Building on Hospital Experience to Support Advisors in Ambulatory Settings
At Emory Healthcare (EHC) much of the care transformation work is informed by the active involvement of Patient and Family Advisors (PFAs) who receive care at EHC facilities. EHC is located in Atlanta, Ga., and offers patients and families the choice of more than 2,000 doctors and 200 locations, including 6 hospitals as well as primary care, urgent care and MinuteClinics. EHC began engaging patients and families in improving their organization about a decade ago. To this day, working with PFAs to improve quality and safety is continuing to spread throughout their organization, including ambulatory settings through initiatives such as TCPI.
In 2008, a Care Transformation Model (see Figure 1) was developed to improve the patient experience at EHC. This model embraced patient- and family-centered care (PFCC) as its guiding principle and, from its inception, leadership has engaged the patient and family voice in order to influence their culture change. Patient and Family Advisory Councils (PFACs) were established that year and helped EHCimprove. On HCAHPS scores, specifically regarding “Likelihood to recommend,” EHC scored 33.7% in 2008 and improved to 86% by 2010.
Strong hospital experience with PFACs supports ongoing efforts of TCPI clinic sites. In TCPI, outreach efforts are underway for patients with diabetes to increase their follow-up appointments. Referral mechanisms have been created with the Diabetes Education Empowerment Classes (DEEP). Attention to standard documentation on care for this population around hypertension has been a focus so that data quality can be improved and the stratification of patients at risk is accurate and appropriate follow up is received. PFAs have been recently added to the committee working to improve diabetes care for EHC clinics. Additionally, there are PFAs who sit on Patient Satisfaction Committee that analyzes data from these practices.
Other system initiatives with patient/family involvement also extend to ambulatory settings. EHC is targeting high-risk patients for shared decision-making process improvement (e.g. oncology, transplant, surgical areas (orthopedics, general surgery), and bleeding disorders). This effort is informed by PFACs already in place (e.g.,Transplant Council).
As part of portal improvement at EHC, a new standard for access to medication information and test results has been implemented. Patients and Family Advisors have been actively involved in this effort. Volunteers are signing up patients and informing them of increased functionality. As a result, use of the portal has gone up steadily for nearly two years.