical and surgical options to treat any disease of the mind.

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