Centers of Excellence: Women’s Health
Editor’s Note: This is the third article in a series detailing BWH’s five Centers of Excellence: Cancer, Cardiovascular, Neurosciences, Orthopedics and Arthritis and Women’s Health
With its aim to improve the health of women and transform their care, the Center of Excellence in Women’s Health encompasses the traditional and critical fields of women’s health (obstetrics, gynecology, breast and gynecological cancers), but also is an integral part of BWH’s four other centers of excellence.
The Center of Excellence in Women’s Health is comprised of two areas: the Department of OB/GYN led by Robert Barbieri, MD, and the Connors Center for Women’s Health and Gender Biology, led by Paula Johnson, MD, MPH. The two areas work collaboratively on the strategic clinical plan for the center of excellence.
Connors Center for Women’s Health and Gender Biology
The Connors Center for Women’s Health and Gender Biology formed in 1999 with a vision to advance research in women’s health and sex- and gender-based biology, and to translate knowledge of sex-specific risks, manifestations, symptoms of disease and responses to treatment into clinical care.
With a focus on generating and applying new knowledge about women’s health and sex differences, the Connors Center has worked with faculty in different departments and divisions to foster the development of interdisciplinary programs, including Cardiology, Neurology, Rheumatology, Orthopedics, Thoracic, Endocrinology and Psychiatry. For example, the Women’s Interventional Cardiology Diagnostic Health Program uses existing technology with a different set of screening protocols to evaluate conditions that are more prevalent in women, such as diffuse artery narrowing and focal narrowing which limit blood supply or “small vessel disease.” And a program for women with arrhythmias focuses on the different symptoms and risks in women.
“The Brigham is looking beyond areas unique to women to advance our understanding of sex differences in all areas of health and disease. It benefits both men and women to understand the cause of differences and base treatment on them,” said Johnson, chief of the Division of Women’s Health and executive director of the Connors Center for Women’s Health and Gender Biology.
The 2005 opening of the Gretchen and Edward Fish Center at 850 Boylston St. was a major accomplishment and step forward for integrating services in women’s health. The center encompasses primary care and 12 specialties working closely together to address areas where the risk and prevalence of disease in women is of particular importance, and to translate emerging knowledge of sex differences into the delivery of care. Since its opening, the Fish Center has more than doubled its patient visits, with 25,000 visits in FY07 compared to 11,000 in FY05.
Research is crucial to understanding sex differences, informing care and changing treatment. A research advisory council, led by Jill Goldstein, PhD, director of Research for the Connors Center, is preparing to develop a birth cohort across the entire hospital to serve a wide range of research communities and assess the status of electronic prenatal and labor/delivery records, reconfigure fields to facilitate ease and validity of data entered by providers and facilitate incorporation of electronic records into a research database. This will allow the Brigham to gather information on newborns and their parents, and to follow those people over time, learning more about early determinants of risk and prevalence of disease later in life.
OB/GYN
The Center of Excellence in Women’s Health builds on a strong foundation of excellence in OB/GYN care, which began with the opening of the Boston Lying-In Hospital in 1832.
Today, BWH is a leader in OB, GYN, Gynecologic Oncology and Breast Cancer in Eastern Massachusetts. BWH ranked first in the nation in gynecology, according to the 2008 honor roll published by U.S. News & World Report.
BWH continues to make advances in the care of this population, all the while ensuring patient satisfaction—the latest Press Ganey scores put Gynecology in the 99th percentile and Obstetrics in the 86th percentile when compared with 500-plus bed teaching hospitals that use Press Ganey.
OB/GYN’s specialty network includes affiliations with 29 hospitals, health centers and practices in and around Boston and as far as Exeter, N.H.
The Department of OB/GYN is on top of the latest developments in the rapidly-evolving surgical field. In 2006, the Division of Minimally Invasive Gynecologic Surgery formed, directed by Jon Ivar Einarsson, MD. Already, it has become a busy clinical practice with six major cases performed every week on average. With this division, BWH is in a unique position to be able to offer minimally invasive gynecologic surgical techniques to a very broad patient population, including those with certain gynecologic cancers, infertility, uterine fibroids, endometriosis, pelvic pain, abnormal uterine bleeding and pelvic organ prolapse.
The expanded use of minimally invasive surgical techniques is changing the way physicians perform hysterectomies. In 2006, most hysterectomy procedures at Brigham and Women’s were performed with an abdominal incision. In 2007, the majority of hysterectomy procedures were done through the belly button with minimally invasive techniques.
The use of the da Vinci surgical robot has expanded the application of minimally invasive surgery to especially complex problems such as large fibroids and cervical cancer. The first robotic radical hysterectomy and pelvic lymphadenectomy and the first robotic myomectomy in New England were performed at BWH in 2006.
The Department of OB/GYN has a long history of excellence in research. Daniel Cramer, MD, ScD, is leading a Specialized Program of Research Excellence (SPORE) in ovarian cancer, a study now in its fourth year to address the full range of prevention, early detection and treatment of the disease. Cynthia Morton, PhD, is leading research to determine the role of genes in the biology of uterine fibroids in order to develop individualized treatment. Thomas McElrath, MD, PhD, is involved in the Prediction of Preeclampsia in Pregnancy Study to recruit a large cohort of women with both normal and adverse pregnancy outcomes.
Teaching
With a stellar reputation in excellent patient care, innovation and research, Women’s Health at BWH draws talent from all over the world for educational opportunities.
OB/GYN offers an integrated residency training program at BWH and MGH, directed by Lori Berkowitz, MD. Currently, 40 residents are participating in this training program to become clinically superior obstetrician-gynecologists. The residency program recently added a summer laparoscopy and hysteroscopy skills workshop, a rotating ethics program and the inclusion of breast health in the curriculum. The Brigham and Women’s Hospital is the sponsor for fellowship programs in Maternal-Fetal Medicine, Gynecologic Oncology, Reproductive Endocrinology and Infertility, Urogynecology, Family Planning and Minimally Invasive Gynecologic Surgery.
In addition, the Connors Center is home to a new, Harvard-wide Global Women’s Health Fellowship, led by Hilarie Cranmer, MD, MPH, from BWH’s Department of Emergency Medicine. The program enables fellows to complete an MPH at the Harvard School of Public Health, advance their clinical work, and conduct international field work and research.
“So often, women’s health globally focuses on maternal mortality or on HIV/AIDS, but we are looking at the issues affecting women’s health more broadly,” Johnson said. “Improving the health of women is an important step to improving the health of communities. It’s not just about safely delivering a healthy baby if you’re not around five years later to take care of the child.”