Skip to main content

Rounds Preview: Innovations in Women's Health

 |  By Jim Molpus  
   August 07, 2012

 

This article appears in the July 2012 issue of HealthLeaders magazine.


Hospitals have known for years that there are many advantages to marketing a comprehensive set of women's health services as a single unit. Not only do women represent a huge consumer segment with their own growing list of healthcare needs, but they are also the chief decision-makers for their family's care.

The current challenge for many health systems is to create the operational and clinical structures required to deliver a truly comprehensive set of women's health services. North Shore-LIJ Health System set out four years ago to create the Katz Institute for Women's Health to provide that comprehensive structure.

"It's a major priority for us as an organization because we have to get way, way beyond thinking of women's health as being limited to pregnancy and delivery," says Michael Dowling, president and CEO of North Shore-LIJ Health System. "It's not an easy thing to do because women's health, in many ways, is almost everything. You have to cut across a multitude of departments and service lines to be able to put a coherent face and a coherent structure around the women's health delivery system. If it only becomes a marketing issue, it sounds good, but you've got no substance behind it and at the end of the day it will fail."

Jennifer Mieres, MD, senior vice president of North Shore-LIJ Office of Community and Public Health, says clinical research has focused in recent years on defining women's health more broadly and identifying gender-based differences in care delivery. Those gaps in delivery made little sense given the profile of healthcare spending. "When you look at U.S. healthcare expenditures, women spend a lot more in terms of health," says Mieres. "Inpatient expenses are about $188 billion for women compared to $165 billion for men. Home health expenditures are $24 billion for women compared to $14 billion for men."

 

With a clinical and business imperative to start with, North Shore-LIJ began to design a template for a women's health center of excellence, for which Mieres was appointed director. The strategic plan was built around four areas of focus:

  1. Clinical services: Facilitate integration of multidisciplinary clinical services that address women's unique needs across the lifespan, focusing on prevention and treatment, and providing a convenient one-stop-shopping format.
  2. Research: Integrate and expand the activities and programs of the women's health research agenda.
  3. Community outreach: Integrate community outreach, education, and recruitment with the activities of the center of excellence.
  4. Professional education and health literacy: Disseminate information on diseases specific to women, for health maintenance and disease prevention and for living with illness.

A vice president was appointed to each of the four areas of focus, with Stacey Rosen, MD, a practicing cardiologist, appointed VP of clinical services for the Katz Institute. A clinical services steering committee was formed with representatives from the major clinical areas of women's health, including the traditional practices dedicated strictly to women such as OB-GYN and gynecological and breast cancer, Mieres says, but also cardiology, neurology, endocrinology, radiology, urology, and rheumatology. Rosen began the integration process by going department by department to break down barriers—some structural and some cultural—that had kept women's health services from acting as a single unit and guiding patients to where they need to be.

"If you meet with the chairs of obstetrics and gynecology, they are going to be hard-pressed to deny that I am better at managing cardiac and hypertension and diabetes than they are," Rosen says. "And I don't deliver babies. So wouldn't it be great if every time their patient had an OB-GYN visit they were reminded about other nongynecologic opportunities for wellness?"

The bridge was different with each department, Rosen says. So for the GYN oncologists, the cardiologists could offer to preop screen their patients and follow them after their hysterectomies. Or for the psychiatrists, it might be adding a postpartum depression flyer in the materials given to mothers after delivery.

 

"I think that's how you start it," Rosen says. "You start it man-on-man. You start it very focused and small where there are maybe some little politically charged issues, and then your vertical silos start interacting with each other. I think back to the cardiac world. You know, a cath person used to hate the surgeon. If you had to send someone to open-heart surgery instead of putting stents in, that was a failure. But now every good cardiac program has complete integration of the services, and if the patient does well and everybody's service line does well, that's a success."

Beyond physician relations, a key initial step was to review the definition of women's health to encompass evidence-based care in three areas:

  • Conditions where women are uniquely affected, such as gynecologic disorders, obstetrics, and breast diseases
  • Conditions where women are affected disproportionately more than men, such as in osteoporosis, depression, and gallstone disease
  • Conditions where the manifestation in women is different from that in men, such as heart disease, lung cancer, or rheumatoid arthritis

Perhaps the trickiest in terms of clinical services integration is the latter. Better evidence on gender-based clinical guidelines has helped. Rosen and her team make sure the information is disseminated throughout the women's health organizational matrix so emergency physicians, OBs, and other disciplines that come in contact with women know, for example, that heart disease is still the No. 1 killer of women, and that a woman may present different symptoms than men will. 

 

"In some instances, the disease is different," Rosen says. "There are women who will have chest pain with normal coronaries, normal arteries, and no blockages, and people in the past thought they were being 'histrionic.' And what we've learned through research over time is that there is something still wrong with their arteries—that it's not 'no disease,' but it's a different kind of disease. When women get diabetes, for instance, it's a much bigger risk factor for heart disease than men. There's that whole category of a very common disease sometimes being different in the female population."

The matrix for the clinical integration is based on having specific expertise—i.e., a specialist with an interest in clinical research in women's health within his or her particular discipline—and making the connections so that women get coordinated care. In that model, the vertical silo breaks down, so a cardiology program expands into a cardiovascular wellness program, Rosen says, citing a model being developed by Boston's Brigham and Women's Hospital.

"The program has a group of those doctors who focus on women and heart disease," Rosen says. "They do outreach and screening and prevention. They provide primary cardiac care to patients who identify as having the disease or are at risk. They integrate with noncardiac programs where heart disease is prevalent, including diabetes patients or high-risk maternity patients. In other words, the services then go away from the vertical cardiology and say, 'Well, where else are there women who are at risk or have heart disease that I can integrate services better?' That's how the clinical transformation in our organization needs to be. It needs to be a clinical practice that is for women in heart disease, but then it has to have sort of horizontal pods that go out to anywhere women would otherwise receive care."

 

The clinical integration link between those horizontal pods is a navigator model, specifically a staffed resource center that acts as a single phone number for women to call with any questions, Mieres says. The center is staffed by three full-time navigators and backed up by nurses and physicians when the clinical complexity requires a higher level of expertise.

"You call one number, and we can help you connect to anyone within our system, any service line, to deal with your complaints," Mieres says. "We women all have busy lives. Women want to be able to do one-stop shopping, so that's what we're trying to provide." The navigators ask basic questions about the health issue, and then guide the patient toward specific services, so, for example, a patient seeking information on a hip or knee replacement can get a first or second consult with one of the orthopedic surgeons who specialize in gender-specific aspects of the procedure, Mieres says.

 


This article appears in the July 2012 issue of HealthLeaders magazine.

Reprint HLR0712-9

Jim Molpus is the director of the HealthLeaders Exchange.

Tagged Under:


Get the latest on healthcare leadership in your inbox.