Dana Reissner RN, BSN Michelle “Cookie” Crossley RN, BSN

1. Dana Reissner RN, BSN Michelle “Cookie” Crossley RN, BSN Anita Patel MD Manager, Outreach Services Medical Director, Transplant

2. Henry Ford Center of Excellence • The Henry Ford Transplant Institute was established in 2004 as a Henry Ford Center of Excellence • Pulled all existing transplant programs under one umbrella, established a brand identity and began marketing under one name:

3. Henry Ford has long been committed to providing organ transplantation. The Henry Ford Transplant Institute has grown to become one of the nation’s busiest and highest regarded transplant centers. We are one of only two multi-organ transplantation centers in Michigan with transplant programs for: Liver Heart Multivisceral Pancreas Kidney Lungs Bone Marrow

4. Outreach Goals • Educate staff and referring physicians about transplant • Create/maintain relationships with referring physicians • Establish outreach clinics in high visibility areas • Keep dialysis centers updated per pt status • Keep referring MD’s up to date on latest services/technologies/research we offer

5. Our referring physician strategy:Culture Building • Identify physician champions • Target select specialties • Build a culture of “Yes” • Commitment to face-to-face relationship building • Creating remark-worthy content • Messages that offer knowledge sharing • Building a belief system

6. Outreach Transplant Coordinator • Serves as a point of contact for referring physicians and dialysis centers • Educates patients and support staff regarding transplant • Functions as the “Go To Girl” for questions or problems • Smoothes the transition from referral to listing

7. Learning Objective • To initiate creative and innovative ways to increase knowledge, awareness and access to transplantation in underserved demographical areas.

8. Background We sought to investigate if collaborating with community physicians in their demographic areas would affect patient access to kidney transplant evaluations and improve both patient and physician satisfaction

9. Challenges • Inner city 800 bed hospital • Detroit demographics-82.7% African Americans, Caucasians 10.6% • Referring physician loyalties, new patient business • Wide referral catchment area

10. Catchment area

11. Challenges • Patient travel long distances for evaluations • Safety concerns • Lack of familiarity with our providers • Physician business models and referral patterns and loyalties

12. Methodology • Reviewed counties with dialysis centers, referring physician offices to assess needs • Analyzed physician referral patterns • All organ transplant types • Assessed personnel need • Location of offices • Sent out questionaire to referring physicians and patients to explore their needs and ease of referral

14. Preliminary Findings • 66% of HF kidney transplant business was from referring physicians outside of Detroit area • 72 percent of physicians wanted us to see patients in their geographic locale • Cost of travel/transportaion was an issue with patients • Social support-another concerns

15. Established Outreach Clinics • Kidney- Lansing, Ypsilanti, Flint, Pontiac, Macomb, Novi • Liver- Kalamazoo, Grand Rapids • Heart- Wyandotte, Southfield(Providence), St. John, Macomb • Lung- Novi, Grand Blanc

16. Retrospective data analysis • We retrospectively analyzed the number of new patient evaluations done for eligibility for kidney transplantation and reevaluations done from 2007 to 2013 to assess if there was any change in number of referrals received and processed by our transplant center. • Data also included referrals processed in outreach clinics opened in Metro Detroit area and in outlying cities in Michigan.

17. Outreach referrals.

18. Growth over 7 years

19. Results • Although the total number of new patient evaluations did not increase markedly, we noted a 35% increase in number of evaluation visits from 700 to over 900 patients. • This resulted from more number of patients showing up for their yearly reevaluation and hence progressing to listing. Our outreach patients increased by 2.6 fold with highest increase in remote clinics.

20. Results • There has been an increase in waitlist by 26%; referrals by 50%, patient satisfaction scores by 68% and provider satisfaction by >80%.

21. Conclusions • Our referrals have increased significantly since outreach inception. • Referring physician satisfaction has increased resulting in better communication among our physicians with external providers. • Community physicians now view themselves as an extension to our program and an integral part of our team. • By working closely with referring physicians, patients view their care as complete

22. Conclusions • Having access close to home has improved patient outcomes and eased the burden for those with transportation challenges. • Patients in the rural areas have been able to overcome the stereotype of “inner city hospital”, knowing that their travel to a clinic is minimal. • We now have 14 total community outreach locations throughout Michigan for kidney, lung, heart and liver transplant programs as well as 3 shared care programs for VADS and are still growing.