Focused care: hospital specialty centers from bariatric to orthopedic.

ACROSS INDIANA hospitals are developing specialty centers to provide the focused care for conditions ranging from cancer and headaches to organ transplants and brain surgery. By combining specialized staff, new technology and patient support services in a single location, these centers are meeting the needs of a growing number of patients.

Clarian Neuroscience Methodist and Indiana University Hospitals, Indianapolis

"Having sub-specialty expertise is what makes neuroscience centers stand out," says Dr. Gerald Szkotnicki, director of neuroscience for Clarian Health. "Our physicians are known nationally and internationally for their work on pituitary tumors doing different surgical approaches to that particular type of tumor ... We have often operated on inoperable tumors with positive results, because of the confidence and recent and highly specialized training of some of our physicians. They know they can get into a certain part of the brain like no one else can."

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Few centers have the latest technology that Clarian Neuroscience offers, such as the Polstar, an intraoperative MRI that allows surgeons to view changes in the patient's brain or Spine while the surgery is in progress. In its next phase of development, the center plans to add imaging equipment that will produce live images in the operating room that are as good as in any diagnostic center. Clarian Neuroscience also has an in terventional neuroradiology suite for surgery performed using special miniaturized tools.

"It is minimally invasive brain surgery using the vascular system to access the brain," Szkotnicki says. "There's a huge shortage of such specialists, so we are lucky to have two of the nation's top specialists in neurovascular work. We are happy to have that service available, and it's available 24/7 for emergencies."

Neurotrauma is a strong part of the neuroscience program and multiple specialists need to he available in "short order," but a full range of services are available for advanced elective surgery.

Szkotnicki also credits the highly trained and experienced staff of neuroscience nurses and other support staff with being the foundation of a neuroscience center.

Methodist Hospital will be the anchor site for Clarian's neuroscience center, and will provide the high-end, neuroscience diagnostic and interventional services.

Colorectal Cancer Center, St. Francis Hospital and Health Centers, indianapolisarea

More than 100 patients have come through the Colorectal Cancer Center since it opened last July. Dedicated to the prevention, diagnosis and treatment of colorectal cancer, the third leading cause of cancer deaths in Indiana, the center features the latest technology, such as megavoltage cone beam imaging for more precise targeting of tumors, and it has piloted selective internal radiation therapy for colon cancer that has spread to the liver. Patients can participate in 100 clinical research trials though St. Francis Cancer Research Foundation.

A multidisciplinary team of more than 25 physicians discuss every case that comes through the center, a virtual center that encompasses several St. Francis campuses, for a more coordinated approach to care. A unique feature of the center is the nurse navigator, who schedules appointments, testing and acts as a liaison between the patients and all the doctors. Having one point of contact makes the process easier for patients.

"What the center does is allow for improved communication," says Michael Morelli, M.D., medical director of the Colorectal Cancer Center. "It allows physicians with different expertise to work together, and it allows the nurse navigator to tie all that together to offer patients a more positive experience. When you combine all that with the high level of expertise and the high level of technology utilized among the physicians, it creates better outcomes.

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Headache Center St. Vincent Carmel

Indiana's only dedicated headache center opened this January, headed by Dr. Edward Zdobylak, M.D., neurologist and medical director. The new 2,000-square-foot facility is located on the first floor of St. Vincent Carmel.

The environment was created specifically with migraine sufferers in mind. Zdobylak says that was one advantage to designing the center from the ground up. There are no fluorescent lights, and all lights are dimmable to zero. Carpeting is used to muffle sound, and classical music plays softly in the background.

Prior to the center's opening, Hoosiers had to travel to Chicago or Ann Arbor, Mich., to be treated in a dedicated center. Approximately 400,000 people in Indiana suffer from migraines. Less than half of them have visited a physician. Zdobylak wants to see those numbers change.

Everyone who comes to the narcotic-free, outpatient center for treatment will have a consultation with Zdobylak. The first step is to make an accurate diagnosis. Migraines are often misdiagnosed as sinus headaches or tension headaches. Then a. treatment can be determined. Zdobylak says there have been some "amazing advances" in the last 10 years, but many people aren't aware of that. In the few months the center has been open, he has seen patients ranging from those who have lived with migraines for years to teenagers who are just beginning to experience them.

"One of the things I want to do is work with businesses directly," Zdobylak says. "Ages 18 through 54 are the most productive years for workers. But in 1999 (the most recent data available) businesses lost $16 billion in indirect costs from missed work and decreased productivity due to migraines. Most people with migraines have three bed-ridden days per year."

Joint Academy St. Mary Medical Center, Hobart

Slated to open officially in June, the Joint Academy was a natural progression of enhancing one of its strongest service lines, according to Janice Ryba, hospital administrator, St. Mary Medical Center, part of the Community Healthcare System.

"The mission of our hospital is to meet the community need," Ryba says. "Our orthopedic service line was a good fit for the facility, since the majority of patients that we service are Medicare patients, and there is a high volume of utilization of orthopedics services for a Medicare population. We have 25 physicians with privileges to provide orthopedic surgeries here at St. Mary's, so we thought that drove the strength in orthopedics to focus on a joint care program."

The program, developed in conjunction with Marshall Steele & Associates, a company that offers "physician-engineered" solutions, features a team-building approach to physical therapy and innovative techniques in pain management, rapid rehabilitation and education.

Prior to surgery, patients go to class to receive education on the surgery and the process at each step. Each patient is assigned a dedicated team of orthopedic professionals and has a private suite, with accommodations for a family member or friend who acts as a "coach" during the process. Patients participate in group therapy and interact with other patients going through the same experience. They continue therapy after discharge at the Outpatient Rehabilitation Center, based at the hospital, where they receive education and follow-up from certified physical therapists, occupational therapists and social workers.

Cancer Center of Indiana Floyd Memorial Hospital and Health Services, New Albany

The Cancer Center of Indiana uses the latest technology and techniques--a linear accelerator, Intensity Modulated Radiation Therapy (IMRT), ACCULOC implanted fiducials (gold markers) that increase the effectiveness of radiation therapy for prostate cancer patients and brachytherapy (prostate seed implants).

"We are just trying to make it even more convenient, a one-stop shop for cancer patients," says Rayna Withers, director of radiation oncology. "They can come here and receive their chemo and their radiation, their blood work and x-rays. We have treatment-planning CTs in our department. With the addition of an onsite PET CT the center will be able to do diagnostic CTs, so patients wouldn't really have to go anywhere else. That's our target."

The center, which opened in 2001, began offering biofeedback therapy last year, in conjunction with a social worker who teaches breathing techniques. "Another thing we do that a lot of facilities haven't introduced yet, is we offer free massage therapy for our patients and their immediate caregivers," Withers says. Both the massages and biofeedback therapy are possible through grants from four local organizations.

The center shines when it comes to patient-focused care. "Our patient satisfaction scores come back in the 94 and 95 percentile," Withers says. "They all just brag on the staff and how caring and compassionate they are. Our receptionist will greet them by their first name when they get off the elevator. I think patients really appreciate that. Here we really try to focus on the patient, and since we are smaller, we provide more of a family atmosphere."

Joslin Diabetes Center St. Mary's Hospital, Evansville

Evansville's Joslin Diabetes Center opened in July 2003. It is one of only 29 centers affiliated with Boston's renowned Joslin Diabetes Center, the world's largest diabetes research center and provider of diabetes education. Joslin centers have the advantage of being on the forefront when it comes to the latest treatments for diabetes patients

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