Hospital uses award to test health initiatives
Hospital uses award to test health initiatives
Do women’s 1-stop centers increase utilization?
When the Magee-Womens Hospital in Pittsburgh became one of the nation’s six centers of excellence last year, the staff decided to use the award money to investigate the prevailing "truth" that one-stop women’s health care models result in better health utilization.
On the consumer side, they plan to sharpen women’s savvy in finding "women-friendly" managed care plans. Magee also will use its research connections to encourage women to volunteer for clinical trials when researchers publish public notices.
The building blocks for the initiatives were in place before Magee won the 1996 National Center of Excellence in Women’s Health award from the Department of Health and Human Services (HHS) in Washington, DC.
"The $250,000 in contract funds that came with the award allow us to recommit our efforts to research and women’s health care directions that were already in place," says Debbie Linhart, MHA, vice president of ambulatory care and strategic development. "In no way was the money enough to start the programs from scratch."
Many women’s health resources have grouped the components of women’s health care in central locations. Fueling the effort is the belief that women will use medical and wellness services more fully when they can get all of them in one place.
"There’s not a great deal of information supporting that assumption," says Margaret McLaughlin, PhD, associate director of the research institute at Magee.
McLaughlin suspects that other factors influences choices. "One problem with utilization of one-stop health service is managed care plans," she notes. "Most plans allow one visit a year for a pap smear without pre-authorization. And for many reproductively active women, that’s their only medical contact all year."
If a center offers cholesterol screening and a smoking cessation program, will women use it? Probably not unless their managed care plans pay for lab work and smoking withdrawal sessions, McLaughlin says, and she’s in an ideal position to find out.
Satellite clinics established
McLaughlin directs Magee’s study of utilization under two delivery models staffed by the same set of health providers. One of the hospital’s satellite clinics offers one-stop screening, acute care, and health information. A second satellite has acute care only and refers patients to Magee’s other facilities for educational or preventive services. McLaughlin will compare the health outcomes from both satellites, searching for scientific reasons to pursue the one-stop health care vision or find better ways to promote prevention and health maintenance services.
Managed care threatens to usurp some of the control women have gained in governing their health care. Pre-authorization provisions place women in a "Mother, may I?" position, Linhart contends.
Although she recognizes that many plans are allowing more self-determined provider contacts, a woman can’t always discern which plans allow such choices. "One of our roles is to empower women by providing knowledge," she says.
To that end, guidelines in Magee’s educational materials help women sharpen their savvy in discerning whether a plan’s general claims address their health and wellness needs. (For a sample patient handout, please see Attention, Women, inserted in this issue.)
Following are additional services and conditions Magee urges women to examine:
• access to infertility and pregnancy termination services without referral by a primary care provider;
• coverage for neonatal intensive care services;
• conditions for switching doctors;
• payment for second opinions from plan doctors or out-of-plan doctors;
• guidelines for maternity hospital stays and home visits;
• out-of-pocket maximum charges;
• prescription payment provisions.
Promoting participation in clinical trials
In close partnership with the University of Pittsburgh’s medical and nursing schools, Magee is in a prime position to advance the feminine presence in medical research. Under its 18-month contract, Magee will work to acclimate women to the idea of volunteering for studies. "There’s been a hue and cry against male medicine for excluding women from clinical trials," McLaughlin says, "but now we have to get them to participate, or we won’t be able to go any further."
We must familiarize women with the process of clinical trials, McLaughlin advises. Most studies involve fairly routine interventions such as giving blood samples that allow researchers to follow the changes from pre-menopause to perimenopause life stages, she explains. In its public education efforts, Magee will emphasize that research studies give women the opportunity to:
• learn more about their bodies through contacts with the researchers;
• receive health benefits such as learning about risk factors and how to manage them;
• gain the satisfaction of helping the cause of women’s health and knowing others will benefit from their service.
"If researchers set up clinical trials on women, and then don’t find the subjects, we won’t get the clinical data we hope to see in a few years," McLaughlin says.
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