#MEQAPI – Tweetchat May 17-2018 3:00ET Women’s Health – A Quality Crisis

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.


This is National Women’s Health Week #NWHW, so it is fitting to reflect on how women experience the healthcare system differently to men.

In many papers and articles, authors describe how healthcare policies, equipment, processes, measurements, etc. have been built (historically) by men, and one could say are custom-designed to suit the male experience of medicine. This would be fine if the two sexes experienced illness in the same way, had identical manifestations, and identical outcomes. However, there are significant differences between how men and women, for instance, experience heart failure. Because of historical male influence, the way heart failure is described, detected, treated, etc. have tended to under-diagnose heart failure in women, and have inferior outcomes.

Since the definition of quality is how well the outcomes fit the process customer’s goals the quality of medicine is lower for women than men if the outcomes are inferior.

Likewise, the access women have the health services, including OB/GYN, may be sub-optimal. In many states, there are entire zipcodes with no facilities offering OB/GYN services. Women may often encounter higher prices for the same healthcare products and services – the so-called “pink-tax”.

These factors may translate to lower healthcare quality, as seen from the perspective of women and the process-customer.

The major causes of death in women (figure 1)* are pretty much the same as men (figure 2)*, but there are differences in the rank order and rates, and perhaps more importantly, how the two sexes experience healthcare.

CoD WomenFigure 1. Leading causes of death in women 1999-2016 .

CoD MenFigure 2. Leading causes of death in men 1999-2016.


This chat will cover several aspects of healthcare as experienced by the female patient, and we look at several high-value areas of healthcare related to women’s health.

Some reading material from Physician’s Weekly and other sources:



Womens health


  1. Access: What assists and what hinders women’s access to care?
  2. Cost: What factors increase or decrease the cost of care to women? (“Pink Tax”?)
  3. Heart disease: What risks, issues, and missed opportunities exist in relation to Heart disease in women?
  4. Cancer: What risks, issues, and missed opportunities exist in relation to cancer in women?
  5. Stroke: What risks, issues, and missed opportunities exist in relation to cancer in women?
  6. Reproductive health: What risks, issues, and missed opportunities exist in relation to Reproductive health in women?

*Tables taken from Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2016 on CDC WONDER Online Database, released December, 2017. Data are from the Multiple Cause of Death Files, 1999-2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on May 14, 2018


MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Accessibility, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.


The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.




Published by

Matthew Loxton

Healthcare Analyst using Lean Six Sigma, Knowledge Management, & Organizational Learning to improve healthcare http://linkedin.com/in/mloxton

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