Dean Schillinger
The American Medical Association (AMA) recently recognized San Francisco General Hospital Medical Center for developing exemplary programs to improve communication between health care professionals and patients.
San Francisco General Hospital Medical Center (SFGHMC) is one of eight hospitals nationwide to receive this honor. It was selected as part of the AMA Ethical Force Program's Patient-Centered Communication Initiative, which called the SFGH-UCSF effort "a well-spring of innovation regarding health communication."
"It is a great honor to be recognized by the AMA for our efforts in promoting strong communication between our providers and patients," said Gene Marie O'Connell, chief executive administrator of SFGHMC. "Mutual understanding between patients and health care providers is critical to good health outcomes. I am very proud of San Francisco General and the priority staff has placed on serving all San Franciscans."
SFGHMC's patient-centered communication programs span a wide range of endeavors. These efforts include enhancing chronic disease care, promoting shared decisionmaking and coping with illness, developing efficient systems to improve medical interpretation, and assisting immigrants and refugees in a healthy start in San Francisco.
The tremendous diversity of patients at SFGHMC reflects the diversity of San Francisco. According to 2004-05 data, the General Medicine Clinic at SFGHMC serves a diverse patient mix that includes 27 percent Latino, 25 percent black, 23 percent white, 22 percent Asian and 3 percent other.
Effective health care communication is critical to ensure positive health care outcomes for the SFGHMC's diverse patient population, says Dean Schillinger, MD, associate professor of medicine, who works for the UCSF Primary Care Research Center in the Department of Medicine at SFGHMC.
Language barriers, low health-literacy levels and cultural differences can all affect the quality of care that patients receive.
"It's apparent that communication barriers are a major detriment to quality of care," says Schillinger, who joined the UCSF faculty in 1995 after being trained at UCSF. "Current research tends to focus on new drugs or new technologies, but working at SFGH, where patients come from different cultures, speak different languages and have different literacy skills, we were forced to focus efforts on improving health communication."
For example, to improve the clinical experience for women with breast cancer, SFGHMC offers a Breast Clinic Health Education Program, a weekly health project targeting patients in the waiting room of the Breast Clinic. There, patients can wait up to three hours, aggravating the already stressful time of uncertainty and illness. The program, run by an experienced bilingual staff, aims to transform the waiting room into an environment that fosters interactive learning, healthy living practices and problem-solving skills through group discussions and patient-physician interactions. The program has served more than 500 patients, including many Spanish- and Cantonese-speaking women.
Improving Diabetes Management
Another area of focus is enhancing chronic disease care, particularly self-management support for diabetes patients. The goals of the IDEALL (Improving Diabetes Efforts Across Language and Literacy) Project are to implement and evaluate disease management programs tailored to the language and literacy levels of patients with diabetes. The IDEALL Project has two main objectives: to test the feasibility and acceptability of health communication interventions in a public delivery system, and to compare the effects of technologically oriented vs. interpersonally oriented chronic disease support among patients with communication barriers.
The IDEALL Project is part of a systemwide initiative to improve chronic disease management in the Community Health Network of San Francisco, the integrated delivery system for San Francisco County's uninsured and publicly insured residents. To date, 400 English-, Spanish- and Cantonese-speaking patients with diabetes and poor blood sugar control are enrolled in the project. They are randomized to receive weekly phone calls via an automated telephone diabetes management system, monthly group medical visits or usual care.
"We are currently evaluating the IDEALL Project, including the extent of patient engagement, patient-centered outcomes, physiologic outcomes, and health care utilization and costs," says Schillinger.
While the start-up costs for a project like this one may be higher to retrain the workforce, Schillinger says, in the long run, he expects to reduce overall health care costs as patients better control their diabetes and prevent complications that could bring them to the Emergency Department.
Other studies are ongoing to evaluate improved programs for patients with chronic heart disease and those who want to stop smoking.
The relationship between UCSF and the City and County of San Francisco began in the late 1800s. Under an affiliation agreement, UCSF provides all of the physicians necessary for operating a level-one trauma center, an emergency department and all other clinical services at SFGH. In addition to a strong partnership in patient care, UCSF uses SFGH as a major center of medical education training and research.
Source: Lisa Cisneros
