המכון הלאומי לחקר שירותי הבריאות ומדיניות הבריאות (ע”ר)

The Israel National Institute For Health Policy Research

ETGAR – A medical school’s partnership with hospitals across the Galilee to innovatively tackle transition between care settings

Researchers: Mary Rudolf1, Sivan Spitzer-Shohat1,2, Bishara Bisharat3, Tsvi Sheleg4, Salman Zarka5
  1. Bar-Ilan University
  2. University of Chicago
  3. Yezreel Valley College
  4. Galil Medical Center
  5. Ziv Medical Center
Background: Adverse events at hospital discharge are particularly common for vulnerable patients. ETGAR is a novel medical student-delivered service that assists disadvantaged patients following hospital discharge. Implemented in four Galilee hospitals, it is a required course in the BIU curriculum. Following training in health literacy, cultural competence, and communication skills, students are referred suitable patients by ward staff. Working in pairs, they prepare a simplified discharge letter and conduct a home visit where they verify understanding, check medications and liaise with community/hospital services as necessary.
Objectives: To evaluate ETGAR’s impact on patients’ transition home; students’ competence in working with disadvantaged patients; and the implementation process.
Method: Service impact was assessed through CTM3 (Care Transmission Measure) and the MDT (Medication-Discrepancies Table). Students were assessed for self-perceived confidence/skills at discharge, plain language writing skills and ability to identify SDH. Stake-holders’ views were obtained.
Findings: 334 students assisted 1,010 patients in 2015-2019, taking on average 4 actions/visit. CTM3 scores improved in the subsample of 227 patients called two-weeks later (3.2±1.0vs3.7±0.6,p<0.001; 3.3±1.0vs3.7±0.7,p<0.001). 1,013 medication discrepancies due to system-level errors and patient-factors in 46% patients were addressed. Students’ confidence (3.0±0.9 vs 3.6±0.7,p<.01) and skills (5.0±1.2vs5.4±1.1,p<.05) increased.
Analysis of 85 discharge letters demonstrated improved written simplification skills (3.6±0.9vs4.1±0.8,p<.001). Analysis of 177 reports affirmed the ability to identify SDH. ETGAR was implemented successfully, although Arab patients were under-represented. Department heads and students described ETGAR’s value and educational benefits.
Patients rated ETGAR highly (4.8±0.5, scale1-5) and praised students’ commitment and attentiveness.
Conclusions: ETGAR provided a service of value and was successful in training medical students to work with disadvantaged patients.
Recommendations: ETGAR offers a model for how adverse events tied to hospital discharge may be reduced, while training students to address health illiteracy and inequalities
Research number: R/87/2016
Research end date: 08/2019
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