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Young: Changes to maternity safety net will improve Travis County care

Our region’s system for women’s health care is broken. It is needlessly difficult, fragile and sometimes even dangerous for the people who need it. The experience of one of my recent patients — we’ll call her Sara, though it’s not her real name — shows how.

Sara was 18-years-old, pregnant and underinsured. She was also struggling with several medical issues that required a higher level of care. By the time I saw her, Sara had seen at least four different providers — not counting consultants — in four different settings. She had been admitted to two different hospitals in different systems. Her medical story was spread across at least four sets of medical records.

But for this systemic fragmentation, Sara could have avoided at least one hospital visit. She could have been subjected to fewer medical tests and interventions, which would have been better for her and more efficient for the system. She would have experienced less stress, worried less about her unborn child and enjoyed a smoother pregnancy.

Sara’s story is important not because it’s unusual, but rather because it’s common. The obstetrical and gynecological system serving women in Travis County often imposes obstacles on the very women it’s meant to help.

It’s past time to fix it.

Since I arrived at the Dell Medical School at the University of Texas at Austin last year, I have been working with a wide range of partners and team members to create a more integrated and more effective system for women’s health in Travis County. That system will launch on April 4 in collaboration with Central Health, CommUnityCare, the Seton Healthcare Family, St. David’s and the Community Care Collaborative. This partnership is redefining the health safety net in Travis County through transformative models of care.

This project represents the first significant redesign of our local health care system to come out of Travis County’s voters’ investment in the Dell Medical School. This new model of health care will provide the foundation for more ambitious “woman-centered” care design and delivery projects. We plan to measure and demonstrate the value of this work to all of Travis County and to women in every part of the community while maintaining and improving access to reproductive health services. The pillars of this effort are safe and cost-effective care:

  • We will improve women’s access to the right providers at the right time — and to a higher level of care earlier for the majority of the conditions they will face. We’ll also embed academic specialists and subspecialists in the communities of our patients.
  • We will create safer care, both by establishing standards that providers must achieve and by consolidating great care in centers of excellence. Referral guidelines, stratified by risk, will ensure that women are cared for by the right provider at the right time. Ultrasound services will be performed through accredited units, improving detection of abnormalities in routine screening. Handoffs between providers will be warmer, in part due to training and collaboration, but also through the placement of providers in the community as a part of the inpatient care team.
  • We will ensure that care is more cost-effective. By receiving care from the most appropriate providers, women won’t be subjected to unnecessary tests or procedures. We will reduce the delay in treatment that comes from multiple referrals. Providers will practice to the “top of their license,” utilizing all of their training and feeling confident that a system of providers will support them whenever there’s a question or concern.

Ultimately, the success of this redesign project will be determined by improved outcomes — the health of women in Travis County. We will measure patient satisfaction and traditional outcomes, and we will carefully monitor care for our patients, adjusting and improving the system as we go.

The Dell Medical School was created to bring about just this kind of opportunity for all of our community.

Young is the inaugural chair of Women’s Health at the Dell Medical School at the University of Texas.

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