1. The Center for Family Medicine SpartanBurg Regional Hospital system
HealthPALs
The Center for Family Medicine
SpartanBurg Regional Hospital system

2. HealthPALs
P- PATIENT
A-ADVOCATE
L-LIAISON

3. WHO ARE “HealthPALs” GROUP OF VOLUNTEERS VARIOUS LEVELS OF TRAINING
laypeople
nursing students
Pre-professional health students
medical students
residents
clergy

4. HealthPALs COMMON INTEREST
“HELPING PEOPLE IN NEED MAKE BETTER HEALTHCARE DECISIONS”

5. “POOR” DECISIONS
USING THE ER FOR PRIMARY CARE - EXPENSIVE - FRAGMENTED CARE -POOR OUTCOMES -LAPSES IN FOLLOW UP

6. “POOR” DECISIONS WHY DO THESE PATIENTS GO TO ER? NOWHERE ELSE TO GO?
EASY ACCESS but long wait
NO COPAY!
DON’T KNOW ANY BETTER
THEY CAN GET WHAT THEY WANT
FAILURE OF SYSTEM

7. “POOR” DECISIONS COMPLIANCE AND ADHERENCE ISSUES
DON’T PICKUP PRESCRIPTIONS
DON’T KNOW HOW TO TAKE MEDS
UNCLEAR OF INSTRUCTIONS
HURDLES WITHIN SYSTEM
POOR FACILITATION
LACK OF UNDERSTANDING
PRESCRIPTIONS
APPOINTMENTS TESTS

8. “POOR” DECISIONS
PRESCRIPTION MEDICINE ABUSE -narcotic pain meds, benzos, stimulants ILLEGAL DRUG USE -cocaine, heroin, meth, bath salts, mj, etc. SUBSTANCE ABUSE -alcohol, tobacco

12. OPPORTUNITIES Interact with patients in continuity
Engage and lend a friendly ear
Provide assistance through resource tools
Establish an advocacy relationship
Provide value to people in need
Make a difference!!!

13. HealthPALs at CFM
Patient selection: Needy for various reasons Frequent no shows Trouble following plan Reinforcement Reassurance Special programs

14. HealthPALs at CFM List of patients in need of assistance
Phone lines, EMR access
Screen view of patient information
Script of questions and guidance
Contacts with community healthcare resources
Opportunity to meet patients and interact
Establish continuity relationship
Supervision by faculty
Attendings, residents, nursing staff, social workers

15. The Encounter Introduce yourself Let them know that you mean to help
Establish rapport
“talk with them like your grandparents”
Examples:
“have you gotten your prescriptions?”
“ did you get your lab tests?”
“do you understand…?”

18. Encounters: Special Programs
“I’d like to let you know about a special program at the Center for Family Medicine…”
For example smoking cessation, ABI screening, diabetes group visits, nutrition counseling, …
Many patients are just not aware of the services available

19. Special Programs Hospital follow up Smoking cessation
Weight management
Complex medication management
Others

20. HealthPALs at CFM Summer Session
Pilot Duration
6 week program
June 8th to July 17th
Sessions Held Tuesday through Thursday AM & PM
Record of each Encounter and any interventions
Debrief after each session

21. Week 1 - Patients with No-shows to appointments
Goal: investigate reasons patients are no-showing, reschedule patients and encourage them to attend appointments
Students began training in patient advocacy with close guidance and attention of the clinical coordinator
Review of script with volunteers followed by an example call completed by coordinator and an example write-up
Students were then encouraged to call patients and ‘get their feet wet with the process’
Students showed a range of comfort talking to patients – some were eager and confident talking to patients – others were more shy and nervous speaking with patients
EMR access was granted to the HealthPALs and students were instructed on appropriate use of medical records as a tool for patient advocacy.

22. Week 2 - follow up previously called patients, patients with frequent ER visits (5 or greater in the last 23 months)
Goals: investigate reasons patients are going to ER for primary care concerns instead of CFM, educate patients on appropriate use of ER vs primary care clinic, suggest local resources for improving care (outside the ER), schedule patients for follow-ups at CFM
HealthPALs were given a packet of resources in Spartanburg area (food, shelter, transportation, substance abuse rehab, family planning etc.) the weekend before to study and use as a tool as advocates.
Students were also instructed to assess patient’s understanding of PCP and educate patients on importance of having a PCP.
Data on selected patients was recorded

23. Week 3 – Follow up with previously called patients, CFM patients with any ER visits in last 23 months, no show patients.
Goal: use EMR to investigate patients on ER lists and no show lists to find gaps in care that can be effectively bridged with patient advocacy.
Patients with fewer than 5 ER visits in the last 23 months were excluded in the previous week which focused on excessive ER use.

24. Goal: Reach out to CFM patients recently discharged from the hospital
Week 4 – Continue follow-up with previously called patients, CFM patients recently discharged from the hospital
Goal: Reach out to CFM patients recently discharged from the hospital
HealthPALs built advocacy relationships with patients recently discharged
Bridged the gap between providers and patients to ensure patients were comfortable with their recovery plan and have no questions
Coached patients on importance of following discharge instructions, taking meds, reaching out for assistance etc.

25. Week 5 – continue follow-up with patients
Goal: Follow Up with patients called in previous 4 weeks of summer session
Ensure patients are able to attend appointments and have appropriate means to access care
Continue to coach patients of the importance of maintaining a relationship with their PCP instead of using ER for primary care needs
Follow through with recently discharged patients to ensure they are able to complete their recovery
Remind patients that they can contact the providers at CFM at any time if they have any concerns regarding their health.

26. HealthPALs – Summer Session Data
total attempted calls
approx. 430
Patients
Encounters
interventions
total
150
215 86
ER Patient Data
Pts Answered
Knowledge of PCP
No Knowledge of PCP 34 19 15
55.90%
44.10%
Reason for ER Visit over CFM
Care needed after CFM hours 10
Perceived severity of illness 17
CFM staff 'doesn’t give me what I need' 1
Sent to ER from CFM for admission
just because'

27. Problems/limitations/errors
Major Issue
we are trying to advocate for patients who are non-compliant, have chronic disease, have issues with access to care  this patient population frequently does not have reliable contact information.
Many move locations frequently/change phone and address,
many use pay as you go phones that run out of minutes but can still be utilized for texting,
many patients change addresses or give a false address/phone number to staff at CFM to avoid getting billed
HealthPALs volunteers can become frustrated and disillusioned when spending time calling patients without being able to contact them (part of the process before calling a patient involves spending time looking up the patient on the EMR to investigate their case)
Volunteers are disappointed when they are unable to contact patients they think could use their help (then show up in the ER for care.)

28. Future Considerations
Increased face to face interaction with patients – (telemedicine concept?)
encourage meeting patients in the office at appointments to put a face to the name and solidify relationships
Work on integrating the HealthPALs program into the routine care/care coordination at CFM
potential for nurses, residents and attendings to refer difficult patients to HealthPALs for follow-up calls and investigative purposes
Increased awareness of HealthPALs
Pamphlets for each patient’s room, signs throughout the hospital
Increased coordination with other community healthcare agencies
Year round sessions to provide continuity of support