Organization of a Women's Health Center
Prepared for RadiologyWeb by Ellen Shaw de Paredes, M.D.
Contributing authors: Ellen Shaw de Paredes, M.D., Judy Collins, RN, OGNP, Wendy Klein, M.D., Medical College of Virginia Commonwealth University
In the last two decades, women's health concerns have begun to be addressed more specifically through several avenues. Largely as a result of awareness and public concern, Congress designated Department of Defense funds directed to breast cancer research. Congress also passed the Mammography Quality Standards Act (MQSA) in 1992 which required all facilities performing mammography to function at a basic or standard level of quality .
Since the 1970's, centers devoted to the health care needs of women have also emerged. Women's health care was one of the most rapid growing areas of health care service between 1985 and 1988 . Women's Health Care Centers offer comprehensive education, prevention, diagnosis and, sometimes, treatment in a single site. In these centers, multiple interactions with various health care providers, including primary care physicians and specialists, and various diagnostic evaluations can occur during one visit. The obvious advantage to the patient or customer is a more efficient and complete coordination of her basic health care needs. Such patient-focused delivery of care which crosses departmental organization is expeditious, well planned, and allows for rapid communication of findings to all concerned.
Objectives in planning a women's health center relate to providing comprehensive services by experts in a convenient setting and a patient-focused atmosphere. Patients are the focus of care, and providers from various specialties go to the center to provide their services. The setting provides an excellent opportunity for linking the women's center to the expertise offered at the main campus academic medical center.
The women's health center at the Medical College of Virginia is within a larger free-standing outpatient building, which includes representation from the major departments in the medical center. Portions of the clinical space are shared, maximizing an efficient use of space and staff. A primary presence is maintained daily by physicians from the departments of OB/GYN, Internal Medicine, and Radiology, with other services providing scheduled coverage. Nurse practitioners, a dietician, clinical social workers, and counselors provide extensive support to the clinical aspects of the center.
In planning and implementing such a center, the establishment of a consumer-based health care advisory council is most helpful. The women who are members of the advisory board can provide information about the health needs for women in the community.
The success of the women's health center is dependent on many factors including the integration of services, dedication and expertise of the staff, sound marketing and outreach to the community, accessibility of location and hours, and re-evaluation with patient feedback.
Key to the concept of the women's center is the emphasis on health maintenance, prevention, and changing health risk behaviors. Increasing the utilization of screening mammography on a regular basis is one of the fundamental components of the program.
Physician referral for screening mammograms is an important incentive to increasing utilization of this procedure. Having the mammography area within or contiguous with a clinical women's health center readily increases the volume of women who undergo screening on a regular basis. The marketing of the breast imaging services to the community has also enhanced the growth of the radiology practice and has served as an additional referral source to the women's center in general. A computerized database is utilized for reporting mammography and for the medical audit required by the Mammography Quality Standards Act. In our center, the computerized patient reporting and tracking database for mammography patients is utilized to generate recall letters to patients as well. The use of such reminders is advantageous in improving the regular utilization of screening by women.
The design of the center is such that the clinical space is free-flowing from one area to the next. Radiology is adjacent to the women's center. The design is such that patients seen in the women's center for example, for a routine gynecologic exam, are scheduled at the same time for annual mammography. Centralized scheduling for various services in the building enhances the coordination of the visits.
The radiology services are far more comprehensive than screening mammography. Full-time staffing by a breast imager ensures that diagnostic mammography can be directed and performed at any time, and a more comprehensive approach to patient care is provided. Breast ultrasound is performed at the same time if needed, and the patient leaves the radiology area with the results of her study.
A full range of breast interventional procedures is offered, including stereotactic breast biopsy, cyst aspiration, fine needle aspiration biopsy, ultrasound guided core biopsy, galactography and needle localization. Patients who are found on mammography to have an abnormality requiring percutaneous biopsy are informed of the findings and are scheduled for the procedure. Patients who require a surgical consultation may be scheduled with the surgical oncologist who sees patients in the center. The surgical consultation is also coordinated with the Comprehensive Breast Health Center at the main campus where the multidisciplinary team including surgical, radiation and medical oncologists, pathologists and radiologists are involved in the patient's management.
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