Patient Advocacy

Department: Department of Internal Medicine

Heather E Harrell M.D., F.A.C.P.

Associate Dean, Medical Education And Professor

Department: MD-CHFM RURAL HEALTH-OLD TOWN

Grant Harrell MD

Assistant Professor & Medical Director

Student Limit of 4

Purpose

Quality healthcare goes beyond simply ordering the correct test, making the right diagnosis, or performing a procedure competently.  The highest quality healthcare seeks to ensure that patients achieve the best health outcomes once they leave healthcare facilities and resume their daily lives.  In order to accomplish this, physicians must appreciate the context in which their patients live, work, and play to develop shared strategies that maximize the likelihood of improving the overall health of both the individual and their community.  

The Patient Advocacy Track allows a deeper dive into the experience of patients as they navigate the structures of the healthcare system and attempt to carry out the demands of this system in their daily lives.  Students entering this track will have the opportunity to improve their communication skills by learning culturally humble, socially-conscious strategies for engagement while developing relationships with a small panel of patients.  Students will conduct regular phone/video check-ins with patients, attend some healthcare appointments with patients, and if applicable be present during ER or hospital admissions.  Home visits are also a possibility depending on the patient’s primary care clinic and specific circumstances.  Most patients in a student’s panel will be recruited from the Mobile Outreach Clinic, UF Family Medicine in Old Town, or General Internal Medicine at the Medical Plaza.  An option to have a student’s PFF family and patients they meet through the Equal Access Clinic as a part of their panel is also acceptable.   These specific populations of patients are predominantly low-income although the settings encompass both rural and urban locations.  Some patients will be insured while others are not, and the degree of social support present will vary.

While learning first-hand about a patient’s experience is a valuable educational opportunity, students in this track also are expected to work towards addressing barriers to care that arise as they become more familiar with their panel’s individual circumstances.  Being an effective advocate also requires being educated on community resources that are available to patients and learning how to connect patients with needed resources. Therefore, part of a participant’s task will include being a “Care Coordinator”.   An award of distinction in patient advocacy is available to those students who participate in policy development initiatives locally or develop quality improvement projects aimed at improving the specific barriers faced by their patients.

Objectives

• Communicate with patients through in person and telehealth modalities using appropriate literacy levels and with a culturally humble attitude.
• Identify community resources to help patients overcome barriers to care.
• Identify features of traditional healthcare delivery that contribute to health disparities.
• Conduct a home visit to inform strategies for improving the health and safety of an individual patient including performing a home-safety evaluation.
• Participate actively in community health forums open to the public.
• Participate in local and/or state health policy development.

Activities

Students in the Patient Advocacy Track will be expected to complete the following types of activities both in preparation for monthly track meetings and as skill building sessions to help improve their advocacy skills:

• “Care Coordination” video series
• Online modules on advocacy, policy making and patient communication
• Group discussions on prepared readings, podcasts, and videos
• Live talks on various topics related to the track (includes select talk in other discovery tracks)
• Attendance at community meetings such as Alachua County safety net collaborative, GNV4ALL or Alachua county healthcare advisory board
• As schedules permit, join patients during office visits, hospital visits, other health-related appointments
• Attend supervised home visit

Award of Distinction

In order to qualify for this designation all of the following requirements must be met in addition to choosing one of the additional project options:

• Attend all group discussions during pre-clinical years and 6 talks of your choosing
• Attend at least 4 Alachua County Safety Net Collaborative Meetings and at least 2 other community-based meetings which can include but are not limited to:
  • Alachua County Healthcare Advisory Board
  • Children’s Trust of Alachua County
  • GNV4ALL Health and Transportation Committee
• Complete at least one supervised home visit and if applicable complete a state or federally approved home safety evaluation checklist
• Attend at least 2 healthcare related appointments or admissions and complete a reflective writing assignment on each encounter
• Complete all online modules with certificate of completion submitted
• Complete at least 10 care coordination calls/video conferences with accompanying care coordination note for patients within your panel

Project Options

1. Quality Improvement:  Based on your experiences of co-navigating the health system with your patients, identify a quality improvement initiative that would help address a contributor to health disparities.  The project will be submitted as an oral presentation that covers:
   • Description of the problem as it relates to the care received by your panel
   • Description of the proposed initiative including estimates of cost and/or cost savings, as well as feasibility and what settings are most appropriate for the initiative (clinic, hospital, home, church, community center etc.)
   • Discussion of how the proposal would be evaluated and what would be considered a success
2. Local Policy/Community Initiative: Through your attendance and participation in various community forums, identify an ongoing policy proposal or local health-related initiative (health-related can be considered a loose term given that Alachua County has a “health in all policies” philosophy) to volunteer your time.  You will need to volunteer a sufficient amount of time to be able to present the substance of this policy as a presentation to the track and also to outline your specific involvement.  Your presentation should include:
   • Description of the problem the policy/initiative is trying to address
   • Who are the key players driving the policy/initiative (e.g. neighborhood(s), constituency of individuals around an issue, business, political leaders, specific professionals etc.)?
   • Who has jurisdiction (is this a city or county issue)?
   • What are the specifics of the proposal?  How would it work?  What would it cost?  What would it save?
   • Are there comparable policies/initiatives in other cities/counties/states?
   • How would the proposal be funded?  What is the plan for sustainability?
   • Describe the process of how this policy/initiative was developed.  How did it start?  What processes had to be completed in order to move the proposal along?  What challenges have been encountered?

Projects can be completed as individuals or in groups of up to 3.  Groups may be appropriate in cases where there is shared interest and involvement in a local policy or in cases where a commonly shared patient barrier is encountered.   Finding a faculty/community mentor is recommended to help provide project guidance.  Periodic check-ins with the track director are recommended to ensure that the project is meeting expectations of quality to warrant an award of distinction.

Assessment

• Participation in monthly discussions
• Patient evaluations
• Reflections
• Project