71 For most physicians, discharging a patient from the hospital means discharging responsibility for his care. Thanks to a mandatory course in Azrieli Faculty of Medicine, however, a new crop of Israeli doctors will view discharges as merely the start of a journey—and one, more importantly, in which they have a role to play, too. ETGAR (“Challenge”) was established by the Azrieli Faculty to address disadvantaged populations’ high rate of hospital readmissions, which not only result in higher costs for the healthcare system, but also reflect a lower proportion of positive patient outcomes. By training medical students to communicate with patients more effectively and understand the effect of social determinants on health outcomes, ETGAR helps ensure amore successful transition to the home setting, and helps tomorrow’s doctors reduce the country’s health inequities. “In a study of hundreds of readmitted patients, we realized that many simply didn’t understand their discharge papers, which contain the medical instructions they need to manage their healing on their own,” explains Dr. Sivan Spitzer, director and co-founder, together with Azrieli Faculty professor emeritus Mary Rudolf, of ETGAR. “To compoundmatters, the discharge process is often rushed and the instructions objectively unclear. It’s no wonder that there were medication discrepancies in nearly half the cases, nor that some patients ended up right back where they began.” To address the issue, ETGAR teaches students to write instructions that patients can read, and to speak to patients in ways they can understand. In many cases, that means translating into more straightforward terms; in others, it means translating—literally: ETGAR also invested in a studentrun staff that can translate into Arabic and Russian. “The simple addition of a line of translated text can make the difference to a patient’s feeling of confidence about taking responsibility for his care,” Spitzer says. As part of the course, students also conduct a follow-up home visit inwhich they assess the patient’s medical compliance and overall welfare. Recognizing the importance of reinforcement to ensuring successful outcomes, Spitzer plans in the coming years to build out the follow-up component, both by increasing the number of visits and calls and including other members of the local community. By involving not only health services but alsomunicipalities in the healing process, she believes that ETGAR can ensure still more positive outcomes for individual patients and engage a larger number of northern residents. In recognition of its impact on the North and its enhancement of Israeli healthcare, Bar-Ilan recently selected ETGAR as its flagship program for the fourth consecutive year. “One empowered patient at a time,” concludes Spitzer, “we can change the face of the Galilee.” From Hospital to Home and Beyond ETGAR for Advancing Health Equity
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