The Stanford Patient Advocacy Program

1
The Stanford Patient Advocacy Program Developing
Student Leaders and Improving Quality of Care for
Underserved Populations
Gonzalez P, Castillo T, Garcia G, Banchoff A
Stanford-Based Course
Clinic Partners
Background
Clinic-Based Program
Program Pilot Year 2004-05
The Patient Advocacy Program now partners with
six free clinics and community health centers in
Northern Californias San Mateo and Santa Clara
Counties.
Students accepted to the Program are required to
enroll in a year-long Stanford course MED
257A/B/C Patient Advocacy in Community
Clinics Instructors Gabriel Garcia, MD Ann
Banchoff, MSW, MPH
From mid-October through early June, Patient
Advocates serve weekly shifts of 3-4 hours at one
of the Programs six partner clinics.  In
addition to providing direct service to patients
and providers, the Patient Advocates work
throughout the academic year with clinic staff on
assessment and advocacy projects that are
designed to meet a clinic-identified need.

• The Patient Advocacy Program was developed in
  2004 to meet several intersecting needs in the
  community and at Stanford University
• The need among area clinics for reliable,
  trained volunteers to enhance patient care
• The demand among students for substantive
  clinical and
• community-based experiences with underserved
  populations
• The need to build a diverse and culturally
  competent healthcare workforce
• Stanford Patient Advocacy Program Mission
• To enhance patient care for underserved
  populations by sustaining a reliable corps of
  trained student volunteers at area free and
  community clinics.

• The Patient Advocacy Program was piloted in
  2004-05 with 14 students and 2 clinic partners
• Ravenswood Family Health Center, East Palo Alto
• MayView Community Health Center, Palo Alto
• Program Evaluation
• At the completion of the pilot year, quantitative
  and qualitative evaluation data were collected
  from clinic staff and participating students.
  The following data are from the clinic provider
  and staff evaluations

Course Objectives 1) Provide students with
concrete skills for working with patients in
free and community health clinics 2) Broaden
students' understanding of the context of
community clinic services, their patient
populations, and the social role of providers.
3) Train students to deliver specific health
interventions in a culturally competent manner.

• Patient Advocate Role
• To assist patients in receiving and managing
  their health care, Patient Advocates
• Administer age-appropriate Staying Healthy
  Assessments
• Provide health education materials based on SHA
  results
• Make community referrals based on providers
  suggestions
• Provide interpreter services for both patients
  and providers
• Conduct follow up calls and consultations

• Course Requirements
• Consistent course attendance for all three
  quarters
• Active participation in class discussions,
  reflection, skill-building sessions and role
  plays
• Completion of reading and homework assignments
• Weekly clinic shifts throughout the academic
  year
• Weekly reflection papers on clinic shifts
• A final project and paper addressing a health
  care challenge faced by one of the partnering
  clinics

Clinic Partners from left, Marie Wang, Arbor
Free Clinic JoAnn Cabrera, MayView Community
Health Centers Jeffrey Carroll Erika Simpson,
Ravenswood Family Health Center Jason Wong,
Samaritan House Gigi Liu, Pacific Free Clinic
Program Structure

• The Patient Advocacy Program is comprised of two
  complementary components
• 1) A year-long course at the Stanford
  School of Medicine
• 2) A concurrent year-long clinic-based
  service requirement
• Program Application Process
• Approximately 20 students are accepted into the
  Program in June prior to the academic year of
  their enrollment in the Program. Undergraduate
  and medical student applicants are considered
  based on the following selection criteria
• Commitment to enrolling in the Programs course
  and to fulfilling weekly shifts at a partner
  clinic throughout the academic year
• Strong interest in community health and in
  working with underserved populations
• Proficiency in Spanish, Vietnamese, or Mandarin
• (oral proficiency tests administered by Stanford
  Language Center)

MayView Community Health Center
www.mayview.org Palo Alto and Mountain View,
CA Provides high quality primary health care to
people from all cultural and ethnic backgrounds
regardless of their ability to pay serving 4,000
patients with gt14,775 services per year.
93 of clinic providers and staff were definitely
interested in continuing the Patient Advocacy
Program

• Curriculum Focus on Building Skills
• After several weeks of role play practice in
  class and in clinics with providers, Patient
  Advocates become proficient in
• Explaining patient rights and responsibilities
• Complying with HIPAA patient confidentiality/OSHA
  safety standards
• Completing patient histories and Staying Healthy
  Assessments
• Communicating with patients in a cultural
  competent manner
• Describing key community resources to patients
• Accurately recording information in patient
  charts

Samaritan House Free Clinic www.samaritanhouse.co
m Redwood City, CA Established in 1974,
Samaritan House is a non-profit health and human
services agency that runs a Free Clinic for low
income families and individuals in San Mateo
County, CA.
Most Useful Patient Advocate Roles
28 clinic providers and staff surveyed
Providing Patient Education and Referrals
(39) Spanish Interpretation (21) Performing
Basic Clinical Procedures (14)
Ravenswood Family Health Center
www.ravenswoodfhc.org East Palo Alto, CA Since
2001, RFHC has been a nonprofit medical clinic
offering primary health care services to S. San
Mateo County residents, regardless of ability to
pay. RFHC works to eliminate cultural and
language barriers to health by providing
bilingual medical staff health education
services.
Right Dario Maciel-Hernandez explains health
education materials to a patient at the
Ravenswood Family Health Center (RFHC). Below
Natalia Ramos discusses a patients Staying
Healthy Assessment results with RFHC providers.

• Program Refinement and Growth
• In response to the pilot evaluation data as well
  as to increased student interest and clinic
  needs, the 2005-06 Program was refined by
• Development of a student leadership model to
  coordinate the clinic-based component of the
  Program
• Modification of the Patient Advocate role to
  incorporate more provision of patient education
  and community referrals
• Requirement of Spanish proficiency testing for
  all Program applicants
• Modification of curriculum to build patient
  communication and health education skills
• Expansion to four new clinic sites Arbor Free
  Clinic, Pacific Free Clinic, Samaritan House Free
  Clinic, and MayView Community Health Center in
  Mountain View

Pacific Free Clinic http//pacific.stanford.edu
East San Jose, CA PFC was established in 2003 by
Stanford medical students. This student-run
clinic operates on Saturdays as a clinical
training environment that provides free health
care services to the medically uninsured--
particularly immigrants with low English
proficiency.

• Program Administration and Coordination
• Program direction and course instruction are
  provided by faculty and staff at the Stanford
  School of Medicine
• Gabriel Garcia, MD
• Associate Professor of Medicine and Dean of MD
  Admissions
• Ann Banchoff, MSW, MPH
• Program Director, Office of Community Health
• Student Leadership
• Previously trained students provide key
  leadership in the coordination of the
  clinic-based program.
• 1 Clinic Program Coordinator
• 6 Clinic Site Coordinators
• 1 Health Education Coordinator

Figure Sample Staying Healthy Assessment form
administered by Patient Advocates
Future Plans

• Establish a Patient Advocate Student Group to
  solidify and sustain the Programs student
  leadership.

Arbor Free Clinic http//arbor.stanford.edu
East Menlo Park, CA Arbor was established in
1990 by Stanford medical students. This
student-run Sunday clinic provides quality free
health care services to the medically
underserved, and serves an interactive, clinical
learning environment for Stanford medical
students.

• Explore opportunities for Patient Advocates to
  volunteer their services at annual Bay Area
  health fairs for underserved populations.

• Develop a Summer component for the Program to
  provide Patient Advocates with intensive language
  and cultural competency training.

Funding for the Stanford Patient Advocacy Program
has been provided by a grant from