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Welcome to the Clinical
Center Grand Rounds,

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a weekly series of educational
lectures for physicians and

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health care professionals
broadcast from the Clinical

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Center at the National
Institutes of Health in

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Bethesda, MD.

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The NIH Clinical Center is the
world's largest hospital totally

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dedicated to investigational
research and leads the global

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effort in training today's
investigators and discovering

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tomorrow's cures.

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Learn more by visiting us online
at http://clinicalcenter.nih.gov

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>>WELCOME TO TODAY'S CLINICAL

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CENTER GRAND ROUNDS.

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THIS WEEK IS PATIENT SAFETY

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AWARENESS WEEK.

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PATIENT SAFETY AWARENESS WEEK

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WAS FOUNDED IN 2003, BY THE

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NATIONAL PATIENT SAFETY

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FOUNDATION, WHICH LATER MERGED

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WITH THE INSTITUTE FOR HEALTH

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CARE IMPROVEMENT.

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THIS WEEK WAS ESTABLISHED TO

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ESTABLISH EVERYONE TO LEARN MORE

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ABOUT HEALTH CARE SAFETY, TO

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ADVANCE IMPORTANT DISCUSSIONS

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LOCALLY AND GLOBALLY, AND TO

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INSPIRE ACTION TO IMPROVE THE

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SAFETY OF THE HEALTH CARE SYSTEM

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FOR PATIENTS AND FOR THE

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WORKFORCE.

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AT THE NIH CLINICAL CENTER,

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WE'RE GUIDED BY OUR INDIVIDUAL

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AND COLLECTIVE PASSION FOR HIGH

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RELIABILITY IN THE SAFE DELIVERY

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OF PATIENT-CENTRIC CARE IN A

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CLINICAL RESEARCH ENVIRONMENT.

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WE PROVIDE HOPE THROUGH

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PIONEERING CLINICAL RESEARCH TO

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IMPROVE HUMAN HEALTH.

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FOR US, WE KNOW SAFE AND

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HIGH-QUALITY PATIENT CARE ARE

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INTEGRAL TO THE WORLD CHANGING

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CLINICAL RESEARCH.

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OUR SPEAKER TODAY IS DR. BLAIR

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EIG, WITH THE NON-PATIENT SAFETY

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ORGANIZATION DESIGNATED BY

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MARYLAND AND BY OUR SIBLING

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FEDERAL AGENCY THE AGENCY FOR

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HEALTH CARE RESEARCH AND

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QUALITY.

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DR. EIG IS A NATIVE OF MARYLAND,

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AND RECEIVED A BACHELOR'S IN

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BIOLOGY AND BIOCHEMISTRY AND

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MASTER'S IN BIOCHEMISTRY IN

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BRANDEIS UNIVERSITY.

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HE EARNED A MEDICAL DEGREE FROM

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HARVARD MEDICAL SCHOOL, AND

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COMPLETED HIS PEDIATRIC

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RESIDENCY AND CHIEF RESIDENCY AT

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CHILDREN'S NATIONAL MEDICAL

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CENTER IN WASHINGTON, D.C.

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HE LATER COMPLETED A MASTER'S IN

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BUSINESS ADMINISTRATION FROM

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AMERICAN UNIVERSITY, ALSO IN

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WASHINGTON, D.C.

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DR.  EIG IS AT THE GEORGE

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WASHINGTON SCHOOL OF MEDICINE,

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CHIEF MEDICAL OFFICER AT HOLY

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CROSS HEALTH SYSTEM, PART OF THE

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MARYLAND REGION OF TRINITY

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HEALTH FOR 19 YEARS.

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PRIOR TO THAT, HE PRACTICED

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PRIMARY CARE PEDIATRICS FOR 14

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YEARS IN SILVER SPRING.

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HE HAS SERVED AS PRESIDENT OF

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THE MEDICAL STAFF AT CHILDREN'S

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NATIONAL, CHAIR OF THE

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LABORATORY ADVISORY COMMITTEE

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FOR STATE OF MARYLAND, BOARD

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CHAIR FOR MARYLAND HEALTH CARE

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EDUCATION INSTITUTE, A MEMBER OF

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THE EXECUTIVE COMMITTEE OF THE

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MARYLAND HOSPITAL ASSOCIATION.

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I RECEIVED A LEADERSHIP AWARD

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FROM MONTGOMERY COUNTY PEDIATRIC

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SOCIETY, AND PEDIATRICIAN OF THE

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YEAR FROM THE SAME SOCIETY, AS

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WELL AS MAYNARD CONE AWARD FOR

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PEDIATRICS FROM CHILDREN'S

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NATIONAL MEDICAL CENTER.

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PLEASE WELCOME OUR SPEAKER, DR.

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BLAIR EIG, FOR HIS PRESENTATION,

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HEALTH EQUITY AS A PATIENT

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SAFETY ISSUE.

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DR. EIG.

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>> THANK YOU VERY MUCH,
DAVID.

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THANK YOU ALL FOR INVITING ME

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HERE TO SPEAK TODAY ON THE

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TIMELY AND IMPORTANT ISSUE FOR

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SAFE DELIVERY OF HEALTH CARE AND

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FOR THE SUCCESS OF CLINICAL

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RESEARCH.

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I'M A NATIVE OF THE COMMUNITY,

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HONORED TO PRESENT TO THE

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CLINICAL CENTER.

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I ATTENDED A LOCAL HIGH SCHOOL,

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HAVE A BIG NUMBER REUNION WITH A

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ZERO AT THE END LATER THIS YEAR.

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I ALSO CARED FOR MANY OF THE

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CLINICAL STAFF FAMILY MEMBERS

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WHEN I WAS IN PEDIATRIC PRACTICE

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IN SILVER SPRING EARLY IN MY

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CAREER AND OVERSAW CARE OF MANY

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MORES CHIEF MEDICAL OFFICER AT

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HOLY CROSS FOR ALMOST 20 YEARS.

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FINALLY, AS I THINK DAVID

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MENTIONED, WE REALLY APPRECIATE

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HAVING THE CLINICAL CENTER AS A

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MEMBER OF THE MARYLAND PATIENT

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SAFETY CENTER.

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WE HAVE MANY CONFERENCES AND

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EDUCATIONAL PROGRAMS THAT YOU

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CAN ATTEND, MOST FOR FREE, SOME

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FOR REDUCED FREE, AND MANY

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INCLUDE CONTINUING EDUCATION

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LIKE CME FOR FREE.

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SO WE OFFER THAT TO YOU AND

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PLEASE WOULD LIKE YOU TO AVAIL

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YOURSELF OF THAT.

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TODAY I'LL BE DISCUSSING HEALTH

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EQUITY.

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WHAT IT IS, MORE ACCURATELY THE

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LACK OF IT, HOW IT IMPACTS

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DISPARITIES IN CLINICAL CARE AND

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CLINICAL RESEARCH AND WHAT WE

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CAN DO TO PROMOTE A MORE

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EQUITABLE HEALTH CARE SYSTEM,

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BECAUSE A MORE EQUITABLE HEALTH

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CARE SYSTEM WILL RESULT IN

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BETTER AND SAFER HEALTH CARE

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OUTCOMES FOR ALL OF OUR

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PATIENTS.

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THROUGHOUT THE TALK I'LL WEAVE

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IN WHAT WE'RE DOING AT THE

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MARYLAND PATIENT SAFETY CENTER

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IN THIS REGARD, WORKING ON

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DISPARITIES IN HEALTH CARE,

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IMPROVING SAFETY OF CARE

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PROVIDED, AND TRYING TO HELP

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BOTH CLINICIANS AND RESEARCHERS

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DO BETTER IN TERMS OF PROVIDING

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EQUITABLE CARE.

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I'LL END WITH SOME IDEAS ON WHAT

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YOU AS CLINICAL RESEARCHERS AND

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CAREGIVERS CAN DO TO IMPROVE

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HEALTH EQUITY AND THE GREAT WORK

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YOU DO.

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ASSISTED IN PREPARING THIS TALK

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BY MY STAFF AT THE MARYLAND

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PATIENT SAFETY CENTER.

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I WANT TO CALL OUT SPECIFICALLY

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DR. ADRIAN BURGESS, AN R.N.

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Ph.D., EXPERT IN MATERNAL CARE

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AND LED PROGRAMS IN THAT AREA

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INCLUDING SOME I'LL TALK ABOUT

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TODAY INCLUDING BIRTH EQUITY.

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I HAVE NO CONFLICTS, ACTUAL OR

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POTENTIAL, CONFLICTS OF INTEREST

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TO REPORT.

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THESE ARE LEARNING OBJECTIVES.

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BOTH VERY GOOD, A LITTLE COMPLEX

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BUT UNDERSTANDING THE IMPACT OF

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PERSONAL BIASES, IMPLICIT AND

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EXPLICIT, OF DIVERSITY AND

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INCLUSION ON SAFETY PATIENT

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CARE, AND STRATEGIES TO  MITIGAE

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BUYS AND IMPROVE REPRESENTATION,

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ESPECIALLY IN CLINICAL RESEARCH.

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WE'LL GET STARTED WITH A QUOTE

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FROM DR. KING.

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OF ALL THE FORMS OF INEQUALITY

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INJUSTICE IN HEALTH IS THE MOST

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SHOCKING AND MOST INHUMAN

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BECAUSE IT OFTEN RESULTS IN

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PHYSICAL DEATH.

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THE DIAGRAM YOU SEE ON THE

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SLIDE, SORRY IT'S NOT AS CLEAR

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AS IT MIGHT BE, IS FROM THE

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MID-1960s, WHERE THEY STILL

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HAD SEGREGATED UNITS AT THE

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HOSPITAL.

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THERE'S A WING FOR BLACK

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FEMALES, BLACK MALES, AND WHITE

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FEMALES.

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AND AS IT WAS IN EDUCATION,

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SEPARATE WAS NOT EQUAL.

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AND THIS OBVIOUSLY IS LONG GONE

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BUT THERE STILL ARE SOME

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STRUCTURAL ISSUES IN THE HEALTH

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CARE WE PROVIDE THAT MAY LEAD TO

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UNEQUAL OUTCOMES DEPENDING UPON

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YOUR ETHNICITY, RACE, COUNTRY OF

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ORIGIN, LANGUAGE.

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WE'LL TALK MORE ABOUT THAT

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TODAY.

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SO WHAT IS HEALTH EQUITY?

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THIS IS THE DEFINITION FROM THE

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CDC, I REFER YOU TO THE CDC FOR

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MORE EXTENSIVE DISCUSSION ON THE

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WEBSITE.

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BUT HEALTH EQUITY IS THE STATE

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IN WHICH EVERYONE HAS A FAIR AND

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JUST OPPORTUNITY TO ATTAIN THEIR

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HIGHEST LEVEL OF HEALTH.

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NOT EVERYONE WILL BE ABLE OR

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WILL WANT TO SEEK THAT OUT, BUT

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EVERYBODY SHOULD HAVE THAT

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OPPORTUNITY.

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AND I'LL ALSO POINT OUT,

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SOMETHING WE'LL TALK ABOUT HERE,

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IS IN THE THIRD BULLET POINT

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THAT IS INVOLVES ACKNOWLEDGING

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AND ADDRESSING RACISM AS A

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THREAT TO PUBLIC HEALTH AND

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RESEARCH, AND THE HISTORY OF

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UNETHICAL PRACTICES IN PUBLIC

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HEALTH TO LED TO INEQUITABLE

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HEALTH OUTCOMES.

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THIS ALSO IMPACTS THE TRUST THAT

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VARIOUS COMMUNITIES HAVE IN THE

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HEALTH CARE SYSTEM, AND IN

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CLINICAL RESEARCH.

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AGAIN, WE'LL TALK ABOUT THAT,

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BUT IT'S IMPORTANT TO UNDERSTAND

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THAT THERE IS A LEVEL OF -- IN

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THE STRUCTURE OF OUR HEALTH CARE

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SYSTEM AND IN OUR CLINICAL

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RESEARCH THAT STILL LEADS TO

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UNEQUAL REACHING OUT AT

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OUTCOMES, AND A LACK OF TRUST

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THAT CERTAIN COMMUNITIES HAVE IN

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US.

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AND WE NEED TO OVERCOME THAT.

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SO, WHAT IS THE IMPORTANCE OF

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HEALTH EQUITY?

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AND THE FIRST IS MAYBE THE MOST

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IMPORTANT.

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IT'S WHAT AMERICA IS ABOUT.

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IT'S OUR DREAM.

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HERE'S THE QUOTE FROM

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DECLARATION OF INDEPENDENCE,

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ACKNOWLEDGE THAT WAS WRITTEN BY

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THOMAS JEFFERSON WHO OWNED

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SLAVES.

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HE ALSO WROTE, WHICH WAS THE --

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IN THE SPIRIT OF THE TIME ALL

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MEN ARE CREATED EQUAL, I CHANGED

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THAT, ALL ARE CREATED EQUAL.

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THAT'S WHAT WE BELIEVE IN OUR

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SYSTEM, THAT EVERYBODY HAS AN

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00:09:32,240 --> 00:09:32,800
EQUAL CHANCE.

261
00:09:32,800 --> 00:09:34,640
AND SHOULD HAVE AN EQUAL CHANCE

262
00:09:34,640 --> 00:09:37,640
TO LIFE, LIBERTY, PURSUIT OF

263
00:09:37,640 --> 00:09:39,800
HAPPINESS AND HEALTH CARE.

264
00:09:39,800 --> 00:09:41,280
THERE'S AN ETHICAL IMPERATIVE.

265
00:09:41,280 --> 00:09:44,200
IT'S THE RIGHT THING TO DO.

266
00:09:44,200 --> 00:09:46,880
WE ALL AGREE, I WOULD HOPE, THAT

267
00:09:46,880 --> 00:09:50,000
EVERYBODY SHOULD HAVE THAT EQUAL

268
00:09:50,000 --> 00:09:54,560
CHANCE TO THE BEST HEALTH CARE

269
00:09:54,560 --> 00:09:54,840
ATTAINABLE.

270
00:09:54,840 --> 00:09:55,840
THERE'S COMMUNITY STANDARDS.

271
00:09:55,840 --> 00:09:57,760
WE DON'T THINK THAT ONE GROUP OF

272
00:09:57,760 --> 00:10:00,840
OUR COMMUNITY HAS A LESS OF A

273
00:10:00,840 --> 00:10:02,160
RIGHT THAN ANOTHER.

274
00:10:02,160 --> 00:10:05,240
AND MANY OF OUR SOCIAL AND

275
00:10:05,240 --> 00:10:07,080
RELIGIOUS TRADITIONS SPEAK TO

276
00:10:07,080 --> 00:10:08,520
COMPASSION FOR THOSE WHO HAVE

277
00:10:08,520 --> 00:10:11,240
LESS THAN THE REST OF US, THAT

278
00:10:11,240 --> 00:10:12,400
WE SHOULD HAVE COMPASSION AND

279
00:10:12,400 --> 00:10:13,840
PROVIDE FOR THOSE IN NEED

280
00:10:13,840 --> 00:10:14,880
BECAUSE THEY DON'T HAVE THE

281
00:10:14,880 --> 00:10:17,720
RESOURCES, THEY DON'T HAVE THE

282
00:10:17,720 --> 00:10:20,040
KNOWLEDGE, THEY DON'T HAVE THE

283
00:10:20,040 --> 00:10:22,200
ABILITY TO GAIN THAT, AND WE

284
00:10:22,200 --> 00:10:24,520
SHOULD HELP PROVIDE THAT FOR

285
00:10:24,520 --> 00:10:24,720
THEM.

286
00:10:24,720 --> 00:10:26,240
FINALLY, I'LL COME BACK TO THIS

287
00:10:26,240 --> 00:10:31,200
AGAIN A FEW TIMES, THERE'S A

288
00:10:31,200 --> 00:10:32,360
FINANCIAL COST TO SOCIETY.

289
00:10:32,360 --> 00:10:34,160
MAYBE IT GOES WITHOUT SAYING,

290
00:10:34,160 --> 00:10:37,840
BUT I OFTEN WANT TO REPEAT FOR

291
00:10:37,840 --> 00:10:42,560
EVERYONE THAT IT IS MUCH MORE

292
00:10:42,560 --> 00:10:44,040
EXPENSIVE TO TREAT THE ILLNESS

293
00:10:44,040 --> 00:10:47,160
OR THE MEDICAL ERROR THAT OCCURS

294
00:10:47,160 --> 00:10:51,240
THAN TO PREVENT IT. 

295
00:10:51,240 --> 00:10:57,320
SO DEVELOPING SAFE AND BROAD

296
00:10:57,320 --> 00:10:59,760
HEALTH CARE AND RESEARCH IS AN

297
00:10:59,760 --> 00:11:00,520
IMPERATIVE BECAUSE IT'S CHEAPER

298
00:11:00,520 --> 00:11:02,200
THAN HAVING TO BE REACTIONARY

299
00:11:02,200 --> 00:11:08,800
AND PAY FOR IT WHEN IT GOES

300
00:11:08,800 --> 00:11:11,120
WRONG. 

301
00:11:11,120 --> 00:11:12,480
CAUSES OF HEALTH CARE

302
00:11:12,480 --> 00:11:13,560
DISPARITIES WE'LL CONTINUE TO

303
00:11:13,560 --> 00:11:15,760
LEARN OF THE SOCIAL DETERMINANTS

304
00:11:15,760 --> 00:11:17,520
OF HEALTH.

305
00:11:17,520 --> 00:11:19,560
THOSE INCLUDE NOT HAVING

306
00:11:19,560 --> 00:11:20,640
RESOURCES, POVERTY,

307
00:11:20,640 --> 00:11:21,640
ENVIRONMENTAL THREATS THAT SOME

308
00:11:21,640 --> 00:11:23,640
COMMUNITIES, AND WE'VE LEARNED

309
00:11:23,640 --> 00:11:26,880
OF THIS MOST RECENTLY IN OHIO,

310
00:11:26,880 --> 00:11:30,160
IT'S ALSO HAPPENED IN VARIOUS

311
00:11:30,160 --> 00:11:32,040
COMMUNITIES STRUGGLING WITH LEAD

312
00:11:32,040 --> 00:11:32,920
CONTAMINATING THE WATER, THAT

313
00:11:32,920 --> 00:11:34,200
THERE ARE ENVIRONMENTAL THREATS

314
00:11:34,200 --> 00:11:35,880
OUT THERE THAT PUT SOME PEOPLE

315
00:11:35,880 --> 00:11:39,280
AT MORE RISK AND THEY TEND TO BE

316
00:11:39,280 --> 00:11:42,600
IN AREAS THAT HAVE LESS ACCESS

317
00:11:42,600 --> 00:11:46,240
TO BOTH HEALTH CARE AND OTHER

318
00:11:46,240 --> 00:11:47,200
RESOURCES.

319
00:11:47,200 --> 00:11:48,360
THERE'S INDIVIDUAL AND

320
00:11:48,360 --> 00:11:50,520
BEHAVIORAL FACTORS THAT MAY NOT

321
00:11:50,520 --> 00:11:52,040
HAVE TO DO WITH SOCIAL

322
00:11:52,040 --> 00:11:53,000
DETERMINANTS OF HEALTH, BUT THE

323
00:11:53,000 --> 00:11:58,640
LACK OF TRUST IN THE SYSTEM OR

324
00:11:58,640 --> 00:12:00,400
NOT JUST UNDERSTANDING,

325
00:12:00,400 --> 00:12:01,360
EDUCATIONAL INEQUALITIES, AGAIN

326
00:12:01,360 --> 00:12:09,920
WITHOUT THE KNOWLEDGE OF WHAT IS

327
00:12:09,920 --> 00:12:10,280
NEEDED.

328
00:12:10,280 --> 00:12:12,520
AND RACISM, STILL BUILT IN SOME

329
00:12:12,520 --> 00:12:14,920
OF OUR SYSTEMS THAT WILL FAVOR

330
00:12:14,920 --> 00:12:17,440
SOME OVER OTHERS IN TERMS OF THE

331
00:12:17,440 --> 00:12:20,840
ABILITY TO GET THEIR OPTIMAL

332
00:12:20,840 --> 00:12:24,680
HEALTH, AND THERE IS WITHIN US

333
00:12:24,680 --> 00:12:25,560
ALL SOME IMPLICIT BIAS, WE'RE

334
00:12:25,560 --> 00:12:26,840
BORN WITH THAT.

335
00:12:26,840 --> 00:12:29,400
WE DEAL WITH IT, THAT MAY CAUSE

336
00:12:29,400 --> 00:12:31,560
US TO TREAT DIFFERENT GROUPS IN

337
00:12:31,560 --> 00:12:33,240
OUR CASE AS HEALTH CARE

338
00:12:33,240 --> 00:12:37,440
PROVIDERS, DIFFERENT GROUPS OF

339
00:12:37,440 --> 00:12:38,240
PATIENTS, RESEARCH SUBJECTS

340
00:12:38,240 --> 00:12:39,280
DIFFERENTLY BECAUSE OF THE

341
00:12:39,280 --> 00:12:41,720
CATEGORY THEY COME FROM, WHETHER

342
00:12:41,720 --> 00:12:46,000
THAT BE ETHNICITY, RACE, COUNTRY

343
00:12:46,000 --> 00:12:47,080
OF ORIGIN, LANGUAGE FOCUSED.

344
00:12:47,080 --> 00:12:49,480
WE HAVE TO ACKNOWLEDGE THAT

345
00:12:49,480 --> 00:12:52,000
EXISTS, AND OVERCOME IT, EVEN

346
00:12:52,000 --> 00:12:55,400
THOUGH WE CAN'T ALL -- WE HAVE

347
00:12:55,400 --> 00:12:57,040
TO -- THE KNOWLEDGE WE'RE NOT

348
00:12:57,040 --> 00:12:57,240
PERFECT.

349
00:12:57,240 --> 00:12:59,240
WE'LL GET INTO THIS A LITTLE BIT

350
00:12:59,240 --> 00:13:02,480
MORE AS WE GO ALONG.

351
00:13:02,480 --> 00:13:04,280
ON THE RIGHT SIDE, THE COLUMN

352
00:13:04,280 --> 00:13:07,960
SHOWS MANY OF THE DISEASES THAT

353
00:13:07,960 --> 00:13:10,600
ARE IMPACTED, THAT SHOW

354
00:13:10,600 --> 00:13:14,000
SIGNIFICANT DISPARITIES AMONG

355
00:13:14,000 --> 00:13:16,400
VARIOUS GROUPS, AGAIN ETHNICITY,

356
00:13:16,400 --> 00:13:17,960
RACE, LANGUAGE, COUNTRY OF

357
00:13:17,960 --> 00:13:18,560
ORIGIN.

358
00:13:18,560 --> 00:13:20,040
DIABETES, HEART DISEASE, CANCER,

359
00:13:20,040 --> 00:13:21,240
COMPLICATIONS OF PREGNANCY, AND

360
00:13:21,240 --> 00:13:23,400
OF COURSE WE KNOW COVID, WE'VE

361
00:13:23,400 --> 00:13:24,800
JUST BEEN LIVING THROUGH THAT,

362
00:13:24,800 --> 00:13:26,800
WHERE THERE ARE DIFFERENTIAL

363
00:13:26,800 --> 00:13:27,840
OUTCOMES DEPENDING UPON PERHAPS

364
00:13:27,840 --> 00:13:30,120
WHERE YOU LIVE OR WHO YOU ARE.

365
00:13:30,120 --> 00:13:31,880
I WILL BE PRESENTING DATA AS I

366
00:13:31,880 --> 00:13:33,840
DO IN THIS SLIDE ON MATERNAL

367
00:13:33,840 --> 00:13:37,120
MORBIDITY AND MORTALITY BECAUSE

368
00:13:37,120 --> 00:13:37,880
THAT'S WHAT WE'RE CONCENTRATING

369
00:13:37,880 --> 00:13:40,400
ON IN OUR HEALTH EQUITY WORK AT

370
00:13:40,400 --> 00:13:41,840
THE PATIENT SAFETY CENTER.

371
00:13:41,840 --> 00:13:45,440
AND WHAT YOU SEE HERE IS DATA

372
00:13:45,440 --> 00:13:48,600
FROM THE CDC ON COMPLICATIONS OF

373
00:13:48,600 --> 00:13:49,840
PREGNANCY, SEVERE MATERNAL

374
00:13:49,840 --> 00:13:53,880
MORBIDITY AND MORTALITY, I'M

375
00:13:53,880 --> 00:13:56,160
SORRY SEVERE MATERNAL MORBIDITY,

376
00:13:56,160 --> 00:13:57,800
WHERE BLACK AND NATIVE AMERICAN

377
00:13:57,800 --> 00:14:00,080
WOMEN HAVE TWICE THE RATE OF

378
00:14:00,080 --> 00:14:02,000
COMPLICATIONS OF PREGNANCY AS

379
00:14:02,000 --> 00:14:03,640
WHITE WOMEN IN AMERICA.

380
00:14:03,640 --> 00:14:04,840
THAT HOLDS TRUE FOR MOST OF THE

381
00:14:04,840 --> 00:14:06,040
STATES IN THE COUNTRY.

382
00:14:06,040 --> 00:14:08,840
WE'LL GET TO MARYLAND DATA IN A

383
00:14:08,840 --> 00:14:09,840
LITTLE BIT.

384
00:14:09,840 --> 00:14:11,640
THERE ARE REASONS FOR THAT, THAT

385
00:14:11,640 --> 00:14:13,600
WE COVERED ON THE LAST SLIDE, IN

386
00:14:13,600 --> 00:14:15,720
TERMS OF SOCIAL DETERMINANTS OF

387
00:14:15,720 --> 00:14:18,720
HEALTH, AND PERHAPS STRUCTURAL

388
00:14:18,720 --> 00:14:21,000
RACISM, AND SOME IMPLICIT BIAS

389
00:14:21,000 --> 00:14:23,240
IN THE CAREGIVERS.

390
00:14:23,240 --> 00:14:24,960
ALL OF WHICH VARY IN ALL OF

391
00:14:24,960 --> 00:14:26,160
THESE DISEASES.

392
00:14:26,160 --> 00:14:27,400
THEY ALSO AFFECT ACCESS TO

393
00:14:27,400 --> 00:14:28,720
HEALTH CARE, DEPENDING UPON

394
00:14:28,720 --> 00:14:30,240
WHERE YOU LIVE, INNER CITY OR

395
00:14:30,240 --> 00:14:32,400
PERHAPS RURAL AREAS, YOU MAY NOT

396
00:14:32,400 --> 00:14:36,000
HAVE THE SAME ACCESS.

397
00:14:36,000 --> 00:14:36,720
AND PREVENTIVE MEASURES VARY

398
00:14:36,720 --> 00:14:38,040
DEPENDING ON WHERE YOU LIVE AND

399
00:14:38,040 --> 00:14:39,120
WHO YOU ARE.

400
00:14:39,120 --> 00:14:41,240
FINALLY, AS I SAID BEFORE, THE

401
00:14:41,240 --> 00:14:43,400
OVERALL COST TO THE SYSTEM OF

402
00:14:43,400 --> 00:14:45,880
ALLOWING DISPARITIES AND

403
00:14:45,880 --> 00:14:48,960
ALLOWING ERRORS TO OCCUR FOR

404
00:14:48,960 --> 00:14:52,920
POORER HEALTH TO RESULT COSTS US

405
00:14:52,920 --> 00:14:53,760
MORE.

406
00:14:53,760 --> 00:15:01,600
PREVENTION OF BOTH ERRORS AND

407
00:15:01,600 --> 00:15:12,040
DISEASE IS LESS EXPENSIVE. 

408
00:15:15,200 --> 00:15:16,800
AS I SAID, I'LL TALK A LITTLE

409
00:15:16,800 --> 00:15:18,760
BIT MORE ABOUT COMPLICATIONS OF

410
00:15:18,760 --> 00:15:19,480
PREGNANCY.

411
00:15:19,480 --> 00:15:20,280
THESE ARE DISPARITIES IN

412
00:15:20,280 --> 00:15:21,360
MATERNAL MORTALITY IN THE U.S.

413
00:15:21,360 --> 00:15:23,360
THE REASON I BRING UP THIS SLIDE

414
00:15:23,360 --> 00:15:24,920
IS TO SHOW THAT THERE'S THREE

415
00:15:24,920 --> 00:15:26,600
TIMES THE RATE OF MATERNAL

416
00:15:26,600 --> 00:15:27,720
MORTALITY IN BLACK WOMEN

417
00:15:27,720 --> 00:15:29,520
COMPARED TO WHITE WOMEN IN THE

418
00:15:29,520 --> 00:15:29,800
COUNTRY.

419
00:15:29,800 --> 00:15:33,560
AND AS YOU CAN SEE FROM 2018 TO

420
00:15:33,560 --> 00:15:35,280
2020, IT'S GETTING WORSE.

421
00:15:35,280 --> 00:15:37,800
SO THIS IS A CALL FOR ACTION.

422
00:15:37,800 --> 00:15:41,960
WE NEED TO ADDRESS THIS.

423
00:15:41,960 --> 00:15:44,120
AND HAPPY TO SAYS MANY AREAS ARE

424
00:15:44,120 --> 00:15:47,440
ADDRESSING IT, EVEN IN OP EDS IN

425
00:15:47,440 --> 00:15:49,880
THE "WASHINGTON POST," NOT A BAD

426
00:15:49,880 --> 00:15:50,920
THING, IT'S CALLING OUR

427
00:15:50,920 --> 00:15:52,000
ATTENTION TO IT.

428
00:15:52,000 --> 00:15:54,560
THIS IS LOOKING AT IT FROM THE

429
00:15:54,560 --> 00:15:55,120
VIEW OF EDUCATION.

430
00:15:55,120 --> 00:15:59,480
I THINK THIS POINTS OUT THAT

431
00:15:59,480 --> 00:16:02,360
IT'S NOT ALL EVERY SOCIAL

432
00:16:02,360 --> 00:16:04,080
DETERMINANT OF HEALTH THAT IS

433
00:16:04,080 --> 00:16:05,880
INVOLVED IN THE DISPARITY.

434
00:16:05,880 --> 00:16:13,920
SPECIFICALLY HERE, YOU SEE THAT

435
00:16:13,920 --> 00:16:15,840
WHITE WOMEN ARE THE THIRD GROUP

436
00:16:15,840 --> 00:16:18,240
OF BARS OVER FROM THE LEFT,

437
00:16:18,240 --> 00:16:20,920
BLACK WOMEN ARE THE LAST GROUP

438
00:16:20,920 --> 00:16:24,120
OF BARS, CLOSEST TO THE RIGHT.

439
00:16:24,120 --> 00:16:25,880
AND THAT DESPITE HIGHER

440
00:16:25,880 --> 00:16:28,520
EDUCATION, GREEN AND YELLOW ARE

441
00:16:28,520 --> 00:16:30,800
COLLEGE EDUCATED, THERE'S STILL

442
00:16:30,800 --> 00:16:34,080
TWO TO THREE TIMES THE MORTALITY

443
00:16:34,080 --> 00:16:37,360
RATE IN BLACK WOMEN COMPARED TO

444
00:16:37,360 --> 00:16:37,720
WHITE.

445
00:16:37,720 --> 00:16:39,680
SO IT ISN'T EDUCATION THAT'S

446
00:16:39,680 --> 00:16:42,520
PREVENTING THAT DISPARITY.

447
00:16:42,520 --> 00:16:43,800
IT'S STILL THERE.

448
00:16:43,800 --> 00:16:47,640
OTHER CONFOUNDING FACTORS,

449
00:16:47,640 --> 00:16:48,440
PHYSICIAN-PATIENT RACIAL

450
00:16:48,440 --> 00:16:49,480
CONCORDANCE, DOES IT MATTER,

451
00:16:49,480 --> 00:16:50,800
DOES HAVING A DOCTOR OF THE SAME

452
00:16:50,800 --> 00:16:52,440
ETHNICITY OR RACE MAKE A

453
00:16:52,440 --> 00:16:52,920
DIFFERENCE?

454
00:16:52,920 --> 00:16:54,200
IN SOME STUDIES IT DOES.

455
00:16:54,200 --> 00:16:55,600
IN SOME IT DOES NOT.

456
00:16:55,600 --> 00:16:58,280
SPECIFICALLY, THIS WAS A STUDY

457
00:16:58,280 --> 00:17:04,480
DONE IN STATE OF FLORIDA, YOU

458
00:17:04,480 --> 00:17:06,120
CAN SEE 1.8 MILLION HOSPITAL

459
00:17:06,120 --> 00:17:08,200
BIRTHS REVIEWED.

460
00:17:08,200 --> 00:17:11,520
AND IT'S FOUND THAT RACIAL

461
00:17:11,520 --> 00:17:14,440
CONCORDANCE, THAT IS A BLACK

462
00:17:14,440 --> 00:17:16,320
PHYSICIAN WITH A BLACK INFANT,

463
00:17:16,320 --> 00:17:17,600
RESULTED IN A SIGNIFICANT

464
00:17:17,600 --> 00:17:18,440
IMPROVEMENT IN MORTALITY FOR

465
00:17:18,440 --> 00:17:20,200
THOSE BLACK INFANTS.

466
00:17:20,200 --> 00:17:22,560
THAT WAS NOT THE SAME FOR THE

467
00:17:22,560 --> 00:17:23,200
MOTHERS.

468
00:17:23,200 --> 00:17:23,960
MATERNAL MORTALITY WAS NOT

469
00:17:23,960 --> 00:17:25,400
AFFECTED IN THIS STUDY.

470
00:17:25,400 --> 00:17:27,680
BUT IT DOES BRING UP THE

471
00:17:27,680 --> 00:17:29,680
QUESTION OF WHY WOULD THIS

472
00:17:29,680 --> 00:17:31,400
HAPPEN, SO MORE INVESTIGATION IS

473
00:17:31,400 --> 00:17:36,120
NEEDED, AND DOES IT MAKE A

474
00:17:36,120 --> 00:17:37,200
DIFFERENCE IN THE OUTCOME FOR

475
00:17:37,200 --> 00:17:43,440
PATIENTS, AND MAKE IT SAFER FOR

476
00:17:43,440 --> 00:17:43,880
CARE?

477
00:17:43,880 --> 00:17:47,520
THIS IS WHERE I THROW IN MY

478
00:17:47,520 --> 00:17:48,800
APPEAL, I THINK AS MANY HAVE,

479
00:17:48,800 --> 00:17:51,400
FOR MORE DIVERSITY IN THE HEALTH

480
00:17:51,400 --> 00:17:52,520
CARE WORKFORCE.

481
00:17:52,520 --> 00:17:57,360
WE BELIEVE THAT IT CAN IMPROVE

482
00:17:57,360 --> 00:17:59,240
QUALITY OF CARE, OUTCOMES IN

483
00:17:59,240 --> 00:18:00,000
DISPARITIES.

484
00:18:00,000 --> 00:18:04,040
OBVIOUSLY THERE ARE BARRIERS TO

485
00:18:04,040 --> 00:18:05,480
DIVERSITY IN EDUCATION,

486
00:18:05,480 --> 00:18:06,440
UNDERREPRESENTATION OF FACULTY,

487
00:18:06,440 --> 00:18:07,520
MEDICINE AND NURSING, BUT WE'RE

488
00:18:07,520 --> 00:18:09,360
ON A JOURNEY TO GET THERE.

489
00:18:09,360 --> 00:18:12,760
AGAIN, WE BELIEVE THAT THIS WILL

490
00:18:12,760 --> 00:18:13,920
HELP IMPROVE OR REDUCE THE

491
00:18:13,920 --> 00:18:17,360
DISPARITIES WE'RE SEEING IN THE

492
00:18:17,360 --> 00:18:18,240
CARE THAT IS GIVEN.

493
00:18:18,240 --> 00:18:23,720
SO, THIS IS FROM AN ARTICLE BY

494
00:18:23,720 --> 00:18:25,800
MARSHAL CHIN IN 2021, BRITISH

495
00:18:25,800 --> 00:18:26,440
MEDICAL JOURNAL.

496
00:18:26,440 --> 00:18:30,360
IT HAS SOME GOOD IDEAS ABOUT HOW

497
00:18:30,360 --> 00:18:32,280
TO IMPROVE PATIENT SAFETY

498
00:18:32,280 --> 00:18:33,240
THROUGH HEALTH EQUITY.

499
00:18:33,240 --> 00:18:35,880
I THINK ONE OF THE MAIN

500
00:18:35,880 --> 00:18:37,680
CONFLICTS HERE IS TO INCLUDE

501
00:18:37,680 --> 00:18:43,320
HEALTH EQUITY EXPERTS ON

502
00:18:43,320 --> 00:18:44,320
INTERDISCIPLINARY TEAMS SO YOU

503
00:18:44,320 --> 00:18:46,800
CAN LOOK AT SYSTEMS FOR BIAS,

504
00:18:46,800 --> 00:18:47,360
SEE WHETHER THE SOCIAL

505
00:18:47,360 --> 00:18:48,360
DETERMINANTS OF HEALTH ARE

506
00:18:48,360 --> 00:18:49,680
AFFECTING THE CARE THAT IS

507
00:18:49,680 --> 00:18:51,200
PROVIDED TO DIFFERENT GROUPS OF

508
00:18:51,200 --> 00:18:52,760
PEOPLE, OR IN THE CASE OF THE

509
00:18:52,760 --> 00:18:54,120
CLINICAL CENTER ON THE CLINICAL

510
00:18:54,120 --> 00:18:55,400
RESEARCH THAT IS CONDUCTED ON

511
00:18:55,400 --> 00:18:57,800
DIFFERENT GROUPS OF PEOPLE.

512
00:18:57,800 --> 00:19:00,000
WE NEED TO DEVELOP VALIDATED

513
00:19:00,000 --> 00:19:00,880
PERFORMANCE MEASURES, ONES THAT

514
00:19:00,880 --> 00:19:03,880
EVALUATE NOT JUST OVERALL

515
00:19:03,880 --> 00:19:05,840
OUTCOMES OF CARE THAT IS

516
00:19:05,840 --> 00:19:07,400
PROVIDED OR CLINICAL RESEARCH

517
00:19:07,400 --> 00:19:10,120
STUDY THAT IS PERFORMED, BUT

518
00:19:10,120 --> 00:19:10,760
AMONGST VARIOUS GROUPS, BECAUSE

519
00:19:10,760 --> 00:19:12,640
UNTIL YOU LOOK, YOU MAY NOT KNOW

520
00:19:12,640 --> 00:19:14,520
THAT IT IS BETTER FOR SOME

521
00:19:14,520 --> 00:19:18,240
GROUPS THAN OTHERS.

522
00:19:18,240 --> 00:19:19,080
AND THEN IMPLEMENTING IT,

523
00:19:19,080 --> 00:19:23,800
IMPLEMENTING THOSE HEALTH EQUITY

524
00:19:23,800 --> 00:19:28,320
CONSCIOUS INTERVENTIONS THAT YOU

525
00:19:28,320 --> 00:19:30,520
MAY DEVELOP, AND NURTURING MORAL

526
00:19:30,520 --> 00:19:32,120
INCENTIVES TO IMPROVE EQUITY AND

527
00:19:32,120 --> 00:19:36,040
SAFETY PATIENT CARE.

528
00:19:36,040 --> 00:19:39,920
SO NOW WE'LL MOVE ON TO HEALTH

529
00:19:39,920 --> 00:19:42,480
EQUITY IN CLINICAL RESEARCH.

530
00:19:42,480 --> 00:19:44,920
SOMETHING I THINK THAT WILL BE

531
00:19:44,920 --> 00:19:47,320
OF INTEREST, HOPEFULLY, TO MOST

532
00:19:47,320 --> 00:19:51,400
OF YOU LISTENING IN TODAY. 

533
00:19:51,400 --> 00:19:54,320
THIS IS FROM A STUDY, SORRY,

534
00:19:54,320 --> 00:19:59,560
IT'S A WORKING PAPER THAT WAS

535
00:19:59,560 --> 00:20:08,640
PUBLISHED IN CHILD HEALTH IN

536
00:20:08,640 --> 00:20:09,240
2019, AN EXCELLENT READ FOR

537
00:20:09,240 --> 00:20:11,640
THOSE OF YOU INVOLVED IN

538
00:20:11,640 --> 00:20:12,440
CLINICAL RESEARCH.

539
00:20:12,440 --> 00:20:15,760
I'LL READ THE QUOTE ON HERE.

540
00:20:15,760 --> 00:20:17,440
RACIAL AND ETHNIC EQUITY IN

541
00:20:17,440 --> 00:20:18,640
RESEARCH MEANS APPLYING TOOLS

542
00:20:18,640 --> 00:20:19,920
AND PRACTICES NEEDED TO

543
00:20:19,920 --> 00:20:21,800
RECOGNIZE PEOPLE OF COLOR'S

544
00:20:21,800 --> 00:20:23,480
EXPERIENCES WITH UNEQUAL POWER

545
00:20:23,480 --> 00:20:25,160
DIFFERENTIALS AND ACCESS TO

546
00:20:25,160 --> 00:20:26,720
RESOURCES AND OPPORTUNITY, WHILE

547
00:20:26,720 --> 00:20:28,840
CONSIDERING HISTORICAL AND

548
00:20:28,840 --> 00:20:32,040
CURRENT LIVED REALITIES,

549
00:20:32,040 --> 00:20:32,840
INCLUDING STRUCTURAL RACISM."

550
00:20:32,840 --> 00:20:35,080
UNTIL I THINK WE UNDERSTAND

551
00:20:35,080 --> 00:20:38,240
THIS, WE WON'T BE ABLE TO DEAL

552
00:20:38,240 --> 00:20:42,160
WITH EFFECTIVELY DIFFERENTIAL

553
00:20:42,160 --> 00:20:44,480
OUTCOMES THAT WE MAY SEE IN

554
00:20:44,480 --> 00:20:47,440
RESEARCH AND ALSO DIFFERENTIAL

555
00:20:47,440 --> 00:20:48,600
ENROLLMENT, BECAUSE AS THE NEXT

556
00:20:48,600 --> 00:20:53,760
SLIDE WILL SHOW, THAT ALTHOUGH

557
00:20:53,760 --> 00:20:56,920
PEOPLE OF COLOR MAKE UP ABOUT

558
00:20:56,920 --> 00:21:00,400
39% OF THE USE POPULATION,

559
00:21:00,400 --> 00:21:04,600
PERCENTAGE GROWING, ONLY 2 TO

560
00:21:04,600 --> 00:21:06,160
16% IN TRIALS REPRESENT THAT

561
00:21:06,160 --> 00:21:08,520
COMMUNITY OF PEOPLE OF COLOR.

562
00:21:08,520 --> 00:21:09,400
WE NEED CLINICAL TRIALS THAT

563
00:21:09,400 --> 00:21:11,760
LOOK LIKE ALL OF US TO BE

564
00:21:11,760 --> 00:21:13,360
EFFECTIVE, AS SAID ON THE SLIDE.

565
00:21:13,360 --> 00:21:15,320
IT'S AN UNDERSTANDING AS WE MOVE

566
00:21:15,320 --> 00:21:15,560
FORWARD.

567
00:21:15,560 --> 00:21:17,520
AGAIN, I'LL COME BACK TO THIS

568
00:21:17,520 --> 00:21:21,800
LATER, THAT TO BE EFFECTIVE IN

569
00:21:21,800 --> 00:21:23,120
OUR CLINICAL TRIALS, WE NEED TO

570
00:21:23,120 --> 00:21:24,320
BE ABLE TO BROADEN THEM.

571
00:21:24,320 --> 00:21:28,120
AND I KNOW THERE'S WORK ON THAT

572
00:21:28,120 --> 00:21:29,600
HAPPENING AT THE CLINICAL CENTE.

573
00:21:29,600 --> 00:21:33,720
SO A LITTLE BIT OF HISTORY NOW,

574
00:21:33,720 --> 00:21:35,360
TO UNDERSTAND WHY THERE MAY BE

575
00:21:35,360 --> 00:21:39,320
ISSUES IN TERMS OF ENROLLING

576
00:21:39,320 --> 00:21:41,160
COMMUNITIES OF COLOR IN CLINICAL

577
00:21:41,160 --> 00:21:41,760
RESEARCH.

578
00:21:41,760 --> 00:21:43,800
THERE'S A LACK OF TRUST.

579
00:21:43,800 --> 00:21:44,800
BASED UPON A LOT OF HISTORY,

580
00:21:44,800 --> 00:21:46,520
SOME OF THIS IS WELL KNOWN, SOME

581
00:21:46,520 --> 00:21:48,760
YOU MAY NOT BUT WE'LL GO OVER IT

582
00:21:48,760 --> 00:21:49,520
AGAIN.

583
00:21:49,520 --> 00:21:52,880
WE'LL START WITH DR. MARION

584
00:21:52,880 --> 00:21:56,520
SIMMS, LAUDED AS FOUNDER OF

585
00:21:56,520 --> 00:21:59,160
MODERN SURGICAL GYNECOLOGY.

586
00:21:59,160 --> 00:22:05,400
HE DEVELOPED A TREATMENT FOR

587
00:22:05,400 --> 00:22:09,800
VESCOVAGINAL FISTULAS IN THE

588
00:22:09,800 --> 00:22:12,320
1800S, OPERATING ON ENCLAVED

589
00:22:12,320 --> 00:22:14,600
AFRICAN WOMEN, NO CONSENT, NO

590
00:22:14,600 --> 00:22:17,360
ANESTHESIA, OPERATING WITHOUT

591
00:22:17,360 --> 00:22:22,000
PERMISSION ON AFRICAN AMERICAN

592
00:22:22,000 --> 00:22:23,040
ENSLAVED WOMEN.

593
00:22:23,040 --> 00:22:25,840
IT'S TAKEN A WHILE TO COME TO

594
00:22:25,840 --> 00:22:27,280
GRIPS WITH EXACTLY WHAT

595
00:22:27,280 --> 00:22:28,800
HAPPENED, AND YOU CAN SEE IN THE

596
00:22:28,800 --> 00:22:31,240
BACKGROUND OF THE SLIDE A STATUE

597
00:22:31,240 --> 00:22:32,880
OF DR. SIMMS IN CENTRAL PARK IN

598
00:22:32,880 --> 00:22:35,040
NEW YORK THAT WAS TAKEN DOWN

599
00:22:35,040 --> 00:22:39,200
ALONG WITH MANY OTHER STATUES OF

600
00:22:39,200 --> 00:22:40,400
PROMINENT MEMBERS OF THE

601
00:22:40,400 --> 00:22:42,040
CONFEDERATE STATES BACK A FEW

602
00:22:42,040 --> 00:22:45,120
YEARS AGO.

603
00:22:45,120 --> 00:22:47,320
IT'S A MIXED BAG OF HIS LEGACY

604
00:22:47,320 --> 00:22:49,400
IN TERMS OF WHAT HE

605
00:22:49,400 --> 00:22:52,800
ACCOMPLISHED, AND HOW HE DID IT.

606
00:22:52,800 --> 00:22:54,840
YOU'LL SEE ON THESE SLIDES

607
00:22:54,840 --> 00:22:56,680
REFERENCES TO VERY GOOD BOOKS

608
00:22:56,680 --> 00:22:57,960
COVERING THE SUBJECT.

609
00:22:57,960 --> 00:23:08,520
SOMETHING MORE WELL KNOWN IS THE

610
00:23:15,840 --> 00:23:16,520
TUSKEGEE STUDY, 399

611
00:23:16,520 --> 00:23:21,320
PARTICIPANTS, BLACK MALES WITH

612
00:23:21,320 --> 00:23:22,840
SYPHILIS, 201 WITHOUT, NO

613
00:23:22,840 --> 00:23:25,800
CONSENT AT THAT TIME.

614
00:23:25,800 --> 00:23:27,000
WHAT'S MOST REMARKABLE WHEN

615
00:23:27,000 --> 00:23:29,840
PENICILLIN WAS COVERED AND CAME

616
00:23:29,840 --> 00:23:34,040
INTO  GENERAL USE IN MID-1940s,

617
00:23:34,040 --> 00:23:36,480
KNOWN TO BE A TREATMENT, NONE OF

618
00:23:36,480 --> 00:23:38,160
THE MEN IN THE STUDY WERE

619
00:23:38,160 --> 00:23:41,080
TREATED, DID NOT COME TO LIGHT

620
00:23:41,080 --> 00:23:44,840
UNTIL 1972 WHEN AN ARTICLE WAS

621
00:23:44,840 --> 00:23:45,560
PUBLISHED, CREATING A GREAT

622
00:23:45,560 --> 00:23:47,920
SENSATION AT THE TIME, QUICKLY

623
00:23:47,920 --> 00:23:49,400
THE STUDY WAS CLOSED.

624
00:23:49,400 --> 00:23:53,240
BUT THIS STUDY LIVES ON, NOT

625
00:23:53,240 --> 00:23:56,240
ONLY IN PRINT, THERE'S AN

626
00:23:56,240 --> 00:24:00,040
EXCELLENT 

627
00:24:00,040 --> 00:24:04,440
EXCELLENT BOOK ON IT, "BAD

628
00:24:04,440 --> 00:24:04,960
BLOOD."

629
00:24:04,960 --> 00:24:06,360
YOU CAN UNDERSTAND THE LINGERING

630
00:24:06,360 --> 00:24:12,440
LACK OF TRUST IN THE HEALTH CARE

631
00:24:12,440 --> 00:24:14,520
SYSTEM, IN THE GOVERNMENT, AND

632
00:24:14,520 --> 00:24:16,120
CLINICAL RESEARCH BASED ON WHAT

633
00:24:16,120 --> 00:24:22,560
HAPPENED TO THESE MEN IN THE

634
00:24:22,560 --> 00:24:24,240
TUSKEGEE SYPHILIS STUDY.

635
00:24:24,240 --> 00:24:29,160
WE'VE ALL HEARD OF HENRIETTA

636
00:24:29,160 --> 00:24:31,280
LACKS, WENT TO JOHNS HOPKINS,

637
00:24:31,280 --> 00:24:36,520
DIED SEVEN MONTHS LATER, A

638
00:24:36,520 --> 00:24:37,640
BIOPSY SIMPLE DEVELOPED THE HEEL

639
00:24:37,640 --> 00:24:43,240
A  -- HeLa CELL LINE, WHICH I

640
00:24:43,240 --> 00:24:43,840
REMEMBER USING IN COLLEGE IN

641
00:24:43,840 --> 00:24:44,640
MEDICAL CENTER.

642
00:24:44,640 --> 00:24:48,920
THERE WAS NO CONSENT, NO FAMILY

643
00:24:48,920 --> 00:24:51,640
KNOWLEDGE, UNTIL 1975.

644
00:24:51,640 --> 00:24:53,720
THIS HAS BEEN WELL DOCUMENTED IN

645
00:24:53,720 --> 00:24:57,440
BOOKS AND NOW MOVIES.

646
00:24:57,440 --> 00:25:01,560
BUT AGAIN, CREATED A MISTRUST

647
00:25:01,560 --> 00:25:02,400
WITHIN COMMUNITIES OF THE

648
00:25:02,400 --> 00:25:03,200
SYSTEM, HEALTH CARE SYSTEM, OF

649
00:25:03,200 --> 00:25:06,080
THE RESEARCH COMMUNITY, BECAUSE

650
00:25:06,080 --> 00:25:08,400
OF WHAT HAPPENED MANY YEARS AGO

651
00:25:08,400 --> 00:25:10,520
BUT IT STILL LINGERS. 

652
00:25:10,520 --> 00:25:14,320
AND IN FACT LINGERED THROUGH

653
00:25:14,320 --> 00:25:18,680
COVID, AS WE KNOW HESITANCY IN

654
00:25:18,680 --> 00:25:21,200
CLINICAL STUDIES OF VACCINE

655
00:25:21,200 --> 00:25:22,920
DEVELOPMENT AND VACCINE

656
00:25:22,920 --> 00:25:23,840
HESITANCY, HESITANCY TO RECEIVE

657
00:25:23,840 --> 00:25:26,040
THE VACCINE WAS A SIGNIFICANT

658
00:25:26,040 --> 00:25:28,160
ISSUE IN COMMUNITIES OF COLOR

659
00:25:28,160 --> 00:25:30,960
DURING THE PANDEMIC.

660
00:25:30,960 --> 00:25:35,200
AND AS WE ALSO KNOW, THOSE

661
00:25:35,200 --> 00:25:36,040
COMMUNITIES SUFFERED GREATER.

662
00:25:36,040 --> 00:25:40,240
THERE AGAIN WAS DISPARITY IN

663
00:25:40,240 --> 00:25:41,880
TERMS OF OUTCOMES, IN

664
00:25:41,880 --> 00:25:49,560
COMMUNITIES OF COLOR, WITH COVI.

665
00:25:49,560 --> 00:25:50,680
HISTORIC RACISM, INSTITUTIONAL

666
00:25:50,680 --> 00:25:52,280
RACISM DRIVES DISTRUST, THE

667
00:25:52,280 --> 00:25:55,720
HISTORY I JUST DETAILED ABOUT

668
00:25:55,720 --> 00:25:58,120
VARIOUS CLINICAL STUDIES LED TO

669
00:25:58,120 --> 00:25:58,600
CONTINUED DISTRUSTFUL

670
00:25:58,600 --> 00:25:59,080
COMMUNITIES.

671
00:25:59,080 --> 00:26:04,320
THE GOOD NEWS IS WE'VE SEEN

672
00:26:04,320 --> 00:26:06,520
SIGNIFICANT IMPROVEMENT IN

673
00:26:06,520 --> 00:26:08,040
PARTICIPATION IN RESEARCH

674
00:26:08,040 --> 00:26:10,600
STUDIES, RELATED TO COVID

675
00:26:10,600 --> 00:26:11,760
VACCINATION AND TREATMENT, AND

676
00:26:11,760 --> 00:26:13,400
IN RECEIVING THE VACCINE,

677
00:26:13,400 --> 00:26:14,240
ALTHOUGH VACCINATION RATES STILL

678
00:26:14,240 --> 00:26:21,200
ARE LOWER THAN IN THE WHITE

679
00:26:21,200 --> 00:26:22,840
COMMUNITY.

680
00:26:22,840 --> 00:26:24,480
I'LL PIVOT WHO WE IN THE

681
00:26:24,480 --> 00:26:25,480
MARYLAND PATIENT SAFETY CENTER

682
00:26:25,480 --> 00:26:28,080
ARE DOING RELATED TO HEALTH

683
00:26:28,080 --> 00:26:28,320
EQUITY.

684
00:26:28,320 --> 00:26:30,280
AS I THINK DR. LANG TALKED ABOUT

685
00:26:30,280 --> 00:26:31,600
BEFORE, WE ARE ARE AN

686
00:26:31,600 --> 00:26:33,320
INDEPENDENT NON-PROFIT IN THE

687
00:26:33,320 --> 00:26:35,120
STATE OF MARYLAND, CREATED BY AN

688
00:26:35,120 --> 00:26:37,520
ACT OF THE MARYLAND LEGISLATURE,

689
00:26:37,520 --> 00:26:38,160
AND DESIGNATED BY MARYLAND

690
00:26:38,160 --> 00:26:40,680
HEALTH CARE COMMISSION.

691
00:26:40,680 --> 00:26:42,360
OUR MISSION IS SIMPLE.

692
00:26:42,360 --> 00:26:43,960
KEEPING MARYLAND HEALTH CARE

693
00:26:43,960 --> 00:26:44,160
SAFE.

694
00:26:44,160 --> 00:26:46,480
WE HAVE MANY ACTIVITIES.

695
00:26:46,480 --> 00:26:47,360
WE HAVE COLLABORATIVES ACROSS

696
00:26:47,360 --> 00:26:49,640
THE STATE, BOTH AT HOSPITALS AND

697
00:26:49,640 --> 00:26:52,920
IN THE OUTPATIENT COMMUNITY, ON

698
00:26:52,920 --> 00:26:57,520
INFECTION CONTROL, ON HAND

699
00:26:57,520 --> 00:27:01,240
WASHING, ON C-SECTION RATES,

700
00:27:01,240 --> 00:27:02,560
ANYTHING THAT WE CAN GET

701
00:27:02,560 --> 00:27:04,120
EVERYONE TO AGREE TO AND WORK

702
00:27:04,120 --> 00:27:06,160
ON, WE WILL WORK ON TO IMPROVE

703
00:27:06,160 --> 00:27:08,840
THE CARE ACROSS ALL MARYLANDERS.

704
00:27:08,840 --> 00:27:11,440
WE DO A LOT OF EDUCATION, BOTH

705
00:27:11,440 --> 00:27:16,360
IN PERSON AND ONLINE AND

706
00:27:16,360 --> 00:27:18,080
e-LEARNING WITH TWO MAJOR

707
00:27:18,080 --> 00:27:19,520
CONFERENCES A YEAR, ONE I'LL

708
00:27:19,520 --> 00:27:23,920
TALK ABOUT IN A MOMENT, BUT ALSO

709
00:27:23,920 --> 00:27:26,760
A SAFETY CONFERENCE IN THE FALL.

710
00:27:26,760 --> 00:27:28,280
FINALLY CARING FOR THE CAREGIVER

711
00:27:28,280 --> 00:27:29,840
PROGRAM WHICH I THINK THE

712
00:27:29,840 --> 00:27:31,160
CLINICAL CENTER IS IMPLEMENTING

713
00:27:31,160 --> 00:27:32,240
AT THIS TIME.

714
00:27:32,240 --> 00:27:35,440
THAT'S THE RISE PROGRAM FROM

715
00:27:35,440 --> 00:27:38,240
JOHNS HOPKINS, WHICH IS PEER

716
00:27:38,240 --> 00:27:41,040
SUPPORT, STAFF PEER SUPPORT, IN

717
00:27:41,040 --> 00:27:45,760
TIMES OF STRESS.

718
00:27:45,760 --> 00:27:46,360
RECENTLY CREATED BY ARMSTRONG

719
00:27:46,360 --> 00:27:47,640
INSTITUTE AT JOHNS HOPKINS FOR

720
00:27:47,640 --> 00:27:49,600
WHEN MEDICAL ERRORS OCCUR IN

721
00:27:49,600 --> 00:27:54,040
CLINICAL UNITS, BUT IT'S BEEN

722
00:27:54,040 --> 00:27:56,080
EXTENDED FOR ANY STRESS THAT

723
00:27:56,080 --> 00:27:58,920
STAFF CAN SUPPORT OTHER STAFF

724
00:27:58,920 --> 00:28:00,400
WITH, INCLUDING ALL OF THE

725
00:28:00,400 --> 00:28:02,480
STRESS OF THE PANDEMIC, AND

726
00:28:02,480 --> 00:28:03,680
WORKFORCE SHORTAGES THAT MANY

727
00:28:03,680 --> 00:28:06,080
HOSPITALS ARE GOING THROUGH

728
00:28:06,080 --> 00:28:08,120
RIGHT NOW, AND IN WORKPLACE

729
00:28:08,120 --> 00:28:11,120
VIOLENCE, AS I THINK WE'RE ALL

730
00:28:11,120 --> 00:28:16,040
AWARE IN HEALTH CARE, WE'VE SEEN

731
00:28:16,040 --> 00:28:21,560
AN INCREASE, SIGNIFICANT

732
00:28:21,560 --> 00:28:23,600
INVIOLENCE IN THE HEALTH CARE

733
00:28:23,600 --> 00:28:24,160
WORKPLACE.

734
00:28:24,160 --> 00:28:25,360
WE'RE A FEDERALLY DESIGNATED

735
00:28:25,360 --> 00:28:26,640
PATIENT SAFETY ORGANIZATION SO

736
00:28:26,640 --> 00:28:29,400
WE RUN THE MID-ATLANTIC PATIENT

737
00:28:29,400 --> 00:28:30,680
SAFETY ORGANIZATION WITH

738
00:28:30,680 --> 00:28:32,800
REPORTING MEDICAL ERRORS, BUT

739
00:28:32,800 --> 00:28:34,240
MOST IMPORTANTLY WITH CONVENING

740
00:28:34,240 --> 00:28:35,400
PATIENT SAFETY OFFICERS ACROSS

741
00:28:35,400 --> 00:28:37,720
THE STATE REGULAR MEETINGS TO

742
00:28:37,720 --> 00:28:39,040
DISCUSS PATIENT SAFETY ISSUES

743
00:28:39,040 --> 00:28:42,960
INCLUDING SAFE TABLES WHERE WE

744
00:28:42,960 --> 00:28:45,360
CAN DISCUSS UNTOWARD EVENTS AND

745
00:28:45,360 --> 00:28:46,840
SOLUTIONS FOR IMPROVING THE CARE

746
00:28:46,840 --> 00:28:52,800
OF PATIENTS ACROSS THE STATE.

747
00:28:52,800 --> 00:28:54,160
OUR WORK IN HEALTH EQUITY IS

748
00:28:54,160 --> 00:28:55,640
DETAILED ON THE RIGHT SIDE, BUT

749
00:28:55,640 --> 00:28:57,840
THE FIRST IS OUR HEALTH EQUITY

750
00:28:57,840 --> 00:28:58,800
CONFERENCE COMING UP.

751
00:28:58,800 --> 00:29:00,680
THIS IS OUR ANNUAL PATIENT

752
00:29:00,680 --> 00:29:01,880
SAFETY CONFERENCE HELD IN PERSON

753
00:29:01,880 --> 00:29:06,680
AT THE HILTON IN BALTIMORE, BUT

754
00:29:06,680 --> 00:29:08,680
ALSO HELD ONLINE, AS MEMBERS OF

755
00:29:08,680 --> 00:29:10,240
THE MARYLAND PATIENT SAFETY

756
00:29:10,240 --> 00:29:12,960
CENTER, YEAR ALL WELCOME TO JOIN

757
00:29:12,960 --> 00:29:15,480
US FOR FREE, AND AS I SAID

758
00:29:15,480 --> 00:29:17,320
BEFORE, THERE ARE CONTINUING

759
00:29:17,320 --> 00:29:17,920
EDUCATION CREDITS INCLUDING CME

760
00:29:17,920 --> 00:29:19,360
CREDITS THAT ARE AVAILABLE TO

761
00:29:19,360 --> 00:29:20,280
YOU FOR ATTENDING THIS

762
00:29:20,280 --> 00:29:21,480
CONFERENCE, WHETHER IN PERSON AT

763
00:29:21,480 --> 00:29:25,160
THE HILTON WHERE YOU GET A NICE

764
00:29:25,160 --> 00:29:29,800
LUNCH OR ONLINE AT YOUR COMPUTE.

765
00:29:29,800 --> 00:29:30,880
IT'S ON MARCH 31st, COMING UP

766
00:29:30,880 --> 00:29:33,400
IN JUST A BIT OVER TWO WEEKS,

767
00:29:33,400 --> 00:29:37,240
AND WE'LL BE TALKING A LOT ABOUT

768
00:29:37,240 --> 00:29:38,840
HEALTH EQUITY ACROSS ALL ASPECTS

769
00:29:38,840 --> 00:29:42,360
OF HEALTH EQUITY, AND HOW WE CAN

770
00:29:42,360 --> 00:29:44,680
IMPROVE HEALTH EQUITY, IMPROVING

771
00:29:44,680 --> 00:29:47,280
OUTCOMES FOR PATIENTS.

772
00:29:47,280 --> 00:29:48,440
WE'VE ALSO DONE WORK IN COVID

773
00:29:48,440 --> 00:29:50,520
VACCINE HESITANCY, AND THE BIRTH

774
00:29:50,520 --> 00:29:53,440
EQUITY PROGRAM, AND I'LL JUST

775
00:29:53,440 --> 00:29:54,400
START WITH SAYING THAT MARYLAND

776
00:29:54,400 --> 00:29:58,240
IS ONE OF THE MOST DIVERSE

777
00:29:58,240 --> 00:30:00,320
STATES IN THE COUNTRY.

778
00:30:00,320 --> 00:30:05,360
I THINK IT'S 7th ON THIS LIST.

779
00:30:05,360 --> 00:30:07,320
HAS APPEARED HIGHER ON OTHER

780
00:30:07,320 --> 00:30:09,400
LISTS DEPENDING HOW YOU DEFINE

781
00:30:09,400 --> 00:30:09,640
DIVERSITY.

782
00:30:09,640 --> 00:30:13,640
BUT THAT JUST, TO US, IT

783
00:30:13,640 --> 00:30:17,120
SUGGESTS WE DO HAVE WORK TO DO

784
00:30:17,120 --> 00:30:19,960
ON VARIOUS ISSUES ASSOCIATED

785
00:30:19,960 --> 00:30:24,720
WITH DISPARITIES IN MARYLAND.

786
00:30:24,720 --> 00:30:26,320
SO WE STARTED OFF WITH REDUCING

787
00:30:26,320 --> 00:30:27,880
COVID VACCINE HESITANCY IN

788
00:30:27,880 --> 00:30:28,960
COMMUNITIES OF COLOR.

789
00:30:28,960 --> 00:30:30,840
WE DID THIS IN CONJUNCTION WITH

790
00:30:30,840 --> 00:30:32,840
MARYLAND HOSPITAL ASSOCIATION

791
00:30:32,840 --> 00:30:36,120
AND THE STATE, REALIZING THAT

792
00:30:36,120 --> 00:30:37,520
BLACK AND LATINX COMMUNITIES

793
00:30:37,520 --> 00:30:39,400
WERE SIGNIFICANTLY LESS LIKELY

794
00:30:39,400 --> 00:30:40,920
TO GET THE COVID VACCINE

795
00:30:40,920 --> 00:30:44,440
ESPECIALLY EARLY WHEN THE

796
00:30:44,440 --> 00:30:48,680
VACCINE BECAME AVAILABLE.

797
00:30:48,680 --> 00:30:50,520
DR. NICOLE ROCHESTER LED

798
00:30:50,520 --> 00:30:51,760
WEBINARS DISCUSSING SYSTEMIC

799
00:30:51,760 --> 00:30:53,400
RACISM AND BIAS IN HEALTH CARE,

800
00:30:53,400 --> 00:30:56,920
WHICH HAS LED TO THE VACCINE

801
00:30:56,920 --> 00:30:57,160
AWARENESS.

802
00:30:57,160 --> 00:30:58,360
AND STRATEGIES TO INCREASE

803
00:30:58,360 --> 00:31:00,120
ACCEPTANCE IN COMMUNITIES OF

804
00:31:00,120 --> 00:31:02,280
COLOR, AND STRATEGIES TO

805
00:31:02,280 --> 00:31:02,960
INCREASE VACCINE ACCEPTANCE IN

806
00:31:02,960 --> 00:31:07,600
HEALTH CARE STAFF, ALSO A

807
00:31:07,600 --> 00:31:09,040
SIGNIFICANT ISSUE.

808
00:31:09,040 --> 00:31:10,600
WE HAD 700 LEADERS FROM ACROSS

809
00:31:10,600 --> 00:31:11,920
THE REGION INVOLVED IN THAT.

810
00:31:11,920 --> 00:31:14,640
WE HOPE WE WERE PART OF

811
00:31:14,640 --> 00:31:16,000
IMPROVING THE ACCEPTANCE OF

812
00:31:16,000 --> 00:31:17,480
VACCINE THAT WE'VE SEEN OVER THE

813
00:31:17,480 --> 00:31:19,880
LAST COUPLE OF YEARS.

814
00:31:19,880 --> 00:31:21,800
OUR MAJOR PROGRAM HAS BEEN

815
00:31:21,800 --> 00:31:22,920
DEALING WITH SEVERE MATERNAL

816
00:31:22,920 --> 00:31:25,680
MORBIDITY IN MARYLAND.

817
00:31:25,680 --> 00:31:28,240
AS I DESCRIBED BEFORE, THE DATA

818
00:31:28,240 --> 00:31:31,120
IN MARYLAND IS NO DIFFERENT THAN

819
00:31:31,120 --> 00:31:34,600
MANY OF THE STATES ACROSS THE

820
00:31:34,600 --> 00:31:36,280
COUNTRY.

821
00:31:36,280 --> 00:31:37,760
BLACK MATERNAL MORBIDITY IS

822
00:31:37,760 --> 00:31:41,160
TWICE THE RATE OF WHITE MATERNAL

823
00:31:41,160 --> 00:31:42,800
MORBIDITY IN MARYLAND.

824
00:31:42,800 --> 00:31:45,400
IN GRAPH YELLOW IS BLACK

825
00:31:45,400 --> 00:31:47,520
MATERNAL MORBIDITY, RED AT THE

826
00:31:47,520 --> 00:31:48,960
BOTTOM IS WHITE MATERNAL

827
00:31:48,960 --> 00:31:49,400
MORBIDITY.

828
00:31:49,400 --> 00:31:53,240
MARYLAND MADE A PLEDGE TO REDUCE

829
00:31:53,240 --> 00:31:54,560
THIS, THE OVERALL MATERNAL

830
00:31:54,560 --> 00:31:56,600
MORBIDITY BY 20% OVER THE NEXT

831
00:31:56,600 --> 00:31:59,560
THREE YEARS, FOUR YEARS I GUESS

832
00:31:59,560 --> 00:32:05,160
NOW, AND WE RECOGNIZE THAT WE

833
00:32:05,160 --> 00:32:06,240
CAN'T MAKE HEADWAY WITH THIS,

834
00:32:06,240 --> 00:32:08,120
YOU CAN SEE THE DOTTED LINES ARE

835
00:32:08,120 --> 00:32:10,120
THE WAY MARYLAND WANTS TO REDUCE

836
00:32:10,120 --> 00:32:12,960
THESE PROJECTING HOW THE TO

837
00:32:12,960 --> 00:32:14,160
REDUCE MATERNAL MORBIDITY, CAN'T

838
00:32:14,160 --> 00:32:16,520
MAKE HEADWAY IF WE DON'T

839
00:32:16,520 --> 00:32:17,440
ACTUALLY ADDRESS THE DISPARITY

840
00:32:17,440 --> 00:32:19,480
THAT IS THERE.

841
00:32:19,480 --> 00:32:22,440
SO WE'VE DEVELOPED THE BIRTH

842
00:32:22,440 --> 00:32:24,320
EQUITY MARYLAND PROGRAM, TO

843
00:32:24,320 --> 00:32:27,480
PROMOTE HEALTH EQUITY, AND

844
00:32:27,480 --> 00:32:28,120
ANTI-RACISM IN MATERNAL HEALTH

845
00:32:28,120 --> 00:32:32,720
ACROSS THE STATE.

846
00:32:32,720 --> 00:32:33,320
WE'RE EDUCATING NON-OBSTETRIC

847
00:32:33,320 --> 00:32:37,560
PROVIDERS, THERE'S ALREADY A

848
00:32:37,560 --> 00:32:44,240
PROGRAM TO EDUCATE BOTH IMPLICIT

849
00:32:44,240 --> 00:32:50,400
BIAS AND ANTI-RACISM AND IMPROVE

850
00:32:50,400 --> 00:32:51,480
MATERNAL CARE WITH THE PROGRAM

851
00:32:51,480 --> 00:32:53,320
THROUGH JOHNS HOPKINS ACROSS THE

852
00:32:53,320 --> 00:32:54,600
STATE, ALL BIRTHING HOSPITALS IN

853
00:32:54,600 --> 00:32:57,600
MARYLAND ARE PARTICIPATING.

854
00:32:57,600 --> 00:32:58,840
THAT'S INVOLVING OBSTETRICIANS,

855
00:32:58,840 --> 00:33:00,560
MIDWIVES, MATERNITY NURSES.

856
00:33:00,560 --> 00:33:02,120
WE RECOGNIZE, AND WE ACTUALLY

857
00:33:02,120 --> 00:33:04,920
PARTICIPATE AS PART OF THE MD

858
00:33:04,920 --> 00:33:07,480
MOM PROGRAM, BUT WE RECOGNIZE

859
00:33:07,480 --> 00:33:10,320
THAT BOTH PREGNANT AND

860
00:33:10,320 --> 00:33:11,800
POSTPARTUM WOMEN ARE FREQUENTLY

861
00:33:11,800 --> 00:33:19,040
SEEN BY NON-OBSTETRIC PROVIDERS,

862
00:33:19,040 --> 00:33:21,040
EMERGENCY ROOM, CLINICS AND

863
00:33:21,040 --> 00:33:22,600
QUALIFIED HEALTH CENTERS AND

864
00:33:22,600 --> 00:33:23,880
COMMUNITY HEALTH WORKERS AND

865
00:33:23,880 --> 00:33:26,960
WANT TO EXTEND THAT EDUCATION TO

866
00:33:26,960 --> 00:33:28,040
NON-OBSTETRIC PROVIDERS AND

867
00:33:28,040 --> 00:33:29,520
WE'VE ALREADY STARTED.

868
00:33:29,520 --> 00:33:30,800
WE'VE BEEN THROUGH OUR FIRST

869
00:33:30,800 --> 00:33:32,480
PILOT PHASE AND ARE ABOUT TO

870
00:33:32,480 --> 00:33:35,200
ROLL IT OUT ACROSS THE STATE.

871
00:33:35,200 --> 00:33:36,680
IN FACT, MARYLAND HOSPITAL

872
00:33:36,680 --> 00:33:37,400
ASSOCIATION'S EXECUTIVE

873
00:33:37,400 --> 00:33:39,880
COMMITTEE HAS PLEDGED ALL

874
00:33:39,880 --> 00:33:43,600
MARYLAND HOSPITALS WILL

875
00:33:43,600 --> 00:33:45,720
PARTICIPATE. 

876
00:33:45,720 --> 00:33:50,840
AND THE EDUCATION INCLUDES

877
00:33:50,840 --> 00:33:52,960
EDUCATION ABOUT DISPARITIES,

878
00:33:52,960 --> 00:33:53,840
IDENTIFICATION OF COMPLICATIONS,

879
00:33:53,840 --> 00:33:55,640
AND WHAT TO DO ABOUT IT.

880
00:33:55,640 --> 00:34:02,120
SIMPLY SAID, IF WE CAN GET MORE

881
00:34:02,120 --> 00:34:03,280
OF OUR NON-OBSTETRIC PROVIDERS

882
00:34:03,280 --> 00:34:04,840
WHO SEE WOMEN TO RECOGNIZE

883
00:34:04,840 --> 00:34:08,240
SOMETHING BRONC MAY -- WRONG MAY

884
00:34:08,240 --> 00:34:10,760
BE GOING ON RELATED TO MATERNAL

885
00:34:10,760 --> 00:34:13,400
MORBIDITY THEY WILL CONTACT

886
00:34:13,400 --> 00:34:14,480
OBSTETRICIAN COLLEAGUE TO SEE

887
00:34:14,480 --> 00:34:16,320
THE PATIENT SO WE DON'T MISS

888
00:34:16,320 --> 00:34:17,560
SOMETHING BECAUSE IT'S MISSED

889
00:34:17,560 --> 00:34:18,400
OPPORTUNITIES, THE THINGS WE

890
00:34:18,400 --> 00:34:24,000
COULD HAVE HAVE FIXED, THAT

891
00:34:24,000 --> 00:34:25,880
WE'RE TRYING TO ADDRESS.

892
00:34:25,880 --> 00:34:30,360
THIS IS THE STEPS WE'RE TAKING.

893
00:34:30,360 --> 00:34:32,800
WE HAVE INITIAL BASELINE

894
00:34:32,800 --> 00:34:34,720
ASSESSMENT, WE GET ON TO

895
00:34:34,720 --> 00:34:38,160
EDUCATION, WEBINARS ON RACISM

896
00:34:38,160 --> 00:34:39,760
AND BIAS IN MATERNAL HEALTH CARE

897
00:34:39,760 --> 00:34:42,600
AND EDUCATION ON THE DRIVERS OF

898
00:34:42,600 --> 00:34:43,480
MATERNAL MORBIDITY AND MORTALITY

899
00:34:43,480 --> 00:34:46,320
ESPECIALLY IN THE BLACK

900
00:34:46,320 --> 00:34:48,640
COMMUNITY. 

901
00:34:48,640 --> 00:34:49,840
FINALLY A TEAM STEPS-BASED

902
00:34:49,840 --> 00:34:50,360
TRAINING.

903
00:34:50,360 --> 00:34:51,720
IF YOU HAVEN'T PARTICIPATED, IT

904
00:34:51,720 --> 00:34:53,520
INVOLVES THE ENTIRE HEALTH CARE

905
00:34:53,520 --> 00:34:55,960
TEAM, GETS EVERYONE ON THE

906
00:34:55,960 --> 00:34:57,160
HEALTH CARE TEAM ENABLED TO

907
00:34:57,160 --> 00:34:59,400
SPEAK UP WHEN THEY SEE SOMETHING

908
00:34:59,400 --> 00:35:01,080
THEY THINK MAY BE GOING WRONG.

909
00:35:01,080 --> 00:35:07,880
WE DON'T WANT TO MISS ANYBODY'S

910
00:35:07,880 --> 00:35:12,040
OBSERVATIONS THAT SOMETHING MAY

911
00:35:12,040 --> 00:35:13,440
BE HAPPENING AND JUST RELY ON

912
00:35:13,440 --> 00:35:14,560
THE PROVIDER, THE DOCTOR, THE

913
00:35:14,560 --> 00:35:15,000
NURSE.

914
00:35:15,000 --> 00:35:25,080
WE WANT EVERYBODY TO

915
00:35:25,080 --> 00:35:25,480
PARTICIPATE.

916
00:35:25,480 --> 00:35:26,600
IN CLINICS ACROSS THE STATE,

917
00:35:26,600 --> 00:35:28,760
THIS IS IMPORTANT, MOST OF THEM

918
00:35:28,760 --> 00:35:30,120
ARE DEFINITELY COMMITTING TO IT,

919
00:35:30,120 --> 00:35:32,080
TO SEE IF THEY CAN IMPROVE,

920
00:35:32,080 --> 00:35:33,600
ESPECIALLY IN DISPARITIES WE'RE

921
00:35:33,600 --> 00:35:35,640
SEEING IN MATERNAL CARE, REDUCE

922
00:35:35,640 --> 00:35:41,280
OVERALL RATE OF MATERNAL

923
00:35:41,280 --> 00:35:42,200
MORBIDITY IN MARYLAND.

924
00:35:42,200 --> 00:35:45,520
SO IN MY CLOSING SECTION HERE,

925
00:35:45,520 --> 00:35:49,320
I'LL TALK ABOUT HOW IN RESEARCH,

926
00:35:49,320 --> 00:35:51,880
CLINICAL RESEARCH, WE CAN DO

927
00:35:51,880 --> 00:35:52,520
BETTER.

928
00:35:52,520 --> 00:36:02,080
THE QUESTION HOW DO WE ADDRESS

929
00:36:02,080 --> 00:36:02,960
INEQUITIES IN OUTCOME, THE

930
00:36:02,960 --> 00:36:04,680
GRAPHIC IS FROM THE CDC LOOKING

931
00:36:04,680 --> 00:36:07,360
AT THE WAYS TO ADDRESS HEALTH

932
00:36:07,360 --> 00:36:09,280
EQUITY, BOTH IN THE

933
00:36:09,280 --> 00:36:11,800
INFRASTRUCTURE THAT WE BUILD, IN

934
00:36:11,800 --> 00:36:12,880
PROGRAMS, IN MEASUREMENT, IN

935
00:36:12,880 --> 00:36:13,200
POLICY.

936
00:36:13,200 --> 00:36:14,840
WE'LL TALK A LITTLE BIT ABOUT

937
00:36:14,840 --> 00:36:18,120
THAT HERE.

938
00:36:18,120 --> 00:36:19,320
WHAT ARE THE PITFALLS IN

939
00:36:19,320 --> 00:36:19,800
CLINICAL RESEARCH?

940
00:36:19,800 --> 00:36:22,600
WELL, ONE OF THE BIG ONES IS

941
00:36:22,600 --> 00:36:24,280
LACK OF DIVERSITY IN STUDY

942
00:36:24,280 --> 00:36:25,080
PARTICIPANTS WE ALREADY

943
00:36:25,080 --> 00:36:26,400
DISCUSSED, BUT ALSO ON STUDY

944
00:36:26,400 --> 00:36:28,120
TEAMS, ON THE COMMITTEES

945
00:36:28,120 --> 00:36:31,200
INVOLVED IN RESEARCH, AND ON THE

946
00:36:31,200 --> 00:36:31,600
IRB.

947
00:36:31,600 --> 00:36:33,400
WE DON'T HAVE EQUITABLE

948
00:36:33,400 --> 00:36:37,480
REPRESENTATION THROUGHOUT THE

949
00:36:37,480 --> 00:36:38,160
PROCESS.

950
00:36:38,160 --> 00:36:40,440
IT'S HARD TO UNDERSTAND,

951
00:36:40,440 --> 00:36:43,960
REALIZE, BE AWARE, SEE, THE

952
00:36:43,960 --> 00:36:46,000
INEQUITIES, THE INEQUALITIES,

953
00:36:46,000 --> 00:36:49,080
DISPARITIES THAT MIGHT RESULT

954
00:36:49,080 --> 00:36:51,400
WITHIN A STUDY, BECAUSE WE JUST

955
00:36:51,400 --> 00:36:53,440
DIDN'T KNOW.

956
00:36:53,440 --> 00:36:56,200
SO, IMPLICIT AND EXPLICIT BIAS

957
00:36:56,200 --> 00:36:56,800
EXISTS.

958
00:36:56,800 --> 00:36:59,920
SPECIFICALLY TO IMPLICIT BIAS, I

959
00:36:59,920 --> 00:37:01,880
HIGHLY RECOMMEND EVERYONE, AND

960
00:37:01,880 --> 00:37:06,120
THIS IS IN -- I THINK THE LINK

961
00:37:06,120 --> 00:37:08,120
IS IN THE RESOURCES SLIDE AT THE

962
00:37:08,120 --> 00:37:10,960
END OF THIS TALK, BUT THE

963
00:37:10,960 --> 00:37:12,600
HARVARD IMPLICIT ASSOCIATION

964
00:37:12,600 --> 00:37:14,840
TEST, WHICH IS ANONYMOUS, ONLY

965
00:37:14,840 --> 00:37:20,960
YOU GET THE RESULTS, THEY DO

966
00:37:20,960 --> 00:37:21,840
COLLECT DE-IDENTIFIED DATA BUT

967
00:37:21,840 --> 00:37:25,240
OVERALL BUT DON'T KNOW YOU, YOU

968
00:37:25,240 --> 00:37:27,400
DON'T KNOW THEM.

969
00:37:27,400 --> 00:37:29,280
AND TO TEST WHAT BIASES YOU MAY

970
00:37:29,280 --> 00:37:30,480
HAVE, WE ALL HAVE THEM.

971
00:37:30,480 --> 00:37:33,880
I KNOW I HAVE THEM. 

972
00:37:33,880 --> 00:37:37,600
THAT ARE BUILT INTO US, FOR

973
00:37:37,600 --> 00:37:40,640
WHATEVER REASONS, THAT MAY

974
00:37:40,640 --> 00:37:43,080
INFECT -- THAT MAY AFFECT YOUR

975
00:37:43,080 --> 00:37:44,760
PERFORMANCE OF YOUR CLINICAL

976
00:37:44,760 --> 00:37:47,520
DUTIES, THE WAY YOU TREAT

977
00:37:47,520 --> 00:37:48,600
VARIOUS GROUPS OF PATIENTS, OR

978
00:37:48,600 --> 00:37:51,800
THE WAY YOU TREAT VARIOUS GROUPS

979
00:37:51,800 --> 00:38:00,520
OF CLINICAL RESEARCH SUBJECTS.

980
00:38:00,520 --> 00:38:03,080
OTHER PITFALLS, LACK OF

981
00:38:03,080 --> 00:38:04,360
COMMUNICATION, NOT CONNECTING TO

982
00:38:04,360 --> 00:38:06,000
COMMUNITIES, I DISCUSSED LACK OF

983
00:38:06,000 --> 00:38:07,360
TRUST FROM COMMUNITIES OF COLOR

984
00:38:07,360 --> 00:38:11,600
AND HISTORY THAT'S THERE, THAT

985
00:38:11,600 --> 00:38:13,480
LACK OF TRUST STILL EXISTING,

986
00:38:13,480 --> 00:38:14,760
THE ABILITY TO MEASURE HEALTH

987
00:38:14,760 --> 00:38:15,000
EQUITY.

988
00:38:15,000 --> 00:38:18,360
IF WE JUST LOOK AT OVERALL

989
00:38:18,360 --> 00:38:20,040
OUTCOMES OF OUR CLINICAL

990
00:38:20,040 --> 00:38:21,560
RESEARCH STUDIES, AND NOT

991
00:38:21,560 --> 00:38:25,480
STRATIFY THE DATA AS TO

992
00:38:25,480 --> 00:38:26,800
ETHNICITY, RACE, COUNTRY OF

993
00:38:26,800 --> 00:38:28,640
ORIGIN, LANGUAGE, WE ARE MISSING

994
00:38:28,640 --> 00:38:31,720
DISPARITIES IN OUTCOMES THAT ARE

995
00:38:31,720 --> 00:38:33,640
IMPORTANT AS WE MOVE THAT

996
00:38:33,640 --> 00:38:35,600
TREATMENT FORWARD.

997
00:38:35,600 --> 00:38:37,400
AND NEED TO UNDERSTAND THAT

998
00:38:37,400 --> 00:38:40,080
BECAUSE IF WE DON'T ASK FOR THAT

999
00:38:40,080 --> 00:38:43,200
DATA, WE WON'T GET IT AND WON'T

1000
00:38:43,200 --> 00:38:43,640
KNOW.

1001
00:38:43,640 --> 00:38:44,240
OBVIOUSLY THE SOCIAL

1002
00:38:44,240 --> 00:38:45,840
DETERMINANTS OF HEALTH ARE A

1003
00:38:45,840 --> 00:38:47,000
MAJOR FACTOR, BUT THOSE ARE

1004
00:38:47,000 --> 00:38:49,960
GOING TO TAKE A LONG TIME AND

1005
00:38:49,960 --> 00:38:52,080
INVOLVE ALL OF US IN

1006
00:38:52,080 --> 00:38:54,160
COMMUNITIES, AND IN GOVERNMENT,

1007
00:38:54,160 --> 00:38:57,800
TO BE WORKING ON IN TERMS OF

1008
00:38:57,800 --> 00:38:58,360
IMPROVEMENT OF THE SOCIAL

1009
00:38:58,360 --> 00:39:00,200
DETERMINANTS OF HEALTH SO THAT

1010
00:39:00,200 --> 00:39:02,920
WE CAN DECREASE DISPARITIES

1011
00:39:02,920 --> 00:39:04,240
BASED ON THOSE.

1012
00:39:04,240 --> 00:39:05,920
THE SURVEYS THAT YOU MIGHT BE

1013
00:39:05,920 --> 00:39:08,360
USING, GETS BACK TO THE DATA,

1014
00:39:08,360 --> 00:39:09,600
ARE THEY BIASED, THAT WILL BE

1015
00:39:09,600 --> 00:39:11,800
GETTING BACK TO THE LACK OF

1016
00:39:11,800 --> 00:39:14,080
DIVERSITY ON STUDY TEAMS,

1017
00:39:14,080 --> 00:39:17,280
COMMITTEES, IRBs.

1018
00:39:17,280 --> 00:39:19,520
AND FINALLY, A QUOTE FROM,

1019
00:39:19,520 --> 00:39:21,920
AGAIN, ANOTHER ARTICLE WE HAVE

1020
00:39:21,920 --> 00:39:27,720
IN THE RESOURCES SECTION,

1021
00:39:27,720 --> 00:39:29,760
IMPLEMENTATION RESEARCH

1022
00:39:29,760 --> 00:39:30,600
METHODOLOGIES FOR ACHIEVING

1023
00:39:30,600 --> 00:39:31,600
SCIENTIFIC EQUITY IN HEALTH

1024
00:39:31,600 --> 00:39:33,600
EQUITY FROM ETHNICITY AND

1025
00:39:33,600 --> 00:39:35,400
DISEASE IN 2019.

1026
00:39:35,400 --> 00:39:36,520
IMPLEMENTATION SCIENCE CAN

1027
00:39:36,520 --> 00:39:38,280
EXACERBATE HEALTH DISPARITIES IF

1028
00:39:38,280 --> 00:39:39,720
IT'S USED AS BIAS TOWARD

1029
00:39:39,720 --> 00:39:41,760
EMPATHIES THAT ALREADY HAVE

1030
00:39:41,760 --> 00:39:43,400
HIGHEST CAPACITIES FOR

1031
00:39:43,400 --> 00:39:43,920
DELIVERING EVIDENCE-BASED

1032
00:39:43,920 --> 00:39:46,280
INTERVENTIONS, SO WE COME UP

1033
00:39:46,280 --> 00:39:51,000
WITH EVIDENCE-BASED

1034
00:39:51,000 --> 00:39:51,920
INTERVENTIONS AND THEN WE

1035
00:39:51,920 --> 00:39:53,280
DISTRIBUTE TO PLACES THAT

1036
00:39:53,280 --> 00:39:54,680
ALREADY DO WELL, TAKE IT TO

1037
00:39:54,680 --> 00:39:56,760
PLACES THAT DON'T DO IT WELL

1038
00:39:56,760 --> 00:39:58,080
THEY WON'T GET THE BENEFIT.

1039
00:39:58,080 --> 00:40:00,480
WE NEED TO UNDERSTAND THAT.

1040
00:40:00,480 --> 00:40:03,000
SO, TALK ABOUT THE PITFALLS,

1041
00:40:03,000 --> 00:40:06,800
ALSO TALK ABOUT WHAT YOU CAN DO.

1042
00:40:06,800 --> 00:40:10,240
AND HOW YOU CAN DO BETTER.

1043
00:40:10,240 --> 00:40:12,480
REACHING OUT TO THE COMMUNITY,

1044
00:40:12,480 --> 00:40:16,600
EITHER AS INDIVIDUAL, AS A TEAM,

1045
00:40:16,600 --> 00:40:18,080
AND AS AN ORGANIZATION.

1046
00:40:18,080 --> 00:40:21,120
IT'S NOT JUST YOUR LOCAL

1047
00:40:21,120 --> 00:40:21,680
COMMUNITY.

1048
00:40:21,680 --> 00:40:23,120
BETHESDA, FOR EXAMPLE, WHERE THE

1049
00:40:23,120 --> 00:40:24,760
CLINICAL CENTER IS LOCATED, BUT

1050
00:40:24,760 --> 00:40:26,080
COMMUNITIES WHERE YOU LIVE, OUT

1051
00:40:26,080 --> 00:40:28,960
AND AROUND THIS AREA, AND

1052
00:40:28,960 --> 00:40:30,400
ESPECIALLY MONTGOMERY COUNTY,

1053
00:40:30,400 --> 00:40:31,440
FOR EXAMPLE, IS THE LARGEST

1054
00:40:31,440 --> 00:40:32,760
COUNTY IN THE STATE OF MARYLAND,

1055
00:40:32,760 --> 00:40:35,080
ALSO ONE OF THE MOST DIVERSE

1056
00:40:35,080 --> 00:40:37,600
COUNTIES, IF NOT THE MOST

1057
00:40:37,600 --> 00:40:38,680
DIVERSE, IN THE COUNTRY.

1058
00:40:38,680 --> 00:40:41,000
IT'S REALLY AN OPPORTUNITY TO

1059
00:40:41,000 --> 00:40:43,600
REACH OUT TO VARIOUS ETHNIC

1060
00:40:43,600 --> 00:40:46,000
GROUPS, RACIAL GROUPS, COUNTRY

1061
00:40:46,000 --> 00:40:48,640
OF ORIGIN GROUPS, LANGUAGE

1062
00:40:48,640 --> 00:40:53,760
GROUPS, TO GET REPRESENTATION ON

1063
00:40:53,760 --> 00:40:54,880
YOUR CLINICAL RESEARCH

1064
00:40:54,880 --> 00:40:58,280
COMMITTEES, IRB, TO BE ABLE TO

1065
00:40:58,280 --> 00:41:02,120
ENGAGE THE COMMUNITY IN THAT

1066
00:41:02,120 --> 00:41:02,400
RESEARCH.

1067
00:41:02,400 --> 00:41:03,600
PARTNER WITH TRUSTED RESEARCHERS

1068
00:41:03,600 --> 00:41:05,080
AND COMMUNITIES, WE LEARNED A

1069
00:41:05,080 --> 00:41:06,560
GREAT DEAL DURING COVID, BOTH IN

1070
00:41:06,560 --> 00:41:08,280
THE CLINICAL RESEARCH THAT WAS

1071
00:41:08,280 --> 00:41:11,160
DONE, AND IN THE ROLLOUT OF THE

1072
00:41:11,160 --> 00:41:13,480
VACCINE, THAT THERE ARE TRUSTED

1073
00:41:13,480 --> 00:41:14,240
RESOURCES IN COMMUNITIES, I

1074
00:41:14,240 --> 00:41:18,200
THINK WE ALL KNOW THAT THE HAIR

1075
00:41:18,200 --> 00:41:20,040
SALONS AND BARBERSHOPS ARE A

1076
00:41:20,040 --> 00:41:22,360
GREAT RESOURCE FOR EDUCATION AND

1077
00:41:22,360 --> 00:41:23,320
COMMUNICATION, AND UNDERSTANDING

1078
00:41:23,320 --> 00:41:24,960
HOW THE COMMUNITY STANDS ON

1079
00:41:24,960 --> 00:41:25,440
VARIOUS ISSUES.

1080
00:41:25,440 --> 00:41:27,600
SO THAT COULD BE A GREAT SITE

1081
00:41:27,600 --> 00:41:29,120
FOR RECRUITMENT.

1082
00:41:29,120 --> 00:41:32,520
THERE ARE OTHER PLACES WITHIN

1083
00:41:32,520 --> 00:41:38,560
COMMUNITIES THAT ARE SIMILAR.

1084
00:41:38,560 --> 00:41:39,760
THERE IS COMMUNITY-BASED

1085
00:41:39,760 --> 00:41:40,640
PARTICIPATORY RESEARCH, WHICH

1086
00:41:40,640 --> 00:41:46,440
INCREASES THE VALUE OF STUDY FOR

1087
00:41:46,440 --> 00:41:47,840
COMMUNITY AND RESEARCHERS,

1088
00:41:47,840 --> 00:41:49,840
INVOLVE THE COMMUNITY, AND BOTH

1089
00:41:49,840 --> 00:41:51,480
CAN BENEFIT, AND UNDERSTAND THE

1090
00:41:51,480 --> 00:41:53,560
COMMUNITY DATA, THE POLICY, THE

1091
00:41:53,560 --> 00:41:55,360
HISTORIES ASSOCIATED WITH THE

1092
00:41:55,360 --> 00:41:57,520
COMMUNITIES YOU'RE WORKING WITH.

1093
00:41:57,520 --> 00:41:58,960
ENGAGE PATIENTS AND FAMILIES.

1094
00:41:58,960 --> 00:42:00,360
I THINK PRETTY MUCH ALL

1095
00:42:00,360 --> 00:42:03,400
HOSPITALS ACROSS THE COUNTRY

1096
00:42:03,400 --> 00:42:05,360
HAVE SOME FORM OF PATIENT FAMILY

1097
00:42:05,360 --> 00:42:05,760
ADVISORY COUNCIL.

1098
00:42:05,760 --> 00:42:07,600
I THINK IT'S NOW REQUIRED,

1099
00:42:07,600 --> 00:42:09,960
ALTHOUGH NOT ALL USE THEM FOR

1100
00:42:09,960 --> 00:42:12,960
THE SAME PURPOSES.

1101
00:42:12,960 --> 00:42:14,240
BUT ENGAGING PATIENTS AND

1102
00:42:14,240 --> 00:42:16,440
FAMILIES THAT ARE INVOLVED IN

1103
00:42:16,440 --> 00:42:18,000
THE RESEARCH, ENGAGING THEM IN

1104
00:42:18,000 --> 00:42:20,600
THE DESIGN AND THE ONGOING

1105
00:42:20,600 --> 00:42:22,120
RESULTS OF THE STUDY I THINK IS

1106
00:42:22,120 --> 00:42:24,200
A VERY GOOD THING TO FIND OUT

1107
00:42:24,200 --> 00:42:26,480
HOW YOU'RE DOING AND HOW IT'S

1108
00:42:26,480 --> 00:42:28,800
RELATING TO BOTH THE PATIENT'S

1109
00:42:28,800 --> 00:42:30,560
FAMILIES AND THE COMMUNITY.

1110
00:42:30,560 --> 00:42:31,640
RECOGNIZE THAT THERE ARE

1111
00:42:31,640 --> 00:42:34,400
DIFFERENCES THAT EXIST BETWEEN

1112
00:42:34,400 --> 00:42:34,960
CULTURES.

1113
00:42:34,960 --> 00:42:37,040
YOU'RE NOT GOING TO -- WE'RE NOT

1114
00:42:37,040 --> 00:42:37,560
HOMOGENOUS.

1115
00:42:37,560 --> 00:42:38,200
THAT'S A GOOD THING.

1116
00:42:38,200 --> 00:42:40,640
BUT YOU NEED TO UNDERSTAND THAT.

1117
00:42:40,640 --> 00:42:42,520
RESEARCH TEAM, I SAID THIS

1118
00:42:42,520 --> 00:42:46,760
BEFORE, NEEDS TO REFLECT THE

1119
00:42:46,760 --> 00:42:49,480
POPULATION YOU'RE STUDYING.

1120
00:42:49,480 --> 00:42:50,880
AND UNDERSTAND THAT CULTURAL

1121
00:42:50,880 --> 00:42:53,320
DIFFERENCES CAN HAVE A

1122
00:42:53,320 --> 00:42:55,160
SIGNIFICANT IMPACT ON THE

1123
00:42:55,160 --> 00:42:59,440
OUTCOME OF YOUR STUDY, AND COULD

1124
00:42:59,440 --> 00:43:01,960
AFFECT -- COULD POSITIVELY OR

1125
00:43:01,960 --> 00:43:02,840
NEGATIVELY AFFECT YOUR STUDY

1126
00:43:02,840 --> 00:43:03,400
DESIGN.

1127
00:43:03,400 --> 00:43:07,960
TRAIN THE TEAM ON IMPLICIT BIAS

1128
00:43:07,960 --> 00:43:10,800
AND CULTURAL COMPETENCY.

1129
00:43:10,800 --> 00:43:12,560
THERE ARE VARIOUS IMPLICIT BIAS

1130
00:43:12,560 --> 00:43:14,000
PAINTINGS OUT THERE, SOME BETTER

1131
00:43:14,000 --> 00:43:17,040
THAN OTHERS, STILL UNKNOWN

1132
00:43:17,040 --> 00:43:18,360
WHETHER THE STRAIGHT IMPLICIT

1133
00:43:18,360 --> 00:43:19,480
BIAS TRAINING IS EFFECTIVE BUT

1134
00:43:19,480 --> 00:43:21,040
IT'S A START.

1135
00:43:21,040 --> 00:43:22,400
AND UNDERSTANDING WHAT YOU'RE

1136
00:43:22,400 --> 00:43:23,400
DEALING WITH ESPECIALLY WITH

1137
00:43:23,400 --> 00:43:25,160
COMMUNITIES YOU'RE REACHING OUT

1138
00:43:25,160 --> 00:43:27,680
TO IS HELPFUL.

1139
00:43:27,680 --> 00:43:29,280
ENGAGE THE COMMUNITY THERE.

1140
00:43:29,280 --> 00:43:33,840
RESEARCH SHOULD BE PATIENT

1141
00:43:33,840 --> 00:43:34,360
CENTERED.

1142
00:43:34,360 --> 00:43:36,680
MAKE SURE THERE'S TRANSLATED

1143
00:43:36,680 --> 00:43:37,880
INFORMED CONSENTS AND

1144
00:43:37,880 --> 00:43:38,760
RECRUITMENT DOCUMENTS SO CAN YOU

1145
00:43:38,760 --> 00:43:41,120
GET PATIENTS FROM A VARIETY OF

1146
00:43:41,120 --> 00:43:42,080
BACKGROUNDS, AND HOLD FOCUS

1147
00:43:42,080 --> 00:43:44,640
GROUPS, AGAIN BACK TO THE

1148
00:43:44,640 --> 00:43:46,720
COMMUNITY, TO UNDERSTAND AND

1149
00:43:46,720 --> 00:43:48,920
WHERE YOU'RE HOLDING THEM, GO TO

1150
00:43:48,920 --> 00:43:50,160
THE COMMUNITY, DON'T EXPECT THEM

1151
00:43:50,160 --> 00:43:54,160
ALWAYS TO COME TO YOU.

1152
00:43:54,160 --> 00:43:55,760
AND FINALLY, I THINK MAYBE

1153
00:43:55,760 --> 00:43:57,440
PRETTY OBVIOUS, WHAT IS

1154
00:43:57,440 --> 00:43:57,800
REPRESENTATIVE?

1155
00:43:57,800 --> 00:44:00,040
WHAT GROUPS, IS IT EVERYBODY?

1156
00:44:00,040 --> 00:44:04,320
IS IT SPECIFIC POPULATIONS OF

1157
00:44:04,320 --> 00:44:06,120
SPECIFIC ETHNIC CULTURAL GROUPS

1158
00:44:06,120 --> 00:44:08,920
THAT ARE APPROPRIATE

1159
00:44:08,920 --> 00:44:11,120
REPRESENTATIVES FOR THE DISEASE

1160
00:44:11,120 --> 00:44:12,320
THAT YOU ARE INVESTIGATING AND

1161
00:44:12,320 --> 00:44:17,680
TRYING TO COME UP WITH SOLUTIONS

1162
00:44:17,680 --> 00:44:18,240
FOR.

1163
00:44:18,240 --> 00:44:22,520
ONE FINAL NOTE IS THAT ANALYZING

1164
00:44:22,520 --> 00:44:24,000
PRESENTING RESEARCH IS A

1165
00:44:24,000 --> 00:44:25,680
SIGNIFICANT ISSUE, AND YOU NEED

1166
00:44:25,680 --> 00:44:28,160
TO BE THOUGHTFUL ABOUT THIS

1167
00:44:28,160 --> 00:44:32,120
BECAUSE THE WAY THAT RACE AND

1168
00:44:32,120 --> 00:44:33,800
ETHNICITY, EVEN COUNTRY OF

1169
00:44:33,800 --> 00:44:35,920
ORIGIN REPORTED ACROSS CLINICAL

1170
00:44:35,920 --> 00:44:38,600
STUDIES VARIES SIGNIFICANTLY.

1171
00:44:38,600 --> 00:44:45,480
THIS WAS AN OPINION PIECE IN

1172
00:44:45,480 --> 00:44:48,680
JAMA, THAT IN 2021, THAT

1173
00:44:48,680 --> 00:44:50,720
SUGGESTED WAYS TO STANDARDIZE

1174
00:44:50,720 --> 00:44:54,120
THE REPORTING OF RACE AND

1175
00:44:54,120 --> 00:44:57,200
ETHNICITY ACROSS CLINICAL

1176
00:44:57,200 --> 00:44:59,320
STUDIES SO WE'RE ALL TALKING IN

1177
00:44:59,320 --> 00:45:00,400
THE SAME LANGUAGE, AND THAT'S

1178
00:45:00,400 --> 00:45:01,840
VERY IMPORTANT SO I HIGHLY

1179
00:45:01,840 --> 00:45:04,200
RECOMMEND READING THIS.

1180
00:45:04,200 --> 00:45:06,160
AGAIN, IT'S IN OUR RESOURCES

1181
00:45:06,160 --> 00:45:06,560
SECTION HERE.

1182
00:45:06,560 --> 00:45:07,960
WORDS DO MATTER.

1183
00:45:07,960 --> 00:45:13,080
AND YOU NEED TO ASK QUESTIONS

1184
00:45:13,080 --> 00:45:16,680
AND STRATIFY YOUR DATA

1185
00:45:16,680 --> 00:45:19,680
CONSIDERING THE VARIOUS

1186
00:45:19,680 --> 00:45:20,320
RACE/ETHNICITY AS SUGGESTED

1187
00:45:20,320 --> 00:45:24,040
BEFORE, SO YOU KNOW IF THERE'S

1188
00:45:24,040 --> 00:45:25,560
DIFFERENTIAL IMPACT OF YOUR

1189
00:45:25,560 --> 00:45:28,520
INVESTIGATION AND THE OUTCOME ON

1190
00:45:28,520 --> 00:45:29,880
VARIOUS GROUPS.

1191
00:45:29,880 --> 00:45:34,440
THAT IS MY LAST SLIDE.

1192
00:45:34,440 --> 00:45:35,360
THIS IS RESOURCES SECTION, AND

1193
00:45:35,360 --> 00:45:37,320
HOPEFULLY THESE SLIDES WILL BE

1194
00:45:37,320 --> 00:45:40,400
AVAILABLE TO YOU ON REQUEST.

1195
00:45:40,400 --> 00:45:43,560
SO THAT YOU CAN LOOK AT ANY OF

1196
00:45:43,560 --> 00:45:45,240
THE SLIDES, OR SPECIFICALLY, OR

1197
00:45:45,240 --> 00:45:47,400
ESPECIALLY RESOURCES THAT ARE

1198
00:45:47,400 --> 00:45:48,480
AVAILABLE, BECAUSE THEY ARE ALL

1199
00:45:48,480 --> 00:45:49,280
GOOD.

1200
00:45:49,280 --> 00:45:50,760
THERE'S A LOT THERE.

1201
00:45:50,760 --> 00:45:55,040
BUT THEY WILL HELP, I THINK, IN

1202
00:45:55,040 --> 00:45:57,000
DEVELOPING MORE CULTURALLY

1203
00:45:57,000 --> 00:45:58,200
APPROPRIATE AND HEALTH EQUITY

1204
00:45:58,200 --> 00:46:00,760
AWARE CLINICAL RESEARCH IN THE

1205
00:46:00,760 --> 00:46:01,920
FUTURE THAT I THINK WILL HELP US

1206
00:46:01,920 --> 00:46:06,360
ALL, BECAUSE IT WILL IMPROVE THE

1207
00:46:06,360 --> 00:46:10,200
OUTCOMES FOR EVERYONE, WHICH IS

1208
00:46:10,200 --> 00:46:12,160
OUR GOAL, AND REALLY MAKE US

1209
00:46:12,160 --> 00:46:13,960
MORE AWARE OF WHERE WE NEED TO

1210
00:46:13,960 --> 00:46:15,880
GO IN THE FUTURE.

1211
00:46:15,880 --> 00:46:17,400
SO, THAT'S IT.

1212
00:46:17,400 --> 00:46:19,160
I THANK YOU VERY MUCH AGAIN FOR

1213
00:46:19,160 --> 00:46:21,120
THIS OPPORTUNITY TO TALK ABOUT

1214
00:46:21,120 --> 00:46:23,240
SOMETHING THAT WE HERE AT THE

1215
00:46:23,240 --> 00:46:25,080
MARYLAND PATIENT SAFETY CENTER

1216
00:46:25,080 --> 00:46:26,160
ARE VERY PASSIONATE ABOUT AND

1217
00:46:26,160 --> 00:46:28,680
I'LL BE HAPPY TO ENTERTAIN ANY

1218
00:46:28,680 --> 00:46:28,960
QUESTIONS.

1219
00:46:28,960 --> 00:46:30,440
>> WELL, THANK YOU VERY
MUCH,

1220
00:46:30,440 --> 00:46:31,440
DR. EIG.

1221
00:46:31,440 --> 00:46:33,600
THAT WAS FABULOUS.

1222
00:46:33,600 --> 00:46:34,800
VERY, VERY IMPORTANT TOPICS, AND

1223
00:46:34,800 --> 00:46:36,240
A LOT THERE.

1224
00:46:36,240 --> 00:46:37,560
BUT DEFINITELY AS YOU SAID, YOU

1225
00:46:37,560 --> 00:46:41,360
KNOW, ALL OF US ARE HERE OR IN

1226
00:46:41,360 --> 00:46:43,680
HEALTH CARE TO PROVIDE

1227
00:46:43,680 --> 00:46:45,440
HIGH-QUALITY AND SAFETY PATIENT

1228
00:46:45,440 --> 00:46:46,760
CARE, AND ANY DISPARITIES AND

1229
00:46:46,760 --> 00:46:47,920
EQUITY ISSUES ARE AFFECTING OUR

1230
00:46:47,920 --> 00:46:49,240
ABILITY TO DO THAT.

1231
00:46:49,240 --> 00:46:52,040
THAT GOES THE SAME WITH

1232
00:46:52,040 --> 00:46:53,120
HIGH-QUALITY RESEARCH.

1233
00:46:53,120 --> 00:46:55,520
SO THANK YOU FOR BRINGING THOSE.

1234
00:46:55,520 --> 00:46:56,840
I'D LIKE TO REMIND EVERYBODY TO

1235
00:46:56,840 --> 00:46:58,560
ASK A QUESTION IF YOU'RE

1236
00:46:58,560 --> 00:46:59,680
WATCHING ON VIDEOCAST RIGHT

1237
00:46:59,680 --> 00:47:01,080
BELOW YOU MIGHT SCROLL DOWN,

1238
00:47:01,080 --> 00:47:03,720
THERE'S A BUTTON THAT SAYS LIVE

1239
00:47:03,720 --> 00:47:04,400
FEEDBACK, SEND YOUR QUESTIONS,

1240
00:47:04,400 --> 00:47:08,400
AND WE DO HAVE A QUESTION HERE.

1241
00:47:08,400 --> 00:47:15,000
DR. EIG, CONCERNING THE MATERNAL

1242
00:47:15,000 --> 00:47:16,520
MORBIDITY AND BLACK-WHITE

1243
00:47:16,520 --> 00:47:17,480
DIFFERENCE AGAINST COLLEGE

1244
00:47:17,480 --> 00:47:18,800
EDUCATED UNIVERSITY WOMEN, THERE

1245
00:47:18,800 --> 00:47:22,720
MAY BE CULTURAL DIFFERENCES IN

1246
00:47:22,720 --> 00:47:24,920
DIET AND PRACTICES NOT GENERALLY

1247
00:47:24,920 --> 00:47:26,680
RECOGNIZED TO MATTER.

1248
00:47:26,680 --> 00:47:29,640
IS THERE COMPARATIVE DATA FOR

1249
00:47:29,640 --> 00:47:31,160
PHYSICIAN MATERNAL MORBIDITY AND

1250
00:47:31,160 --> 00:47:34,080
ARE DIFFERENCES THE SAME?

1251
00:47:34,080 --> 00:47:35,440
IN OTHER WORDS, PHYSICIANS AND

1252
00:47:35,440 --> 00:47:37,280
OTHER HEALTH CARE MORE AWARE OF

1253
00:47:37,280 --> 00:47:39,680
CHANGES NEEDED IN PREGNANCY.

1254
00:47:39,680 --> 00:47:41,520
THE QUESTION IS PHYSICIANS WHO

1255
00:47:41,520 --> 00:47:46,480
ARE BLACK, DO THEY HAVE

1256
00:47:46,480 --> 00:47:47,760
DIFFERENT OUTCOMES VERSUS

1257
00:47:47,760 --> 00:47:48,280
WHITES?

1258
00:47:48,280 --> 00:47:49,640
>> SO FAR, THERE'S NO DATA
TO

1259
00:47:49,640 --> 00:47:51,080
THAT EFFECT THOUGH IT'S BEING

1260
00:47:51,080 --> 00:47:51,600
LOOKED AT.

1261
00:47:51,600 --> 00:47:54,560
I THINK WHEN I DISCUSSED THE

1262
00:47:54,560 --> 00:47:56,560
STUDY DONE IN FLORIDA, WHICH WAS

1263
00:47:56,560 --> 00:47:58,640
A VERY EXTENSIVE STUDY, TOOK A

1264
00:47:58,640 --> 00:48:02,920
WHILE TO COLLECT THAT DATA, THEY

1265
00:48:02,920 --> 00:48:04,120
DEFINITELY SAW CONCORDANCE WITH

1266
00:48:04,120 --> 00:48:05,440
BLACK PHYSICIANS AND BLACK

1267
00:48:05,440 --> 00:48:06,440
INFANT MORTALITY.

1268
00:48:06,440 --> 00:48:09,040
THEY DID NOT SEE CONCORDANCE

1269
00:48:09,040 --> 00:48:11,040
WITH BLACK PHYSICIANS AND BLACK

1270
00:48:11,040 --> 00:48:11,920
MATERNAL MORTALITY.

1271
00:48:11,920 --> 00:48:13,240
THAT DOESN'T MEAN IT DOESN'T

1272
00:48:13,240 --> 00:48:13,560
EXIST.

1273
00:48:13,560 --> 00:48:17,760
IT DIDN'T EXIST IN THAT STUDY.

1274
00:48:17,760 --> 00:48:19,040
SO MORE RESEARCH IS BEING DONE.

1275
00:48:19,040 --> 00:48:21,880
AND THIS IS NOT TO SUGGEST THAT

1276
00:48:21,880 --> 00:48:23,520
BLACK PATIENTS SHOULD ONLY SEE

1277
00:48:23,520 --> 00:48:23,880
BLACK DOCTORS.

1278
00:48:23,880 --> 00:48:27,920
THIS IS THAT THERE'S AN ISSUE IN

1279
00:48:27,920 --> 00:48:31,960
SOME CASES WITH PROBABLY TRUST,

1280
00:48:31,960 --> 00:48:34,240
PROBABLY SOME CULTURAL

1281
00:48:34,240 --> 00:48:35,160
DIFFERENCES, CULTURAL

1282
00:48:35,160 --> 00:48:38,920
COMPETENCY, THAT MAY AFFECT

1283
00:48:38,920 --> 00:48:41,040
OUTCOMES ESPECIALLY SEEN

1284
00:48:41,040 --> 00:48:42,240
PROBABLY IN RECOMMENDATIONS,

1285
00:48:42,240 --> 00:48:43,240
ADVICE GIVEN, HEALTH PREVENTION.

1286
00:48:43,240 --> 00:48:46,000
THAT HAS BEEN SEEN IN STUDIES,

1287
00:48:46,000 --> 00:48:49,720
WHERE A BLACK PHYSICIAN WAS MORE

1288
00:48:49,720 --> 00:48:51,920
SUCCESSFUL IN GETTING BLACK

1289
00:48:51,920 --> 00:48:54,040
PATIENTS TO CHANGE PRACTICES, IN

1290
00:48:54,040 --> 00:48:55,920
TERMS OF PREVENTIVE CARE,

1291
00:48:55,920 --> 00:48:58,120
ESPECIALLY IN CARDIAC DISEASE.

1292
00:48:58,120 --> 00:49:00,720
SO THAT DOES EXIST, BUT AGAIN

1293
00:49:00,720 --> 00:49:04,040
IT'S NOT THE SUGGESTION THAT WE

1294
00:49:04,040 --> 00:49:05,440
SHOULD HAVE A DIFFERENT SYSTEM

1295
00:49:05,440 --> 00:49:08,040
OF WHO CARES FOR WHO.

1296
00:49:08,040 --> 00:49:09,240
IT'S THAT EVERYONE SHOULD

1297
00:49:09,240 --> 00:49:11,120
RECOGNIZE THAT AND TRY TO FIGURE

1298
00:49:11,120 --> 00:49:13,080
OUT HOW EVERYBODY, NO MATTER

1299
00:49:13,080 --> 00:49:14,200
WHAT RACE OF PHYSICIAN OR RACE

1300
00:49:14,200 --> 00:49:15,960
OF PATIENT IS, CAN GIVE THE BEST

1301
00:49:15,960 --> 00:49:16,640
CARE POSSIBLE.

1302
00:49:16,640 --> 00:49:22,640
IT'S GOING TO  TO TAKE SOME TIMD

1303
00:49:22,640 --> 00:49:24,520
WE NEED TO INVESTIGATE FULLY TO

1304
00:49:24,520 --> 00:49:25,560
DO THAT.

1305
00:49:25,560 --> 00:49:27,240
GOING BACK TO I THINK FIRST PART

1306
00:49:27,240 --> 00:49:30,280
OF THE QUESTION, HAVING TO DO

1307
00:49:30,280 --> 00:49:32,080
WITH EDUCATION, THE INTERESTING

1308
00:49:32,080 --> 00:49:33,800
THING IN BLACK MATERNAL

1309
00:49:33,800 --> 00:49:36,080
MORBIDITY IS CERTAINLY EDUCATION

1310
00:49:36,080 --> 00:49:39,360
DOESN'T SEEM TO BE THE EFFECT

1311
00:49:39,360 --> 00:49:41,640
HERE. 

1312
00:49:41,640 --> 00:49:46,160
AND IT IS AND ALSO WEALTH, IT'S

1313
00:49:46,160 --> 00:49:47,560
NOT REGARDING WEALTH.

1314
00:49:47,560 --> 00:49:52,280
IN FACT, THERE'S A HIGHER RATE

1315
00:49:52,280 --> 00:49:54,920
IN THE WEALTHIER AND OLDER BLACK

1316
00:49:54,920 --> 00:49:57,200
WOMEN.

1317
00:49:57,200 --> 00:49:58,560
SO, THAT -- AND THAT'S BEING

1318
00:49:58,560 --> 00:50:00,520
LOOKED AT RIGHT NOW.

1319
00:50:00,520 --> 00:50:01,800
WHY IS THAT?

1320
00:50:01,800 --> 00:50:02,920
IT'S TO SAY SOCIAL DETERMINANTS

1321
00:50:02,920 --> 00:50:06,600
OF HEALTH GIVE US A DIRECTION I

1322
00:50:06,600 --> 00:50:07,720
THINK INTO THESE DISPARITIES,

1323
00:50:07,720 --> 00:50:09,000
BUT EACH SOCIAL DETERMINANT OF

1324
00:50:09,000 --> 00:50:12,640
HEALTH IS NOT ACTIVE IN EACH

1325
00:50:12,640 --> 00:50:13,200
DISPARITY.

1326
00:50:13,200 --> 00:50:15,040
WE NEED TO UNDERSTAND THAT.

1327
00:50:15,040 --> 00:50:16,240
IT'S MUCH MORE COMPLEX THAN WE'D

1328
00:50:16,240 --> 00:50:18,320
LIKE IT TO BE BUT AS WE LOOK AT

1329
00:50:18,320 --> 00:50:19,440
EACH DISPARITY WE CAN SEE WHAT

1330
00:50:19,440 --> 00:50:21,160
IS ACTIVE, WHAT IS NOT, AND WORK

1331
00:50:21,160 --> 00:50:24,240
ON THINGS THAT ARE ACTIVE.

1332
00:50:24,240 --> 00:50:24,520
>> GREAT.

1333
00:50:24,520 --> 00:50:26,720
THANKS VERY MUCH.

1334
00:50:26,720 --> 00:50:28,000
THANKS FOR THE QUESTION.

1335
00:50:28,000 --> 00:50:29,360
WHILE WE WAIT TO SEE IF THERE'S

1336
00:50:29,360 --> 00:50:32,160
MORE QUESTIONS AS THEY COME IN,

1337
00:50:32,160 --> 00:50:33,760
YOU DID TOUCH ON THIS, WHAT CAN

1338
00:50:33,760 --> 00:50:35,960
WE DO?

1339
00:50:35,960 --> 00:50:39,000
I JOTTED DOWN, AS A HEALTH CARE

1340
00:50:39,000 --> 00:50:40,200
WORKER, MYSELF AS A PHYSICIAN

1341
00:50:40,200 --> 00:50:42,520
BUT ANY HEALTH CARE WORKER NOT

1342
00:50:42,520 --> 00:50:45,800
RUNNING A HOSPITAL OR RESEARCH,

1343
00:50:45,800 --> 00:50:47,640
BUT WHAT COULD I AS AN

1344
00:50:47,640 --> 00:50:50,200
INDIVIDUAL DO, I WAS THINKING

1345
00:50:50,200 --> 00:50:50,680
ABOUT LIST OF SOCIAL

1346
00:50:50,680 --> 00:50:51,720
DETERMINANTS OF HEALTH, IF

1347
00:50:51,720 --> 00:50:54,680
SOMEBODY SAID, GOSH, THIS IS

1348
00:50:54,680 --> 00:50:55,920
OVERWHELMING, WHAT ONE THING

1349
00:50:55,920 --> 00:50:58,480
COULD I DO, ADD TO MY DAY OR

1350
00:50:58,480 --> 00:51:01,320
WEEK, EVEN FOR A SMALL AMOUNT OF

1351
00:51:01,320 --> 00:51:03,160
TIME THAT YOU THINK WOULD HAVE

1352
00:51:03,160 --> 00:51:03,560
THE MOST IMPACT?

1353
00:51:03,560 --> 00:51:04,960
>> I THINK IT'S REACHING
OUT TO

1354
00:51:04,960 --> 00:51:06,160
THE COMMUNITY, THOSE IN NEED IN

1355
00:51:06,160 --> 00:51:06,680
YOUR COMMUNITY.

1356
00:51:06,680 --> 00:51:08,960
THAT CAN BE DONE VARIOUS WAYS.

1357
00:51:08,960 --> 00:51:10,040
THERE ARE COMMUNITY GROUPS THAT

1358
00:51:10,040 --> 00:51:12,240
YOU CAN JOIN, THERE ARE

1359
00:51:12,240 --> 00:51:15,640
COMMUNITY PROJECTS, WHETHER IT'S

1360
00:51:15,640 --> 00:51:19,680
WORKING AT A FOOD KITCHEN, OR

1361
00:51:19,680 --> 00:51:20,920
WORKING ON CONSTRUCTION

1362
00:51:20,920 --> 00:51:22,640
PROJECTS, LIKE HABITAT FOR

1363
00:51:22,640 --> 00:51:24,840
HUMANITY, WHATEVER THE LOCAL

1364
00:51:24,840 --> 00:51:25,720
ORGANIZATION IS.

1365
00:51:25,720 --> 00:51:27,480
YOU GET TO GO TO THE COMMUNITY.

1366
00:51:27,480 --> 00:51:29,520
GET TO TALK TO PEOPLE FROM THE

1367
00:51:29,520 --> 00:51:29,800
COMMUNITY.

1368
00:51:29,800 --> 00:51:30,560
YOU START UNDERSTANDING THE

1369
00:51:30,560 --> 00:51:33,160
ISSUES THAT THEY ARE DEALING

1370
00:51:33,160 --> 00:51:34,200
WITH.

1371
00:51:34,200 --> 00:51:34,720
UNDERSTANDING NOT ONLY THE

1372
00:51:34,720 --> 00:51:36,120
SOCIAL DETERMINANTS OF HEALTH

1373
00:51:36,120 --> 00:51:39,400
THAT MIGHT BE AFFECTING THAT

1374
00:51:39,400 --> 00:51:41,480
COMMUNITY, BUT ALSO WHAT TRUST

1375
00:51:41,480 --> 00:51:43,440
OR MISTRUST IS IN THAT COMMUNITY

1376
00:51:43,440 --> 00:51:45,640
OF THE HEALTH CARE SYSTEM.

1377
00:51:45,640 --> 00:51:47,560
BY BEING THERE YOU CAN

1378
00:51:47,560 --> 00:51:49,400
REPRESENTATIVE THE HEALTH CARE

1379
00:51:49,400 --> 00:51:51,120
COMMITTEE, SHOWING CARE AND

1380
00:51:51,120 --> 00:51:52,560
CONCERN, START REDUCING THAT

1381
00:51:52,560 --> 00:51:53,280
DISTRUST.

1382
00:51:53,280 --> 00:51:54,640
I THINK THAT COMMUNICATION, WE

1383
00:51:54,640 --> 00:51:56,680
TEND TO GET SILOED IN WHAT WE DO

1384
00:51:56,680 --> 00:51:58,280
BECAUSE OUR LIVES ARE BUSY AND

1385
00:51:58,280 --> 00:52:00,080
WE STAY WITHIN THE COMMUNITIES

1386
00:52:00,080 --> 00:52:01,640
THAT WE'RE USED TO.

1387
00:52:01,640 --> 00:52:04,120
SO WE DON'T REACH OUT, NOT

1388
00:52:04,120 --> 00:52:05,120
BECAUSE WE'RE BAD PEOPLE, IT'S

1389
00:52:05,120 --> 00:52:07,080
BECAUSE WE DON'T HAVE TIME.

1390
00:52:07,080 --> 00:52:10,520
SO IT IS TAKING THE TIME TO FIND

1391
00:52:10,520 --> 00:52:13,000
A COMMUNITY GROUP, COMMUNITY

1392
00:52:13,000 --> 00:52:14,200
ACTIVITY, A COMMUNITY COMMITTEE,

1393
00:52:14,200 --> 00:52:15,600
THAT YOU CAN PARTICIPATE ON SO

1394
00:52:15,600 --> 00:52:17,680
THAT YOU CAN REACH OUT AND THEN

1395
00:52:17,680 --> 00:52:20,200
THEY CAN START UNDERSTANDING

1396
00:52:20,200 --> 00:52:21,960
YOU, AND THROUGH YOU, THE

1397
00:52:21,960 --> 00:52:24,400
CLINICAL CENTER, FOR EXAMPLE,

1398
00:52:24,400 --> 00:52:26,880
AND GAINING COMMUNITY'S TRUST IN

1399
00:52:26,880 --> 00:52:27,480
WHAT YOU DO.

1400
00:52:27,480 --> 00:52:28,440
>> GREAT.

1401
00:52:28,440 --> 00:52:31,520
THANKS FOR THAT ANSWER.

1402
00:52:31,520 --> 00:52:32,880
WE HAVE ANOTHER QUESTION.

1403
00:52:32,880 --> 00:52:37,080
THANK YOU FOR A FANTASTIC TALK.

1404
00:52:37,080 --> 00:52:38,720
YOU MENTIONED NURTURING MORAL

1405
00:52:38,720 --> 00:52:39,120
INCENTIVES.

1406
00:52:39,120 --> 00:52:41,880
ASKED IF YOU COULD ELABORATE ON

1407
00:52:41,880 --> 00:52:45,800
THAT PHRASE OR GIVE SOME

1408
00:52:45,800 --> 00:52:46,080
EXAMPLES.

1409
00:52:46,080 --> 00:52:49,200
>> I THINK SIMPLY, MAYBE A
TOO

1410
00:52:49,200 --> 00:52:51,960
PACKED PHRASE, BUT THE IDEA IS

1411
00:52:51,960 --> 00:52:56,440
WE ALL HAVE CERTAIN ETHICAL AND

1412
00:52:56,440 --> 00:52:58,960
MORAL IDEALS WITHIN WHATEVER

1413
00:52:58,960 --> 00:53:00,040
COMMUNITY AND WHATEVER COUNTRY

1414
00:53:00,040 --> 00:53:01,920
WE LIVE IN, THAT WE THINK ARE

1415
00:53:01,920 --> 00:53:02,280
RIGHT.

1416
00:53:02,280 --> 00:53:04,400
THIS IS THE WAY IT OUGHT TO BE.

1417
00:53:04,400 --> 00:53:08,480
I THINK GETTING BACK TO AMERICA,

1418
00:53:08,480 --> 00:53:09,920
YOU KNOW, AND LEAVING THOMAS

1419
00:53:09,920 --> 00:53:12,640
JEFFERSON AND PERSONAL ISSUES

1420
00:53:12,640 --> 00:53:14,520
ASIDE THERE, THE CONCEPT THAT WE

1421
00:53:14,520 --> 00:53:17,480
ALL HAVE THE RIGHT TO LIFE,

1422
00:53:17,480 --> 00:53:19,000
LIBERTY, PURSUIT OF HAPPINESS,

1423
00:53:19,000 --> 00:53:20,640
AND PURSUIT OF GOOD HEALTH CARE.

1424
00:53:20,640 --> 00:53:24,040
SO, WHAT WE NEED TO DO IS

1425
00:53:24,040 --> 00:53:26,360
NURTURE THAT IDEAL THAT WE LIVE

1426
00:53:26,360 --> 00:53:27,760
IN, AGAIN, IT'S NOT TRUE FOR

1427
00:53:27,760 --> 00:53:29,440
EVERYBODY BUT WE LIVE IN WHAT WE

1428
00:53:29,440 --> 00:53:31,840
FEEL TO BE A FREE SOCIETY, AND

1429
00:53:31,840 --> 00:53:35,200
THAT EVERYBODY SHOULD HAVE THE

1430
00:53:35,200 --> 00:53:37,160
RIGHT TO ACCESS GOOD QUALITY

1431
00:53:37,160 --> 00:53:38,360
HEALTH CARE.

1432
00:53:38,360 --> 00:53:42,960
AND IF WE CAN NURTURE THAT, THAT

1433
00:53:42,960 --> 00:53:44,160
SIMPLE MORAL AND ETHICAL

1434
00:53:44,160 --> 00:53:48,320
CONSTRUCT, I THINK WE CAN ALL DO

1435
00:53:48,320 --> 00:53:48,640
BETTER.

1436
00:53:48,640 --> 00:53:50,920
YOU KNOW, I KNOW THIS BRINGS TO

1437
00:53:50,920 --> 00:53:52,560
MIND TO EVERYBODY WITH ALL OF

1438
00:53:52,560 --> 00:53:55,320
THE POLITICAL DISCOURSE WE'RE

1439
00:53:55,320 --> 00:53:57,520
HAVING RIGHT NOW, IT MAKES IT

1440
00:53:57,520 --> 00:53:58,080
MORE DIFFICULT.

1441
00:53:58,080 --> 00:54:01,360
I TEND TO BE AN OPTIMIST, AND I

1442
00:54:01,360 --> 00:54:07,480
TEND TO WANT PEOPLE TO DO

1443
00:54:07,480 --> 00:54:08,000
BETTER.

1444
00:54:08,000 --> 00:54:09,600
I THINK, AGAIN, THE IDEA WE HAVE

1445
00:54:09,600 --> 00:54:11,080
THROUGH OUR SOCIETY, AND SOME

1446
00:54:11,080 --> 00:54:13,400
PEOPLE THROUGH THEIR RELIGION OR

1447
00:54:13,400 --> 00:54:15,800
CULTURAL GROUP, MORALS AND

1448
00:54:15,800 --> 00:54:18,080
ETHICS WE THINK NEEDED TO BE THE

1449
00:54:18,080 --> 00:54:20,080
RIGHT THING TO DO, WHAT BEE NEED

1450
00:54:20,080 --> 00:54:27,960
TO DO IS NURTURE THAT, MOVE IT

1451
00:54:27,960 --> 00:54:29,160
FORWARD, MAKE THIS PLACE BETTER

1452
00:54:29,160 --> 00:54:30,880
WHICH WE BELIEVE AT THE SAFETY

1453
00:54:30,880 --> 00:54:32,520
CENTER WILL IMPROVE, YOU KNOW,

1454
00:54:32,520 --> 00:54:34,720
HEALTH EQUITY FOR ALL, AND THERE

1455
00:54:34,720 --> 00:54:35,920
BY IMPROVE HEALTH OUTCOMES FOR

1456
00:54:35,920 --> 00:54:39,440
ALL, WHICH IS OUR GOAL.

1457
00:54:39,440 --> 00:54:42,160
>> GREAT.

1458
00:54:42,160 --> 00:54:42,400
THANKS.

1459
00:54:42,400 --> 00:54:44,120
HERE'S A QUESTION, DO YOU HAVE

1460
00:54:44,120 --> 00:54:46,280
ANY SUGGESTIONS ON HOW WE CAN

1461
00:54:46,280 --> 00:54:47,520
ENCOURAGE UNDERREPRESENTED

1462
00:54:47,520 --> 00:54:48,600
INDIVIDUALS TO ENGAGE IN

1463
00:54:48,600 --> 00:54:49,240
RESEARCH?

1464
00:54:49,240 --> 00:54:51,720
I UNDERSTAND THAT WE NEED MORE

1465
00:54:51,720 --> 00:54:54,120
INDIVIDUALS IN DIVERSE

1466
00:54:54,120 --> 00:54:56,720
COMMUNITIES TO PARTICIPATE IN

1467
00:54:56,720 --> 00:54:57,080
RESEARCH.

1468
00:54:57,080 --> 00:55:00,760
THINKING ABOUT HOW TO OVERCOME

1469
00:55:00,760 --> 00:55:02,160
THE UNDERSTANDABLE RELUCTANCE.

1470
00:55:02,160 --> 00:55:02,760
>> RIGHT.

1471
00:55:02,760 --> 00:55:04,080
AGAIN, FIRST IS UNDERSTANDING.

1472
00:55:04,080 --> 00:55:06,120
I MEAN, FIRST IS KNOWLEDGE.

1473
00:55:06,120 --> 00:55:07,560
AND I TRIED TO DO A LITTLE BIT

1474
00:55:07,560 --> 00:55:09,360
OF THAT TODAY BUT READ SOME MORE

1475
00:55:09,360 --> 00:55:12,240
ABOUT IT, READ ABOUT THE VARIOUS

1476
00:55:12,240 --> 00:55:15,920
HISTORICAL -- I'VE GOT THE BOOKS

1477
00:55:15,920 --> 00:55:20,480
THERE IN THE POWERPOINT. 

1478
00:55:20,480 --> 00:55:22,560
BUT READ ABOUT HISTORICAL

1479
00:55:22,560 --> 00:55:24,120
EPISODES IN CLINICAL RESEARCH

1480
00:55:24,120 --> 00:55:26,840
THAT ARE NOT GOOD, BUT WE CAN AT

1481
00:55:26,840 --> 00:55:28,360
LEAST UNDERSTAND THEM, SPEAK TO

1482
00:55:28,360 --> 00:55:28,720
IT.

1483
00:55:28,720 --> 00:55:30,200
AND THEN IT IS, AGAIN, REACHING

1484
00:55:30,200 --> 00:55:31,760
OUT TO THE COMMUNITIES, NOT ALL

1485
00:55:31,760 --> 00:55:34,160
OF THEM ARE RIGHT THERE IN

1486
00:55:34,160 --> 00:55:34,920
BETHESDA, BUT FINDING

1487
00:55:34,920 --> 00:55:37,200
COMMUNITIES AND THE GOOD NEWS IS

1488
00:55:37,200 --> 00:55:40,600
EVEN IN WHAT WE CONSIDER TO BE A

1489
00:55:40,600 --> 00:55:41,480
WEALTHY MONTGOMERY COUNTY,

1490
00:55:41,480 --> 00:55:42,120
DIFFERENT COMMUNITIES YOU DON'T

1491
00:55:42,120 --> 00:55:44,120
KNOW ABOUT.

1492
00:55:44,120 --> 00:55:46,280
AND REACHING OUT TO THOSE

1493
00:55:46,280 --> 00:55:48,400
COMMUNITIES, START TALKING WITH

1494
00:55:48,400 --> 00:55:48,600
THEM.

1495
00:55:48,600 --> 00:55:52,880
ONCE YOU ENGAGED THEM AND ENGAGE

1496
00:55:52,880 --> 00:55:55,800
WHETHER IT'S COMMITTEES, YOU

1497
00:55:55,800 --> 00:55:58,680
KNOW, AGAIN COMMUNITY BOARDS,

1498
00:55:58,680 --> 00:56:00,680
COMMITTEES, OR PERHAPS RELIGIOUS

1499
00:56:00,680 --> 00:56:02,920
INSTITUTIONS IN THOSE

1500
00:56:02,920 --> 00:56:05,760
COMMUNITIES OF VARIOUS KINDS,

1501
00:56:05,760 --> 00:56:08,080
CULTURAL AND SOCIAL, COUNTRY OF

1502
00:56:08,080 --> 00:56:09,840
ORIGIN GROUPS WHICH MAY HAVE A

1503
00:56:09,840 --> 00:56:12,240
DIFFERENT LANGUAGE SO YOU MIGHT

1504
00:56:12,240 --> 00:56:14,640
NEED A TRANSLATOR, AND AS WE

1505
00:56:14,640 --> 00:56:17,280
FOUND WITH COVID, HAIR SALONS

1506
00:56:17,280 --> 00:56:19,800
AND BARBERSHOPS, WHERE THE

1507
00:56:19,800 --> 00:56:20,800
COMMUNITY GATHERS REGULARLY TO

1508
00:56:20,800 --> 00:56:23,840
REACH OUT THERE AND SAY, HEY,

1509
00:56:23,840 --> 00:56:28,080
I'M DOING WORK AT THE CLINICAL

1510
00:56:28,080 --> 00:56:29,440
CENTER AT NIH, WE'RE TRYING TO

1511
00:56:29,440 --> 00:56:31,200
IMPROVE HEALTH CARE FOR

1512
00:56:31,200 --> 00:56:32,600
EVERYBODY, BUT WE CAN'T RECRUIT

1513
00:56:32,600 --> 00:56:34,040
PEOPLE FROM YOUR COMMUNITY,

1514
00:56:34,040 --> 00:56:36,120
WHAT'S WRONG, WHAT CAN WE DO?

1515
00:56:36,120 --> 00:56:37,880
JUST STARTING THAT CONVERSATION.

1516
00:56:37,880 --> 00:56:38,880
DOESN'T HAPPEN OVERNIGHT.

1517
00:56:38,880 --> 00:56:40,280
NOTHING DOES.

1518
00:56:40,280 --> 00:56:42,120
DON'T GET DISCOURAGED.

1519
00:56:42,120 --> 00:56:42,400
KEEP TRYING.

1520
00:56:42,400 --> 00:56:44,000
IT IS THE RIGHT THING TO DO.

1521
00:56:44,000 --> 00:56:45,800
I THINK IT IS HAPPENING MORE

1522
00:56:45,800 --> 00:56:46,200
NOW.

1523
00:56:46,200 --> 00:56:47,480
I THINK COVID ACTUALLY OPENED

1524
00:56:47,480 --> 00:56:48,680
OUR EYES ON THAT.

1525
00:56:48,680 --> 00:56:52,720
BUT WE WILL NEED TO DO MORE.

1526
00:56:52,720 --> 00:56:54,840
AND HONESTLY, TO TAKE BACK TO

1527
00:56:54,840 --> 00:56:56,040
THE NIH LEADERSHIP, CLINICAL

1528
00:56:56,040 --> 00:56:59,000
CENTER LEADERSHIP, THEY CAN DO

1529
00:56:59,000 --> 00:57:01,480
MORE BY SPONSORING INDIVIDUAL

1530
00:57:01,480 --> 00:57:02,880
STAFF IN THEIR ORGANIZATION OR

1531
00:57:02,880 --> 00:57:05,200
HELPING THEM CONNECT WITH THOSE

1532
00:57:05,200 --> 00:57:06,280
GROUPS IN THE COMMUNITY.

1533
00:57:06,280 --> 00:57:09,560
>> THAT'S GREAT, YEAH.

1534
00:57:09,560 --> 00:57:09,920
THANKS.

1535
00:57:09,920 --> 00:57:11,000
MATERNAL MORTALITY, A QUESTION,

1536
00:57:11,000 --> 00:57:13,400
WHAT IS THE MOST COMMON CAUSE OF

1537
00:57:13,400 --> 00:57:15,040
DEATH IN THE MATERNAL

1538
00:57:15,040 --> 00:57:16,680
MORTALITIES WHICH YOU HAD

1539
00:57:16,680 --> 00:57:16,920
STUDIED?

1540
00:57:16,920 --> 00:57:18,320
>> IT VARIES AS TO THE
DATA THAT

1541
00:57:18,320 --> 00:57:20,600
YOU'RE LOOKING AT.

1542
00:57:20,600 --> 00:57:23,800
SOME MATERNAL MORTALITY DATA,

1543
00:57:23,800 --> 00:57:26,360
ESPECIALLY FROM THE CDC,

1544
00:57:26,360 --> 00:57:28,920
INVOLVES ONLY -- YOU KNOW, IN

1545
00:57:28,920 --> 00:57:33,680
THE PERIOD OF TIME ESSENTIALLY

1546
00:57:33,680 --> 00:57:36,480
THAT -- I'M TRYING TO REMEMBER

1547
00:57:36,480 --> 00:57:38,680
IF IT'S CDC OR MARYLAND STATE

1548
00:57:38,680 --> 00:57:42,160
DATA, SOME IS AT THE HOSPITAL,

1549
00:57:42,160 --> 00:57:44,560
I'LL JUST TELL YOU SOME IS AT

1550
00:57:44,560 --> 00:57:48,960
THE HOSPITAL, SOME IS WITHIN 365

1551
00:57:48,960 --> 00:57:50,600
DAYS, A YEAR OF DELIVERY.

1552
00:57:50,600 --> 00:57:53,360
WHEN WE REVIEW WE SUPPORT THE

1553
00:57:53,360 --> 00:57:54,560
STATE'S MATERNAL MORTALITY

1554
00:57:54,560 --> 00:57:56,000
REVIEW THEME, THERE'S ABOUT 40

1555
00:57:56,000 --> 00:57:57,960
TO 50 DEATHS, MATERNAL DEATHS,

1556
00:57:57,960 --> 00:58:00,560
IN MARYLAND A YEAR, BUT MANY OF

1557
00:58:00,560 --> 00:58:05,080
THOSE ARE WITHIN A YEAR AFTER

1558
00:58:05,080 --> 00:58:06,120
DELIVERY.

1559
00:58:06,120 --> 00:58:07,880
AND SO IN THOSE, IN THE ONES

1560
00:58:07,880 --> 00:58:09,680
THAT TAKE UP TO 365 DAYS AFTER

1561
00:58:09,680 --> 00:58:12,040
DELIVERY, AS YOU MIGHT EXPECT

1562
00:58:12,040 --> 00:58:13,800
OVER THE LAST SEVERAL YEARS

1563
00:58:13,800 --> 00:58:15,560
DEATHS DUE TO OPIOID OVERDOSE

1564
00:58:15,560 --> 00:58:16,880
WERE THE GREATEST NUMBER.

1565
00:58:16,880 --> 00:58:19,520
BUT THAT WAS NOT DIRECTLY AND

1566
00:58:19,520 --> 00:58:21,360
DID NOT APPEAR TO BE DIRECTLY

1567
00:58:21,360 --> 00:58:23,120
RELATED TO THE PREGNANCY OR

1568
00:58:23,120 --> 00:58:23,880
POSTPARTUM PERIOD.

1569
00:58:23,880 --> 00:58:26,920
WHEN WE LOOK AT PREGNANCY AND

1570
00:58:26,920 --> 00:58:28,000
POSTPARTUM PERIOD IT TENDS TO

1571
00:58:28,000 --> 00:58:34,840
VARY YEAR TO YEAR, USUALLY

1572
00:58:34,840 --> 00:58:38,200
HYPERTENSIVE-ASSOCIATED DISEASE,

1573
00:58:38,200 --> 00:58:40,080
SO ECLAMPSIA, PREECLAMPSIA, ALSO

1574
00:58:40,080 --> 00:58:41,360
HEMORRHAGIC DISEASE, BLEEDING,

1575
00:58:41,360 --> 00:58:42,680
WHICH HOSPITALS HAVE GOTTEN MUCH

1576
00:58:42,680 --> 00:58:45,120
BETTER AT IN TERMS OF HANDLING

1577
00:58:45,120 --> 00:58:47,400
OBSTETRIC BLEEDING LIKE A

1578
00:58:47,400 --> 00:58:47,920
TRAUMA, THAT'S IMPROVED

1579
00:58:47,920 --> 00:58:49,360
SIGNIFICANTLY I THINK OVER THE

1580
00:58:49,360 --> 00:58:51,920
LAST 10 YEARS.

1581
00:58:51,920 --> 00:58:54,560
STILL NEEDS MORE IMPROVEMENT BUT

1582
00:58:54,560 --> 00:58:55,400
IT'S BETTER.

1583
00:58:55,400 --> 00:58:56,520
AND CARDIAC DISEASE, DISCOVERED

1584
00:58:56,520 --> 00:58:57,840
OR UNDISCOVERED AT THE TIME OF

1585
00:58:57,840 --> 00:58:59,040
DEATH.

1586
00:58:59,040 --> 00:59:01,040
ALL OF THOSE ARE INVOLVED,

1587
00:59:01,040 --> 00:59:07,360
CERTAINLY THERE ARE LESS COMMON

1588
00:59:07,360 --> 00:59:09,040
DISORDERS, PULMONARY EMBOLUS,

1589
00:59:09,040 --> 00:59:11,520
INFECTION, ALL OF THEM, MANY ARE

1590
00:59:11,520 --> 00:59:12,840
PREVENTIBLE.

1591
00:59:12,840 --> 00:59:14,600
WE HAVE TO RECOGNIZE THEM, WHICH

1592
00:59:14,600 --> 00:59:17,240
IS ONE OF THE REASONS WE'RE

1593
00:59:17,240 --> 00:59:19,320
DOING BOTH M.D. MOM PROGRAM AND

1594
00:59:19,320 --> 00:59:20,000
BIRTH EQUITY PROGRAM.

1595
00:59:20,000 --> 00:59:20,720
>> OKAY.

1596
00:59:20,720 --> 00:59:21,520
THANKS VERY MUCH.

1597
00:59:21,520 --> 00:59:23,680
WE'RE JUST IN THE LAST FEW

1598
00:59:23,680 --> 00:59:25,960
SECONDS, SO THERE'S A FINAL

1599
00:59:25,960 --> 00:59:27,280
COMMENT THAT SPEAKS FOR MANY.

1600
00:59:27,280 --> 00:59:29,160
THANK YOU FOR THIS LOVELY AND

1601
00:59:29,160 --> 00:59:29,600
PRACTICAL TALK.

1602
00:59:29,600 --> 00:59:32,840
SO THANK YOU VERY MUCH, DR. EIG,

1603
00:59:32,840 --> 00:59:35,840
I'LL TAKE THE OPPORTUNITY TO

1604
00:59:35,840 --> 00:59:38,560
REMIND PEOPLE THAT NEXT TUESDAY

1605
00:59:38,560 --> 00:59:42,960
THERE'S A SPECIAL TOWN HALL,

1606
00:59:42,960 --> 00:59:45,240
FACILITATED DISCUSSION ON POLICE

1607
00:59:45,240 --> 00:59:47,120
BRUTALITY THAT INCLUDES OUR

1608
00:59:47,120 --> 00:59:49,320
CLINICAL CENTER CEO AND DIRECTOR

1609
00:59:49,320 --> 00:59:52,240
OF NIH OFFICE OF EQUITY,

1610
00:59:52,240 --> 00:59:54,440
DIVERSITY AND INCLUSION,

1611
00:59:54,440 --> 00:59:56,920
ACTUALLY LIVE IN LIPSETT

1612
00:59:56,920 --> 00:59:59,360
AUDITORIUM OR WEBCAST TUESDAY AT

1613
00:59:59,360 --> 01:00:01,400
ELEVEN, LOOK FOR ANNOUNCEMENTS

1614
01:00:01,400 --> 01:00:02,560
FROM THE CLINICAL CENTER DEIA

1615
01:00:02,560 --> 01:00:04,160
PROGRAM ON THAT.

1616
01:00:04,160 --> 01:00:05,480
AGAIN, THANK YOU VERY MUCH, DR.

1617
01:00:05,480 --> 01:00:05,800
EIG.

1618
01:00:05,800 --> 01:00:06,120
AND THANK YOU VERY MUCH TO ALL

1619
01:00:06,120 --> 01:00:07,200
WHO VIEWED THIS.

1620
01:00:07,200 --> 01:00:08,000
WE'LL SEE YOU NEXT WEEK.

1621
01:00:08,000 --> 00:00:00,000
>> THANK YOU.