"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."