Developing a Polyendocrine Metabolic Ovarian Syndrome (PMOS) Center of Excellence - Polyendocrine metabolic ovarian syndrome (PMOS, formerly known as polycystic ovary syndrome) is the most common endocrine disorder in reproductive-age women (10-12% prevalence) and is associated with reproductive, metabolic, cardiovascular, and psychological morbidity across the lifespan. Although evidence-based diagnostic criteria and international guidelines exist, PMOS remains markedly underdiagnosed and undertreated. At Penn Medicine, only 5.9% of female outpatients aged 18-50 carry a documented PMOS diagnosis, far below population estimates, indicating a major implementation gap in timely diagnosis, guideline-concordant screening, and coordinated care. This project will establish a Penn PMOS Center of Excellence (CoE) that transforms PMOS care from a fragmented, specialist-dependent model into a scalable, learning-health-system approach for early identification, phenotype-informed treatment, and longitudinal risk reduction. We will conduct a two-year, single-arm, prospective implementation pilot with a convergent mixed-methods evaluation. Aim 1 will build the organizational foundation for a multidisciplinary PMOS CoE by establishing governance, defining clinical roles, and creating standardized pathways for diagnosis and phenotype-informed treatment. These pathways will connect OBGYN, primary care, adolescent medicine, and specialty partners in metabolic health, cardiology, nutrition, behavioral health, reproductive endocrinology, maternal-fetal medicine, and gynecologic oncology. Aim 2 will reduce underdiagnosis and diagnostic delay through provider education, EMR-based clinical decision support, and a diagnostic pipeline for identifying patients with likely unrecognized PMOS. OBGYN and PCPs will receive guideline-based training and support to use an Epic-based order set. Provider interviews will guide user-centered improvements to clinical decision support, while nested EMR algorithms-including diagnosis-code approaches and large language model/natural language processing -will be validated to accelerate confirmation of PMOS. Aim 3 will improve access to comprehensive root-cause PMOS care by piloting universal and phenotype-based pathways supported by navigation and referral coordination. Patients will receive diagnostic confirmation, counseling on menstrual and fertility concerns, lifestyle and nutrition support, cardiometabolic and psychological screening, and treatment tailored to reproductive goals, metabolic risk, hyperandrogenism, and patient preferences. Navigation support and education materials will help patients complete recommended treatment and specialty referrals. Evaluation will be guided by continuous quality improvement using Plan-Do-Study-Act cycles. We will integrate Epic data, clinical decision support logs, provider training assessments, patient-reported outcomes, and qualitative feedback to assess reach, effectiveness, adoption, implementation, maintenance, and scalability. Outcomes will include provider knowledge and self-efficacy, order-set use, diagnostic yield and time to diagnosis, completion of guideline-concordant screening and referrals, patient satisfaction, PMOS-specific quality of life, and mental health symptoms. The multidisciplinary PMOS CoE will produce a practical toolkit of provider and patient education materials, enhanced EMR-based diagnostic and screening workflows, and phenotype-based referral and navigation processes for dissemination across Penn Medicine and adaptation by peer health systems. The proposed CoE is significant because it addresses a common, under-recognized women's health condition and has the potential to impact tens of thousands of patients across Penn Medicine (40,000), with broader national impact. By improving diagnosis, care coordination, and long-term management for adolescents and women with diagnosed or unrecognized PMOS, this project will generate a scalable model for guideline-concordant, patient-centered PMOS care across the lifespan.
