Tailoring Cardiac Care for Women

Joe Cantlupe, for HealthLeaders Media , December 13, 2013
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Moreover, the prevalence of a related disease, pulmonary arterial hypertension, is twice as common in women than in men, according to Allegheny Health Network's Srinivas Murali, MD, FACC, director of the division of cardiovascular medicine and medical director of the Cardiovascular Institute. "Pulmonary hypertension" describes high blood pressure in the arteries of the lungs. Pulmonary arterial hypertension is one form of pulmonary hypertension.

The Allegheny Health Network's program features a multidisciplinary team that includes pulmonary, rheumatology, and imaging specialists who conduct a comprehensive review of each patient with pulmonary hypertension. Once a patient is diagnosed, the team evaluates the severity of the condition, prescribes treatment, offers educational programs, and coordinates care with referring physicians, Poornima says.

"Our goal is preventive treatment, and we see patients early—before they develop their heart attacks, strokes, symptoms of congestive heart failure, and other cardiovascular risk," she says. "We're seeing increased awareness—not only in referrals from other physicians but also in self-referrals from patients who would like to know more about their disease."

Success key No 2: Using electronic records

While women of child-bearing age may gravitate toward their OB-GYNs for care, they sometimes neglect checkups with primary care physicians after giving birth and may miss some nonobstetrical health issues, says Geisinger's Skelding. Studies have shown a link between certain pregnancy-related complications for women in their 20s through 40s and "having a higher risk of cardiovascular events later in life," she says.

Yet new mothers may not think of the potential problems ahead. "After her delivery, a patient's pregnancy-related issues vanish and she goes on her way, not realizing that she's at risk in the next 20 years for heart disease," says Skelding. "A woman may not see an internist for primary care until
middle age," she adds.

Through electronic health records and community involvement programs, Geisinger is focusing on improving cardiovascular care for women who have complications during pregnancy and may have a greater risk for cardiovascular disease, Skelding says.

"We and other centers around the country are attempting to engage these women early on, after their pregnancy and get them engaged in their health for life," Skelding says. "We try to work with them, to keep their risk factors in check, and have a basic awareness of the risks."

Geisinger has begun using its ProvenCare program, supported by the electronic medical records, to treat pregnant women. This will allow Geisinger to identify women with pregnancy-related complications and direct them to healthcare providers to lower their risk of cardiovascular disease later in life. Geisinger has used the program for perinatal care and surgical procedures such as coronary artery bypass grafts.

Overall, the program has shown steady improvements in clinical and financial areas, according to Geisinger officials. In 2012, the hospital reported an 80% improvement in reduced inhospital mortality rates and a 29% decrease in pulmonary complications, through the use of coronary artery bypass grafts since ProvenCare was initiated. The hospital's data was the result of reviews of 132 patients before the use of the ProvenCare and 321 afterward. An earlier Geisinger report showed ProvenCare reduced the length of patient stays from 6.2 to 5.7 days, with a 30-day readmission rate that fell 44%, from 6.9% to 3.8% between 2005 and 2009

The total inpatient profit per coronary artery bypass graft case increased by $1,946, according to the 2012 report.

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