Southern women in general compare unfavorably to women in other regions of the United States in terms of health: rates of obesity, smoking and premature births are higher in the South than elsewhere, and Tennessee’s women are no exception.
A 2007 report by the National Women’s Law Center ranks the overall health of Tennessee’s women at 45th among states, while the American Heart Association rates Nashville-Davidson County as the least “heart-friendly” city for women in the country.
Officials with local health care systems have recognized the need for a more holistic approach to women’s health care. Saint Thomas Health Services, Vanderbilt University Medical Center and HCA’s TriStar Health System are devoting energy and resources to shoring up traditional women’s programs while creating new ones geared to preventative care.
The women’s health market is crucial for the hospital sector: According to the National Hospital Discharge Survey, U.S. women underwent 43 percent more hospital procedures than men in 2006. Of course, the number of obstetrical cases was an important factor in that spread, but even excluding births, women were responsible for 2 million more cases than men.
And the potential payoff for local hospital systems’ investments isn’t only with their female patients: Women make 80 percent of all health care purchasing decisions and a satisfied woman customer can be a crucial — and profitable — referral source for family members and friends.
Covering the Ob/Gyn basics
Both Saint Thomas and TriStar have in recent years added to their neonatal intensive care units: Saint Thomas at Baptist Hospital, TriStar at its Centennial Women’s Hospital.
Baptist’s neonatal units have increased from 26 to 50. (The system also has a neonatal center at Middle Tennessee Medical Center in Murfreesboro.)
Amanda Cecconi, women’s health service line executive at STHS, said the expansion is a natural outgrowth for Baptist. Much as Saint Thomas has become known for its heart care, so, too, has Baptist become the “obstetrics and gynecology facility for the ‘big, bad’ stuff,” Cecconi said.
Joann Ettien, administrator and COO of Centennial Women’s Hospital, said the expansion of her facility’s NICU is a result of a community needs assessment TriStar and Centennial officials conducted in 2006.
The expansion is in the final of three phases. When complete, the NICU will include 60 beds, 16 of which are devoted to critical-care patients. Rooms in the new unit are designed to allow family members to stay with their babies, and new and expectant mothers have access to a multi-disciplinary team of specialists, including lactation consultants, occupational and massage therapists for the infants and neonatal nurse practitioners.
Moving on to whole body health
But women’s health is about more than just reproduction. Breast and pelvic health, like pregnancy, are gateways to health care services for many women. To address one of these concerns, Saint Thomas’ Centers for Breast Health offer services at its three Nashville-area hospitals that run the gamut from educating women on breast self exams, to mammograms and ultrasounds, to pre-operative surgery classes and reconstructive surgery for women who have been diagnosed with breast cancer.
Cecconi said even those centers are evolving into full-service offerings, with one director for all three. Saint Thomas recently opened an all-digital mammography program at Middle Tennessee Medical.
Though Vanderbilt has had to postpone plans for a freestanding women’s hospital, a new home for its independent breast clinic is nearing completion. The Vanderbilt Breast Center opened earlier this month in an 18,000-square-foot space at the newly renovated 100 Oaks Mall. The center will feature four digital mammography machines, five ultrasound machines, new bone density testing technology and a magnetic resonance imaging machine solely for breast imaging.
Center Director Dianne Harris said the MRI is much more accurate than traditional mammography, allowing a view of the entire chest wall.
“This is the gold standard,” Harris said, adding an MRI is recommended for women who have high risk factors, such as first-degree relatives with breast cancer or women with fibro-cystic breast disease.
In November 2007, Saint Thomas opened The Center for Pelvic Health in Franklin near Williamson Medical Center. A direct outgrowth of obstetrics and gynecology, the center addresses issues like pelvic pain and incontinence, conditions encountered by about 40 percent of women who have children.
Physicians working at the center include specialists in uro-gynecology, the fusion of urinary tract issues with gynecological ones. Center services include non-surgical interventions, physical therapy and muscular strengthening of the pelvic floor, as well as surgical treatments.
Trading ounce for pound
Beyond expansion of services for well-established women’s health issues, providers are increasingly honing in on treatments for health issues that, until now, have too often been approached in a gender-blind manner.
Coronary disease, for example, is the leading cause of death in women. Dr. Emily Kurtz, director of preventive cardiology at the Vanderbilt Heart and Vascular Institute, said that while about 50 percent of women recognize that fact, only about 15 percent think they are at risk.
That’s not entirely their fault, either, as the treatment of women has evolved over the last decade. Prior to that, landmark clinical trials had been conducted on men and the results applied to women. And, traditionally, risk factors were highly rated by age.
“The new paradigm is evaluating for lifetime risk of a cardiovascular occurrence,” said Kurtz, adding a family history of coronary disease is “ridiculously important in risk assessment.”
Saint Thomas’ wellness efforts also address cardiac care, as well as weight, sleep and bone density issues, all conditions that can dramatically hurt the quality of life of women. While some, like weight and sleep, may seem common to both genders, the conditions can be pronounced in women.
Sleep disorders, for instance, can become a serious problem for women in menopause or approaching menopause as a result of complex physiological changes. Saint Thomas’ Sleep Disorders Center offers testing and treatment recommendations from board-certified sleep specialists.
But there is even more work to be done when it comes to providing better women’s health care. And it’s work TriStar, Vanderbilt, Saint Thomas and others will continue to strive to provide. With the health care power women wield, they’re simply smart investments.