Welcome to the Clinical Center Grand Rounds,
a weekly series of educational lectures for physicians and
health care professionals broadcast from the Clinical
Center at the National Institutes of Health in
Bethesda, MD.
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dedicated to investigational research and leads the global
effort in training today's investigators and discovering
tomorrow's cures.
Learn more by visiting us online at http://clinicalcenter.nih.gov
>>WELCOME TO TODAY'S CLINICAL
CENTER GRAND ROUNDS.
THIS WEEK IS PATIENT SAFETY
AWARENESS WEEK.
PATIENT SAFETY AWARENESS WEEK
WAS FOUNDED IN 2003, BY THE
NATIONAL PATIENT SAFETY
FOUNDATION, WHICH LATER MERGED
WITH THE INSTITUTE FOR HEALTH
CARE IMPROVEMENT.
THIS WEEK WAS ESTABLISHED TO
ESTABLISH EVERYONE TO LEARN MORE
ABOUT HEALTH CARE SAFETY, TO
ADVANCE IMPORTANT DISCUSSIONS
LOCALLY AND GLOBALLY, AND TO
INSPIRE ACTION TO IMPROVE THE
SAFETY OF THE HEALTH CARE SYSTEM
FOR PATIENTS AND FOR THE
WORKFORCE.
AT THE NIH CLINICAL CENTER,
WE'RE GUIDED BY OUR INDIVIDUAL
AND COLLECTIVE PASSION FOR HIGH
RELIABILITY IN THE SAFE DELIVERY
OF PATIENT-CENTRIC CARE IN A
CLINICAL RESEARCH ENVIRONMENT.
WE PROVIDE HOPE THROUGH
PIONEERING CLINICAL RESEARCH TO
IMPROVE HUMAN HEALTH.
FOR US, WE KNOW SAFE AND
HIGH-QUALITY PATIENT CARE ARE
INTEGRAL TO THE WORLD CHANGING
CLINICAL RESEARCH.
OUR SPEAKER TODAY IS DR. BLAIR
EIG, WITH THE NON-PATIENT SAFETY
ORGANIZATION DESIGNATED BY
MARYLAND AND BY OUR SIBLING
FEDERAL AGENCY THE AGENCY FOR
HEALTH CARE RESEARCH AND
QUALITY.
DR. EIG IS A NATIVE OF MARYLAND,
AND RECEIVED A BACHELOR'S IN
BIOLOGY AND BIOCHEMISTRY AND
MASTER'S IN BIOCHEMISTRY IN
BRANDEIS UNIVERSITY.
HE EARNED A MEDICAL DEGREE FROM
HARVARD MEDICAL SCHOOL, AND
COMPLETED HIS PEDIATRIC
RESIDENCY AND CHIEF RESIDENCY AT
CHILDREN'S NATIONAL MEDICAL
CENTER IN WASHINGTON, D.C.
HE LATER COMPLETED A MASTER'S IN
BUSINESS ADMINISTRATION FROM
AMERICAN UNIVERSITY, ALSO IN
WASHINGTON, D.C.
DR. EIG IS AT THE GEORGE
WASHINGTON SCHOOL OF MEDICINE,
CHIEF MEDICAL OFFICER AT HOLY
CROSS HEALTH SYSTEM, PART OF THE
MARYLAND REGION OF TRINITY
HEALTH FOR 19 YEARS.
PRIOR TO THAT, HE PRACTICED
PRIMARY CARE PEDIATRICS FOR 14
YEARS IN SILVER SPRING.
HE HAS SERVED AS PRESIDENT OF
THE MEDICAL STAFF AT CHILDREN'S
NATIONAL, CHAIR OF THE
LABORATORY ADVISORY COMMITTEE
FOR STATE OF MARYLAND, BOARD
CHAIR FOR MARYLAND HEALTH CARE
EDUCATION INSTITUTE, A MEMBER OF
THE EXECUTIVE COMMITTEE OF THE
MARYLAND HOSPITAL ASSOCIATION.
I RECEIVED A LEADERSHIP AWARD
FROM MONTGOMERY COUNTY PEDIATRIC
SOCIETY, AND PEDIATRICIAN OF THE
YEAR FROM THE SAME SOCIETY, AS
WELL AS MAYNARD CONE AWARD FOR
PEDIATRICS FROM CHILDREN'S
NATIONAL MEDICAL CENTER.
PLEASE WELCOME OUR SPEAKER, DR.
BLAIR EIG, FOR HIS PRESENTATION,
HEALTH EQUITY AS A PATIENT
SAFETY ISSUE.
DR. EIG.
>> THANK YOU VERY MUCH, DAVID.
THANK YOU ALL FOR INVITING ME
HERE TO SPEAK TODAY ON THE
TIMELY AND IMPORTANT ISSUE FOR
SAFE DELIVERY OF HEALTH CARE AND
FOR THE SUCCESS OF CLINICAL
RESEARCH.
I'M A NATIVE OF THE COMMUNITY,
HONORED TO PRESENT TO THE
CLINICAL CENTER.
I ATTENDED A LOCAL HIGH SCHOOL,
HAVE A BIG NUMBER REUNION WITH A
ZERO AT THE END LATER THIS YEAR.
I ALSO CARED FOR MANY OF THE
CLINICAL STAFF FAMILY MEMBERS
WHEN I WAS IN PEDIATRIC PRACTICE
IN SILVER SPRING EARLY IN MY
CAREER AND OVERSAW CARE OF MANY
MORES CHIEF MEDICAL OFFICER AT
HOLY CROSS FOR ALMOST 20 YEARS.
FINALLY, AS I THINK DAVID
MENTIONED, WE REALLY APPRECIATE
HAVING THE CLINICAL CENTER AS A
MEMBER OF THE MARYLAND PATIENT
SAFETY CENTER.
WE HAVE MANY CONFERENCES AND
EDUCATIONAL PROGRAMS THAT YOU
CAN ATTEND, MOST FOR FREE, SOME
FOR REDUCED FREE, AND MANY
INCLUDE CONTINUING EDUCATION
LIKE CME FOR FREE.
SO WE OFFER THAT TO YOU AND
PLEASE WOULD LIKE YOU TO AVAIL
YOURSELF OF THAT.
TODAY I'LL BE DISCUSSING HEALTH
EQUITY.
WHAT IT IS, MORE ACCURATELY THE
LACK OF IT, HOW IT IMPACTS
DISPARITIES IN CLINICAL CARE AND
CLINICAL RESEARCH AND WHAT WE
CAN DO TO PROMOTE A MORE
EQUITABLE HEALTH CARE SYSTEM,
BECAUSE A MORE EQUITABLE HEALTH
CARE SYSTEM WILL RESULT IN
BETTER AND SAFER HEALTH CARE
OUTCOMES FOR ALL OF OUR
PATIENTS.
THROUGHOUT THE TALK I'LL WEAVE
IN WHAT WE'RE DOING AT THE
MARYLAND PATIENT SAFETY CENTER
IN THIS REGARD, WORKING ON
DISPARITIES IN HEALTH CARE,
IMPROVING SAFETY OF CARE
PROVIDED, AND TRYING TO HELP
BOTH CLINICIANS AND RESEARCHERS
DO BETTER IN TERMS OF PROVIDING
EQUITABLE CARE.
I'LL END WITH SOME IDEAS ON WHAT
YOU AS CLINICAL RESEARCHERS AND
CAREGIVERS CAN DO TO IMPROVE
HEALTH EQUITY AND THE GREAT WORK
YOU DO.
ASSISTED IN PREPARING THIS TALK
BY MY STAFF AT THE MARYLAND
PATIENT SAFETY CENTER.
I WANT TO CALL OUT SPECIFICALLY
DR. ADRIAN BURGESS, AN R.N.
Ph.D., EXPERT IN MATERNAL CARE
AND LED PROGRAMS IN THAT AREA
INCLUDING SOME I'LL TALK ABOUT
TODAY INCLUDING BIRTH EQUITY.
I HAVE NO CONFLICTS, ACTUAL OR
POTENTIAL, CONFLICTS OF INTEREST
TO REPORT.
THESE ARE LEARNING OBJECTIVES.
BOTH VERY GOOD, A LITTLE COMPLEX
BUT UNDERSTANDING THE IMPACT OF
PERSONAL BIASES, IMPLICIT AND
EXPLICIT, OF DIVERSITY AND
INCLUSION ON SAFETY PATIENT
CARE, AND STRATEGIES TO MITIGAE
BUYS AND IMPROVE REPRESENTATION,
ESPECIALLY IN CLINICAL RESEARCH.
WE'LL GET STARTED WITH A QUOTE
FROM DR. KING.
OF ALL THE FORMS OF INEQUALITY
INJUSTICE IN HEALTH IS THE MOST
SHOCKING AND MOST INHUMAN
BECAUSE IT OFTEN RESULTS IN
PHYSICAL DEATH.
THE DIAGRAM YOU SEE ON THE
SLIDE, SORRY IT'S NOT AS CLEAR
AS IT MIGHT BE, IS FROM THE
MID-1960s, WHERE THEY STILL
HAD SEGREGATED UNITS AT THE
HOSPITAL.
THERE'S A WING FOR BLACK
FEMALES, BLACK MALES, AND WHITE
FEMALES.
AND AS IT WAS IN EDUCATION,
SEPARATE WAS NOT EQUAL.
AND THIS OBVIOUSLY IS LONG GONE
BUT THERE STILL ARE SOME
STRUCTURAL ISSUES IN THE HEALTH
CARE WE PROVIDE THAT MAY LEAD TO
UNEQUAL OUTCOMES DEPENDING UPON
YOUR ETHNICITY, RACE, COUNTRY OF
ORIGIN, LANGUAGE.
WE'LL TALK MORE ABOUT THAT
TODAY.
SO WHAT IS HEALTH EQUITY?
THIS IS THE DEFINITION FROM THE
CDC, I REFER YOU TO THE CDC FOR
MORE EXTENSIVE DISCUSSION ON THE
WEBSITE.
BUT HEALTH EQUITY IS THE STATE
IN WHICH EVERYONE HAS A FAIR AND
JUST OPPORTUNITY TO ATTAIN THEIR
HIGHEST LEVEL OF HEALTH.
NOT EVERYONE WILL BE ABLE OR
WILL WANT TO SEEK THAT OUT, BUT
EVERYBODY SHOULD HAVE THAT
OPPORTUNITY.
AND I'LL ALSO POINT OUT,
SOMETHING WE'LL TALK ABOUT HERE,
IS IN THE THIRD BULLET POINT
THAT IS INVOLVES ACKNOWLEDGING
AND ADDRESSING RACISM AS A
THREAT TO PUBLIC HEALTH AND
RESEARCH, AND THE HISTORY OF
UNETHICAL PRACTICES IN PUBLIC
HEALTH TO LED TO INEQUITABLE
HEALTH OUTCOMES.
THIS ALSO IMPACTS THE TRUST THAT
VARIOUS COMMUNITIES HAVE IN THE
HEALTH CARE SYSTEM, AND IN
CLINICAL RESEARCH.
AGAIN, WE'LL TALK ABOUT THAT,
BUT IT'S IMPORTANT TO UNDERSTAND
THAT THERE IS A LEVEL OF -- IN
THE STRUCTURE OF OUR HEALTH CARE
SYSTEM AND IN OUR CLINICAL
RESEARCH THAT STILL LEADS TO
UNEQUAL REACHING OUT AT
OUTCOMES, AND A LACK OF TRUST
THAT CERTAIN COMMUNITIES HAVE IN
US.
AND WE NEED TO OVERCOME THAT.
SO, WHAT IS THE IMPORTANCE OF
HEALTH EQUITY?
AND THE FIRST IS MAYBE THE MOST
IMPORTANT.
IT'S WHAT AMERICA IS ABOUT.
IT'S OUR DREAM.
HERE'S THE QUOTE FROM
DECLARATION OF INDEPENDENCE,
ACKNOWLEDGE THAT WAS WRITTEN BY
THOMAS JEFFERSON WHO OWNED
SLAVES.
HE ALSO WROTE, WHICH WAS THE --
IN THE SPIRIT OF THE TIME ALL
MEN ARE CREATED EQUAL, I CHANGED
THAT, ALL ARE CREATED EQUAL.
THAT'S WHAT WE BELIEVE IN OUR
SYSTEM, THAT EVERYBODY HAS AN
EQUAL CHANCE.
AND SHOULD HAVE AN EQUAL CHANCE
TO LIFE, LIBERTY, PURSUIT OF
HAPPINESS AND HEALTH CARE.
THERE'S AN ETHICAL IMPERATIVE.
IT'S THE RIGHT THING TO DO.
WE ALL AGREE, I WOULD HOPE, THAT
EVERYBODY SHOULD HAVE THAT EQUAL
CHANCE TO THE BEST HEALTH CARE
ATTAINABLE.
THERE'S COMMUNITY STANDARDS.
WE DON'T THINK THAT ONE GROUP OF
OUR COMMUNITY HAS A LESS OF A
RIGHT THAN ANOTHER.
AND MANY OF OUR SOCIAL AND
RELIGIOUS TRADITIONS SPEAK TO
COMPASSION FOR THOSE WHO HAVE
LESS THAN THE REST OF US, THAT
WE SHOULD HAVE COMPASSION AND
PROVIDE FOR THOSE IN NEED
BECAUSE THEY DON'T HAVE THE
RESOURCES, THEY DON'T HAVE THE
KNOWLEDGE, THEY DON'T HAVE THE
ABILITY TO GAIN THAT, AND WE
SHOULD HELP PROVIDE THAT FOR
THEM.
FINALLY, I'LL COME BACK TO THIS
AGAIN A FEW TIMES, THERE'S A
FINANCIAL COST TO SOCIETY.
MAYBE IT GOES WITHOUT SAYING,
BUT I OFTEN WANT TO REPEAT FOR
EVERYONE THAT IT IS MUCH MORE
EXPENSIVE TO TREAT THE ILLNESS
OR THE MEDICAL ERROR THAT OCCURS
THAN TO PREVENT IT.
SO DEVELOPING SAFE AND BROAD
HEALTH CARE AND RESEARCH IS AN
IMPERATIVE BECAUSE IT'S CHEAPER
THAN HAVING TO BE REACTIONARY
AND PAY FOR IT WHEN IT GOES
WRONG.
CAUSES OF HEALTH CARE
DISPARITIES WE'LL CONTINUE TO
LEARN OF THE SOCIAL DETERMINANTS
OF HEALTH.
THOSE INCLUDE NOT HAVING
RESOURCES, POVERTY,
ENVIRONMENTAL THREATS THAT SOME
COMMUNITIES, AND WE'VE LEARNED
OF THIS MOST RECENTLY IN OHIO,
IT'S ALSO HAPPENED IN VARIOUS
COMMUNITIES STRUGGLING WITH LEAD
CONTAMINATING THE WATER, THAT
THERE ARE ENVIRONMENTAL THREATS
OUT THERE THAT PUT SOME PEOPLE
AT MORE RISK AND THEY TEND TO BE
IN AREAS THAT HAVE LESS ACCESS
TO BOTH HEALTH CARE AND OTHER
RESOURCES.
THERE'S INDIVIDUAL AND
BEHAVIORAL FACTORS THAT MAY NOT
HAVE TO DO WITH SOCIAL
DETERMINANTS OF HEALTH, BUT THE
LACK OF TRUST IN THE SYSTEM OR
NOT JUST UNDERSTANDING,
EDUCATIONAL INEQUALITIES, AGAIN
WITHOUT THE KNOWLEDGE OF WHAT IS
NEEDED.
AND RACISM, STILL BUILT IN SOME
OF OUR SYSTEMS THAT WILL FAVOR
SOME OVER OTHERS IN TERMS OF THE
ABILITY TO GET THEIR OPTIMAL
HEALTH, AND THERE IS WITHIN US
ALL SOME IMPLICIT BIAS, WE'RE
BORN WITH THAT.
WE DEAL WITH IT, THAT MAY CAUSE
US TO TREAT DIFFERENT GROUPS IN
OUR CASE AS HEALTH CARE
PROVIDERS, DIFFERENT GROUPS OF
PATIENTS, RESEARCH SUBJECTS
DIFFERENTLY BECAUSE OF THE
CATEGORY THEY COME FROM, WHETHER
THAT BE ETHNICITY, RACE, COUNTRY
OF ORIGIN, LANGUAGE FOCUSED.
WE HAVE TO ACKNOWLEDGE THAT
EXISTS, AND OVERCOME IT, EVEN
THOUGH WE CAN'T ALL -- WE HAVE
TO -- THE KNOWLEDGE WE'RE NOT
PERFECT.
WE'LL GET INTO THIS A LITTLE BIT
MORE AS WE GO ALONG.
ON THE RIGHT SIDE, THE COLUMN
SHOWS MANY OF THE DISEASES THAT
ARE IMPACTED, THAT SHOW
SIGNIFICANT DISPARITIES AMONG
VARIOUS GROUPS, AGAIN ETHNICITY,
RACE, LANGUAGE, COUNTRY OF
ORIGIN.
DIABETES, HEART DISEASE, CANCER,
COMPLICATIONS OF PREGNANCY, AND
OF COURSE WE KNOW COVID, WE'VE
JUST BEEN LIVING THROUGH THAT,
WHERE THERE ARE DIFFERENTIAL
OUTCOMES DEPENDING UPON PERHAPS
WHERE YOU LIVE OR WHO YOU ARE.
I WILL BE PRESENTING DATA AS I
DO IN THIS SLIDE ON MATERNAL
MORBIDITY AND MORTALITY BECAUSE
THAT'S WHAT WE'RE CONCENTRATING
ON IN OUR HEALTH EQUITY WORK AT
THE PATIENT SAFETY CENTER.
AND WHAT YOU SEE HERE IS DATA
FROM THE CDC ON COMPLICATIONS OF
PREGNANCY, SEVERE MATERNAL
MORBIDITY AND MORTALITY, I'M
SORRY SEVERE MATERNAL MORBIDITY,
WHERE BLACK AND NATIVE AMERICAN
WOMEN HAVE TWICE THE RATE OF
COMPLICATIONS OF PREGNANCY AS
WHITE WOMEN IN AMERICA.
THAT HOLDS TRUE FOR MOST OF THE
STATES IN THE COUNTRY.
WE'LL GET TO MARYLAND DATA IN A
LITTLE BIT.
THERE ARE REASONS FOR THAT, THAT
WE COVERED ON THE LAST SLIDE, IN
TERMS OF SOCIAL DETERMINANTS OF
HEALTH, AND PERHAPS STRUCTURAL
RACISM, AND SOME IMPLICIT BIAS
IN THE CAREGIVERS.
ALL OF WHICH VARY IN ALL OF
THESE DISEASES.
THEY ALSO AFFECT ACCESS TO
HEALTH CARE, DEPENDING UPON
WHERE YOU LIVE, INNER CITY OR
PERHAPS RURAL AREAS, YOU MAY NOT
HAVE THE SAME ACCESS.
AND PREVENTIVE MEASURES VARY
DEPENDING ON WHERE YOU LIVE AND
WHO YOU ARE.
FINALLY, AS I SAID BEFORE, THE
OVERALL COST TO THE SYSTEM OF
ALLOWING DISPARITIES AND
ALLOWING ERRORS TO OCCUR FOR
POORER HEALTH TO RESULT COSTS US
MORE.
PREVENTION OF BOTH ERRORS AND
DISEASE IS LESS EXPENSIVE.
AS I SAID, I'LL TALK A LITTLE
BIT MORE ABOUT COMPLICATIONS OF
PREGNANCY.
THESE ARE DISPARITIES IN
MATERNAL MORTALITY IN THE U.S.
THE REASON I BRING UP THIS SLIDE
IS TO SHOW THAT THERE'S THREE
TIMES THE RATE OF MATERNAL
MORTALITY IN BLACK WOMEN
COMPARED TO WHITE WOMEN IN THE
COUNTRY.
AND AS YOU CAN SEE FROM 2018 TO
2020, IT'S GETTING WORSE.
SO THIS IS A CALL FOR ACTION.
WE NEED TO ADDRESS THIS.
AND HAPPY TO SAYS MANY AREAS ARE
ADDRESSING IT, EVEN IN OP EDS IN
THE "WASHINGTON POST," NOT A BAD
THING, IT'S CALLING OUR
ATTENTION TO IT.
THIS IS LOOKING AT IT FROM THE
VIEW OF EDUCATION.
I THINK THIS POINTS OUT THAT
IT'S NOT ALL EVERY SOCIAL
DETERMINANT OF HEALTH THAT IS
INVOLVED IN THE DISPARITY.
SPECIFICALLY HERE, YOU SEE THAT
WHITE WOMEN ARE THE THIRD GROUP
OF BARS OVER FROM THE LEFT,
BLACK WOMEN ARE THE LAST GROUP
OF BARS, CLOSEST TO THE RIGHT.
AND THAT DESPITE HIGHER
EDUCATION, GREEN AND YELLOW ARE
COLLEGE EDUCATED, THERE'S STILL
TWO TO THREE TIMES THE MORTALITY
RATE IN BLACK WOMEN COMPARED TO
WHITE.
SO IT ISN'T EDUCATION THAT'S
PREVENTING THAT DISPARITY.
IT'S STILL THERE.
OTHER CONFOUNDING FACTORS,
PHYSICIAN-PATIENT RACIAL
CONCORDANCE, DOES IT MATTER,
DOES HAVING A DOCTOR OF THE SAME
ETHNICITY OR RACE MAKE A
DIFFERENCE?
IN SOME STUDIES IT DOES.
IN SOME IT DOES NOT.
SPECIFICALLY, THIS WAS A STUDY
DONE IN STATE OF FLORIDA, YOU
CAN SEE 1.8 MILLION HOSPITAL
BIRTHS REVIEWED.
AND IT'S FOUND THAT RACIAL
CONCORDANCE, THAT IS A BLACK
PHYSICIAN WITH A BLACK INFANT,
RESULTED IN A SIGNIFICANT
IMPROVEMENT IN MORTALITY FOR
THOSE BLACK INFANTS.
THAT WAS NOT THE SAME FOR THE
MOTHERS.
MATERNAL MORTALITY WAS NOT
AFFECTED IN THIS STUDY.
BUT IT DOES BRING UP THE
QUESTION OF WHY WOULD THIS
HAPPEN, SO MORE INVESTIGATION IS
NEEDED, AND DOES IT MAKE A
DIFFERENCE IN THE OUTCOME FOR
PATIENTS, AND MAKE IT SAFER FOR
CARE?
THIS IS WHERE I THROW IN MY
APPEAL, I THINK AS MANY HAVE,
FOR MORE DIVERSITY IN THE HEALTH
CARE WORKFORCE.
WE BELIEVE THAT IT CAN IMPROVE
QUALITY OF CARE, OUTCOMES IN
DISPARITIES.
OBVIOUSLY THERE ARE BARRIERS TO
DIVERSITY IN EDUCATION,
UNDERREPRESENTATION OF FACULTY,
MEDICINE AND NURSING, BUT WE'RE
ON A JOURNEY TO GET THERE.
AGAIN, WE BELIEVE THAT THIS WILL
HELP IMPROVE OR REDUCE THE
DISPARITIES WE'RE SEEING IN THE
CARE THAT IS GIVEN.
SO, THIS IS FROM AN ARTICLE BY
MARSHAL CHIN IN 2021, BRITISH
MEDICAL JOURNAL.
IT HAS SOME GOOD IDEAS ABOUT HOW
TO IMPROVE PATIENT SAFETY
THROUGH HEALTH EQUITY.
I THINK ONE OF THE MAIN
CONFLICTS HERE IS TO INCLUDE
HEALTH EQUITY EXPERTS ON
INTERDISCIPLINARY TEAMS SO YOU
CAN LOOK AT SYSTEMS FOR BIAS,
SEE WHETHER THE SOCIAL
DETERMINANTS OF HEALTH ARE
AFFECTING THE CARE THAT IS
PROVIDED TO DIFFERENT GROUPS OF
PEOPLE, OR IN THE CASE OF THE
CLINICAL CENTER ON THE CLINICAL
RESEARCH THAT IS CONDUCTED ON
DIFFERENT GROUPS OF PEOPLE.
WE NEED TO DEVELOP VALIDATED
PERFORMANCE MEASURES, ONES THAT
EVALUATE NOT JUST OVERALL
OUTCOMES OF CARE THAT IS
PROVIDED OR CLINICAL RESEARCH
STUDY THAT IS PERFORMED, BUT
AMONGST VARIOUS GROUPS, BECAUSE
UNTIL YOU LOOK, YOU MAY NOT KNOW
THAT IT IS BETTER FOR SOME
GROUPS THAN OTHERS.
AND THEN IMPLEMENTING IT,
IMPLEMENTING THOSE HEALTH EQUITY
CONSCIOUS INTERVENTIONS THAT YOU
MAY DEVELOP, AND NURTURING MORAL
INCENTIVES TO IMPROVE EQUITY AND
SAFETY PATIENT CARE.
SO NOW WE'LL MOVE ON TO HEALTH
EQUITY IN CLINICAL RESEARCH.
SOMETHING I THINK THAT WILL BE
OF INTEREST, HOPEFULLY, TO MOST
OF YOU LISTENING IN TODAY.
THIS IS FROM A STUDY, SORRY,
IT'S A WORKING PAPER THAT WAS
PUBLISHED IN CHILD HEALTH IN
2019, AN EXCELLENT READ FOR
THOSE OF YOU INVOLVED IN
CLINICAL RESEARCH.
I'LL READ THE QUOTE ON HERE.
RACIAL AND ETHNIC EQUITY IN
RESEARCH MEANS APPLYING TOOLS
AND PRACTICES NEEDED TO
RECOGNIZE PEOPLE OF COLOR'S
EXPERIENCES WITH UNEQUAL POWER
DIFFERENTIALS AND ACCESS TO
RESOURCES AND OPPORTUNITY, WHILE
CONSIDERING HISTORICAL AND
CURRENT LIVED REALITIES,
INCLUDING STRUCTURAL RACISM."
UNTIL I THINK WE UNDERSTAND
THIS, WE WON'T BE ABLE TO DEAL
WITH EFFECTIVELY DIFFERENTIAL
OUTCOMES THAT WE MAY SEE IN
RESEARCH AND ALSO DIFFERENTIAL
ENROLLMENT, BECAUSE AS THE NEXT
SLIDE WILL SHOW, THAT ALTHOUGH
PEOPLE OF COLOR MAKE UP ABOUT
39% OF THE USE POPULATION,
PERCENTAGE GROWING, ONLY 2 TO
16% IN TRIALS REPRESENT THAT
COMMUNITY OF PEOPLE OF COLOR.
WE NEED CLINICAL TRIALS THAT
LOOK LIKE ALL OF US TO BE
EFFECTIVE, AS SAID ON THE SLIDE.
IT'S AN UNDERSTANDING AS WE MOVE
FORWARD.
AGAIN, I'LL COME BACK TO THIS
LATER, THAT TO BE EFFECTIVE IN
OUR CLINICAL TRIALS, WE NEED TO
BE ABLE TO BROADEN THEM.
AND I KNOW THERE'S WORK ON THAT
HAPPENING AT THE CLINICAL CENTE.
SO A LITTLE BIT OF HISTORY NOW,
TO UNDERSTAND WHY THERE MAY BE
ISSUES IN TERMS OF ENROLLING
COMMUNITIES OF COLOR IN CLINICAL
RESEARCH.
THERE'S A LACK OF TRUST.
BASED UPON A LOT OF HISTORY,
SOME OF THIS IS WELL KNOWN, SOME
YOU MAY NOT BUT WE'LL GO OVER IT
AGAIN.
WE'LL START WITH DR. MARION
SIMMS, LAUDED AS FOUNDER OF
MODERN SURGICAL GYNECOLOGY.
HE DEVELOPED A TREATMENT FOR
VESCOVAGINAL FISTULAS IN THE
1800S, OPERATING ON ENCLAVED
AFRICAN WOMEN, NO CONSENT, NO
ANESTHESIA, OPERATING WITHOUT
PERMISSION ON AFRICAN AMERICAN
ENSLAVED WOMEN.
IT'S TAKEN A WHILE TO COME TO
GRIPS WITH EXACTLY WHAT
HAPPENED, AND YOU CAN SEE IN THE
BACKGROUND OF THE SLIDE A STATUE
OF DR. SIMMS IN CENTRAL PARK IN
NEW YORK THAT WAS TAKEN DOWN
ALONG WITH MANY OTHER STATUES OF
PROMINENT MEMBERS OF THE
CONFEDERATE STATES BACK A FEW
YEARS AGO.
IT'S A MIXED BAG OF HIS LEGACY
IN TERMS OF WHAT HE
ACCOMPLISHED, AND HOW HE DID IT.
YOU'LL SEE ON THESE SLIDES
REFERENCES TO VERY GOOD BOOKS
COVERING THE SUBJECT.
SOMETHING MORE WELL KNOWN IS THE
TUSKEGEE STUDY, 399
PARTICIPANTS, BLACK MALES WITH
SYPHILIS, 201 WITHOUT, NO
CONSENT AT THAT TIME.
WHAT'S MOST REMARKABLE WHEN
PENICILLIN WAS COVERED AND CAME
INTO GENERAL USE IN MID-1940s,
KNOWN TO BE A TREATMENT, NONE OF
THE MEN IN THE STUDY WERE
TREATED, DID NOT COME TO LIGHT
UNTIL 1972 WHEN AN ARTICLE WAS
PUBLISHED, CREATING A GREAT
SENSATION AT THE TIME, QUICKLY
THE STUDY WAS CLOSED.
BUT THIS STUDY LIVES ON, NOT
ONLY IN PRINT, THERE'S AN
EXCELLENT
EXCELLENT BOOK ON IT, "BAD
BLOOD."
YOU CAN UNDERSTAND THE LINGERING
LACK OF TRUST IN THE HEALTH CARE
SYSTEM, IN THE GOVERNMENT, AND
CLINICAL RESEARCH BASED ON WHAT
HAPPENED TO THESE MEN IN THE
TUSKEGEE SYPHILIS STUDY.
WE'VE ALL HEARD OF HENRIETTA
LACKS, WENT TO JOHNS HOPKINS,
DIED SEVEN MONTHS LATER, A
BIOPSY SIMPLE DEVELOPED THE HEEL
A -- HeLa CELL LINE, WHICH I
REMEMBER USING IN COLLEGE IN
MEDICAL CENTER.
THERE WAS NO CONSENT, NO FAMILY
KNOWLEDGE, UNTIL 1975.
THIS HAS BEEN WELL DOCUMENTED IN
BOOKS AND NOW MOVIES.
BUT AGAIN, CREATED A MISTRUST
WITHIN COMMUNITIES OF THE
SYSTEM, HEALTH CARE SYSTEM, OF
THE RESEARCH COMMUNITY, BECAUSE
OF WHAT HAPPENED MANY YEARS AGO
BUT IT STILL LINGERS.
AND IN FACT LINGERED THROUGH
COVID, AS WE KNOW HESITANCY IN
CLINICAL STUDIES OF VACCINE
DEVELOPMENT AND VACCINE
HESITANCY, HESITANCY TO RECEIVE
THE VACCINE WAS A SIGNIFICANT
ISSUE IN COMMUNITIES OF COLOR
DURING THE PANDEMIC.
AND AS WE ALSO KNOW, THOSE
COMMUNITIES SUFFERED GREATER.
THERE AGAIN WAS DISPARITY IN
TERMS OF OUTCOMES, IN
COMMUNITIES OF COLOR, WITH COVI.
HISTORIC RACISM, INSTITUTIONAL
RACISM DRIVES DISTRUST, THE
HISTORY I JUST DETAILED ABOUT
VARIOUS CLINICAL STUDIES LED TO
CONTINUED DISTRUSTFUL
COMMUNITIES.
THE GOOD NEWS IS WE'VE SEEN
SIGNIFICANT IMPROVEMENT IN
PARTICIPATION IN RESEARCH
STUDIES, RELATED TO COVID
VACCINATION AND TREATMENT, AND
IN RECEIVING THE VACCINE,
ALTHOUGH VACCINATION RATES STILL
ARE LOWER THAN IN THE WHITE
COMMUNITY.
I'LL PIVOT WHO WE IN THE
MARYLAND PATIENT SAFETY CENTER
ARE DOING RELATED TO HEALTH
EQUITY.
AS I THINK DR. LANG TALKED ABOUT
BEFORE, WE ARE ARE AN
INDEPENDENT NON-PROFIT IN THE
STATE OF MARYLAND, CREATED BY AN
ACT OF THE MARYLAND LEGISLATURE,
AND DESIGNATED BY MARYLAND
HEALTH CARE COMMISSION.
OUR MISSION IS SIMPLE.
KEEPING MARYLAND HEALTH CARE
SAFE.
WE HAVE MANY ACTIVITIES.
WE HAVE COLLABORATIVES ACROSS
THE STATE, BOTH AT HOSPITALS AND
IN THE OUTPATIENT COMMUNITY, ON
INFECTION CONTROL, ON HAND
WASHING, ON C-SECTION RATES,
ANYTHING THAT WE CAN GET
EVERYONE TO AGREE TO AND WORK
ON, WE WILL WORK ON TO IMPROVE
THE CARE ACROSS ALL MARYLANDERS.
WE DO A LOT OF EDUCATION, BOTH
IN PERSON AND ONLINE AND
e-LEARNING WITH TWO MAJOR
CONFERENCES A YEAR, ONE I'LL
TALK ABOUT IN A MOMENT, BUT ALSO
A SAFETY CONFERENCE IN THE FALL.
FINALLY CARING FOR THE CAREGIVER
PROGRAM WHICH I THINK THE
CLINICAL CENTER IS IMPLEMENTING
AT THIS TIME.
THAT'S THE RISE PROGRAM FROM
JOHNS HOPKINS, WHICH IS PEER
SUPPORT, STAFF PEER SUPPORT, IN
TIMES OF STRESS.
RECENTLY CREATED BY ARMSTRONG
INSTITUTE AT JOHNS HOPKINS FOR
WHEN MEDICAL ERRORS OCCUR IN
CLINICAL UNITS, BUT IT'S BEEN
EXTENDED FOR ANY STRESS THAT
STAFF CAN SUPPORT OTHER STAFF
WITH, INCLUDING ALL OF THE
STRESS OF THE PANDEMIC, AND
WORKFORCE SHORTAGES THAT MANY
HOSPITALS ARE GOING THROUGH
RIGHT NOW, AND IN WORKPLACE
VIOLENCE, AS I THINK WE'RE ALL
AWARE IN HEALTH CARE, WE'VE SEEN
AN INCREASE, SIGNIFICANT
INVIOLENCE IN THE HEALTH CARE
WORKPLACE.
WE'RE A FEDERALLY DESIGNATED
PATIENT SAFETY ORGANIZATION SO
WE RUN THE MID-ATLANTIC PATIENT
SAFETY ORGANIZATION WITH
REPORTING MEDICAL ERRORS, BUT
MOST IMPORTANTLY WITH CONVENING
PATIENT SAFETY OFFICERS ACROSS
THE STATE REGULAR MEETINGS TO
DISCUSS PATIENT SAFETY ISSUES
INCLUDING SAFE TABLES WHERE WE
CAN DISCUSS UNTOWARD EVENTS AND
SOLUTIONS FOR IMPROVING THE CARE
OF PATIENTS ACROSS THE STATE.
OUR WORK IN HEALTH EQUITY IS
DETAILED ON THE RIGHT SIDE, BUT
THE FIRST IS OUR HEALTH EQUITY
CONFERENCE COMING UP.
THIS IS OUR ANNUAL PATIENT
SAFETY CONFERENCE HELD IN PERSON
AT THE HILTON IN BALTIMORE, BUT
ALSO HELD ONLINE, AS MEMBERS OF
THE MARYLAND PATIENT SAFETY
CENTER, YEAR ALL WELCOME TO JOIN
US FOR FREE, AND AS I SAID
BEFORE, THERE ARE CONTINUING
EDUCATION CREDITS INCLUDING CME
CREDITS THAT ARE AVAILABLE TO
YOU FOR ATTENDING THIS
CONFERENCE, WHETHER IN PERSON AT
THE HILTON WHERE YOU GET A NICE
LUNCH OR ONLINE AT YOUR COMPUTE.
IT'S ON MARCH 31st, COMING UP
IN JUST A BIT OVER TWO WEEKS,
AND WE'LL BE TALKING A LOT ABOUT
HEALTH EQUITY ACROSS ALL ASPECTS
OF HEALTH EQUITY, AND HOW WE CAN
IMPROVE HEALTH EQUITY, IMPROVING
OUTCOMES FOR PATIENTS.
WE'VE ALSO DONE WORK IN COVID
VACCINE HESITANCY, AND THE BIRTH
EQUITY PROGRAM, AND I'LL JUST
START WITH SAYING THAT MARYLAND
IS ONE OF THE MOST DIVERSE
STATES IN THE COUNTRY.
I THINK IT'S 7th ON THIS LIST.
HAS APPEARED HIGHER ON OTHER
LISTS DEPENDING HOW YOU DEFINE
DIVERSITY.
BUT THAT JUST, TO US, IT
SUGGESTS WE DO HAVE WORK TO DO
ON VARIOUS ISSUES ASSOCIATED
WITH DISPARITIES IN MARYLAND.
SO WE STARTED OFF WITH REDUCING
COVID VACCINE HESITANCY IN
COMMUNITIES OF COLOR.
WE DID THIS IN CONJUNCTION WITH
MARYLAND HOSPITAL ASSOCIATION
AND THE STATE, REALIZING THAT
BLACK AND LATINX COMMUNITIES
WERE SIGNIFICANTLY LESS LIKELY
TO GET THE COVID VACCINE
ESPECIALLY EARLY WHEN THE
VACCINE BECAME AVAILABLE.
DR. NICOLE ROCHESTER LED
WEBINARS DISCUSSING SYSTEMIC
RACISM AND BIAS IN HEALTH CARE,
WHICH HAS LED TO THE VACCINE
AWARENESS.
AND STRATEGIES TO INCREASE
ACCEPTANCE IN COMMUNITIES OF
COLOR, AND STRATEGIES TO
INCREASE VACCINE ACCEPTANCE IN
HEALTH CARE STAFF, ALSO A
SIGNIFICANT ISSUE.
WE HAD 700 LEADERS FROM ACROSS
THE REGION INVOLVED IN THAT.
WE HOPE WE WERE PART OF
IMPROVING THE ACCEPTANCE OF
VACCINE THAT WE'VE SEEN OVER THE
LAST COUPLE OF YEARS.
OUR MAJOR PROGRAM HAS BEEN
DEALING WITH SEVERE MATERNAL
MORBIDITY IN MARYLAND.
AS I DESCRIBED BEFORE, THE DATA
IN MARYLAND IS NO DIFFERENT THAN
MANY OF THE STATES ACROSS THE
COUNTRY.
BLACK MATERNAL MORBIDITY IS
TWICE THE RATE OF WHITE MATERNAL
MORBIDITY IN MARYLAND.
IN GRAPH YELLOW IS BLACK
MATERNAL MORBIDITY, RED AT THE
BOTTOM IS WHITE MATERNAL
MORBIDITY.
MARYLAND MADE A PLEDGE TO REDUCE
THIS, THE OVERALL MATERNAL
MORBIDITY BY 20% OVER THE NEXT
THREE YEARS, FOUR YEARS I GUESS
NOW, AND WE RECOGNIZE THAT WE
CAN'T MAKE HEADWAY WITH THIS,
YOU CAN SEE THE DOTTED LINES ARE
THE WAY MARYLAND WANTS TO REDUCE
THESE PROJECTING HOW THE TO
REDUCE MATERNAL MORBIDITY, CAN'T
MAKE HEADWAY IF WE DON'T
ACTUALLY ADDRESS THE DISPARITY
THAT IS THERE.
SO WE'VE DEVELOPED THE BIRTH
EQUITY MARYLAND PROGRAM, TO
PROMOTE HEALTH EQUITY, AND
ANTI-RACISM IN MATERNAL HEALTH
ACROSS THE STATE.
WE'RE EDUCATING NON-OBSTETRIC
PROVIDERS, THERE'S ALREADY A
PROGRAM TO EDUCATE BOTH IMPLICIT
BIAS AND ANTI-RACISM AND IMPROVE
MATERNAL CARE WITH THE PROGRAM
THROUGH JOHNS HOPKINS ACROSS THE
STATE, ALL BIRTHING HOSPITALS IN
MARYLAND ARE PARTICIPATING.
THAT'S INVOLVING OBSTETRICIANS,
MIDWIVES, MATERNITY NURSES.
WE RECOGNIZE, AND WE ACTUALLY
PARTICIPATE AS PART OF THE MD
MOM PROGRAM, BUT WE RECOGNIZE
THAT BOTH PREGNANT AND
POSTPARTUM WOMEN ARE FREQUENTLY
SEEN BY NON-OBSTETRIC PROVIDERS,
EMERGENCY ROOM, CLINICS AND
QUALIFIED HEALTH CENTERS AND
COMMUNITY HEALTH WORKERS AND
WANT TO EXTEND THAT EDUCATION TO
NON-OBSTETRIC PROVIDERS AND
WE'VE ALREADY STARTED.
WE'VE BEEN THROUGH OUR FIRST
PILOT PHASE AND ARE ABOUT TO
ROLL IT OUT ACROSS THE STATE.
IN FACT, MARYLAND HOSPITAL
ASSOCIATION'S EXECUTIVE
COMMITTEE HAS PLEDGED ALL
MARYLAND HOSPITALS WILL
PARTICIPATE.
AND THE EDUCATION INCLUDES
EDUCATION ABOUT DISPARITIES,
IDENTIFICATION OF COMPLICATIONS,
AND WHAT TO DO ABOUT IT.
SIMPLY SAID, IF WE CAN GET MORE
OF OUR NON-OBSTETRIC PROVIDERS
WHO SEE WOMEN TO RECOGNIZE
SOMETHING BRONC MAY -- WRONG MAY
BE GOING ON RELATED TO MATERNAL
MORBIDITY THEY WILL CONTACT
OBSTETRICIAN COLLEAGUE TO SEE
THE PATIENT SO WE DON'T MISS
SOMETHING BECAUSE IT'S MISSED
OPPORTUNITIES, THE THINGS WE
COULD HAVE HAVE FIXED, THAT
WE'RE TRYING TO ADDRESS.
THIS IS THE STEPS WE'RE TAKING.
WE HAVE INITIAL BASELINE
ASSESSMENT, WE GET ON TO
EDUCATION, WEBINARS ON RACISM
AND BIAS IN MATERNAL HEALTH CARE
AND EDUCATION ON THE DRIVERS OF
MATERNAL MORBIDITY AND MORTALITY
ESPECIALLY IN THE BLACK
COMMUNITY.
FINALLY A TEAM STEPS-BASED
TRAINING.
IF YOU HAVEN'T PARTICIPATED, IT
INVOLVES THE ENTIRE HEALTH CARE
TEAM, GETS EVERYONE ON THE
HEALTH CARE TEAM ENABLED TO
SPEAK UP WHEN THEY SEE SOMETHING
THEY THINK MAY BE GOING WRONG.
WE DON'T WANT TO MISS ANYBODY'S
OBSERVATIONS THAT SOMETHING MAY
BE HAPPENING AND JUST RELY ON
THE PROVIDER, THE DOCTOR, THE
NURSE.
WE WANT EVERYBODY TO
PARTICIPATE.
IN CLINICS ACROSS THE STATE,
THIS IS IMPORTANT, MOST OF THEM
ARE DEFINITELY COMMITTING TO IT,
TO SEE IF THEY CAN IMPROVE,
ESPECIALLY IN DISPARITIES WE'RE
SEEING IN MATERNAL CARE, REDUCE
OVERALL RATE OF MATERNAL
MORBIDITY IN MARYLAND.
SO IN MY CLOSING SECTION HERE,
I'LL TALK ABOUT HOW IN RESEARCH,
CLINICAL RESEARCH, WE CAN DO
BETTER.
THE QUESTION HOW DO WE ADDRESS
INEQUITIES IN OUTCOME, THE
GRAPHIC IS FROM THE CDC LOOKING
AT THE WAYS TO ADDRESS HEALTH
EQUITY, BOTH IN THE
INFRASTRUCTURE THAT WE BUILD, IN
PROGRAMS, IN MEASUREMENT, IN
POLICY.
WE'LL TALK A LITTLE BIT ABOUT
THAT HERE.
WHAT ARE THE PITFALLS IN
CLINICAL RESEARCH?
WELL, ONE OF THE BIG ONES IS
LACK OF DIVERSITY IN STUDY
PARTICIPANTS WE ALREADY
DISCUSSED, BUT ALSO ON STUDY
TEAMS, ON THE COMMITTEES
INVOLVED IN RESEARCH, AND ON THE
IRB.
WE DON'T HAVE EQUITABLE
REPRESENTATION THROUGHOUT THE
PROCESS.
IT'S HARD TO UNDERSTAND,
REALIZE, BE AWARE, SEE, THE
INEQUITIES, THE INEQUALITIES,
DISPARITIES THAT MIGHT RESULT
WITHIN A STUDY, BECAUSE WE JUST
DIDN'T KNOW.
SO, IMPLICIT AND EXPLICIT BIAS
EXISTS.
SPECIFICALLY TO IMPLICIT BIAS, I
HIGHLY RECOMMEND EVERYONE, AND
THIS IS IN -- I THINK THE LINK
IS IN THE RESOURCES SLIDE AT THE
END OF THIS TALK, BUT THE
HARVARD IMPLICIT ASSOCIATION
TEST, WHICH IS ANONYMOUS, ONLY
YOU GET THE RESULTS, THEY DO
COLLECT DE-IDENTIFIED DATA BUT
OVERALL BUT DON'T KNOW YOU, YOU
DON'T KNOW THEM.
AND TO TEST WHAT BIASES YOU MAY
HAVE, WE ALL HAVE THEM.
I KNOW I HAVE THEM.
THAT ARE BUILT INTO US, FOR
WHATEVER REASONS, THAT MAY
INFECT -- THAT MAY AFFECT YOUR
PERFORMANCE OF YOUR CLINICAL
DUTIES, THE WAY YOU TREAT
VARIOUS GROUPS OF PATIENTS, OR
THE WAY YOU TREAT VARIOUS GROUPS
OF CLINICAL RESEARCH SUBJECTS.
OTHER PITFALLS, LACK OF
COMMUNICATION, NOT CONNECTING TO
COMMUNITIES, I DISCUSSED LACK OF
TRUST FROM COMMUNITIES OF COLOR
AND HISTORY THAT'S THERE, THAT
LACK OF TRUST STILL EXISTING,
THE ABILITY TO MEASURE HEALTH
EQUITY.
IF WE JUST LOOK AT OVERALL
OUTCOMES OF OUR CLINICAL
RESEARCH STUDIES, AND NOT
STRATIFY THE DATA AS TO
ETHNICITY, RACE, COUNTRY OF
ORIGIN, LANGUAGE, WE ARE MISSING
DISPARITIES IN OUTCOMES THAT ARE
IMPORTANT AS WE MOVE THAT
TREATMENT FORWARD.
AND NEED TO UNDERSTAND THAT
BECAUSE IF WE DON'T ASK FOR THAT
DATA, WE WON'T GET IT AND WON'T
KNOW.
OBVIOUSLY THE SOCIAL
DETERMINANTS OF HEALTH ARE A
MAJOR FACTOR, BUT THOSE ARE
GOING TO TAKE A LONG TIME AND
INVOLVE ALL OF US IN
COMMUNITIES, AND IN GOVERNMENT,
TO BE WORKING ON IN TERMS OF
IMPROVEMENT OF THE SOCIAL
DETERMINANTS OF HEALTH SO THAT
WE CAN DECREASE DISPARITIES
BASED ON THOSE.
THE SURVEYS THAT YOU MIGHT BE
USING, GETS BACK TO THE DATA,
ARE THEY BIASED, THAT WILL BE
GETTING BACK TO THE LACK OF
DIVERSITY ON STUDY TEAMS,
COMMITTEES, IRBs.
AND FINALLY, A QUOTE FROM,
AGAIN, ANOTHER ARTICLE WE HAVE
IN THE RESOURCES SECTION,
IMPLEMENTATION RESEARCH
METHODOLOGIES FOR ACHIEVING
SCIENTIFIC EQUITY IN HEALTH
EQUITY FROM ETHNICITY AND
DISEASE IN 2019.
IMPLEMENTATION SCIENCE CAN
EXACERBATE HEALTH DISPARITIES IF
IT'S USED AS BIAS TOWARD
EMPATHIES THAT ALREADY HAVE
HIGHEST CAPACITIES FOR
DELIVERING EVIDENCE-BASED
INTERVENTIONS, SO WE COME UP
WITH EVIDENCE-BASED
INTERVENTIONS AND THEN WE
DISTRIBUTE TO PLACES THAT
ALREADY DO WELL, TAKE IT TO
PLACES THAT DON'T DO IT WELL
THEY WON'T GET THE BENEFIT.
WE NEED TO UNDERSTAND THAT.
SO, TALK ABOUT THE PITFALLS,
ALSO TALK ABOUT WHAT YOU CAN DO.
AND HOW YOU CAN DO BETTER.
REACHING OUT TO THE COMMUNITY,
EITHER AS INDIVIDUAL, AS A TEAM,
AND AS AN ORGANIZATION.
IT'S NOT JUST YOUR LOCAL
COMMUNITY.
BETHESDA, FOR EXAMPLE, WHERE THE
CLINICAL CENTER IS LOCATED, BUT
COMMUNITIES WHERE YOU LIVE, OUT
AND AROUND THIS AREA, AND
ESPECIALLY MONTGOMERY COUNTY,
FOR EXAMPLE, IS THE LARGEST
COUNTY IN THE STATE OF MARYLAND,
ALSO ONE OF THE MOST DIVERSE
COUNTIES, IF NOT THE MOST
DIVERSE, IN THE COUNTRY.
IT'S REALLY AN OPPORTUNITY TO
REACH OUT TO VARIOUS ETHNIC
GROUPS, RACIAL GROUPS, COUNTRY
OF ORIGIN GROUPS, LANGUAGE
GROUPS, TO GET REPRESENTATION ON
YOUR CLINICAL RESEARCH
COMMITTEES, IRB, TO BE ABLE TO
ENGAGE THE COMMUNITY IN THAT
RESEARCH.
PARTNER WITH TRUSTED RESEARCHERS
AND COMMUNITIES, WE LEARNED A
GREAT DEAL DURING COVID, BOTH IN
THE CLINICAL RESEARCH THAT WAS
DONE, AND IN THE ROLLOUT OF THE
VACCINE, THAT THERE ARE TRUSTED
RESOURCES IN COMMUNITIES, I
THINK WE ALL KNOW THAT THE HAIR
SALONS AND BARBERSHOPS ARE A
GREAT RESOURCE FOR EDUCATION AND
COMMUNICATION, AND UNDERSTANDING
HOW THE COMMUNITY STANDS ON
VARIOUS ISSUES.
SO THAT COULD BE A GREAT SITE
FOR RECRUITMENT.
THERE ARE OTHER PLACES WITHIN
COMMUNITIES THAT ARE SIMILAR.
THERE IS COMMUNITY-BASED
PARTICIPATORY RESEARCH, WHICH
INCREASES THE VALUE OF STUDY FOR
COMMUNITY AND RESEARCHERS,
INVOLVE THE COMMUNITY, AND BOTH
CAN BENEFIT, AND UNDERSTAND THE
COMMUNITY DATA, THE POLICY, THE
HISTORIES ASSOCIATED WITH THE
COMMUNITIES YOU'RE WORKING WITH.
ENGAGE PATIENTS AND FAMILIES.
I THINK PRETTY MUCH ALL
HOSPITALS ACROSS THE COUNTRY
HAVE SOME FORM OF PATIENT FAMILY
ADVISORY COUNCIL.
I THINK IT'S NOW REQUIRED,
ALTHOUGH NOT ALL USE THEM FOR
THE SAME PURPOSES.
BUT ENGAGING PATIENTS AND
FAMILIES THAT ARE INVOLVED IN
THE RESEARCH, ENGAGING THEM IN
THE DESIGN AND THE ONGOING
RESULTS OF THE STUDY I THINK IS
A VERY GOOD THING TO FIND OUT
HOW YOU'RE DOING AND HOW IT'S
RELATING TO BOTH THE PATIENT'S
FAMILIES AND THE COMMUNITY.
RECOGNIZE THAT THERE ARE
DIFFERENCES THAT EXIST BETWEEN
CULTURES.
YOU'RE NOT GOING TO -- WE'RE NOT
HOMOGENOUS.
THAT'S A GOOD THING.
BUT YOU NEED TO UNDERSTAND THAT.
RESEARCH TEAM, I SAID THIS
BEFORE, NEEDS TO REFLECT THE
POPULATION YOU'RE STUDYING.
AND UNDERSTAND THAT CULTURAL
DIFFERENCES CAN HAVE A
SIGNIFICANT IMPACT ON THE
OUTCOME OF YOUR STUDY, AND COULD
AFFECT -- COULD POSITIVELY OR
NEGATIVELY AFFECT YOUR STUDY
DESIGN.
TRAIN THE TEAM ON IMPLICIT BIAS
AND CULTURAL COMPETENCY.
THERE ARE VARIOUS IMPLICIT BIAS
PAINTINGS OUT THERE, SOME BETTER
THAN OTHERS, STILL UNKNOWN
WHETHER THE STRAIGHT IMPLICIT
BIAS TRAINING IS EFFECTIVE BUT
IT'S A START.
AND UNDERSTANDING WHAT YOU'RE
DEALING WITH ESPECIALLY WITH
COMMUNITIES YOU'RE REACHING OUT
TO IS HELPFUL.
ENGAGE THE COMMUNITY THERE.
RESEARCH SHOULD BE PATIENT
CENTERED.
MAKE SURE THERE'S TRANSLATED
INFORMED CONSENTS AND
RECRUITMENT DOCUMENTS SO CAN YOU
GET PATIENTS FROM A VARIETY OF
BACKGROUNDS, AND HOLD FOCUS
GROUPS, AGAIN BACK TO THE
COMMUNITY, TO UNDERSTAND AND
WHERE YOU'RE HOLDING THEM, GO TO
THE COMMUNITY, DON'T EXPECT THEM
ALWAYS TO COME TO YOU.
AND FINALLY, I THINK MAYBE
PRETTY OBVIOUS, WHAT IS
REPRESENTATIVE?
WHAT GROUPS, IS IT EVERYBODY?
IS IT SPECIFIC POPULATIONS OF
SPECIFIC ETHNIC CULTURAL GROUPS
THAT ARE APPROPRIATE
REPRESENTATIVES FOR THE DISEASE
THAT YOU ARE INVESTIGATING AND
TRYING TO COME UP WITH SOLUTIONS
FOR.
ONE FINAL NOTE IS THAT ANALYZING
PRESENTING RESEARCH IS A
SIGNIFICANT ISSUE, AND YOU NEED
TO BE THOUGHTFUL ABOUT THIS
BECAUSE THE WAY THAT RACE AND
ETHNICITY, EVEN COUNTRY OF
ORIGIN REPORTED ACROSS CLINICAL
STUDIES VARIES SIGNIFICANTLY.
THIS WAS AN OPINION PIECE IN
JAMA, THAT IN 2021, THAT
SUGGESTED WAYS TO STANDARDIZE
THE REPORTING OF RACE AND
ETHNICITY ACROSS CLINICAL
STUDIES SO WE'RE ALL TALKING IN
THE SAME LANGUAGE, AND THAT'S
VERY IMPORTANT SO I HIGHLY
RECOMMEND READING THIS.
AGAIN, IT'S IN OUR RESOURCES
SECTION HERE.
WORDS DO MATTER.
AND YOU NEED TO ASK QUESTIONS
AND STRATIFY YOUR DATA
CONSIDERING THE VARIOUS
RACE/ETHNICITY AS SUGGESTED
BEFORE, SO YOU KNOW IF THERE'S
DIFFERENTIAL IMPACT OF YOUR
INVESTIGATION AND THE OUTCOME ON
VARIOUS GROUPS.
THAT IS MY LAST SLIDE.
THIS IS RESOURCES SECTION, AND
HOPEFULLY THESE SLIDES WILL BE
AVAILABLE TO YOU ON REQUEST.
SO THAT YOU CAN LOOK AT ANY OF
THE SLIDES, OR SPECIFICALLY, OR
ESPECIALLY RESOURCES THAT ARE
AVAILABLE, BECAUSE THEY ARE ALL
GOOD.
THERE'S A LOT THERE.
BUT THEY WILL HELP, I THINK, IN
DEVELOPING MORE CULTURALLY
APPROPRIATE AND HEALTH EQUITY
AWARE CLINICAL RESEARCH IN THE
FUTURE THAT I THINK WILL HELP US
ALL, BECAUSE IT WILL IMPROVE THE
OUTCOMES FOR EVERYONE, WHICH IS
OUR GOAL, AND REALLY MAKE US
MORE AWARE OF WHERE WE NEED TO
GO IN THE FUTURE.
SO, THAT'S IT.
I THANK YOU VERY MUCH AGAIN FOR
THIS OPPORTUNITY TO TALK ABOUT
SOMETHING THAT WE HERE AT THE
MARYLAND PATIENT SAFETY CENTER
ARE VERY PASSIONATE ABOUT AND
I'LL BE HAPPY TO ENTERTAIN ANY
QUESTIONS.
>> WELL, THANK YOU VERY MUCH,
DR. EIG.
THAT WAS FABULOUS.
VERY, VERY IMPORTANT TOPICS, AND
A LOT THERE.
BUT DEFINITELY AS YOU SAID, YOU
KNOW, ALL OF US ARE HERE OR IN
HEALTH CARE TO PROVIDE
HIGH-QUALITY AND SAFETY PATIENT
CARE, AND ANY DISPARITIES AND
EQUITY ISSUES ARE AFFECTING OUR
ABILITY TO DO THAT.
THAT GOES THE SAME WITH
HIGH-QUALITY RESEARCH.
SO THANK YOU FOR BRINGING THOSE.
I'D LIKE TO REMIND EVERYBODY TO
ASK A QUESTION IF YOU'RE
WATCHING ON VIDEOCAST RIGHT
BELOW YOU MIGHT SCROLL DOWN,
THERE'S A BUTTON THAT SAYS LIVE
FEEDBACK, SEND YOUR QUESTIONS,
AND WE DO HAVE A QUESTION HERE.
DR. EIG, CONCERNING THE MATERNAL
MORBIDITY AND BLACK-WHITE
DIFFERENCE AGAINST COLLEGE
EDUCATED UNIVERSITY WOMEN, THERE
MAY BE CULTURAL DIFFERENCES IN
DIET AND PRACTICES NOT GENERALLY
RECOGNIZED TO MATTER.
IS THERE COMPARATIVE DATA FOR
PHYSICIAN MATERNAL MORBIDITY AND
ARE DIFFERENCES THE SAME?
IN OTHER WORDS, PHYSICIANS AND
OTHER HEALTH CARE MORE AWARE OF
CHANGES NEEDED IN PREGNANCY.
THE QUESTION IS PHYSICIANS WHO
ARE BLACK, DO THEY HAVE
DIFFERENT OUTCOMES VERSUS
WHITES?
>> SO FAR, THERE'S NO DATA TO
THAT EFFECT THOUGH IT'S BEING
LOOKED AT.
I THINK WHEN I DISCUSSED THE
STUDY DONE IN FLORIDA, WHICH WAS
A VERY EXTENSIVE STUDY, TOOK A
WHILE TO COLLECT THAT DATA, THEY
DEFINITELY SAW CONCORDANCE WITH
BLACK PHYSICIANS AND BLACK
INFANT MORTALITY.
THEY DID NOT SEE CONCORDANCE
WITH BLACK PHYSICIANS AND BLACK
MATERNAL MORTALITY.
THAT DOESN'T MEAN IT DOESN'T
EXIST.
IT DIDN'T EXIST IN THAT STUDY.
SO MORE RESEARCH IS BEING DONE.
AND THIS IS NOT TO SUGGEST THAT
BLACK PATIENTS SHOULD ONLY SEE
BLACK DOCTORS.
THIS IS THAT THERE'S AN ISSUE IN
SOME CASES WITH PROBABLY TRUST,
PROBABLY SOME CULTURAL
DIFFERENCES, CULTURAL
COMPETENCY, THAT MAY AFFECT
OUTCOMES ESPECIALLY SEEN
PROBABLY IN RECOMMENDATIONS,
ADVICE GIVEN, HEALTH PREVENTION.
THAT HAS BEEN SEEN IN STUDIES,
WHERE A BLACK PHYSICIAN WAS MORE
SUCCESSFUL IN GETTING BLACK
PATIENTS TO CHANGE PRACTICES, IN
TERMS OF PREVENTIVE CARE,
ESPECIALLY IN CARDIAC DISEASE.
SO THAT DOES EXIST, BUT AGAIN
IT'S NOT THE SUGGESTION THAT WE
SHOULD HAVE A DIFFERENT SYSTEM
OF WHO CARES FOR WHO.
IT'S THAT EVERYONE SHOULD
RECOGNIZE THAT AND TRY TO FIGURE
OUT HOW EVERYBODY, NO MATTER
WHAT RACE OF PHYSICIAN OR RACE
OF PATIENT IS, CAN GIVE THE BEST
CARE POSSIBLE.
IT'S GOING TO TO TAKE SOME TIMD
WE NEED TO INVESTIGATE FULLY TO
DO THAT.
GOING BACK TO I THINK FIRST PART
OF THE QUESTION, HAVING TO DO
WITH EDUCATION, THE INTERESTING
THING IN BLACK MATERNAL
MORBIDITY IS CERTAINLY EDUCATION
DOESN'T SEEM TO BE THE EFFECT
HERE.
AND IT IS AND ALSO WEALTH, IT'S
NOT REGARDING WEALTH.
IN FACT, THERE'S A HIGHER RATE
IN THE WEALTHIER AND OLDER BLACK
WOMEN.
SO, THAT -- AND THAT'S BEING
LOOKED AT RIGHT NOW.
WHY IS THAT?
IT'S TO SAY SOCIAL DETERMINANTS
OF HEALTH GIVE US A DIRECTION I
THINK INTO THESE DISPARITIES,
BUT EACH SOCIAL DETERMINANT OF
HEALTH IS NOT ACTIVE IN EACH
DISPARITY.
WE NEED TO UNDERSTAND THAT.
IT'S MUCH MORE COMPLEX THAN WE'D
LIKE IT TO BE BUT AS WE LOOK AT
EACH DISPARITY WE CAN SEE WHAT
IS ACTIVE, WHAT IS NOT, AND WORK
ON THINGS THAT ARE ACTIVE.
>> GREAT.
THANKS VERY MUCH.
THANKS FOR THE QUESTION.
WHILE WE WAIT TO SEE IF THERE'S
MORE QUESTIONS AS THEY COME IN,
YOU DID TOUCH ON THIS, WHAT CAN
WE DO?
I JOTTED DOWN, AS A HEALTH CARE
WORKER, MYSELF AS A PHYSICIAN
BUT ANY HEALTH CARE WORKER NOT
RUNNING A HOSPITAL OR RESEARCH,
BUT WHAT COULD I AS AN
INDIVIDUAL DO, I WAS THINKING
ABOUT LIST OF SOCIAL
DETERMINANTS OF HEALTH, IF
SOMEBODY SAID, GOSH, THIS IS
OVERWHELMING, WHAT ONE THING
COULD I DO, ADD TO MY DAY OR
WEEK, EVEN FOR A SMALL AMOUNT OF
TIME THAT YOU THINK WOULD HAVE
THE MOST IMPACT?
>> I THINK IT'S REACHING OUT TO
THE COMMUNITY, THOSE IN NEED IN
YOUR COMMUNITY.
THAT CAN BE DONE VARIOUS WAYS.
THERE ARE COMMUNITY GROUPS THAT
YOU CAN JOIN, THERE ARE
COMMUNITY PROJECTS, WHETHER IT'S
WORKING AT A FOOD KITCHEN, OR
WORKING ON CONSTRUCTION
PROJECTS, LIKE HABITAT FOR
HUMANITY, WHATEVER THE LOCAL
ORGANIZATION IS.
YOU GET TO GO TO THE COMMUNITY.
GET TO TALK TO PEOPLE FROM THE
COMMUNITY.
YOU START UNDERSTANDING THE
ISSUES THAT THEY ARE DEALING
WITH.
UNDERSTANDING NOT ONLY THE
SOCIAL DETERMINANTS OF HEALTH
THAT MIGHT BE AFFECTING THAT
COMMUNITY, BUT ALSO WHAT TRUST
OR MISTRUST IS IN THAT COMMUNITY
OF THE HEALTH CARE SYSTEM.
BY BEING THERE YOU CAN
REPRESENTATIVE THE HEALTH CARE
COMMITTEE, SHOWING CARE AND
CONCERN, START REDUCING THAT
DISTRUST.
I THINK THAT COMMUNICATION, WE
TEND TO GET SILOED IN WHAT WE DO
BECAUSE OUR LIVES ARE BUSY AND
WE STAY WITHIN THE COMMUNITIES
THAT WE'RE USED TO.
SO WE DON'T REACH OUT, NOT
BECAUSE WE'RE BAD PEOPLE, IT'S
BECAUSE WE DON'T HAVE TIME.
SO IT IS TAKING THE TIME TO FIND
A COMMUNITY GROUP, COMMUNITY
ACTIVITY, A COMMUNITY COMMITTEE,
THAT YOU CAN PARTICIPATE ON SO
THAT YOU CAN REACH OUT AND THEN
THEY CAN START UNDERSTANDING
YOU, AND THROUGH YOU, THE
CLINICAL CENTER, FOR EXAMPLE,
AND GAINING COMMUNITY'S TRUST IN
WHAT YOU DO.
>> GREAT.
THANKS FOR THAT ANSWER.
WE HAVE ANOTHER QUESTION.
THANK YOU FOR A FANTASTIC TALK.
YOU MENTIONED NURTURING MORAL
INCENTIVES.
ASKED IF YOU COULD ELABORATE ON
THAT PHRASE OR GIVE SOME
EXAMPLES.
>> I THINK SIMPLY, MAYBE A TOO
PACKED PHRASE, BUT THE IDEA IS
WE ALL HAVE CERTAIN ETHICAL AND
MORAL IDEALS WITHIN WHATEVER
COMMUNITY AND WHATEVER COUNTRY
WE LIVE IN, THAT WE THINK ARE
RIGHT.
THIS IS THE WAY IT OUGHT TO BE.
I THINK GETTING BACK TO AMERICA,
YOU KNOW, AND LEAVING THOMAS
JEFFERSON AND PERSONAL ISSUES
ASIDE THERE, THE CONCEPT THAT WE
ALL HAVE THE RIGHT TO LIFE,
LIBERTY, PURSUIT OF HAPPINESS,
AND PURSUIT OF GOOD HEALTH CARE.
SO, WHAT WE NEED TO DO IS
NURTURE THAT IDEAL THAT WE LIVE
IN, AGAIN, IT'S NOT TRUE FOR
EVERYBODY BUT WE LIVE IN WHAT WE
FEEL TO BE A FREE SOCIETY, AND
THAT EVERYBODY SHOULD HAVE THE
RIGHT TO ACCESS GOOD QUALITY
HEALTH CARE.
AND IF WE CAN NURTURE THAT, THAT
SIMPLE MORAL AND ETHICAL
CONSTRUCT, I THINK WE CAN ALL DO
BETTER.
YOU KNOW, I KNOW THIS BRINGS TO
MIND TO EVERYBODY WITH ALL OF
THE POLITICAL DISCOURSE WE'RE
HAVING RIGHT NOW, IT MAKES IT
MORE DIFFICULT.
I TEND TO BE AN OPTIMIST, AND I
TEND TO WANT PEOPLE TO DO
BETTER.
I THINK, AGAIN, THE IDEA WE HAVE
THROUGH OUR SOCIETY, AND SOME
PEOPLE THROUGH THEIR RELIGION OR
CULTURAL GROUP, MORALS AND
ETHICS WE THINK NEEDED TO BE THE
RIGHT THING TO DO, WHAT BEE NEED
TO DO IS NURTURE THAT, MOVE IT
FORWARD, MAKE THIS PLACE BETTER
WHICH WE BELIEVE AT THE SAFETY
CENTER WILL IMPROVE, YOU KNOW,
HEALTH EQUITY FOR ALL, AND THERE
BY IMPROVE HEALTH OUTCOMES FOR
ALL, WHICH IS OUR GOAL.
>> GREAT.
THANKS.
HERE'S A QUESTION, DO YOU HAVE
ANY SUGGESTIONS ON HOW WE CAN
ENCOURAGE UNDERREPRESENTED
INDIVIDUALS TO ENGAGE IN
RESEARCH?
I UNDERSTAND THAT WE NEED MORE
INDIVIDUALS IN DIVERSE
COMMUNITIES TO PARTICIPATE IN
RESEARCH.
THINKING ABOUT HOW TO OVERCOME
THE UNDERSTANDABLE RELUCTANCE.
>> RIGHT.
AGAIN, FIRST IS UNDERSTANDING.
I MEAN, FIRST IS KNOWLEDGE.
AND I TRIED TO DO A LITTLE BIT
OF THAT TODAY BUT READ SOME MORE
ABOUT IT, READ ABOUT THE VARIOUS
HISTORICAL -- I'VE GOT THE BOOKS
THERE IN THE POWERPOINT.
BUT READ ABOUT HISTORICAL
EPISODES IN CLINICAL RESEARCH
THAT ARE NOT GOOD, BUT WE CAN AT
LEAST UNDERSTAND THEM, SPEAK TO
IT.
AND THEN IT IS, AGAIN, REACHING
OUT TO THE COMMUNITIES, NOT ALL
OF THEM ARE RIGHT THERE IN
BETHESDA, BUT FINDING
COMMUNITIES AND THE GOOD NEWS IS
EVEN IN WHAT WE CONSIDER TO BE A
WEALTHY MONTGOMERY COUNTY,
DIFFERENT COMMUNITIES YOU DON'T
KNOW ABOUT.
AND REACHING OUT TO THOSE
COMMUNITIES, START TALKING WITH
THEM.
ONCE YOU ENGAGED THEM AND ENGAGE
WHETHER IT'S COMMITTEES, YOU
KNOW, AGAIN COMMUNITY BOARDS,
COMMITTEES, OR PERHAPS RELIGIOUS
INSTITUTIONS IN THOSE
COMMUNITIES OF VARIOUS KINDS,
CULTURAL AND SOCIAL, COUNTRY OF
ORIGIN GROUPS WHICH MAY HAVE A
DIFFERENT LANGUAGE SO YOU MIGHT
NEED A TRANSLATOR, AND AS WE
FOUND WITH COVID, HAIR SALONS
AND BARBERSHOPS, WHERE THE
COMMUNITY GATHERS REGULARLY TO
REACH OUT THERE AND SAY, HEY,
I'M DOING WORK AT THE CLINICAL
CENTER AT NIH, WE'RE TRYING TO
IMPROVE HEALTH CARE FOR
EVERYBODY, BUT WE CAN'T RECRUIT
PEOPLE FROM YOUR COMMUNITY,
WHAT'S WRONG, WHAT CAN WE DO?
JUST STARTING THAT CONVERSATION.
DOESN'T HAPPEN OVERNIGHT.
NOTHING DOES.
DON'T GET DISCOURAGED.
KEEP TRYING.
IT IS THE RIGHT THING TO DO.
I THINK IT IS HAPPENING MORE
NOW.
I THINK COVID ACTUALLY OPENED
OUR EYES ON THAT.
BUT WE WILL NEED TO DO MORE.
AND HONESTLY, TO TAKE BACK TO
THE NIH LEADERSHIP, CLINICAL
CENTER LEADERSHIP, THEY CAN DO
MORE BY SPONSORING INDIVIDUAL
STAFF IN THEIR ORGANIZATION OR
HELPING THEM CONNECT WITH THOSE
GROUPS IN THE COMMUNITY.
>> THAT'S GREAT, YEAH.
THANKS.
MATERNAL MORTALITY, A QUESTION,
WHAT IS THE MOST COMMON CAUSE OF
DEATH IN THE MATERNAL
MORTALITIES WHICH YOU HAD
STUDIED?
>> IT VARIES AS TO THE DATA THAT
YOU'RE LOOKING AT.
SOME MATERNAL MORTALITY DATA,
ESPECIALLY FROM THE CDC,
INVOLVES ONLY -- YOU KNOW, IN
THE PERIOD OF TIME ESSENTIALLY
THAT -- I'M TRYING TO REMEMBER
IF IT'S CDC OR MARYLAND STATE
DATA, SOME IS AT THE HOSPITAL,
I'LL JUST TELL YOU SOME IS AT
THE HOSPITAL, SOME IS WITHIN 365
DAYS, A YEAR OF DELIVERY.
WHEN WE REVIEW WE SUPPORT THE
STATE'S MATERNAL MORTALITY
REVIEW THEME, THERE'S ABOUT 40
TO 50 DEATHS, MATERNAL DEATHS,
IN MARYLAND A YEAR, BUT MANY OF
THOSE ARE WITHIN A YEAR AFTER
DELIVERY.
AND SO IN THOSE, IN THE ONES
THAT TAKE UP TO 365 DAYS AFTER
DELIVERY, AS YOU MIGHT EXPECT
OVER THE LAST SEVERAL YEARS
DEATHS DUE TO OPIOID OVERDOSE
WERE THE GREATEST NUMBER.
BUT THAT WAS NOT DIRECTLY AND
DID NOT APPEAR TO BE DIRECTLY
RELATED TO THE PREGNANCY OR
POSTPARTUM PERIOD.
WHEN WE LOOK AT PREGNANCY AND
POSTPARTUM PERIOD IT TENDS TO
VARY YEAR TO YEAR, USUALLY
HYPERTENSIVE-ASSOCIATED DISEASE,
SO ECLAMPSIA, PREECLAMPSIA, ALSO
HEMORRHAGIC DISEASE, BLEEDING,
WHICH HOSPITALS HAVE GOTTEN MUCH
BETTER AT IN TERMS OF HANDLING
OBSTETRIC BLEEDING LIKE A
TRAUMA, THAT'S IMPROVED
SIGNIFICANTLY I THINK OVER THE
LAST 10 YEARS.
STILL NEEDS MORE IMPROVEMENT BUT
IT'S BETTER.
AND CARDIAC DISEASE, DISCOVERED
OR UNDISCOVERED AT THE TIME OF
DEATH.
ALL OF THOSE ARE INVOLVED,
CERTAINLY THERE ARE LESS COMMON
DISORDERS, PULMONARY EMBOLUS,
INFECTION, ALL OF THEM, MANY ARE
PREVENTIBLE.
WE HAVE TO RECOGNIZE THEM, WHICH
IS ONE OF THE REASONS WE'RE
DOING BOTH M.D. MOM PROGRAM AND
BIRTH EQUITY PROGRAM.
>> OKAY.
THANKS VERY MUCH.
WE'RE JUST IN THE LAST FEW
SECONDS, SO THERE'S A FINAL
COMMENT THAT SPEAKS FOR MANY.
THANK YOU FOR THIS LOVELY AND
PRACTICAL TALK.
SO THANK YOU VERY MUCH, DR. EIG,
I'LL TAKE THE OPPORTUNITY TO
REMIND PEOPLE THAT NEXT TUESDAY
THERE'S A SPECIAL TOWN HALL,
FACILITATED DISCUSSION ON POLICE
BRUTALITY THAT INCLUDES OUR
CLINICAL CENTER CEO AND DIRECTOR
OF NIH OFFICE OF EQUITY,
DIVERSITY AND INCLUSION,
ACTUALLY LIVE IN LIPSETT
AUDITORIUM OR WEBCAST TUESDAY AT
ELEVEN, LOOK FOR ANNOUNCEMENTS
FROM THE CLINICAL CENTER DEIA
PROGRAM ON THAT.
AGAIN, THANK YOU VERY MUCH, DR.
EIG.
AND THANK YOU VERY MUCH TO ALL
WHO VIEWED THIS.
WE'LL SEE YOU NEXT WEEK.
>> THANK YOU.