1 00:00:05,338 --> 00:00:07,340 GOOD MORNING. 2 00:00:07,340 --> 00:00:11,177 WELCOME TO DAY TWO OF THE NHLBI 3 00:00:11,177 --> 00:00:11,878 WORKSHOP ON BLOOD PRESSURE 4 00:00:11,878 --> 00:00:13,813 ASSESSMENT ACROSS THE LIFESPAN, 5 00:00:13,813 --> 00:00:15,748 TO IMPROVE CLINICAL RESEARCH AND 6 00:00:15,748 --> 00:00:16,983 CLINICAL PRACTICE. 7 00:00:16,983 --> 00:00:20,586 WE HA HAD A TERRIFIC DAY ONE OFE 8 00:00:20,586 --> 00:00:23,122 WORKSHOP WITH THREE ENGAGING AND 9 00:00:23,122 --> 00:00:24,857 STIMULATING SESSIONS. 10 00:00:24,857 --> 00:00:28,528 TODAY, WE HAVE TWO PRESENTATION 11 00:00:28,528 --> 00:00:30,196 SESSIONS FOLLOWED BY AN 12 00:00:30,196 --> 00:00:32,899 HOUR-LONG CLOSED SESSION 6, 13 00:00:32,899 --> 00:00:33,800 CONVENED IN THREE BREAKOUT 14 00:00:33,800 --> 00:00:34,901 ROOMS. 15 00:00:34,901 --> 00:00:36,903 WE WILL THEN RECONVENE IN THE 16 00:00:36,903 --> 00:00:40,473 MAIN ROOM FOR A REPORT FROM THE 17 00:00:40,473 --> 00:00:43,076 BREAKOUT SESSIONS. 18 00:00:43,076 --> 00:00:45,244 DR. ABDALLA AND DR. JURASCHEK, 19 00:00:45,244 --> 00:00:46,579 DO YOU HAVE ANY OPENING REMARKS 20 00:00:46,579 --> 00:00:48,047 FOR TODAY BEFORE WE TURN IT OVER 21 00:00:48,047 --> 00:00:52,151 TO THE SESSION 4 MODERATORS? 22 00:00:52,151 --> 00:00:54,720 >> REALLY EXCITED FOR THE SECOND 23 00:00:54,720 --> 00:00:55,054 DAY. 24 00:00:55,054 --> 00:00:57,123 WE HAD SUCH A GREAT, RICH 25 00:00:57,123 --> 00:00:58,424 DISCUSSION ON DAY ONE. 26 00:00:58,424 --> 00:01:00,993 AND I THINK WE'LL HAVE PLENTY 27 00:01:00,993 --> 00:01:02,929 MORE THIS AFTERNOON, AND LOOKING 28 00:01:02,929 --> 00:01:05,631 FORWARD TO THE BREAKOUT -- THE 29 00:01:05,631 --> 00:01:07,066 DISCUSSIONS AS WELL TO CONTINUE 30 00:01:07,066 --> 00:01:08,501 TO PROBE SOME OF THE ISSUES 31 00:01:08,501 --> 00:01:09,368 FURTHER. 32 00:01:09,368 --> 00:01:11,671 SO THANK YOU AGAIN TO ALL OF OUR 33 00:01:11,671 --> 00:01:14,140 PARTICIPANTS AND THE DISCUSSANTS 34 00:01:14,140 --> 00:01:19,212 AND NHLBI FOR THIS REMARKABLE 35 00:01:19,212 --> 00:01:23,149 EVENT. 36 00:01:23,149 --> 00:01:27,420 >> THANK YOU. 37 00:01:27,420 --> 00:01:37,864 SO LET US START SESSION 4. 38 00:01:38,531 --> 00:01:39,632 >> OKAY. 39 00:01:39,632 --> 00:01:40,967 GOOD MORNING, EVERYONE. 40 00:01:40,967 --> 00:01:43,536 WELCOME TO SESSION 4. 41 00:01:43,536 --> 00:01:45,138 I THINK FIRST ORDER OF BUSINESS, 42 00:01:45,138 --> 00:01:46,239 WE ARE GOING TO INTRODUCE 43 00:01:46,239 --> 00:01:46,706 OURSELVES. 44 00:01:46,706 --> 00:01:49,642 MY NAME IS DAICHI SHIMBO. 45 00:01:49,642 --> 00:01:51,944 I'M PROFESSOR OF MEDICINE AT 46 00:01:51,944 --> 00:01:53,045 COLUMBIA UNIVERSITY IRVING 47 00:01:53,045 --> 00:01:53,579 MEDICAL CENTER. 48 00:01:53,579 --> 00:01:55,014 I'M A PREVENTIVE CARDIOLOGIST 49 00:01:55,014 --> 00:01:57,116 AND THE DIRECTOR OF OUR 50 00:01:57,116 --> 00:01:57,717 HYPERTENSION CENTER. 51 00:01:57,717 --> 00:01:59,986 >> AND GOOD MORNING, EVERYONE. 52 00:01:59,986 --> 00:02:04,490 I'M HILARY WALL, SENIOR 53 00:02:04,490 --> 00:02:07,527 SCIENTIST IN THE CENTERS FOR 54 00:02:07,527 --> 00:02:08,394 DISEASE CONTROL AND PREVENTION 55 00:02:08,394 --> 00:02:10,396 AND ALSO SERVE AS THE SCIENCE 56 00:02:10,396 --> 00:02:11,564 LEAD FOR THE NATIONAL MILLION 57 00:02:11,564 --> 00:02:12,198 HEARTS INITIATIVE. 58 00:02:12,198 --> 00:02:14,000 SO I THINK WE WILL GET US KICKED 59 00:02:14,000 --> 00:02:15,835 OFF WITH OUR FIRST SPEAKER WHO 60 00:02:15,835 --> 00:02:17,370 IS DR. BEVERLY GREEN. 61 00:02:17,370 --> 00:02:19,705 SHE IS A SENIOR INVESTIGATOR AND 62 00:02:19,705 --> 00:02:23,276 FAMILY PHYSICIAN AT THE KAISER 63 00:02:23,276 --> 00:02:24,277 PERMANENTE WASHINGTON HEALTH 64 00:02:24,277 --> 00:02:24,810 RESEARCH INSTITUTE. 65 00:02:24,810 --> 00:02:27,079 HER RESEARCH FOCUSES ON SYSTEMS 66 00:02:27,079 --> 00:02:29,448 BASED DESIGN AND LEVERAGING 67 00:02:29,448 --> 00:02:30,416 ELECTRONIC HEALTH RECORDS AND 68 00:02:30,416 --> 00:02:31,884 REMOTE COMMUNICATIONS TO DELIVER 69 00:02:31,884 --> 00:02:33,719 MORE EFFECTIVE AND EFFICIENT 70 00:02:33,719 --> 00:02:34,754 EVIDENCE-BASED PREVENTIVE CARE. 71 00:02:34,754 --> 00:02:37,723 SHE'LL BE SPEAKING TO US ON 72 00:02:37,723 --> 00:02:38,691 INTEGRATING PATIENT GENERATED 73 00:02:38,691 --> 00:02:41,794 DATA WITH CLINICAL ASSESSMENTS. 74 00:02:41,794 --> 00:02:42,228 BEV? 75 00:02:42,228 --> 00:02:42,862 >> GOOD MORNING. 76 00:02:42,862 --> 00:02:47,166 AND THANK YOU FOR INVITING ME, 77 00:02:47,166 --> 00:02:49,135 AND THOSE ARE MY CONFLICTS OF 78 00:02:49,135 --> 00:02:54,340 INTEREST TO REPORT. 79 00:02:54,340 --> 00:02:57,810 SO THIS IS MY OUTLINE FOR THE 80 00:02:57,810 --> 00:02:58,945 DISCUSSION TODAY, AND I'M GOING 81 00:02:58,945 --> 00:03:02,114 TO BE DISCUSSING WHY PATIENT 82 00:03:02,114 --> 00:03:03,216 GENERATED BLOOD PRESSURE DATA IS 83 00:03:03,216 --> 00:03:04,750 IMPORTANT. 84 00:03:04,750 --> 00:03:08,888 CURRENT CHALLENGES TO GATHERING 85 00:03:08,888 --> 00:03:11,624 THAT DATA, AND EXAMPLES OF 86 00:03:11,624 --> 00:03:15,428 PROGRAMS THAT HAVE INTEGRATED 87 00:03:15,428 --> 00:03:16,429 SELF-MEASURED BLOOD PRESSURE 88 00:03:16,429 --> 00:03:19,031 INTO CLINICAL CARE, AND GAPS AND 89 00:03:19,031 --> 00:03:26,639 FUTURE OPPORTUNITIES. 90 00:03:26,639 --> 00:03:30,142 SO CURRENTLY, TWO OF THE LEADING 91 00:03:30,142 --> 00:03:31,577 GUIDELINE GROUPS RECOMMEND OUT 92 00:03:31,577 --> 00:03:33,646 OF OFFICE BLOOD PRESSURE 93 00:03:33,646 --> 00:03:39,318 MONITORING FOR EITHER THE 94 00:03:39,318 --> 00:03:41,988 DIAGNOSIS OR FOR TITRATION OF 95 00:03:41,988 --> 00:03:45,825 MEDICATIONS WITH BOTH HAVING A 96 00:03:45,825 --> 00:03:46,993 RECOMMENDATION, WHICH MEANS 97 00:03:46,993 --> 00:03:49,562 THERE'S HIGH QUALITY EVIDENCE. 98 00:03:49,562 --> 00:03:51,264 ALTHOUGH THOSE ARE RECOMMENDED 99 00:03:51,264 --> 00:03:53,766 FOR DIAGNOSIS AND FOR TREATMENT, 100 00:03:53,766 --> 00:04:00,139 IT'S SELDOM DONE. 101 00:04:00,139 --> 00:04:02,008 SO THE EVIDENCE IS QUITE STRONG 102 00:04:02,008 --> 00:04:04,710 FOR SELF BLOOD PRESSURE 103 00:04:04,710 --> 00:04:05,778 MEASUREMENT, AND SELF BLOOD 104 00:04:05,778 --> 00:04:07,213 PRESSURE MEASUREMENT ON ITS OWN 105 00:04:07,213 --> 00:04:09,282 ON SOME META-ANALYSES, NOT THIS 106 00:04:09,282 --> 00:04:11,817 ONE IN PARTICULAR, HAS SHOWN A 107 00:04:11,817 --> 00:04:13,686 SMALL BUT SIGNIFICANT DECREASE 108 00:04:13,686 --> 00:04:16,522 IN SYSTOLIC BLOOD PRESSURE, AND 109 00:04:16,522 --> 00:04:19,525 WHEN YOU ADD MORE COMPONENTS AND 110 00:04:19,525 --> 00:04:21,127 HIGHER INTENSITY INTERVENTIONS, 111 00:04:21,127 --> 00:04:24,497 IT GETS THE EFFECT OF HOME BLOOD 112 00:04:24,497 --> 00:04:26,632 PRESSURE MONITORING PLUS ADDED 113 00:04:26,632 --> 00:04:29,902 SUPPORT GETS EVEN STRONGER, WITH 114 00:04:29,902 --> 00:04:34,373 THE STRONGEST EFFECT BEING FROM 115 00:04:34,373 --> 00:04:36,942 PHARMACISTS OR NURSE-BASED 116 00:04:36,942 --> 00:04:39,178 MEDICATION TITRATION IN ADDITION 117 00:04:39,178 --> 00:04:41,247 TO SELF-MONITORING, AND THAT'S 118 00:04:41,247 --> 00:04:43,482 BEEN DONE A NUMBER OF WAYS, 119 00:04:43,482 --> 00:04:47,920 THROUGH REMOTE MONITORING 120 00:04:47,920 --> 00:04:51,657 PROGRAMS, SECURE -- STUDY AND 121 00:04:51,657 --> 00:04:52,124 TELEPHONE. 122 00:04:52,124 --> 00:04:54,627 AND I PUT UP A LITTLE NOTE THERE 123 00:04:54,627 --> 00:04:57,163 THAT I THINK THAT THERE'S NO ONE 124 00:04:57,163 --> 00:04:59,065 ANSWER FOR HOW TO COMMUNICATE 125 00:04:59,065 --> 00:04:59,632 THE DATA. 126 00:04:59,632 --> 00:05:04,303 IT HAS TO BE TAILORED TO THE 127 00:05:04,303 --> 00:05:06,339 RESOURCES IN THE SYSTEM AND ALSO 128 00:05:06,339 --> 00:05:16,082 PATIENT PREFERENCES. 129 00:05:16,082 --> 00:05:18,851 ALMOST ALL HIGH QUALITY TRIALS 130 00:05:18,851 --> 00:05:22,588 HAVE SHOWN BENEFITS FROM 131 00:05:22,588 --> 00:05:23,622 LOWERING BLOOD PRESSURE USED 132 00:05:23,622 --> 00:05:25,324 OFFICE BASED BLOOD PRESSURE. 133 00:05:25,324 --> 00:05:26,792 IT'S AN ARGUMENT I OFTEN GET 134 00:05:26,792 --> 00:05:28,227 WHEN I SAY WE SHOULD BE DOING 135 00:05:28,227 --> 00:05:29,628 HOME MONITORS. 136 00:05:29,628 --> 00:05:31,864 ALL THE TRIALS USED CLINIC-BASED 137 00:05:31,864 --> 00:05:32,798 MEASUREMENTS. 138 00:05:32,798 --> 00:05:35,835 BUT THE ARGUMENT I GIVE BACK TO 139 00:05:35,835 --> 00:05:37,570 THAT IS A CLINIC BLOOD PRESSURE 140 00:05:37,570 --> 00:05:40,005 MEASUREMENT IS NOT THE SAME AS A 141 00:05:40,005 --> 00:05:42,608 RESEARCH-BASED MEASUREMENT, AS A 142 00:05:42,608 --> 00:05:45,778 RESEARCHER I KNOW THAT AND I 143 00:05:45,778 --> 00:05:47,880 USUALLY DON'T RELY ON EHR BLOOD 144 00:05:47,880 --> 00:05:49,682 PRESSURE MEASUREMENTS UNLESS THE 145 00:05:49,682 --> 00:05:50,716 HEALTH SYSTEM HAS GONE OUT OF 146 00:05:50,716 --> 00:05:55,187 THEIR WAY TO ASSURE GOOD 147 00:05:55,187 --> 00:05:57,490 MEASUREMENT, WHICH IS SELDOM 148 00:05:57,490 --> 00:05:58,224 COMMON. 149 00:05:58,224 --> 00:05:59,825 AND OFTEN CLINIC MONITORS, EVEN 150 00:05:59,825 --> 00:06:01,093 MONITORS WE USE IN CLINIC, ARE 151 00:06:01,093 --> 00:06:03,763 NOT VALIDATED FOR ACCURACY AND 152 00:06:03,763 --> 00:06:07,700 ARE NOT REGULARLY CALIBRATED, 153 00:06:07,700 --> 00:06:09,835 ESPECIALLY ANEROID MONITORS 154 00:06:09,835 --> 00:06:11,137 WHICH ARE STILL USED A LOT 155 00:06:11,137 --> 00:06:12,371 BECAUSE THEY'RE CHEAPER AND IT 156 00:06:12,371 --> 00:06:13,773 HARD TO PUT AUTOMATED MONITORS 157 00:06:13,773 --> 00:06:17,042 IN EVERY ROOM, AND IMPROVE 158 00:06:17,042 --> 00:06:18,511 TECHNIQUE IS COMMON IN CLINICAL 159 00:06:18,511 --> 00:06:19,145 CARE. 160 00:06:19,145 --> 00:06:20,679 WE'VE HAD A LOT OF DISCUSSION 161 00:06:20,679 --> 00:06:24,350 ABOUT THAT, WE ACTUALLY LOOKED 162 00:06:24,350 --> 00:06:27,052 AT THAT, AND WE DID A SECRET 163 00:06:27,052 --> 00:06:31,357 SHOPPER STUDY AND FOUND WITH 164 00:06:31,357 --> 00:06:32,224 ANEROID MEASUREMENTS, THAT ABOUT 165 00:06:32,224 --> 00:06:33,893 90 TO 95% OF THE MEASUREMENTS 166 00:06:33,893 --> 00:06:34,226 HAD ERRORS. 167 00:06:34,226 --> 00:06:37,129 IT WAS A LITTLE BETTER WITH 168 00:06:37,129 --> 00:06:38,931 AUTOMATED, BUT THE MOST COMMON 169 00:06:38,931 --> 00:06:40,132 ERROR WITH AUTOMATED WAS TALKING 170 00:06:40,132 --> 00:06:41,200 TO THE PATIENT. 171 00:06:41,200 --> 00:06:46,472 AND THEN AS WE SAW WITH 172 00:06:46,472 --> 00:06:52,011 DR. JURASCHEK'S PRESENTATION, 173 00:06:52,011 --> 00:06:52,778 NUMBER ROUNDING IS A PROBLEM AND 174 00:06:52,778 --> 00:06:54,647 WHEN YOU GO TO AUTOMATED 175 00:06:54,647 --> 00:06:55,848 MEASUREMENTS, THIS GOES AWAY. 176 00:06:55,848 --> 00:07:01,153 HOWEVER, THERE IS VALUE IN -- 177 00:07:01,153 --> 00:07:03,722 WELL, NOT ANEROID BUT I WOULD 178 00:07:03,722 --> 00:07:04,690 SAY MERCURY MEASUREMENT, WHICH 179 00:07:04,690 --> 00:07:06,358 IS MUCH EASIER, BUT WE CAN NO 180 00:07:06,358 --> 00:07:07,426 LONGER USE THAT, THEY'RE 181 00:07:07,426 --> 00:07:10,463 PROHIBITED IN MY STATE, THE 182 00:07:10,463 --> 00:07:12,465 MERCK NIEMANNOMETERS. 183 00:07:12,465 --> 00:07:13,532 ALSO NOT RECHECKING BLOOD 184 00:07:13,532 --> 00:07:15,701 PRESSURE, NOT WAITING FOR TIME, 185 00:07:15,701 --> 00:07:17,436 LACK OF AVERAGING AND RELYING ON 186 00:07:17,436 --> 00:07:25,110 THE LOWEST BLOOD PRESSURE NOT 187 00:07:25,110 --> 00:07:26,212 JUST FOR QUALITY METRICS BUT 188 00:07:26,212 --> 00:07:27,279 ALSO IN CLINICAL CARE, THEY 189 00:07:27,279 --> 00:07:29,815 OFTEN HAVE A PATIENT WAIT, AND 190 00:07:29,815 --> 00:07:31,450 AFTER 5, 10 MINUTES, OFTEN IT'S 191 00:07:31,450 --> 00:07:32,985 LOWER, THERE'S A LOT OF STUDIES 192 00:07:32,985 --> 00:07:34,820 SHOWING THAT AND THEN THEY'RE 193 00:07:34,820 --> 00:07:35,654 HAPPY. 194 00:07:35,654 --> 00:07:36,355 GOOD AVERAGE BLOOD PRESSURE 195 00:07:36,355 --> 00:07:37,356 MIGHT BE QUITE DIFFERENT. 196 00:07:37,356 --> 00:07:39,191 AND THIS SHOWS WE HAVE A LOT OF 197 00:07:39,191 --> 00:07:40,493 DISCUSSION, WHICH I WAS HAPPY TO 198 00:07:40,493 --> 00:07:44,230 HEAR YESTERDAY, ABOUT BLOOD 199 00:07:44,230 --> 00:07:45,197 PRESSURE VARIATION, AND THE 200 00:07:45,197 --> 00:07:47,766 HIGHER YOU ARE, THE MORE YOU 201 00:07:47,766 --> 00:07:48,501 HAVE TO FALL. 202 00:07:48,501 --> 00:07:51,837 I LOVE THAT IN OUR TALK ABOUT 203 00:07:51,837 --> 00:07:54,840 BLOOD PRESSURE CARE IN THE 204 00:07:54,840 --> 00:07:58,310 ELDERLY. 205 00:07:58,310 --> 00:07:59,278 THIS IS A COPY OF THE BLOOD 206 00:07:59,278 --> 00:08:02,414 PRESSURE MEASUREMENTS IN A 207 00:08:02,414 --> 00:08:04,517 24-HOUR REPORT IMOWN, AND IN 208 00:08:04,517 --> 00:08:07,720 THIS PARTICULAR PATIENT, THIS 209 00:08:07,720 --> 00:08:11,423 PERSON WAS 71 YEARS OLD, THERE'S 210 00:08:11,423 --> 00:08:13,425 ABOUT A 50-MILLIMETER DIFFERENCE 211 00:08:13,425 --> 00:08:16,228 THROUGHOUT THE DAY IN SYSTOLIC 212 00:08:16,228 --> 00:08:16,595 BLOOD PRESSURES. 213 00:08:16,595 --> 00:08:19,131 SO I ALWAYS SAY, WELL, THE RIGHT 214 00:08:19,131 --> 00:08:19,798 BLOOD PRESSURE -- WILL THE RIGHT 215 00:08:19,798 --> 00:08:21,333 BLOOD PRESSURE SHOW UP? 216 00:08:21,333 --> 00:08:22,868 BECAUSE YOU'RE GETTING A VERY 217 00:08:22,868 --> 00:08:26,272 SMOOL GLIMPSE IN CLINIC. 218 00:08:26,272 --> 00:08:27,072 -- SMALL 219 00:08:27,072 --> 00:08:28,507 GLIMPSE IN CLINIC. 220 00:08:28,507 --> 00:08:29,642 THEN POWERS FOUND THAT FOR 221 00:08:29,642 --> 00:08:31,343 PEOPLE THAT WERE CLOSE TO THE 222 00:08:31,343 --> 00:08:32,678 THRESHOLD, THAT YOU NEED AT 223 00:08:32,678 --> 00:08:35,414 LEAST 10 READINGS TO HAVE 80% 224 00:08:35,414 --> 00:08:36,415 PROBABILITY OF GETTING THE RIGHT 225 00:08:36,415 --> 00:08:41,220 ANSWER. 226 00:08:41,220 --> 00:08:42,388 AND THAT ONLY WHEN THE BLOOD 227 00:08:42,388 --> 00:08:43,589 PRESSURE IS AT THE MORE EXTREMES 228 00:08:43,589 --> 00:08:45,591 CAN YOU BE CONFIDENT THAT YOU 229 00:08:45,591 --> 00:08:51,163 ARE IN THE RIGHT BALLPARK. 230 00:08:51,163 --> 00:08:52,464 SO THERE'S BEEN A LOT OF 231 00:08:52,464 --> 00:08:54,633 INTEREST IN AUTOMATED OFFICE 232 00:08:54,633 --> 00:08:57,269 BLOOD PRESSURE AND MAYBE WE CAN 233 00:08:57,269 --> 00:08:58,871 DECREASE THE TIME TO TWO OR 234 00:08:58,871 --> 00:09:01,307 THREE MINUTES OF REST, MAKE IT 235 00:09:01,307 --> 00:09:03,943 MORE EFFICIENT WITH HALF A 236 00:09:03,943 --> 00:09:05,911 MINUTE, AND THERE WAS A NICE 237 00:09:05,911 --> 00:09:08,781 STUDY BY RORK THAT SHOWED WHEN 238 00:09:08,781 --> 00:09:10,549 YOU AVERAGE BLOOD PRESSURES, 239 00:09:10,549 --> 00:09:13,152 AOBP IS IDENTICAL TO AMBULATORY. 240 00:09:13,152 --> 00:09:14,920 THAT WAS USING MAINLY STUDIES 241 00:09:14,920 --> 00:09:17,389 FROM CANADA, WHICH ACTUALLY USES 242 00:09:17,389 --> 00:09:21,493 A METHOD WITH NO REST. 243 00:09:21,493 --> 00:09:25,631 WHEN WE LOOK AT THE AOB PROTOCOL 244 00:09:25,631 --> 00:09:27,933 THAT WAS USED IN SPRINT, THAT 245 00:09:27,933 --> 00:09:29,535 WAS PRETTY MUCH RECOMMENDED WITH 246 00:09:29,535 --> 00:09:31,070 THE 5 MINUTES OF REST, YOU 247 00:09:31,070 --> 00:09:31,870 ACTUALLY FIND BLOOD PRESSURES 248 00:09:31,870 --> 00:09:33,405 THAT ARE LOWER THAN AMBULATORY 249 00:09:33,405 --> 00:09:34,773 AND WE'RE NOT THE ONLY ONES THAT 250 00:09:34,773 --> 00:09:35,574 FOUND THIS. 251 00:09:35,574 --> 00:09:39,445 THIS IS A STUDY WE DID. 252 00:09:39,445 --> 00:09:41,680 WE FOUND ALMOST A 4-POINT BIAS 253 00:09:41,680 --> 00:09:42,514 DOWNWARDS. 254 00:09:42,514 --> 00:09:43,415 AND AMBULATORY IS ALREADY 255 00:09:43,415 --> 00:09:45,284 SUPPOSED TO BE LOWER THAN 256 00:09:45,284 --> 00:09:47,252 CLINIC, SO IF YOU USED AOBP, YOU 257 00:09:47,252 --> 00:09:50,122 HAVE TO REMEMBER THAT YOU SHOULD 258 00:09:50,122 --> 00:09:54,293 NOT USE A 140/90 THRESHOLD, SO 259 00:09:54,293 --> 00:09:55,694 THAT IS NOT THE COMPLETE ANSWER 260 00:09:55,694 --> 00:09:56,729 UNLESS PEOPLE USE IT PROPERLY. 261 00:09:56,729 --> 00:10:00,499 THE OTHER THING TO NOTICE IS 262 00:10:00,499 --> 00:10:01,367 BLAND-ALTMAN CURVES. 263 00:10:01,367 --> 00:10:03,569 THIS ISN'T AS BAD AS THE 264 00:10:03,569 --> 00:10:04,670 PEDIATRIC CURVES I SAW 265 00:10:04,670 --> 00:10:06,005 YESTERDAY, BUT THERE IS -- YOU 266 00:10:06,005 --> 00:10:07,039 KNOW, FOR THE AVERAGE, IT MIGHT 267 00:10:07,039 --> 00:10:08,440 BE PRETTY GOOD FOR THE GROUP, 268 00:10:08,440 --> 00:10:10,709 BUT FOR YOU AND ME, NOT SO MUCH. 269 00:10:10,709 --> 00:10:15,381 YOU COULD BE AS MUCH AS 270 00:10:15,381 --> 00:10:16,348 20 MILLIMETERS DIFFERENT THAN 271 00:10:16,348 --> 00:10:18,817 THE AVERAGE, SO YOU MAY BE -- A 272 00:10:18,817 --> 00:10:20,319 VERY GOOD CHANCE YOU COULD BE 273 00:10:20,319 --> 00:10:27,059 MISCLASSIFIED. 274 00:10:27,059 --> 00:10:28,961 SO THE PROBLEM IS BP VARIATION 275 00:10:28,961 --> 00:10:31,330 AND THE SOLUTION IS MORE BLOOD 276 00:10:31,330 --> 00:10:34,400 PRESSURE SO HOW DO WE GET THOSE? 277 00:10:34,400 --> 00:10:35,968 UNFORTUNATELY I PRACTICED BEFORE 278 00:10:35,968 --> 00:10:37,269 THERE WAS HEMOGLOBIN A1C FOR 279 00:10:37,269 --> 00:10:37,603 DIABETES. 280 00:10:37,603 --> 00:10:38,971 WE DON'T HAVE ONE FOR 281 00:10:38,971 --> 00:10:39,505 HYPERTENSION. 282 00:10:39,505 --> 00:10:44,977 WOULDN'T IT BE NICE, IF WE HAD 283 00:10:44,977 --> 00:10:46,912 TO USE ONLY BLOOD SUGARS TO 284 00:10:46,912 --> 00:10:47,980 MANAGE DIABETES AND IT WAS MUCH 285 00:10:47,980 --> 00:10:49,715 HARDER TO KNOW THE OVERALL 286 00:10:49,715 --> 00:10:53,719 PICTURE AND WE HAVE THE SAME 287 00:10:53,719 --> 00:10:54,720 PROBLEM IN HYPERTENSION AND WE 288 00:10:54,720 --> 00:10:57,222 DON'T HAVE A HEMOGLOBIN A1C BUT 289 00:10:57,222 --> 00:10:58,791 WE CAN GET SUMMARY DATA AND JUST 290 00:10:58,791 --> 00:11:05,898 MAKE IT LIKE A1C, AND NICELY 291 00:11:05,898 --> 00:11:07,599 WHEN YOU DO AN AMBULATORY TEST, 292 00:11:07,599 --> 00:11:11,470 YOU DO GET A SUMMARY PAGE THAT 293 00:11:11,470 --> 00:11:12,304 SIMPLIFIES EVERYTHING THAT WAS 294 00:11:12,304 --> 00:11:12,838 RECORDED. 295 00:11:12,838 --> 00:11:13,806 THERE'S QUITE A BIT MORE 296 00:11:13,806 --> 00:11:15,407 INFORMATION, BUT THE SUMMARY 297 00:11:15,407 --> 00:11:17,476 PAGE IS USUALLY CORRECT AND IT 298 00:11:17,476 --> 00:11:18,410 DISTILLS ALL THAT INFORMATION SO 299 00:11:18,410 --> 00:11:20,646 YOU CAN MAKE A JUDGE. 300 00:11:20,646 --> 00:11:20,879 MENT. 301 00:11:20,879 --> 00:11:22,948 SO WE NEED SOMETHING LIKE THAT 302 00:11:22,948 --> 00:11:27,319 FOR SMBP, WHERE WE GET THE 303 00:11:27,319 --> 00:11:27,786 AVERAGE RANGE. 304 00:11:27,786 --> 00:11:29,288 WE TALKED ABOUT THE RANGE BEING 305 00:11:29,288 --> 00:11:30,122 IMPORTANT, PARTICULARLY IN OLDER 306 00:11:30,122 --> 00:11:31,356 PEOPLE AND THE PERCENT OVER 307 00:11:31,356 --> 00:11:32,324 TARGET. 308 00:11:32,324 --> 00:11:33,659 THE BLOOD PRESSURE READINGS. 309 00:11:33,659 --> 00:11:36,562 THAT'S AN IMPORTANT NUMBER TOO 310 00:11:36,562 --> 00:11:38,263 AS WELL TO LOOK AT, SO HOW OFTEN 311 00:11:38,263 --> 00:11:39,531 ARE THOSE BLOOD PRESSURES WHERE 312 00:11:39,531 --> 00:11:41,233 YOU WANT THEM TO BE? 313 00:11:41,233 --> 00:11:44,002 BUT THE NEXT QUESTION IS, HOW DO 314 00:11:44,002 --> 00:11:45,804 WE INTEGRATE SELF-MONITORING 315 00:11:45,804 --> 00:11:51,510 INTO CARE? 316 00:11:51,510 --> 00:11:53,812 SO THERE WAS A POLL DONE IN 2021 317 00:11:53,812 --> 00:11:55,948 AND PUBLISHED IN 2022 IN JAMA 318 00:11:55,948 --> 00:11:58,283 NETWORK THAT LOOKED AT -- THAT 319 00:11:58,283 --> 00:12:01,286 SURVEYED OVER 2,000 PEOPLE AND 320 00:12:01,286 --> 00:12:02,688 ASKED ABOUT HOME BLOOD PRESSURE 321 00:12:02,688 --> 00:12:03,388 MONITORING USE. 322 00:12:03,388 --> 00:12:08,026 AND QUITE ASTOUNDING, OVER 75% 323 00:12:08,026 --> 00:12:10,362 OF PEOPLE IN TOTAL ACTUALLY HAD 324 00:12:10,362 --> 00:12:13,065 A HOME MONITOR, AND OVER HALF 325 00:12:13,065 --> 00:12:15,834 USED IT, AND -- OF THE TOTAL, 326 00:12:15,834 --> 00:12:17,336 AND SOME DIDN'T USE IT. 327 00:12:17,336 --> 00:12:21,073 AND THE REASONS FOR NOT OWNING A 328 00:12:21,073 --> 00:12:22,174 MONITOR WAS, I NEVER THOUGHT 329 00:12:22,174 --> 00:12:26,411 ABOUT IT, IT WAS NOT VERY 330 00:12:26,411 --> 00:12:29,715 DIFFERENT BETWEEN THOSE WITH IT 331 00:12:29,715 --> 00:12:31,383 THAT REPORTED A DIAGNOSIS OF 332 00:12:31,383 --> 00:12:32,484 HYPERTENSION WITHOUT, OR THOSE 333 00:12:32,484 --> 00:12:35,187 WITHOUT A REPORT OF 334 00:12:35,187 --> 00:12:35,754 HYPERTENSION. 335 00:12:35,754 --> 00:12:37,823 TOO EXPENSIVE WAS IMPORTANT. 336 00:12:37,823 --> 00:12:39,858 AND SOME PEOPLE THOUGHT THEY 337 00:12:39,858 --> 00:12:41,059 WEREN'T ACCURATE AND THAT MAY BE 338 00:12:41,059 --> 00:12:42,628 TRUE DEPENDING ON THE MONITOR 339 00:12:42,628 --> 00:12:44,029 THEY HAVE AND THEY WERE NOT SURE 340 00:12:44,029 --> 00:12:47,633 HOW TO USE IT IN A SMALL CASE. 341 00:12:47,633 --> 00:12:49,701 AND THERE WAS ANOTHER SLIDE, I 342 00:12:49,701 --> 00:12:50,936 TRIED TO MAKE THIS SO I WOULD 343 00:12:50,936 --> 00:12:53,338 STICK TO MY 15 MINUTE, BUT IT 344 00:12:53,338 --> 00:12:57,843 SHOWED HOW MUCH WAS USED TO 345 00:12:57,843 --> 00:12:58,911 COMMUNICATE HOME BLOOD PRESSURES 346 00:12:58,911 --> 00:12:59,878 WERE RECOMMENDED, AND THAT 347 00:12:59,878 --> 00:13:01,780 NUMBER WAS ABOUT HALF, YOU SPLIT 348 00:13:01,780 --> 00:13:03,715 THE POPULATION AT ABOUT HALF, 349 00:13:03,715 --> 00:13:06,318 AND HOW MANY ACTUALLY SHARED IT, 350 00:13:06,318 --> 00:13:08,353 THAT WAS ABOUT HALF OF THE HALF. 351 00:13:08,353 --> 00:13:11,790 SO SOME PEOPLE DO SHARE THEIR 352 00:13:11,790 --> 00:13:14,426 BLOOD PRESSURES FROM HOME, BUT 353 00:13:14,426 --> 00:13:15,627 IT'S MUCH SMALLER THAN THE 354 00:13:15,627 --> 00:13:17,062 NUMBER OF PEOPLE WHO ACTUALLY 355 00:13:17,062 --> 00:13:19,264 HAVE HOME MONITORS. 356 00:13:19,264 --> 00:13:20,365 AND I'LL MAKE THE POINT, WE 357 00:13:20,365 --> 00:13:21,533 DON'T KNOW THE QUALITY OF THOSE 358 00:13:21,533 --> 00:13:26,238 HOME MONITORS. 359 00:13:26,238 --> 00:13:28,240 SO WE INTERVIEWED PEOPLE, THIS 360 00:13:28,240 --> 00:13:31,143 IS A PAPER WE'VE WRITTEN AND 361 00:13:31,143 --> 00:13:33,912 IT'S UNDER REVIEW, AND WHO WERE 362 00:13:33,912 --> 00:13:37,216 ASKED TO PROVIDE A HOME BLOOD 363 00:13:37,216 --> 00:13:37,783 PRESSURE READING. 364 00:13:37,783 --> 00:13:39,518 IN MY ORGANIZATION, IT WAS A 365 00:13:39,518 --> 00:13:40,485 QUALITY IMPROVEMENT PROGRAM. 366 00:13:40,485 --> 00:13:44,857 MAYBE NOT ONE I WOULD HAVE 367 00:13:44,857 --> 00:13:46,458 DESIGNED, BUT WE RECEIVED SOME 368 00:13:46,458 --> 00:13:49,728 FUNDING TO EVALUATE IT. 369 00:13:49,728 --> 00:13:50,762 AND WE HEARD FROM PATIENT THAT 370 00:13:50,762 --> 00:13:53,165 THEY WANTED MORE INFORMATION ON 371 00:13:53,165 --> 00:13:55,467 SELECTING A MONITOR, USING IT 372 00:13:55,467 --> 00:13:58,937 AND HOW OFTEN TO MEASURE IT. 373 00:13:58,937 --> 00:14:00,272 SO THE ONES THAT SENT IN BLOOD 374 00:14:00,272 --> 00:14:02,708 PRESSURES FROM HOME, THEY HAD 375 00:14:02,708 --> 00:14:04,009 THE MONITOR BUT THEY DIDN'T HAVE 376 00:14:04,009 --> 00:14:05,010 MUCH OF THE INFORMATION THEY 377 00:14:05,010 --> 00:14:05,544 NEEDED. 378 00:14:05,544 --> 00:14:07,246 AND THEY ALSO, WHEN THEY WERE 379 00:14:07,246 --> 00:14:08,480 ASKED TO SEND IN THE BLOOD 380 00:14:08,480 --> 00:14:10,682 PRESSURES WHEN THEY DID, THEY 381 00:14:10,682 --> 00:14:12,384 OFTEN DIDN'T GET FEEDBACK, 382 00:14:12,384 --> 00:14:13,685 PARTICULARLY IF IT WAS IN A GOOD 383 00:14:13,685 --> 00:14:16,255 RANGE. 384 00:14:16,255 --> 00:14:19,024 SO YOU GUYS SAID IT WAS 385 00:14:19,024 --> 00:14:19,491 IMPORTANT. 386 00:14:19,491 --> 00:14:20,392 IS IT NOT IMPORTANT? 387 00:14:20,392 --> 00:14:23,395 WHAT'S THE DEAL, AND THAT PERSON 388 00:14:23,395 --> 00:14:24,596 ACTUALLY HAD UNCONTROLLED BLOOD 389 00:14:24,596 --> 00:14:26,298 PRESSURE AND GOT NO RESPONSE. 390 00:14:26,298 --> 00:14:28,500 AND I DON'T THINK I HEARD 391 00:14:28,500 --> 00:14:29,134 ANYTHING BACK. 392 00:14:29,134 --> 00:14:30,202 IF IT WAS SPIKING OR SOMETHING, 393 00:14:30,202 --> 00:14:31,770 I WOULD HAVE EXPECTED A 394 00:14:31,770 --> 00:14:32,671 RESPONSE, BUT IT WASN'T. 395 00:14:32,671 --> 00:14:34,473 I REALLY DIDN'T THINK ABOUT IT. 396 00:14:34,473 --> 00:14:36,875 THAT WAS A PERSON WITH 397 00:14:36,875 --> 00:14:38,310 CONTROLLED BLOOD PRESSURE. 398 00:14:38,310 --> 00:14:43,181 AND PATIENTS HA -- AWARENESS OF 399 00:14:43,181 --> 00:14:43,782 HIGH BLOOD PRESSURE BUT ITS 400 00:14:43,782 --> 00:14:44,950 SENSE OF IMPORTANCE, HOW MUCH IT 401 00:14:44,950 --> 00:14:46,518 WOULD HURT YOU AND THE TARGETS, 402 00:14:46,518 --> 00:14:51,857 THEY WERE VERY CONFUSED ABOUT. 403 00:14:51,857 --> 00:14:54,593 AND A PERSON WITH UNCONTROLLED 404 00:14:54,593 --> 00:14:55,294 BLOOD PRESSURE THOUGHT THEY WERE 405 00:14:55,294 --> 00:14:58,797 DOING A FOOD JOB A GOOD JOB, ANR 406 00:14:58,797 --> 00:15:01,533 PERSON, I LOVE THIS QUOTE, SAID 407 00:15:01,533 --> 00:15:05,037 ONE DOCTOR WANTED TO SEE ME 408 00:15:05,037 --> 00:15:06,638 BELOW 130, ANOTHER WAS HAPPY IF 409 00:15:06,638 --> 00:15:08,540 I'M BELOW 140, AND ACTUALLY THIS 410 00:15:08,540 --> 00:15:10,142 PERSON ALSO SAID ANOTHER DOCTOR 411 00:15:10,142 --> 00:15:11,944 WANTED BOTH THOSE NUMBERS TO BE 412 00:15:11,944 --> 00:15:13,245 GOOD, SO EVEN THE DOCTORS 413 00:15:13,245 --> 00:15:13,745 THEMSELVES DON'T KNOW. 414 00:15:13,745 --> 00:15:15,614 SO WE HAVE A LOT TO DO WITH 415 00:15:15,614 --> 00:15:20,285 PATIENTS. 416 00:15:20,285 --> 00:15:22,487 SO THERE'S MULTILEVEL BARRIERS 417 00:15:22,487 --> 00:15:24,256 TO PATIENT GENERATED BLOOD 418 00:15:24,256 --> 00:15:27,292 PRESSURES, AND THAT'S THE 419 00:15:27,292 --> 00:15:27,859 SOCIOECONOMIC MODEL WHICH I 420 00:15:27,859 --> 00:15:28,093 LIKE. 421 00:15:28,093 --> 00:15:30,295 YOU CAN'T REALLY SEE IT, BUT IT 422 00:15:30,295 --> 00:15:31,930 PUTS IN THE CONTEXT OF THE 423 00:15:31,930 --> 00:15:33,332 COMMUNITY, THE ENVIRONMENT, 424 00:15:33,332 --> 00:15:36,101 SOCIAL NEEDS, THE PATIENT, THEIR 425 00:15:36,101 --> 00:15:37,369 FAMILY, AND THE CLINIC AND THE 426 00:15:37,369 --> 00:15:38,570 CLINIC SYSTEM. 427 00:15:38,570 --> 00:15:39,871 AND PATIENTS USUALLY DON'T KNOW 428 00:15:39,871 --> 00:15:41,807 HOW TO SELECT A VALIDATED HOME 429 00:15:41,807 --> 00:15:42,307 MONITOR. 430 00:15:42,307 --> 00:15:45,610 WE'VE BEEN TRYING TO GET THE -- 431 00:15:45,610 --> 00:15:48,981 I'M NO LONGER ON THE VALIDATE BP 432 00:15:48,981 --> 00:15:51,083 TEAM, I ENJOYED BEING ON IT BUT 433 00:15:51,083 --> 00:15:54,219 OUR CLINICIANS AND PATIENTS 434 00:15:54,219 --> 00:15:55,554 DON'T UNIVERSALLY -- SOME KNOW 435 00:15:55,554 --> 00:15:56,755 ABOUT IT BUT MOST DON'T. 436 00:15:56,755 --> 00:15:58,390 AND PATIENTS MAY NOT KNOW HOW TO 437 00:15:58,390 --> 00:16:00,225 TAKE THEIR BLOOD PRESSURE 438 00:16:00,225 --> 00:16:01,159 ACCURATELY, BUT THERE WAS A 439 00:16:01,159 --> 00:16:02,461 STUDY THAT SHOWED JUST SHOWING A 440 00:16:02,461 --> 00:16:04,296 VIDEO TO PATIENTS THAT THEY WERE 441 00:16:04,296 --> 00:16:06,031 ABLE TO DEMONSTRATE THAT THEY 442 00:16:06,031 --> 00:16:07,666 COULD TAKE THEIR BLOOD PRESSURE 443 00:16:07,666 --> 00:16:09,101 ACCURATELY, WHICH IS GOOD NEWS, 444 00:16:09,101 --> 00:16:10,602 BECAUSE WE HAVE TO HAVE A LOT OF 445 00:16:10,602 --> 00:16:11,636 WAYS TO REACH PATIENTS. 446 00:16:11,636 --> 00:16:12,637 THEY CAN'T ALWAYS COME IN AND 447 00:16:12,637 --> 00:16:14,039 GET A LESSON. 448 00:16:14,039 --> 00:16:17,542 AND CLINICIANS, PRIMARY CARE 449 00:16:17,542 --> 00:16:18,610 CLINICIANS, MAYBE SPECIALISTS, 450 00:16:18,610 --> 00:16:19,745 REALLY ARE JUST SLAMMED. 451 00:16:19,745 --> 00:16:21,680 AND OFTEN THEY DO TELEVISITS, SO 452 00:16:21,680 --> 00:16:24,249 WE HAVE TO HAVE OTHER WAYS. 453 00:16:24,249 --> 00:16:26,785 AND THEY MAY NOT HAVE ACCESS TO 454 00:16:26,785 --> 00:16:28,553 BE ABLE TO AFFORD BLOOD 455 00:16:28,553 --> 00:16:29,955 PRESSURE, AND FOR MOST, IT'S NOT 456 00:16:29,955 --> 00:16:32,057 A COVERED BENEFIT, AND IN OUR 457 00:16:32,057 --> 00:16:33,825 SYSTEM WHEN IT IS, WE'VE BEEN 458 00:16:33,825 --> 00:16:36,361 TRYING TO GET A VALIDATED BLOOD 459 00:16:36,361 --> 00:16:40,599 PRESSURE MONITOR FOR THE DME 460 00:16:40,599 --> 00:16:42,267 BENEFIT, DURABLE MEDICAL 461 00:16:42,267 --> 00:16:44,469 EQUIPMENT, BUT THE ONE THEY 462 00:16:44,469 --> 00:16:47,039 PROVIDE IS A $25 MONITOR THAT 463 00:16:47,039 --> 00:16:50,042 ISN'T VALIDATED AT ALL. 464 00:16:50,042 --> 00:16:53,845 SO YOU KNOW, THIS IS WHAT WE 465 00:16:53,845 --> 00:16:55,213 FACE AS CLINICIANS IN DEALING 466 00:16:55,213 --> 00:16:56,448 WITH SYSTEMS. 467 00:16:56,448 --> 00:16:58,183 AND CLINICIANS MAY ENDORSE HOME 468 00:16:58,183 --> 00:16:59,384 BLOOD PRESSURE, BUT THEY RARELY 469 00:16:59,384 --> 00:17:01,720 CHECK THE HOME MONITORS FOR 470 00:17:01,720 --> 00:17:04,790 ACCURACY, THEY DON'T KNOW THE 471 00:17:04,790 --> 00:17:05,557 DIFFERENCE BETWEEN CLINIC AND 472 00:17:05,557 --> 00:17:10,562 OUT OF OFFICE, AND AS WE SHOWED 473 00:17:10,562 --> 00:17:11,396 AS AOBP. 474 00:17:11,396 --> 00:17:13,098 AND WE HAVE HEARD FROM 475 00:17:13,098 --> 00:17:14,399 CLINICIANS, DON'T SEND ME ALL 476 00:17:14,399 --> 00:17:16,468 THAT DATA THAT WAS A DISCUSSION 477 00:17:16,468 --> 00:17:18,203 POINT YESTERDAY. 478 00:17:18,203 --> 00:17:19,805 THEY REALLY DON'T WANT TO SEE 479 00:17:19,805 --> 00:17:20,072 IT. 480 00:17:20,072 --> 00:17:22,140 AND THEY DON'T HAVE SUFFICIENT 481 00:17:22,140 --> 00:17:25,477 RESOURCES OR TIME TO IMPLEMENT A 482 00:17:25,477 --> 00:17:27,512 PROGRAM THAT USES ALL THAT DATA. 483 00:17:27,512 --> 00:17:29,548 AND OFTEN IT'S NOT PRESENTED IN 484 00:17:29,548 --> 00:17:33,785 A VERY USABLE WAY AS INDIVIDUAL 485 00:17:33,785 --> 00:17:34,853 MEASUREMENTS AND NOT AVERAGE 486 00:17:34,853 --> 00:17:37,189 RANGE OR THRESHOLD, AND THAT 487 00:17:37,189 --> 00:17:38,223 MAKES IT VERY HARD TO SEE 488 00:17:38,223 --> 00:17:38,757 TRENDS. 489 00:17:38,757 --> 00:17:40,025 YOU CAN LOOK AT THEM, BUT 490 00:17:40,025 --> 00:17:43,628 THERE'S BETTER WAYS. 491 00:17:43,628 --> 00:17:45,297 AND THE SETTING IN MEDICAL 492 00:17:45,297 --> 00:17:47,199 RECORDS IS OFTEN NOT DEFINED. 493 00:17:47,199 --> 00:17:48,533 OURS GET THROWN ALL TOGETHER. 494 00:17:48,533 --> 00:17:50,836 THEY'VE IMPROVED ON THAT, MANY 495 00:17:50,836 --> 00:17:51,837 HEALTH SYSTEMS HAVE AND IN THE 496 00:17:51,837 --> 00:17:52,838 FUTURE, THEY'RE SUPPOSED TO BE 497 00:17:52,838 --> 00:17:54,239 ABLE TO DO THIS, BUT WE HAVEN'T 498 00:17:54,239 --> 00:17:55,974 GOTTEN THERE TO KNOW WHAT THE 499 00:17:55,974 --> 00:17:57,275 SETTING WAS, BECAUSE IT MAKES A 500 00:17:57,275 --> 00:18:04,316 DIFFERENCE. 501 00:18:04,316 --> 00:18:06,218 AND THEN THE HEALTH SYSTEMS 502 00:18:06,218 --> 00:18:09,054 INSURANCE PLANS, MEDICARE DOES 503 00:18:09,054 --> 00:18:11,123 NOT COVER HOME MONITORS UNLESS 504 00:18:11,123 --> 00:18:12,924 IT'S PART OF A REMOTE MONITORING 505 00:18:12,924 --> 00:18:14,059 PROGRAM AND YOU'VE GOT TO HAVE A 506 00:18:14,059 --> 00:18:16,428 WHOLE SETUP FOR THAT. 507 00:18:16,428 --> 00:18:18,296 AND THE FAMILY MEDICINE CODES 508 00:18:18,296 --> 00:18:20,999 ARE NOT USED, AND MEDICAID 509 00:18:20,999 --> 00:18:25,770 COVERAGE VARIES BY STATE. 510 00:18:25,770 --> 00:18:26,938 AND COMMERCIAL INSURANCE MAY OR 511 00:18:26,938 --> 00:18:29,808 MAY NOT COVER HOME MONITORS AS 512 00:18:29,808 --> 00:18:31,543 EQUIPMENT, WE TALKED ABOUT THAT, 513 00:18:31,543 --> 00:18:33,578 AND SUCCESSFUL -- AND THE REASON 514 00:18:33,578 --> 00:18:36,014 MEDICARE ALSO CAN'T GIVE THEM 515 00:18:36,014 --> 00:18:40,018 AWAY, BECAUSE THEY ARE 516 00:18:40,018 --> 00:18:43,455 CONSIDERED AN INDUCEMENT SO THE 517 00:18:43,455 --> 00:18:44,456 INSURANCE PLAN CAN GET IN 518 00:18:44,456 --> 00:18:44,856 TROUBLE. 519 00:18:44,856 --> 00:18:47,359 SO AS I'VE SAID, YOU HAVE TO 520 00:18:47,359 --> 00:18:50,128 HAVE A PROGRAM AND YOU NEED 16 521 00:18:50,128 --> 00:18:52,330 BLOOD PRESSURES A MONTH TO 522 00:18:52,330 --> 00:18:53,899 COLLECT, AND YOU HAVE TO BE FEE 523 00:18:53,899 --> 00:18:56,234 FOR SERVICE BECAUSE MANAGED CARE 524 00:18:56,234 --> 00:18:57,335 CAN'T BILL. 525 00:18:57,335 --> 00:19:03,642 AND NATIONAL POLICIES, HEATUS 526 00:19:03,642 --> 00:19:05,844 DOESN'T HELP US BY TAKING THE 527 00:19:05,844 --> 00:19:07,112 LOWEST BLOOD PRESSURE FROM MORE 528 00:19:07,112 --> 00:19:10,549 THAN ONE READING. 529 00:19:10,549 --> 00:19:12,551 SO HERE'S KEY -- SO THE FUTURE 530 00:19:12,551 --> 00:19:13,685 STATE IS INTEGRATION OF BLOOD 531 00:19:13,685 --> 00:19:15,353 PRESSURE IN THE EHR, A WORK IN 532 00:19:15,353 --> 00:19:15,854 PROGRESS. 533 00:19:15,854 --> 00:19:17,289 I WOULD SAY THAT SOME PLACES ARE 534 00:19:17,289 --> 00:19:20,992 DOING THIS VERY WELL. 535 00:19:20,992 --> 00:19:22,260 THIS IS A SIMPLIFIED VERSION OF 536 00:19:22,260 --> 00:19:26,198 WHAT THE KEY INGREDIENTS ARE. 537 00:19:26,198 --> 00:19:28,600 AND TOOLS FOR ENROLLING, DATA 538 00:19:28,600 --> 00:19:31,469 COLLECTION DASHBOARD, AND MEMBER 539 00:19:31,469 --> 00:19:33,171 DASHBOARD, AND OPERATIONAL 540 00:19:33,171 --> 00:19:37,075 SUPPORT AND CARE PATHWAYS IS THE 541 00:19:37,075 --> 00:19:44,382 HIGH LEVEL PICTURE. 542 00:19:44,382 --> 00:19:45,750 WE HAVE A REMOTE MONITORING 543 00:19:45,750 --> 00:19:47,419 PROGRAM BUT THE REACH IS 544 00:19:47,419 --> 00:19:47,953 EXTREMELY SMALL. 545 00:19:47,953 --> 00:19:49,621 WE DON'T HAVE ENOUGH PHARMACISTS 546 00:19:49,621 --> 00:19:50,522 TO GO AROUND. 547 00:19:50,522 --> 00:19:53,024 IN GEORGIA, THEY'VE BEEN QUITE 548 00:19:53,024 --> 00:19:54,426 SUCCESSFUL, AND THEY ENROLL A 549 00:19:54,426 --> 00:19:55,427 FEW HUNDRED PATIENTS A MONTH BUT 550 00:19:55,427 --> 00:20:01,566 THEY HAVE DEDICATED RESOURCES. 551 00:20:01,566 --> 00:20:02,534 AND MOST COMMUNITY CLINICS DON'T 552 00:20:02,534 --> 00:20:04,069 HAVE A PHARMACIST. 553 00:20:04,069 --> 00:20:07,806 MAYBE FQHCs DO SOMETIMES, BUT 554 00:20:07,806 --> 00:20:08,940 THE VAST MAJORITY OF COMMUNITY 555 00:20:08,940 --> 00:20:11,509 CLINICS DON'T EVEN HAVE A NURSE 556 00:20:11,509 --> 00:20:13,678 RN OFTEN, OR EVEN AN LPN 557 00:20:13,678 --> 00:20:16,448 SOMETIMES. 558 00:20:16,448 --> 00:20:20,118 SO PATIENTS ALSO HAVE TO HAVE A 559 00:20:20,118 --> 00:20:21,319 SMARTPHONE, AND BLUETOOTH IS 560 00:20:21,319 --> 00:20:21,720 PREFERRED. 561 00:20:21,720 --> 00:20:25,090 WE HAVE A PROGRAM CALLED CARE 562 00:20:25,090 --> 00:20:26,558 COMPANION THAT WAS BUILT BY AN 563 00:20:26,558 --> 00:20:28,460 UNNAMED COMMONLY USED EHR 564 00:20:28,460 --> 00:20:33,698 VENDOR. 565 00:20:33,698 --> 00:20:34,933 THESE ARE THE STEPS A CLINICIAN 566 00:20:34,933 --> 00:20:35,800 TAKES TO ENROLL. 567 00:20:35,800 --> 00:20:38,403 OUR HOPE WAS FOR CLINICIANS TO 568 00:20:38,403 --> 00:20:40,005 USE THIS AND ENROLL PATIENTS BUT 569 00:20:40,005 --> 00:20:41,973 I THINK THAT'S A PIPE DREAM. 570 00:20:41,973 --> 00:20:43,275 THEY'RE JUST TOO BUSY AND THE 571 00:20:43,275 --> 00:20:47,879 REACH IS VERY SMALL. 572 00:20:47,879 --> 00:20:50,048 AND HERE'S ANOTHER SET OF THINGS 573 00:20:50,048 --> 00:20:51,383 THEY HAVE TO DO. 574 00:20:51,383 --> 00:20:53,318 THEY CAN CHOOSE ALL THESE 575 00:20:53,318 --> 00:20:54,352 LIFESTYLE MODULES FOR PATIENTS 576 00:20:54,352 --> 00:20:55,520 WHICH SOUNDS GREAT BUT IT'S A 577 00:20:55,520 --> 00:20:59,724 LOT OF STUFF. 578 00:20:59,724 --> 00:21:01,926 AND NEXT, I'M A HEALTH SYSTEMS 579 00:21:01,926 --> 00:21:03,128 RESEARCHER, SO MAKING THINGS 580 00:21:03,128 --> 00:21:07,632 SIMPLE IS MY MOTTO. 581 00:21:07,632 --> 00:21:09,067 THIS IS THE REPRESENTATION 582 00:21:09,067 --> 00:21:10,902 CURRENTLY IN OUR CHART AND 583 00:21:10,902 --> 00:21:13,638 THERE'S A PROBLEM THERE WITH A 584 00:21:13,638 --> 00:21:14,806 HUNDRED OVER 100, I DON'T KNOW 585 00:21:14,806 --> 00:21:16,241 WHAT HAPPENED, BUT IT'S SOMEWHAT 586 00:21:16,241 --> 00:21:16,741 USEFUL. 587 00:21:16,741 --> 00:21:17,409 THERE'S AN AVERAGE IN THE 588 00:21:17,409 --> 00:21:19,044 CORNER, BUT I THINK IT'S TOO 589 00:21:19,044 --> 00:21:24,849 BUSY AND NOT USEFUL ENOUGH. 590 00:21:24,849 --> 00:21:26,318 THIS IS WHAT THE PATIENT SEES. 591 00:21:26,318 --> 00:21:29,788 AND FRANKLY, I WAS INVOLVED WITH 592 00:21:29,788 --> 00:21:32,891 THE PROGRAM, I ACTUALLY HAD 593 00:21:32,891 --> 00:21:36,895 HYPERTENSION, SO THEN WHEN I 594 00:21:36,895 --> 00:21:39,164 LOST MY BLUETOOTH CONNECTION, I 595 00:21:39,164 --> 00:21:41,433 HAD TO GET HELP FROM I.T. TO DO 596 00:21:41,433 --> 00:21:42,701 IT SO IT'S NOT VERY 597 00:21:42,701 --> 00:21:43,268 USER-FRIENDLY. 598 00:21:43,268 --> 00:21:44,469 WE DO HAVE CELLULAR MONITORS 599 00:21:44,469 --> 00:21:46,538 THAT DON'T REQUIRE ANY BLUE 600 00:21:46,538 --> 00:21:48,173 TOOTH, AND THAT'S SOMETHING TO 601 00:21:48,173 --> 00:21:51,276 KEEP LOOKING AT. 602 00:21:51,276 --> 00:21:52,143 I'M GETTING TO THE END. 603 00:21:52,143 --> 00:21:54,512 SO IN SUMMARY, KEY GAPS. 604 00:21:54,512 --> 00:21:55,814 CLINICIANS AND PATIENTS NEED TO 605 00:21:55,814 --> 00:21:57,148 UNDERSTAND HOW TO MEASURE BLOOD 606 00:21:57,148 --> 00:22:02,053 PRESSURE ACCURATELY, AND THEY 607 00:22:02,053 --> 00:22:03,922 REALLY NEED TO UNDERSTAND MORE 608 00:22:03,922 --> 00:22:04,823 ABOUT BLOOD PRESSURE VARIABILITY 609 00:22:04,823 --> 00:22:06,358 AND WHY GETTING MORE BLOOD 610 00:22:06,358 --> 00:22:07,058 PRESSURE IS IMPORTANT WHEN YOU 611 00:22:07,058 --> 00:22:09,260 HAVE TO MAKE CLINICAL DECISIONS. 612 00:22:09,260 --> 00:22:09,994 OBTAINING BLOOD PRESSURES 613 00:22:09,994 --> 00:22:11,429 OUTSIDE OF CLINIC PROVIDES MORE 614 00:22:11,429 --> 00:22:12,764 INFORMATION FOR MANAGEMENT BUT 615 00:22:12,764 --> 00:22:15,066 IS SELDOM USED IN A SYSTEMATIC 616 00:22:15,066 --> 00:22:16,534 WAY. 617 00:22:16,534 --> 00:22:18,103 PATIENTS FREQUENTLY OWN HOME 618 00:22:18,103 --> 00:22:19,337 MONITORS BUT ARE NOT GIVEN THE 619 00:22:19,337 --> 00:22:21,673 TOOLS THEY NEED OR THE RIGHT 620 00:22:21,673 --> 00:22:23,508 CUFF, AND THEY DON'T HAVE EASY 621 00:22:23,508 --> 00:22:25,710 WAYS TO SHARE IT WITH THEIR 622 00:22:25,710 --> 00:22:26,478 CLINICIANS. 623 00:22:26,478 --> 00:22:27,912 REPRESENTATION OF THE DATA IN 624 00:22:27,912 --> 00:22:29,914 THE EHR NEEDS MUCH MORE WORK, 625 00:22:29,914 --> 00:22:34,686 AND EVIDENCE-BASED WORKFLOWS FOR 626 00:22:34,686 --> 00:22:36,187 MANAGING PATIENT GENERATED BLOOD 627 00:22:36,187 --> 00:22:38,089 PRESSURE HAVE BEEN TESTED AND 628 00:22:38,089 --> 00:22:39,057 THEY'RE QUITE EFFECTIVE AND THEY 629 00:22:39,057 --> 00:22:41,259 CAN BE SIMPLE, THEY DON'T HAVE 630 00:22:41,259 --> 00:22:46,798 TO BE AN RMP, WE USE JUST EMAIL 631 00:22:46,798 --> 00:22:48,666 AND WE'RE QUITE SUCCESSFUL WITH 632 00:22:48,666 --> 00:22:50,235 THAT, BUT THEY REMAIN UNDER IT 633 00:22:50,235 --> 00:22:54,305 IS UTILIZED, WE CAN'T GET THE 634 00:22:54,305 --> 00:22:55,240 RESOURCES, THEY NEED 635 00:22:55,240 --> 00:22:57,108 IMPROVEMENTS TO ENSURE THEY'RE 636 00:22:57,108 --> 00:22:58,410 SCALABLE IN REAL WORLD SETTINGS. 637 00:22:58,410 --> 00:23:00,678 FUTURE QUESTIONS FOR RESEARCH. 638 00:23:00,678 --> 00:23:03,615 WHAT IS THE BEST SOLUTION, 639 00:23:03,615 --> 00:23:04,949 CELLULAR, MENTIONED THAT, TEXT, 640 00:23:04,949 --> 00:23:07,252 SECURE EMAIL, GIVING PATIENTS 641 00:23:07,252 --> 00:23:08,953 CHOICE, AND ENGAGEMENT 642 00:23:08,953 --> 00:23:09,854 STRATEGIES, WE HEARD ABOUT THAT, 643 00:23:09,854 --> 00:23:12,290 HOW DO WE GET PATIENTS MORE 644 00:23:12,290 --> 00:23:13,591 ENGAGED, AND WHAT ARE THE 645 00:23:13,591 --> 00:23:14,993 COMPARATIVE EFFECTIVENESS OF 646 00:23:14,993 --> 00:23:21,332 DIFFERENT EHR REPRESENTATIONS OF 647 00:23:21,332 --> 00:23:24,602 CLINICS AND SMBP -- I DIDN'T FIX 648 00:23:24,602 --> 00:23:26,371 THAT -- AND WORKFLOWS ON 649 00:23:26,371 --> 00:23:30,508 DECREASING THERAPEUTIC INERTIA. 650 00:23:30,508 --> 00:23:33,545 AND CAN SELF-MONITORING BLOOD 651 00:23:33,545 --> 00:23:36,147 PRESSURE ALGORITHMS AND AI 652 00:23:36,147 --> 00:23:37,348 ALGORITHMS BE TAILORED SO WE 653 00:23:37,348 --> 00:23:38,516 DON'T DO THIS ON EVERYONE, WE 654 00:23:38,516 --> 00:23:39,751 JUST DO IT ON THE PATIENTS THAT 655 00:23:39,751 --> 00:23:43,154 REALLY NEED THIS INFORMATION. 656 00:23:43,154 --> 00:23:45,757 AND WHAT IS THE COMPARATIVE 657 00:23:45,757 --> 00:23:49,294 EFFECTIVENESS OF SMBP TO 658 00:23:49,294 --> 00:23:49,994 IN-CLINIC MONITOR, WHICH WE KNOW 659 00:23:49,994 --> 00:23:54,165 BUT WE DON'T KNOW IT FOR THE 660 00:23:54,165 --> 00:23:56,701 HARD OUTCOMES, AND WHAT POLICY 661 00:23:56,701 --> 00:23:59,904 SOLUTIONS ARE NEEDED TO ACTUALLY 662 00:23:59,904 --> 00:24:01,473 IGNITE THESE INTERVENTIONS THAT 663 00:24:01,473 --> 00:24:03,842 ARE ALREADY ADDED IN SPACE 664 00:24:03,842 --> 00:24:04,108 SCALABLE. 665 00:24:04,108 --> 00:24:07,579 THANK YOU. 666 00:24:07,579 --> 00:24:09,147 >> OKAY, THANK YOU SO MUCH, 667 00:24:09,147 --> 00:24:09,747 DR. GREEN. 668 00:24:09,747 --> 00:24:11,382 I WOULD LIKE TO INTRODUCE OUR 669 00:24:11,382 --> 00:24:14,519 NEXT SPEAKER, DR. ROBERT BROOK, 670 00:24:14,519 --> 00:24:15,620 WHO'S PROFESSOR OF 671 00:24:15,620 --> 00:24:16,988 CARDIOVASCULAR MEDICINE AT WAYNE 672 00:24:16,988 --> 00:24:20,191 STATE UNIVERSITY. 673 00:24:20,191 --> 00:24:22,360 ALSO THE DIRECTOR OF THE 674 00:24:22,360 --> 00:24:24,796 CARDIOVASCULAR PREVENTION 675 00:24:24,796 --> 00:24:25,864 PROGRAM AND A PHYSICIAN 676 00:24:25,864 --> 00:24:26,998 SCIENTIST AND HAS BEEN A PIONEER 677 00:24:26,998 --> 00:24:29,434 IN THE AREA OF ENVIRONMENTAL 678 00:24:29,434 --> 00:24:30,969 CARDIOLOGY. 679 00:24:30,969 --> 00:24:32,370 TODAY WE'LL SPEAK ON THE 680 00:24:32,370 --> 00:24:33,037 ASSESSING BLOOD PRESSURE BEYOND 681 00:24:33,037 --> 00:24:35,273 THE HOME AND OFFICE, IMPORTANCE 682 00:24:35,273 --> 00:24:36,875 OF ENVIRONMENTAL CONTEXT IN 683 00:24:36,875 --> 00:24:38,142 BLOOD PRESSURE MEASUREMENT. 684 00:24:38,142 --> 00:24:41,913 YOU CAN START WHEN YOU'RE READY. 685 00:24:41,913 --> 00:24:43,414 >> ALL RIGHT, GOOD MORNING, 686 00:24:43,414 --> 00:24:43,681 EVERYONE. 687 00:24:43,681 --> 00:24:48,219 THANK YOU FOR THE INTRODUCTION. 688 00:24:48,219 --> 00:24:49,854 MY TALK I THINK IS A LITTLE 689 00:24:49,854 --> 00:24:50,822 DIFFERENT THAN OTHER TALKS BUT 690 00:24:50,822 --> 00:24:52,090 IT'S IMPORTANT TO ADD TO THE 691 00:24:52,090 --> 00:24:54,425 GLOBAL CONTEXT OF THE COMPLEXITY 692 00:24:54,425 --> 00:24:56,928 OF BLOOD PRESSURE AND IN 693 00:24:56,928 --> 00:25:00,465 PARTICULAR, ITS OVERALL 694 00:25:00,465 --> 00:25:02,133 VARIABILITY. 695 00:25:02,133 --> 00:25:04,102 SO THIS SLIDE IS JUST -- IT'S 696 00:25:04,102 --> 00:25:05,937 BUSY BUT IT'S TO IMPRESS UPON 697 00:25:05,937 --> 00:25:07,038 YOU WHEN THINKING ABOUT 698 00:25:07,038 --> 00:25:08,406 HYPERTENSION OR THINKING ABOUT 699 00:25:08,406 --> 00:25:10,508 SHORT TERM CHANGES IN BLOOD 700 00:25:10,508 --> 00:25:11,943 PRESSURE, OR EVEN DURING THE 701 00:25:11,943 --> 00:25:13,978 MEASUREMENT OF BLOOD PRESSURE 702 00:25:13,978 --> 00:25:18,716 ITSELF, THERE IS A WIDE VARIETY 703 00:25:18,716 --> 00:25:19,951 OF ENVIRONMENTAL EXPOSURES OR 704 00:25:19,951 --> 00:25:22,153 FACTORS THAT PLAY A ROLE IN 705 00:25:22,153 --> 00:25:23,655 IMPACTING BLOOD PRESSURE BOTH 706 00:25:23,655 --> 00:25:25,056 ACUTELY AS WELL AS PROMOTING THE 707 00:25:25,056 --> 00:25:26,457 ONSET OF HYPERTENSION. 708 00:25:26,457 --> 00:25:30,228 THIS WAS A PRIOR PUBLICATION 709 00:25:30,228 --> 00:25:34,165 UPDATED THE SLIDE RECENTLY, AND 710 00:25:34,165 --> 00:25:35,166 CATEGORIZED FACTORS GENERALLY AS 711 00:25:35,166 --> 00:25:37,635 NATURAL FACTORS, AS WELL AS 712 00:25:37,635 --> 00:25:40,505 OTHER NATURAL FACTORS RELATED TO 713 00:25:40,505 --> 00:25:41,839 DISASTERS AS WE'RE SEEING MORE 714 00:25:41,839 --> 00:25:43,408 AND MORE WITH CLIMATE CHANGE, 715 00:25:43,408 --> 00:25:44,943 AND THEN MAN-MADE FACTORS AS 716 00:25:44,943 --> 00:25:45,276 WELL. 717 00:25:45,276 --> 00:25:47,812 AND THEN MORE RECENTLY, OTHER 718 00:25:47,812 --> 00:25:52,483 FACTORS SUCH AS THE IMPACT THAT 719 00:25:52,483 --> 00:25:55,453 CAN OCCUR AFTER LONG TERM 720 00:25:55,453 --> 00:25:56,688 PLAGUES WHICH HAS BEEN KNOWN IN 721 00:25:56,688 --> 00:25:57,989 THE PAST WITH COVID-19. 722 00:25:57,989 --> 00:25:59,490 MANY OF THESE FACTORS ARE KNOWN 723 00:25:59,490 --> 00:26:00,925 SUCH AS THAT I THINK PEOPLE WILL 724 00:26:00,925 --> 00:26:02,360 BE AWARE THAT TEMPERATURE AND 725 00:26:02,360 --> 00:26:03,161 SEASONS AFFECT BLOOD PRESSURE. 726 00:26:03,161 --> 00:26:04,796 SOME OF THEM ARE LESS 727 00:26:04,796 --> 00:26:08,900 WELL-KNOWN, SUCH AS THE PROFOUND 728 00:26:08,900 --> 00:26:12,303 IMPACT OF NORMAL VARIATIONS IN 729 00:26:12,303 --> 00:26:14,606 LIVING OR CHANGING YOUR 730 00:26:14,606 --> 00:26:16,240 ELEVATIONS OR ALTITUDE OR 731 00:26:16,240 --> 00:26:16,674 LATITUDE. 732 00:26:16,674 --> 00:26:17,775 CHANGES IN BLOOD PRESSURE HAVE 733 00:26:17,775 --> 00:26:21,312 BEEN SHOWN AFTER WILDFIRE SMOKE 734 00:26:21,312 --> 00:26:21,913 EXPOSURE, AS WELL AS CLEARLY 735 00:26:21,913 --> 00:26:25,917 AFTER DISASTERS, AFTER HURRICANE 736 00:26:25,917 --> 00:26:28,286 KATRINA, SUPERSTORM SANDY, AFTER 737 00:26:28,286 --> 00:26:29,487 EARTHQUAKES BOTH ACUTELY AND 738 00:26:29,487 --> 00:26:30,355 CHRONICALLY. 739 00:26:30,355 --> 00:26:34,826 MANY MAN-MADE EXPOSURES, SUCH AS 740 00:26:34,826 --> 00:26:36,361 URBAN AND OCCUPATIONAL NOISE, 741 00:26:36,361 --> 00:26:38,262 LIGHT POLLUTION, LIVING NEAR 742 00:26:38,262 --> 00:26:39,797 ROADWAYS, AND THEN MY RESEARCH 743 00:26:39,797 --> 00:26:41,499 WAS PRINCIPALLY IN THE LAST 25 744 00:26:41,499 --> 00:26:45,103 YEARS ON AIR POLLUTANTS HAVE 745 00:26:45,103 --> 00:26:45,670 ACUTE EFFECTS. 746 00:26:45,670 --> 00:26:46,604 I THINK MANY PEOPLE WILL BE 747 00:26:46,604 --> 00:26:47,839 AWARE THAT THE BUILT ENVIRONMENT 748 00:26:47,839 --> 00:26:49,540 PLAYS A ROLE IN MODULATING BLOOD 749 00:26:49,540 --> 00:26:52,010 PRESSURE MORE CHRONICALLY, BUT 750 00:26:52,010 --> 00:26:55,747 BOTH CHRONICALLY AND ACUTELY, 751 00:26:55,747 --> 00:26:56,948 OTHER DIFFERENT TYPES OF 752 00:26:56,948 --> 00:26:58,249 CHEMICALS, PERSISTENT ORGANIC 753 00:26:58,249 --> 00:26:59,250 POLLUTANTS AND DIFFERENT 754 00:26:59,250 --> 00:27:01,185 CHEMICALS WE'RE EXPOSED TO, EVEN 755 00:27:01,185 --> 00:27:02,053 POTENTIALLY DIFFERENT CHEMICALS 756 00:27:02,053 --> 00:27:06,591 IN PLASTICS CAN HAVE AFFEC EFFEN 757 00:27:06,591 --> 00:27:08,126 OUR BLOOD PRESSURE BOTH ACUTELY 758 00:27:08,126 --> 00:27:08,726 AND CHRONICALLY. 759 00:27:08,726 --> 00:27:10,395 SO PERHAPS THE MOST IMPORTANT OR 760 00:27:10,395 --> 00:27:13,865 AT LEAST FROM A PUBLIC HEALTH 761 00:27:13,865 --> 00:27:14,799 STANDPOINT, THE ENVIRONMENTAL 762 00:27:14,799 --> 00:27:16,401 EXPOSURE THAT HAS A EUN VER TALL 763 00:27:16,401 --> 00:27:20,772 IMPACT ON ALL LIVING HUMANS IS 764 00:27:20,772 --> 00:27:21,973 YOUR AMBIENT TEMPERATURE 765 00:27:21,973 --> 00:27:22,407 EXPOSURE. 766 00:27:22,407 --> 00:27:23,975 IT'S BEEN KNOWN FOR QUITE SOME 767 00:27:23,975 --> 00:27:25,610 TIME AND BEEN SHOWN IN DOZENS 768 00:27:25,610 --> 00:27:26,978 AND DOZENS OF STUDIES WITH MORE 769 00:27:26,978 --> 00:27:28,179 AND MORE PRECISE INFORMATION 770 00:27:28,179 --> 00:27:31,916 BEING GAINED THAT IN GENERAL, 771 00:27:31,916 --> 00:27:33,384 THERE'S A LINEAR RELATIONSHIP 772 00:27:33,384 --> 00:27:35,987 BETWEEN LOWER AMBIENT RECENT 773 00:27:35,987 --> 00:27:36,854 TEMPERATURES, WITHIN THE LAST 774 00:27:36,854 --> 00:27:38,589 FEW HOURS TO DAYS, AND YOUR 775 00:27:38,589 --> 00:27:41,225 BLOOD PRESSURE. 776 00:27:41,225 --> 00:27:43,194 BECAUSE WE SPEND MOST OF OUR 777 00:27:43,194 --> 00:27:48,399 TIME, 80, 90% INDOORS, INDOOR 778 00:27:48,399 --> 00:27:49,667 AMBIENT TEMPERATURE CHANGES ARE 779 00:27:49,667 --> 00:27:51,602 ACTUALLY STRONGER PREDICTORS OF 780 00:27:51,602 --> 00:27:52,103 YOUR BLOOD PRESSURE. 781 00:27:52,103 --> 00:27:54,739 YOU CAN SEE SMALL BUT MEANINGFUL 782 00:27:54,739 --> 00:27:57,642 CHANGES, 2 TO 4 MILLIMETERS OF 783 00:27:57,642 --> 00:27:59,811 MERCURY SYSTOLIC IN RELATION TO 784 00:27:59,811 --> 00:28:01,546 THE LAST PRIOR DAYS OUTDOOR OR 785 00:28:01,546 --> 00:28:02,380 INDOOR TEMPERATURE EXPOSURE. 786 00:28:02,380 --> 00:28:03,781 MANY OF YOU ARE PROBABLY AWARE 787 00:28:03,781 --> 00:28:07,652 THAT HYPERTENSION CONTROL RATES 788 00:28:07,652 --> 00:28:08,786 AND BLOOD PRESSURE ARE GENERALLY 789 00:28:08,786 --> 00:28:10,054 HIGHER IN WINTER DUE TO A HOST 790 00:28:10,054 --> 00:28:17,428 OF FACTORS BEYOND JUST THE ACUTE 791 00:28:17,428 --> 00:28:18,196 THERMOREGULATORY 792 00:28:18,196 --> 00:28:21,632 VASOCONSTRICTION AND IMPACTS, 793 00:28:21,632 --> 00:28:22,600 BLOOD PRESSURE SUCH AS WEIGHT 794 00:28:22,600 --> 00:28:24,669 GAIN, ACTIVITY, OTHER BEHAVIORAL 795 00:28:24,669 --> 00:28:26,637 CHANGES, VITAMIN D, BUT CLEARLY 796 00:28:26,637 --> 00:28:28,106 WINTER CAN HAVE AN IMPACT ON 797 00:28:28,106 --> 00:28:28,473 BLOOD PRESSURE. 798 00:28:28,473 --> 00:28:31,008 THIS IS FROM THE ACCOMPLISH TRY 799 00:28:31,008 --> 00:28:35,980 WHICTRIAL, WE HAVE THE DATA, WE 800 00:28:35,980 --> 00:28:37,648 LOOKED AT 10,000 PATIENTS IN 801 00:28:37,648 --> 00:28:39,350 NORTH AMERICA, THE IMPACT OF 802 00:28:39,350 --> 00:28:40,151 SEASON ON BLOOD PRESSURE 803 00:28:40,151 --> 00:28:40,384 CONTROL. 804 00:28:40,384 --> 00:28:41,619 NOW THAT'S BEEN DONE FOR 20 805 00:28:41,619 --> 00:28:42,887 YEARS, BUT WHAT WAS UNIQUE ABOUT 806 00:28:42,887 --> 00:28:44,589 THIS TRIAL, AND THIS ANALYSIS, 807 00:28:44,589 --> 00:28:47,258 WAS THIS WAS DONE IN A VERY, 808 00:28:47,258 --> 00:28:49,060 VERY TIGHTLY CONTROLLED 809 00:28:49,060 --> 00:28:51,262 AGGRESSIVELY TREATED CLINICAL 810 00:28:51,262 --> 00:28:53,931 TRIAL MEASURED ACCURACY BLOOD 811 00:28:53,931 --> 00:28:56,067 PRESSURE TRIAL. 812 00:28:56,067 --> 00:29:00,338 SO PATIENTS WERE ON AVERAGE ON E 813 00:29:00,338 --> 00:29:01,205 MEDICATIONS. 814 00:29:01,205 --> 00:29:02,039 THE BLOOD PRESSURE CONTROL WAS 815 00:29:02,039 --> 00:29:03,641 CLOSE TO 130 SYSTOLIC IN THIS 816 00:29:03,641 --> 00:29:09,580 TRIAL AND DESPITE THE ADDRESS IE 817 00:29:09,580 --> 00:29:11,382 TREATMENT, AGGRESSIVE FOLLOW-UP 818 00:29:11,382 --> 00:29:12,416 AND MANAGEMENT TITRATION OF 819 00:29:12,416 --> 00:29:14,051 MEDICATIONS AND THE GOOD CONTROL 820 00:29:14,051 --> 00:29:15,286 RATE, YOU CAN SEE THE BLOOD 821 00:29:15,286 --> 00:29:17,321 PRESSURE WAS 2 TO 3 MILLIMETERS 822 00:29:17,321 --> 00:29:20,825 OF MERCURY HIGHER IN THE WINTER 823 00:29:20,825 --> 00:29:22,560 IN THE COLDER MONTHS IN NORTH 824 00:29:22,560 --> 00:29:24,162 AMERICA OR IN THE UNITED STATES 825 00:29:24,162 --> 00:29:26,631 IN RELATION TO THE SUMMER MONTHS 826 00:29:26,631 --> 00:29:27,632 AS A REFERENCE AND THE CONTROL 827 00:29:27,632 --> 00:29:29,367 RATE WAS 5 TO 7% LOWER IN THE 828 00:29:29,367 --> 00:29:30,201 COLDER MONTHS. 829 00:29:30,201 --> 00:29:31,903 THIS IS AGAIN ON PEOPLE WHO WERE 830 00:29:31,903 --> 00:29:32,870 VERY AGGRESSIVELY AND WELL 831 00:29:32,870 --> 00:29:33,104 TREATED. 832 00:29:33,104 --> 00:29:35,206 SO THIS IS A IMPACT EVEN IN 833 00:29:35,206 --> 00:29:37,108 MODERN DAY CLINICAL PRACTICE IN 834 00:29:37,108 --> 00:29:41,179 WELL-FREETED PATIENTS. 835 00:29:41,179 --> 00:29:41,712 WELL-TREATED PATIENTS. 836 00:29:41,712 --> 00:29:42,613 PERHAPS MOST IMPORTANTLY FOR 837 00:29:42,613 --> 00:29:46,384 THIS TALK, THERE ARE NOT THAT 838 00:29:46,384 --> 00:29:48,920 MANY BUT THERE ARE A FEW PRETTY 839 00:29:48,920 --> 00:29:50,021 SOLID TRIALS SHOWING THAT DURING 840 00:29:50,021 --> 00:29:51,856 THE PROCESS OF MEASUREMENT OF 841 00:29:51,856 --> 00:29:54,158 BLOOD PRESSURE ITSELF, ACUTE 842 00:29:54,158 --> 00:29:55,259 TEMPERATURE CHANGES, SO NOT JUST 843 00:29:55,259 --> 00:29:57,829 THE PRIOR OR CURRENT DAY OR THE 844 00:29:57,829 --> 00:29:59,797 SEASON, THE TEMPERATURE IN THE 845 00:29:59,797 --> 00:30:02,300 ROOM, EITHER AT HOME OR IN THE 846 00:30:02,300 --> 00:30:03,935 CLINIC WHERE YOU'RE HAVING BLOOD 847 00:30:03,935 --> 00:30:04,702 PRESSURE MEASUREMENT CAN HAVE A 848 00:30:04,702 --> 00:30:06,370 PROFOUND AND RAPID IMPACT ON 849 00:30:06,370 --> 00:30:07,805 YOUR SYSTOLIC AND DIASTOLIC 850 00:30:07,805 --> 00:30:08,706 BLOOD PRESSURE. 851 00:30:08,706 --> 00:30:11,275 SO THE LEFT SIDE PANEL HERE IS A 852 00:30:11,275 --> 00:30:12,844 SLIDE THAT LOOKED AT CLINIC 853 00:30:12,844 --> 00:30:14,879 BLOOD PRESSURE MEASUREMENTS WITH 854 00:30:14,879 --> 00:30:18,249 TEMPERATURE CHANGES BETWEEN 855 00:30:18,249 --> 00:30:22,453 10 DEGREES CELSIUS BEFORE -- FOR 856 00:30:22,453 --> 00:30:23,087 10 TO 15 MINUTES BEFORE 857 00:30:23,087 --> 00:30:24,388 MEASUREMENT AND THEN CROSSED 858 00:30:24,388 --> 00:30:26,591 OVER TO 10 DEGREES CELLS YUM 859 00:30:26,591 --> 00:30:30,862 WARMECELSIUSWARMER AND YOU CAN E 860 00:30:30,862 --> 00:30:32,597 WERE RAPID PROFOUND CHANGES IN 861 00:30:32,597 --> 00:30:33,598 BLOOD PRESSURE WITHIN THE SAME 862 00:30:33,598 --> 00:30:35,166 PERSON WITHIN JUST 10 TO 20 863 00:30:35,166 --> 00:30:36,367 MINUTES OF DIFFERENT TEMPERATURE 864 00:30:36,367 --> 00:30:36,601 CHANGES. 865 00:30:36,601 --> 00:30:40,938 THIS SHOWED ABOUT A 4-MILLIMETER 866 00:30:40,938 --> 00:30:41,772 MERCURY INCREASE IN BLOOD 867 00:30:41,772 --> 00:30:44,475 PRESSURE FOR EVERY 10 DEGREE 868 00:30:44,475 --> 00:30:44,809 CELSIUS LOWER. 869 00:30:44,809 --> 00:30:52,183 A LARGE STUDY FROM YA PAN WHICHT 870 00:30:52,183 --> 00:30:53,384 HAD OVER NEARLY 4,000 PATIENTS 871 00:30:53,384 --> 00:30:54,518 IN MEN AND WOMEN ACROSS 872 00:30:54,518 --> 00:30:56,454 DIFFERENT AGES LOOKED AT HOME 873 00:30:56,454 --> 00:30:57,588 BLOOD PRESSURE AND TEMPERATURE 874 00:30:57,588 --> 00:30:58,356 INSIDE THE HOME DURING 875 00:30:58,356 --> 00:30:59,490 MEASUREMENT IN THE MORNING AS 876 00:30:59,490 --> 00:31:00,558 WELL AS IN THE EVENING AND THIS 877 00:31:00,558 --> 00:31:02,159 WAS JUST REPRESENTATIVE ACROSS 878 00:31:02,159 --> 00:31:03,261 DIFFERENT MEN, WOMEN HAVE THE 879 00:31:03,261 --> 00:31:04,762 SAME IF NOT SLIGHTLY GREATER 880 00:31:04,762 --> 00:31:05,229 IMPACT TO THE SLOPE. 881 00:31:05,229 --> 00:31:06,864 YOU CAN SEE AS YOU AGE, THERE 882 00:31:06,864 --> 00:31:08,399 TENDS TO BE A GREATER IMPACT AS 883 00:31:08,399 --> 00:31:10,434 WELL, WHICH HAS BEEN SHOWN, AND 884 00:31:10,434 --> 00:31:12,103 THAT IS YOUR INDOOR TEMPERATURE 885 00:31:12,103 --> 00:31:16,307 IN YOUR HOUSE DECREASES, YOUR 886 00:31:16,307 --> 00:31:17,742 SYSTOLIC BLOOD PRESSURE DURING 887 00:31:17,742 --> 00:31:18,709 HOME BLOOD PRESSURE MEASUREMENT 888 00:31:18,709 --> 00:31:24,749 INCREASES. 889 00:31:24,749 --> 00:31:26,384 ANOTHER PROFOUND IMPACT IS URBAN 890 00:31:26,384 --> 00:31:28,419 INDUSTRIAL AND MAN-MADE NOISE. 891 00:31:28,419 --> 00:31:30,087 PRESUMABLY ALL NOISES WILL HAVE 892 00:31:30,087 --> 00:31:31,188 THIS IMPACT, BUT MOST OF THE 893 00:31:31,188 --> 00:31:33,224 STUDIES HAVE BEEN BASED UPON 894 00:31:33,224 --> 00:31:35,626 MAN-MADE SOURCES OF NOISE, 895 00:31:35,626 --> 00:31:37,495 OCCUPATIONAL NOISE, AND A LOT OF 896 00:31:37,495 --> 00:31:40,498 NOISE RELATED TO ROADWAYS AND 897 00:31:40,498 --> 00:31:42,900 AIR TRAFFIC. 898 00:31:42,900 --> 00:31:44,702 AND IN GENERAL, 10-DECIBEL 899 00:31:44,702 --> 00:31:47,238 INCREASE OF EXPOSURE TO NOISE IN 900 00:31:47,238 --> 00:31:49,507 YOUR HOME OR EITHER 901 00:31:49,507 --> 00:31:52,576 OCCUPATIONALLY OR NEARBY BEFORE 902 00:31:52,576 --> 00:31:53,444 YOUR BLOOD PRESSURE MEASUREMENT 903 00:31:53,444 --> 00:31:56,614 IS TAKEN, CAN HAVE AN INCREASE 904 00:31:56,614 --> 00:31:59,917 IN HYPERTENSION RATES BY ABOUT 905 00:31:59,917 --> 00:32:03,187 10% ON AVERAGE, LIVING NEAR A 906 00:32:03,187 --> 00:32:05,256 ROADWAY, 50 METERS TO EVEN UP TO 907 00:32:05,256 --> 00:32:06,590 400 METERS CAN INCREASE THE 908 00:32:06,590 --> 00:32:09,460 INSTANCE OF HYPERTENSION BY 909 00:32:09,460 --> 00:32:09,994 ABOUT 13%. 910 00:32:09,994 --> 00:32:16,767 SO THAT'S A LONG-TERM IMPACT. 911 00:32:16,767 --> 00:32:19,370 WHAT ABOUT THE MORE PERTINENT 912 00:32:19,370 --> 00:32:21,572 ACUTE EFFECT OF NOISE WITHIN 913 00:32:21,572 --> 00:32:22,506 REASONABLE CHANGES THAT PEOPLE 914 00:32:22,506 --> 00:32:23,341 ARE EXPOSED TO? 915 00:32:23,341 --> 00:32:27,278 I KNOW WE'RE SUPPOSED TO MEASURE 916 00:32:27,278 --> 00:32:28,379 BLOOD PRESSURE IN A TEMPERATURE 917 00:32:28,379 --> 00:32:29,780 CONTROLLED QUIET SETTING, BUT IN 918 00:32:29,780 --> 00:32:31,215 THIS TRIAL ON THE LEFT, IT WAS A 919 00:32:31,215 --> 00:32:34,185 VERY INTERESTING STUDY WHERE 920 00:32:34,185 --> 00:32:36,020 THEY HAD -- THE PARTICIPANTS 921 00:32:36,020 --> 00:32:38,856 LISTENED TO DIFFERENT TYPES OF 922 00:32:38,856 --> 00:32:40,257 OCCUPATIONAL NOISE SOUNDS 923 00:32:40,257 --> 00:32:41,726 THROUGH HEADPHONES WHICH WERE 924 00:32:41,726 --> 00:32:43,728 MIMICKED, AND THEN MEASURED 925 00:32:43,728 --> 00:32:44,762 BLOOD PRESSURE DURING ACTUALLY 926 00:32:44,762 --> 00:32:46,497 LISTENING TO THE NOISE, SO VERY 927 00:32:46,497 --> 00:32:47,932 ACUTELY, WHAT WAS THE IMPACT? 928 00:32:47,932 --> 00:32:49,934 AND IN THIS STUDY, IT'S SHOWN 929 00:32:49,934 --> 00:32:52,003 ABOUT A MILLIMETER OF MERCURY 930 00:32:52,003 --> 00:32:54,171 INCREASE PER 10-DECIBEL INCREASE 931 00:32:54,171 --> 00:32:55,506 IN OCCUPATIONAL NOISE SOUND 932 00:32:55,506 --> 00:32:58,609 DURING THE PROCESS OF 933 00:32:58,609 --> 00:33:00,745 CLINIC-BASED MEASUREMENT. 934 00:33:00,745 --> 00:33:01,912 THERE'S BEEN A FEW STUDIES THAT 935 00:33:01,912 --> 00:33:04,548 HAVE LOOKED AT WHAT THE IMPACT 936 00:33:04,548 --> 00:33:07,651 OF REALTIME NOISE EXPOSURE IS ON 937 00:33:07,651 --> 00:33:09,954 ABPM MEASUREMENTS, AND NOT 938 00:33:09,954 --> 00:33:11,789 SURPRISINGLY AND QUITE 939 00:33:11,789 --> 00:33:13,657 INTERESTINGLY, YOU SEE SOME OF 940 00:33:13,657 --> 00:33:14,291 THAT VARIABILITY THROUGH THE 941 00:33:14,291 --> 00:33:15,960 COURSE OF THE DAYS, OF COURSE 942 00:33:15,960 --> 00:33:18,262 STRESS AND ACTIVITY AND POSITION 943 00:33:18,262 --> 00:33:19,363 AND FOOD AND SLEEP AND 944 00:33:19,363 --> 00:33:21,298 EVERYTHING WE KNOW ABOUT, BUT IN 945 00:33:21,298 --> 00:33:22,767 FACT, YOUR TEMPERATURE AND 946 00:33:22,767 --> 00:33:28,973 CLEARLY IN THIS STUDY IT LOOKED 947 00:33:28,973 --> 00:33:30,374 AT PATIENTS' INDIVIDUAL NOISE 948 00:33:30,374 --> 00:33:31,776 METER EXPOSURE IMMEDIATELY 949 00:33:31,776 --> 00:33:33,944 PROXIMAL TO THE AMBULATORY BLOOD 950 00:33:33,944 --> 00:33:44,989 PRESSURE MEASUREMENT SHOW 1 TO O 951 00:33:45,322 --> 00:33:46,257 ACUTE IMPACTS OF BOTH 952 00:33:46,257 --> 00:33:47,558 TEMPERATURE AND NOISE. 953 00:33:47,558 --> 00:33:49,026 MY RESEARCH FOR THE LAST 25 954 00:33:49,026 --> 00:33:51,862 YEARS HAS BEEN ON FINE 955 00:33:51,862 --> 00:33:54,665 PARTICULATE MATTER, AIR 956 00:33:54,665 --> 00:33:56,200 POLLUTION AND CARDIOMETABOLIC 957 00:33:56,200 --> 00:33:56,567 HEALTH EFFECTS. 958 00:33:56,567 --> 00:33:58,436 I CAN SAY WITHOUT ANY DOUBT AND 959 00:33:58,436 --> 00:33:59,570 CONCLUSION THAT AIR POLLUTION IS 960 00:33:59,570 --> 00:34:02,440 A RISK FACTOR OF CAUSALLY 961 00:34:02,440 --> 00:34:05,309 RELATED TO CARD VO VASCULAR 962 00:34:05,309 --> 00:34:07,244 DISEASE, RELATED TO THE 963 00:34:07,244 --> 00:34:09,780 INCIDENCE OF CARDIAC DISORDERS 964 00:34:09,780 --> 00:34:11,482 INCLUDING HYPERTENSION AND 965 00:34:11,482 --> 00:34:12,750 DIABETES MELLITUS, AIR POLLUTION 966 00:34:12,750 --> 00:34:14,151 ALSO INCREASES BLOOD PRESSURE, 967 00:34:14,151 --> 00:34:15,653 DOES SO SIMILAR TO MEN 968 00:34:15,653 --> 00:34:17,354 ENVIRONMENTAL FACTORS, 969 00:34:17,354 --> 00:34:18,789 HYPERACUTELY WITHIN HOURS, 970 00:34:18,789 --> 00:34:20,891 ACUTELY WITHIN DAYS AND THEN 971 00:34:20,891 --> 00:34:21,926 CHRONICALLY -- AND THIS WAS ONE 972 00:34:21,926 --> 00:34:23,294 OF SEVERAL MAIN ANALYSES THAT 973 00:34:23,294 --> 00:34:24,728 LOOKED AT THE IMPACT OF THE 974 00:34:24,728 --> 00:34:26,964 INCIDENCE OF LONG TERM FINE 975 00:34:26,964 --> 00:34:29,200 PARTICULATE MATTER, AIR 976 00:34:29,200 --> 00:34:30,401 POLLUTION MATTER, AIR POLLUTION 977 00:34:30,401 --> 00:34:35,473 EXPOSURE BY ABOUT 10MB PER CUBIC 978 00:34:35,473 --> 00:34:35,973 METER. 979 00:34:35,973 --> 00:34:39,910 IN MANY PARTS OF THE COUNTRY, 3, 980 00:34:39,910 --> 00:34:41,378 4 BILLION PEOPLE -- SORRY, OF 981 00:34:41,378 --> 00:34:42,980 THE GLOBE, 3 BILLION PEOPLE ARE 982 00:34:42,980 --> 00:34:46,517 EXPOSED TO MUCH HIGHER LEVELS, 983 00:34:46,517 --> 00:34:48,119 100 TO 200 PER CUBIC METER IN 984 00:34:48,119 --> 00:34:52,189 SOUTH ASIA, INDIA, AND NORTHERN 985 00:34:52,189 --> 00:34:54,191 CHINA, FOR EXAMPLE, ON A ROUTINE 986 00:34:54,191 --> 00:34:55,926 BASIS, SO THIS HAS PROFOUND 987 00:34:55,926 --> 00:35:00,865 GLOBAL IMPACT ON BLOOD PRESSURE. 988 00:35:00,865 --> 00:35:02,933 THIS WAS A SERIES OF STUDIES WE 989 00:35:02,933 --> 00:35:03,801 DID OVER 15 YEARS. 990 00:35:03,801 --> 00:35:06,971 WE DID MANY PANEL STUDIES OF 991 00:35:06,971 --> 00:35:08,539 REAL WORLD EXPOSURES, BUT WE 992 00:35:08,539 --> 00:35:11,041 ALSO WANTED TO SEE WHAT WAS THE 993 00:35:11,041 --> 00:35:14,912 HYPERACUTE IMPACT OF EXPOSURE TO 994 00:35:14,912 --> 00:35:16,680 AIR POLLUTION WHILE YOU'RE BEING 995 00:35:16,680 --> 00:35:17,248 EXPOSED. 996 00:35:17,248 --> 00:35:20,384 AND THIS IS A EXPOSURE CHAMBER 997 00:35:20,384 --> 00:35:22,720 FACILITY THAT WAS A MOBILE UNIT 998 00:35:22,720 --> 00:35:25,656 THAT WE TOOK TO DIFFERENT PLACES 999 00:35:25,656 --> 00:35:28,092 ACROSS THE COUNTRY, MOSTLY IN 1000 00:35:28,092 --> 00:35:31,162 MICHIGAN AS WELL AS IN CA CANADA 1001 00:35:31,162 --> 00:35:32,530 AND TORONTO, ONTARIO, AND WE 1002 00:35:32,530 --> 00:35:34,565 WERE ABLE TO LOOK AT WHAT 1003 00:35:34,565 --> 00:35:36,667 CONTROLLED EXPOSURE TO FINE 1004 00:35:36,667 --> 00:35:41,805 PARTICULATE MATTER AT AROUND 15R 1005 00:35:41,805 --> 00:35:43,174 WHICH IS A COMMON EXPOSURE IN 1006 00:35:43,174 --> 00:35:44,842 MUCH OF THE WORLD, 3 BILLION 1007 00:35:44,842 --> 00:35:45,843 PEOPLE HAVE BEEN EXPOSED TO 1008 00:35:45,843 --> 00:35:47,444 THIS, AND WHAT'S THE IMPACT OF 1009 00:35:47,444 --> 00:35:49,747 THIS AS COMPARED TO FILTERED AIR 1010 00:35:49,747 --> 00:35:52,016 WITH NO PM2.5 AND NO OTHER GASES 1011 00:35:52,016 --> 00:35:53,584 OVER A TWO-HOUR PERIOD. 1012 00:35:53,584 --> 00:35:55,653 AND WE ORIGINALLY SHOWED 1013 00:35:55,653 --> 00:35:56,453 VASOCONSTRICTION, HEART RATE 1014 00:35:56,453 --> 00:35:59,790 VARIABILITY CHANGES, BUT 1015 00:35:59,790 --> 00:36:02,326 CONSISTENTLY OVER A DECADE, 1016 00:36:02,326 --> 00:36:04,695 DECADE 1/2 OF EXPOSURES, WE SAW 1017 00:36:04,695 --> 00:36:07,198 DURING THE FINE PARTICULATE 1018 00:36:07,198 --> 00:36:11,368 MATTER EXPOSURE, DISCERNIBLE AND 1019 00:36:11,368 --> 00:36:13,070 REPRODUCIBLE COHERENT INCREASES 1020 00:36:13,070 --> 00:36:14,171 IN SYSTOLIC BLOOD PRESSURE IN 1021 00:36:14,171 --> 00:36:15,806 THE RANGE OF 1 TO 3 MILLIMETERS 1022 00:36:15,806 --> 00:36:17,374 OF MERCURY AND QUITE 1023 00:36:17,374 --> 00:36:21,078 REPRODUCIBLE DURING THE ACTUAL 1024 00:36:21,078 --> 00:36:23,180 INHALATION OF AIR POLLUTION. 1025 00:36:23,180 --> 00:36:25,082 SO TAKING ALL THIS INTO ACCOUNT, 1026 00:36:25,082 --> 00:36:28,118 AND THIS IS JUST SOME OF THE 1027 00:36:28,118 --> 00:36:29,253 IMPACTS, SOME OF THE MOST COMMON 1028 00:36:29,253 --> 00:36:31,655 ONES THAT WE ARE EXPOSED TO, WE 1029 00:36:31,655 --> 00:36:32,890 ASKED CAN WE ACTUALLY MEASURE 1030 00:36:32,890 --> 00:36:33,557 BLOOD PRESSURE OUT IN A 1031 00:36:33,557 --> 00:36:35,559 COMMUNITY SETTING OUTSIDE FOR 1032 00:36:35,559 --> 00:36:37,094 SCREENING PURPOSES. 1033 00:36:37,094 --> 00:36:38,829 WE HAVE PART OF -- WE'RE LUCKY 1034 00:36:38,829 --> 00:36:41,799 TO BE PART OF A P50 CENTER AT 1035 00:36:41,799 --> 00:36:43,100 WAYNE STATE UNIVERSITY LOOKING 1036 00:36:43,100 --> 00:36:48,205 AT MOBILE HEALTH UNITS AS A 1037 00:36:48,205 --> 00:36:52,009 MEANS TO ATTACK HEALTH 1038 00:36:52,009 --> 00:36:52,710 DISPARITIES AND EQUITY IN 1039 00:36:52,710 --> 00:36:54,945 RELATION TO CARDIAC RISK FACTOR 1040 00:36:54,945 --> 00:36:56,347 CONTROL IN WAYNE COUNTY AND 1041 00:36:56,347 --> 00:36:59,350 PRINCIPALLY I IN THE CITY OF 1042 00:36:59,350 --> 00:37:00,751 DETROIT AND COMMUNITIES OF COLOR 1043 00:37:00,751 --> 00:37:01,885 ACROSS DETROIT. 1044 00:37:01,885 --> 00:37:03,020 ONE OF THE NOVEL ADAPTATIONS TO 1045 00:37:03,020 --> 00:37:05,589 THIS WHICH WAS LAUNCHED DURING 1046 00:37:05,589 --> 00:37:06,924 2020 FOR COVID WAS THE 1047 00:37:06,924 --> 00:37:09,660 MEASUREMENT AND SCREENING OF 1048 00:37:09,660 --> 00:37:12,129 CARDIOMETABOLIC RISK FACTORS, 1049 00:37:12,129 --> 00:37:14,298 AND THE MOBILE UNITS NOW 1050 00:37:14,298 --> 00:37:17,434 SCREENED OVER ABOUT 75,000 TO 1051 00:37:17,434 --> 00:37:19,937 80,000 INDIVIDUAL LIVES OVER THE 1052 00:37:19,937 --> 00:37:23,907 LAST THREE YEARS HAVE WELL OVER 1053 00:37:23,907 --> 00:37:25,476 I THINK NOW 15,000 BLOOD 1054 00:37:25,476 --> 00:37:31,482 PRESSURE MEASUREMENTS. 1055 00:37:31,482 --> 00:37:33,317 NOW THIS WAS DONE GENERALLY 1056 00:37:33,317 --> 00:37:34,685 BECAUSE THE PURPOSE OF THESE 1057 00:37:34,685 --> 00:37:37,888 MOBILE UNITS WAS TO SCREEN A 1058 00:37:37,888 --> 00:37:38,856 HIGH THROUGHPUT LARGE NUMBER OF 1059 00:37:38,856 --> 00:37:40,991 PATIENTS RIGHT IN THEIR OWN 1060 00:37:40,991 --> 00:37:42,359 COMMUNITY, 250 DIFFERENT 1061 00:37:42,359 --> 00:37:44,061 PARTICIPATING COMMUNITY SITES 1062 00:37:44,061 --> 00:37:44,928 ACROSS THE CITY OF DETROIT. 1063 00:37:44,928 --> 00:37:46,497 WHAT WOULD BE THE IMPACT OF 1064 00:37:46,497 --> 00:37:48,365 MEASURING BLOOD PRESSURE OUTSIDE 1065 00:37:48,365 --> 00:37:49,733 ON BLOOD PRESSURE? 1066 00:37:49,733 --> 00:37:52,469 AND WHAT WE SHOWED HERE IN THIS 1067 00:37:52,469 --> 00:37:55,172 SMALL TRIAL WAS WE TRIED TO 1068 00:37:55,172 --> 00:37:56,473 VALIDATE THE IMPACT OF MEASURING 1069 00:37:56,473 --> 00:37:58,409 BLOOD PRESSURE WHICH IS OFTEN 1070 00:37:58,409 --> 00:38:00,377 DONE WHILE PATIENTS ARE IN THEIR 1071 00:38:00,377 --> 00:38:02,246 CAR FOR A HIGH-THROUGHPUT 1072 00:38:02,246 --> 00:38:03,314 MECHANISM. 1073 00:38:03,314 --> 00:38:04,381 AS COMPARED TO WHAT'S DONE IN 1074 00:38:04,381 --> 00:38:05,716 THE CLINIC. 1075 00:38:05,716 --> 00:38:07,718 SO BLOOD PRESSURE IS MEASURED IN 1076 00:38:07,718 --> 00:38:08,419 THE CLINIC, THEY ARE TRANSPORTED 1077 00:38:08,419 --> 00:38:10,220 TO THE CAR, AND THEN MEASURED IN 1078 00:38:10,220 --> 00:38:11,922 THE CLINIC AFTERWARDS, AND WE 1079 00:38:11,922 --> 00:38:13,724 WANTED TO SEE THE IMPACT OF THE 1080 00:38:13,724 --> 00:38:16,460 DIFFERENT ENVIRONMENTAL FACTORS, 1081 00:38:16,460 --> 00:38:17,361 TEMPERATURE, NOISE, POLLUTANTS 1082 00:38:17,361 --> 00:38:20,230 AND SUCH, AND PERHAPS THE 1083 00:38:20,230 --> 00:38:21,098 DIFFERENCE BETWEEN MEASUREMENT 1084 00:38:21,098 --> 00:38:22,232 OF BLOOD PRESSURE IN THE CAR. 1085 00:38:22,232 --> 00:38:23,667 THESE ALL FOLLOWED VERY 1086 00:38:23,667 --> 00:38:25,202 STRINGENTLY USING THE AUTOMATED 1087 00:38:25,202 --> 00:38:26,970 BLOOD PRESSURE MEASUREMENT OF 1088 00:38:26,970 --> 00:38:29,940 5 MINUTES SEATED BEFOREHAND, 1089 00:38:29,940 --> 00:38:31,608 SHOULD LOOK THE A READINGS AND 1090 00:38:31,608 --> 00:38:33,744 OF COURSE STRICT ADHERENCE TO 1091 00:38:33,744 --> 00:38:34,378 THE GUIDELINES FOR BLOOD 1092 00:38:34,378 --> 00:38:38,582 PRESSURE MEASUREMENT. 1093 00:38:38,582 --> 00:38:42,886 AND IN THIS STUDY OF 100 1094 00:38:42,886 --> 00:38:48,025 PATIENTS, WHAT WE SHOWED WAS 1095 00:38:48,025 --> 00:38:52,463 ESSENTIALLY THE DIFFERENCES 1096 00:38:52,463 --> 00:38:53,530 BETWEEN -- THERE'S A LARGE 1097 00:38:53,530 --> 00:38:54,131 VARIATION IN THE TEMPERATURE 1098 00:38:54,131 --> 00:38:58,268 CHANGES AND THE SEASONS. 1099 00:38:58,268 --> 00:39:01,372 AND THESE ARE THE MAIN RESULTS, 1100 00:39:01,372 --> 00:39:04,708 THAT AS IS COMMON FOR BLOOD 1101 00:39:04,708 --> 00:39:05,976 PRESSURE, THE CAR BLOOD PRESSURE 1102 00:39:05,976 --> 00:39:07,378 WAS VERY CLOSE TO THE CLINIC 1103 00:39:07,378 --> 00:39:11,448 BLOOD PRESSURE AS YOU CAN SEE, 1104 00:39:11,448 --> 00:39:12,850 BUT WIDE INTERINDIVIDUAL 1105 00:39:12,850 --> 00:39:13,150 VARIABILITY. 1106 00:39:13,150 --> 00:39:15,018 SO FOLLOWING AND ADAPTING THE 1107 00:39:15,018 --> 00:39:16,086 UNIVERSAL STANDARD FOR 1108 00:39:16,086 --> 00:39:16,887 VALIDATION BLOOD PRESSURE 1109 00:39:16,887 --> 00:39:18,555 MEASUREMENT DEVICES, WE TRIED TO 1110 00:39:18,555 --> 00:39:21,291 VALIDATE THIS METHODOLOGY DUE TO 1111 00:39:21,291 --> 00:39:22,893 ALL THE POTENTIAL IMPACTS OF 1112 00:39:22,893 --> 00:39:23,961 MEASURING BLOOD PRESSURE OUTSIDE 1113 00:39:23,961 --> 00:39:24,795 IN A CAR. 1114 00:39:24,795 --> 00:39:30,267 AND WHAT WE SHOWED WAS 85% OR 8H 1115 00:39:30,267 --> 00:39:32,970 SYSTOLIC AND DIASTOLIC BLOOD 1116 00:39:32,970 --> 00:39:34,538 PRESSURES, BOTH OF THEM LESS 1117 00:39:34,538 --> 00:39:36,673 THAN OR EQUAL TO 10 MILLIMETERS 1118 00:39:36,673 --> 00:39:38,275 OF MERCURY DIFFERENT BETWEEN THE 1119 00:39:38,275 --> 00:39:40,778 AVERAGE OF THE BEFORE AND AFTER 1120 00:39:40,778 --> 00:39:41,378 CLINIC READINGS AND THE CAR 1121 00:39:41,378 --> 00:39:41,812 BLOOD PRESSURE. 1122 00:39:41,812 --> 00:39:42,913 AND OF COURSE THE MEANS WERE 1123 00:39:42,913 --> 00:39:44,548 QUITE CLOSE, BUT THERE WAS 1124 00:39:44,548 --> 00:39:45,649 ALWAYS VARIATIONS ACROSS 1125 00:39:45,649 --> 00:39:47,618 INDIVIDUALS, WHICH IS IMPORTANT 1126 00:39:47,618 --> 00:39:54,024 FOR CATEGORIZATION OF DATA. 1127 00:39:54,024 --> 00:39:56,260 SO MANY ENVIRONMENTAL FACTORS 1128 00:39:56,260 --> 00:39:56,860 CAN INFLUENCE BLOOD PRESSURE 1129 00:39:56,860 --> 00:39:58,629 BOTH ACUTELY, CHRONICALLY AND 1130 00:39:58,629 --> 00:40:00,097 HYPERACUTELY, AS WELL AS PROMOTE 1131 00:40:00,097 --> 00:40:02,099 THE ONSET OF HYPERTENSION. 1132 00:40:02,099 --> 00:40:03,367 TEMPERATURE, WE ALL KNOW ABOUT, 1133 00:40:03,367 --> 00:40:05,602 HAS AN IMPACT ON ALL LIVING PLA 1134 00:40:05,602 --> 00:40:08,105 MALLS. 1135 00:40:08,105 --> 00:40:09,239 LIVING 1136 00:40:09,239 --> 00:40:10,707 MAMMALS, SEASON HAS A LARGER 1137 00:40:10,707 --> 00:40:12,643 IMPACT BECAUSE OF TEMPERATURE 1138 00:40:12,643 --> 00:40:13,610 PLUS OTHER FACTORS. 1139 00:40:13,610 --> 00:40:15,712 NOISE, EVEN AT A 30 TO 1140 00:40:15,712 --> 00:40:16,680 40-DECIBEL RANGE WHICH IS ABOUT 1141 00:40:16,680 --> 00:40:18,248 A QUIET CLINIC SETTING, ANYTHING 1142 00:40:18,248 --> 00:40:20,384 ABOVE THAT WILL BE RELEVANT TO 1143 00:40:20,384 --> 00:40:21,385 IMPACTING BLOOD PRESSURE NOT 1144 00:40:21,385 --> 00:40:23,153 JUST CHRONICALLY BUT ALSO WHILE 1145 00:40:23,153 --> 00:40:24,955 IT'S MEASURED, SO IN A BUSY COLD 1146 00:40:24,955 --> 00:40:26,590 HALLWAY DURING WINTER, YOU CAN 1147 00:40:26,590 --> 00:40:28,358 BE ASSURED THAT BLOOD PRESSURE 1148 00:40:28,358 --> 00:40:30,060 WILL BE HIGHER. 1149 00:40:30,060 --> 00:40:31,695 BLOOD PRESSURE CAN BE ACCURATELY 1150 00:40:31,695 --> 00:40:32,796 DETERMINED IN A COMMUNITY 1151 00:40:32,796 --> 00:40:34,731 SETTING AS WE SHOWED OUTDOORS. 1152 00:40:34,731 --> 00:40:35,766 IF YOU'RE AWARE OF THESE 1153 00:40:35,766 --> 00:40:39,603 ENVIRONMENTAL FACTORS, AND YOU 1154 00:40:39,603 --> 00:40:40,170 RELIGIOUSLY FOLLOW THE 1155 00:40:40,170 --> 00:40:41,171 MEASUREMENT GUIDELINES AND TRY 1156 00:40:41,171 --> 00:40:42,406 TO MITIGATE THE ENVIRONMENTAL 1157 00:40:42,406 --> 00:40:43,240 FACTORS AS MUCH AS POSSIBLE. 1158 00:40:43,240 --> 00:40:45,542 IN THE CARS, WE HAD OF COURSE 1159 00:40:45,542 --> 00:40:48,078 AIR CONDITIONING IN THE SUMMER, 1160 00:40:48,078 --> 00:40:49,580 HEATING IN THE WINTER AND TRIED 1161 00:40:49,580 --> 00:40:51,682 TO HAVE NOISE AND OTHER 1162 00:40:51,682 --> 00:40:52,883 ENVIRONMENTAL EXPOSURES 1163 00:40:52,883 --> 00:40:54,651 MITIGATED AS MUCH AS POSSIBLE. 1164 00:40:54,651 --> 00:40:56,987 OF COURSE IT'S NOT ENTIRELY 1165 00:40:56,987 --> 00:40:58,589 POSSIBLE TO ALLEVIATE ALL OF 1166 00:40:58,589 --> 00:41:00,891 THEM, BUT YOU CAN SEE, IT IS 1167 00:41:00,891 --> 00:41:02,759 PLAUSIBLE TO SAY THAT THIS MASS 1168 00:41:02,759 --> 00:41:05,295 SCREENING COULD BE A HIGH 1169 00:41:05,295 --> 00:41:06,497 THROUGHPUT SCREENING METHOD OF 1170 00:41:06,497 --> 00:41:07,264 BLOOD PRESSURE MEASUREMENT 1171 00:41:07,264 --> 00:41:13,604 OUTDOORS IN A CAR. 1172 00:41:13,604 --> 00:41:16,907 SO GAPS AND FUTURE KNOWLEDGE. 1173 00:41:16,907 --> 00:41:18,308 BASICALLY I THINK IT IS WELL 1174 00:41:18,308 --> 00:41:20,177 RECOGNIZED FOR MANY, MANY 1175 00:41:20,177 --> 00:41:21,144 DECADES ESSENTIALLY THAT 1176 00:41:21,144 --> 00:41:22,479 TEMPERATURE NOISE CAN IMPACT 1177 00:41:22,479 --> 00:41:23,580 BLOOD PRESSURE ACUTELY. 1178 00:41:23,580 --> 00:41:25,015 I THINK THIS NEEDS TO BE PAID A 1179 00:41:25,015 --> 00:41:27,518 LITTLE BIT MORE ATTENTION TO IN 1180 00:41:27,518 --> 00:41:30,354 SPECIFIC IN THE GUIDELINES FOR 1181 00:41:30,354 --> 00:41:31,955 WHAT TEMPERATURE SHOULD BE, WHAT 1182 00:41:31,955 --> 00:41:33,023 NOISE LEVEL SHOULD BE BOTH AT 1183 00:41:33,023 --> 00:41:33,891 HOME AS WELL AS IN THE CLINIC, 1184 00:41:33,891 --> 00:41:35,425 AS WELL AS THE POTENTIAL FOR 1185 00:41:35,425 --> 00:41:37,828 RECENT IMPACTS. 1186 00:41:37,828 --> 00:41:39,496 WE'VE SHOWN IN MANY STUDIES THAT 1187 00:41:39,496 --> 00:41:40,063 TEMPERATURE THE DAY BEFORE 1188 00:41:40,063 --> 00:41:41,698 CLINIC MEASUREMENTS, AIR 1189 00:41:41,698 --> 00:41:42,866 POLLUTION THE DAY BEFORE, THE 1190 00:41:42,866 --> 00:41:44,568 DAY OF, BLOOD PRESSURE 1191 00:41:44,568 --> 00:41:47,638 MEASUREMENTS CAN RAISE BLOOD 1192 00:41:47,638 --> 00:41:49,139 PRESSURE 5, 6 MILLIMETERS OF 1193 00:41:49,139 --> 00:41:50,507 MERCURY AND MOST CLINICIANS, OF 1194 00:41:50,507 --> 00:41:52,543 COURSE, ARE NOT AWARE OF THE 1195 00:41:52,543 --> 00:41:55,979 ACUTE IMPACTS OF POLLUTANTS AS 1196 00:41:55,979 --> 00:41:58,248 WELL AS TEMPERATURE AND NOISE ON 1197 00:41:58,248 --> 00:41:58,649 BLOOD PRESSURE. 1198 00:41:58,649 --> 00:41:59,950 NOT JUST WHILE YOU'RE MEASURING 1199 00:41:59,950 --> 00:42:01,218 IT BUT ALSO WITHIN THE LAST DAY 1200 00:42:01,218 --> 00:42:02,052 OR SO. 1201 00:42:02,052 --> 00:42:03,854 WHAT IS THE IMPACT OF THE 1202 00:42:03,854 --> 00:42:10,260 ENVIRONMENT AND HOW -- PERHAPS 1203 00:42:10,260 --> 00:42:11,628 SOME OF THIS VARIABILITY BETWEEN 1204 00:42:11,628 --> 00:42:13,931 DAYS AND EVEN WITHIN DAY IS DUE 1205 00:42:13,931 --> 00:42:16,867 TO THE ENVIRONMENT, AS IT SHOWED 1206 00:42:16,867 --> 00:42:18,402 WITH NOISE, CLEARLY ALSO BEEN 1207 00:42:18,402 --> 00:42:20,604 SHOWN WITH TEMPERATURE AND WE'VE 1208 00:42:20,604 --> 00:42:22,472 SHOWN WITHIN THE LAST FEW YEARS 1209 00:42:22,472 --> 00:42:24,141 OF AIR POLLUTION, HOW MUCH OF 1210 00:42:24,141 --> 00:42:25,876 THIS IMPACTS KNOCK TURNING 1211 00:42:25,876 --> 00:42:31,882 DNOCTURNAL DIPPING,OUR COLLEAGUD 1212 00:42:31,882 --> 00:42:34,484 A LOT OF DATA ON AIRCRAFT NOISE, 1213 00:42:34,484 --> 00:42:35,719 IN FACT IN NOCTURNAL BLOOD 1214 00:42:35,719 --> 00:42:36,653 PRESSURE AND HOW MUCH OF THIS 1215 00:42:36,653 --> 00:42:38,288 REAL WORLD EXPOSURES THAT WE 1216 00:42:38,288 --> 00:42:41,458 ENCOUNTER THROUGHOUT OUR DAY AND 1217 00:42:41,458 --> 00:42:44,628 THE ROLE IN THE DIFFERENCE 1218 00:42:44,628 --> 00:42:47,030 BETWEEN -- THERE'S SOME 1219 00:42:47,030 --> 00:42:47,798 ARTIFICIALALITY BETWEEN THE 1220 00:42:47,798 --> 00:42:49,866 CLINIC READING AND PERHAPS 1221 00:42:49,866 --> 00:42:51,068 THERE'S A MORE GOOD WINDOW INTO 1222 00:42:51,068 --> 00:42:52,402 WHAT WE'RE EXPOSED TO IN OUR 1223 00:42:52,402 --> 00:42:53,870 REAL LIFE AND WHY IT MIGHT BE 1224 00:42:53,870 --> 00:42:55,072 SLIGHT LEHIGHER. 1225 00:42:55,072 --> 00:42:59,242 THIS WILL HAVE PROFOUND IMPACT 1226 00:42:59,242 --> 00:43:01,011 ON CUFFLESS BLOOD PRESSURE 1227 00:43:01,011 --> 00:43:05,048 MEASUREMENTS OF COURSE AND RAPID 1228 00:43:05,048 --> 00:43:06,316 INCREASES AND LASTLY 1229 00:43:06,316 --> 00:43:07,184 IMPLICATIONS FOR 1230 00:43:07,184 --> 00:43:07,551 HYPERMANAGEMENT. 1231 00:43:07,551 --> 00:43:08,685 HOW CAN WE MOVE FORWARD IF WE 1232 00:43:08,685 --> 00:43:14,491 WANT TO HAVE A MASS 1233 00:43:14,491 --> 00:43:17,361 HIGH-THROUGHPUT TENSION 1234 00:43:17,361 --> 00:43:19,229 SCREENING PROGRAMMING IN 1235 00:43:19,229 --> 00:43:19,529 COMMUNITIES. 1236 00:43:19,529 --> 00:43:20,964 BUILDING A FEW MORE BRICK AND 1237 00:43:20,964 --> 00:43:22,332 MORTAR CLINICS IS NOT GOING TO 1238 00:43:22,332 --> 00:43:24,468 SOLVE THIS PROBLEM AND OUR MOBIL 1239 00:43:24,468 --> 00:43:25,836 HEALTHCARE PROGRAM WITH REMOTE 1240 00:43:25,836 --> 00:43:27,537 PATIENT MONITORING LINKAGE IS 1241 00:43:27,537 --> 00:43:28,672 ONE OF THE SOLUTIONS TO TRY TO 1242 00:43:28,672 --> 00:43:30,007 IMPROVE POPULATION LEVEL BLOOD 1243 00:43:30,007 --> 00:43:30,273 PRESSURE. 1244 00:43:30,273 --> 00:43:31,541 CAN WE ACCURATELY SCREEN BLOOD 1245 00:43:31,541 --> 00:43:34,111 PRESSURE WITH THIS METHOD AND 1246 00:43:34,111 --> 00:43:34,845 CHARACTERIZE PEOPLE FOR 1247 00:43:34,845 --> 00:43:35,946 APPROPRIATE FOLLOW-UP WITH HOME 1248 00:43:35,946 --> 00:43:36,913 BLOOD PRESSURE MONITORING BASED 1249 00:43:36,913 --> 00:43:38,181 UPON THOSE READINGS. 1250 00:43:38,181 --> 00:43:39,483 AND THEN THERE ARE CLEARLY OTHER 1251 00:43:39,483 --> 00:43:40,651 THINGS THAT CLINICIANS NEED TO 1252 00:43:40,651 --> 00:43:42,653 BE MORE AWARE OF, WHICH IS 1253 00:43:42,653 --> 00:43:46,323 IMPACTS OF SEASON ON BLOOD 1254 00:43:46,323 --> 00:43:47,157 PRESSURE, AS WELL AS OTHER 1255 00:43:47,157 --> 00:43:48,425 IMPACTS SUCH AS I'VE HAD 1256 00:43:48,425 --> 00:43:49,660 PATIENTS TRAVEL TO DENVER AND 1257 00:43:49,660 --> 00:43:51,361 HAVE BLOOD PRESSURE BE 1258 00:43:51,361 --> 00:43:52,629 20 MILLIMETERS OF MERCURY HIGHER 1259 00:43:52,629 --> 00:43:53,630 WITH JUST THAT LEVEL OF 1260 00:43:53,630 --> 00:43:54,131 ELEVATION. 1261 00:43:54,131 --> 00:43:58,001 I THINK MOST CLINICIANS ARE NOT 1262 00:43:58,001 --> 00:44:00,170 AWARE OF WHAT THESE TYPES OF 1263 00:44:00,170 --> 00:44:01,071 SEASONAL AND OTHER ENVIRONMENTAL 1264 00:44:01,071 --> 00:44:03,907 FACTORS CAN HAVE ACUTELY AS WELL 1265 00:44:03,907 --> 00:44:07,444 AS SUBACUTELY ON BLOOD PRESSURE. 1266 00:44:07,444 --> 00:44:08,745 AND THAT IS, I THINK, THE LAST 1267 00:44:08,745 --> 00:44:08,945 SLIDE. 1268 00:44:08,945 --> 00:44:09,346 THANK YOU. 1269 00:44:09,346 --> 00:44:09,880 >> GREAT. 1270 00:44:09,880 --> 00:44:11,214 THANK YOU SO MUCH, DR. BROOK, 1271 00:44:11,214 --> 00:44:13,083 FOR THAT THOUGHT-PROVOKING 1272 00:44:13,083 --> 00:44:13,583 PRESENTATION. 1273 00:44:13,583 --> 00:44:14,785 WE'RE GOING TO MOVE ON TO OUR 1274 00:44:14,785 --> 00:44:16,153 LAST SPEAKER IN OUR SESSION, AND 1275 00:44:16,153 --> 00:44:17,354 I JUST WANT TO ENCOURAGE FOLKS 1276 00:44:17,354 --> 00:44:18,522 TO PUT YOUR QUESTIONS IN THE Q & 1277 00:44:18,522 --> 00:44:20,290 A OR THE CHAT SO THAT WE CAN 1278 00:44:20,290 --> 00:44:22,125 HAVE A ROBUST PANEL DISCUSSION 1279 00:44:22,125 --> 00:44:24,194 IN A FEW MINUTES. 1280 00:44:24,194 --> 00:44:26,763 OUR NEXT SPEAKER IS DR. JESUS 1281 00:44:26,763 --> 00:44:28,465 MELGAREJO, WHO IS AN ASSISTANT 1282 00:44:28,465 --> 00:44:30,300 PROFESSOR OF NEUROSCIENCE AT THE 1283 00:44:30,300 --> 00:44:31,168 INSTITUTE OF NEUROSCIENCE AT THE 1284 00:44:31,168 --> 00:44:33,704 UNIVERSITY OF TEXAS, RIO GRANDE 1285 00:44:33,704 --> 00:44:34,137 VALLEY. 1286 00:44:34,137 --> 00:44:35,605 HE IS A PHYSICIAN SCIENTIST 1287 00:44:35,605 --> 00:44:37,474 DEVOTED TO MULTIDISCIPLINARY 1288 00:44:37,474 --> 00:44:39,309 CLINICAL AND EPIDEMIOLOGICAL 1289 00:44:39,309 --> 00:44:40,077 RESEARCH. 1290 00:44:40,077 --> 00:44:41,678 HIS SCIENTIFIC FOCUS AND 1291 00:44:41,678 --> 00:44:44,247 RESEARCH INTERESTS ARE TO EE 1292 00:44:44,247 --> 00:44:46,249 ELUCIDATE THE CONTRIBUTION OF 1293 00:44:46,249 --> 00:44:47,584 24-HOUR BLOOD PRESSURE ON THE 1294 00:44:47,584 --> 00:44:48,952 DEVELOPMENT AND PROGRESSION OF 1295 00:44:48,952 --> 00:44:49,653 AGE-RELATED CONDITIONS. 1296 00:44:49,653 --> 00:44:50,854 TODAY HE'LL BE SPEAKING TO US 1297 00:44:50,854 --> 00:44:52,522 ABOUT IDENTIFYING AND USING 1298 00:44:52,522 --> 00:44:56,126 NOVEL DEVICE-BASED PHENOTYPES. 1299 00:44:56,126 --> 00:44:58,228 >> THANK YOU VERY MUCH, 1300 00:44:58,228 --> 00:44:59,329 PROFESSOR WALL, FOR YOUR 1301 00:44:59,329 --> 00:45:01,231 INTRODUCTION. 1302 00:45:01,231 --> 00:45:02,132 AND GOOD MORNING, EVERYONE. 1303 00:45:02,132 --> 00:45:03,400 I THINK IT'S STILL MORNING IN 1304 00:45:03,400 --> 00:45:06,970 SOME OTHER AREAS OF THE UNITED 1305 00:45:06,970 --> 00:45:08,371 STATES, SO I AM JESUS MELGAREJO 1306 00:45:08,371 --> 00:45:10,574 AND I HAVE TO THANK THE 1307 00:45:10,574 --> 00:45:13,910 ORGANIZERS FOR PREPARING THIS 1308 00:45:13,910 --> 00:45:15,412 IMPORTANT WORKSHOP ON BLOOD 1309 00:45:15,412 --> 00:45:16,747 PRESSURE ASSESSMENT ACROSS THE 1310 00:45:16,747 --> 00:45:17,080 LIFESPAN. 1311 00:45:17,080 --> 00:45:20,884 IT AN HONOR TO MEET HERE TODAY 1312 00:45:20,884 --> 00:45:22,552 AND TALK ABOUT IDENTIFYING AND 1313 00:45:22,552 --> 00:45:24,321 USING NOVEL DEVICE BASED 1314 00:45:24,321 --> 00:45:25,021 PHENOTYPES. 1315 00:45:25,021 --> 00:45:32,529 I HAVE NO CONFLICTS OF INTEREST. 1316 00:45:32,529 --> 00:45:33,730 SO WHY DO WE MEASURE BLOOD 1317 00:45:33,730 --> 00:45:34,431 PRESSURE? 1318 00:45:34,431 --> 00:45:36,900 ESSENTIALLY WE DO IT BECAUSE WE 1319 00:45:36,900 --> 00:45:38,702 NEED TO TREAT HYPERTENSION. 1320 00:45:38,702 --> 00:45:41,404 WE HAVE ALREADY DISCUSSED WE ARE 1321 00:45:41,404 --> 00:45:43,440 WELL AWARE ABOUT THIS, THAT 1322 00:45:43,440 --> 00:45:44,941 TREATING BLOOD PRESSURE, 1323 00:45:44,941 --> 00:45:47,844 DIAGNOSING, TREATING AND 1324 00:45:47,844 --> 00:45:48,478 CONTROLLING BLOOD PRESSURE IS 1325 00:45:48,478 --> 00:45:49,980 ONE OF THE MAIN MODIFIABLE RISK 1326 00:45:49,980 --> 00:45:52,115 FACTORS THAT ARE ASSOCIATED WITH 1327 00:45:52,115 --> 00:45:57,654 AN IDEAL LIFECOURSE, AND THAT'S 1328 00:45:57,654 --> 00:45:59,356 THE -- WHEN WE LOOK INTO OUR 1329 00:45:59,356 --> 00:46:00,724 LIFESPAN AND WE WANT TO ACHIEVE 1330 00:46:00,724 --> 00:46:01,892 THIS GREEN LINE, BUT OF COURSE 1331 00:46:01,892 --> 00:46:03,393 WE KNOW THERE'S AN AVERAGE 1332 00:46:03,393 --> 00:46:04,728 LIFECOURSE IN WHICH INDIVIDUALS, 1333 00:46:04,728 --> 00:46:08,799 THEY HAVE A HIGHER RISK OF 1334 00:46:08,799 --> 00:46:11,501 DEVELOPING TARGET ORGAN DAMAGE 1335 00:46:11,501 --> 00:46:13,103 OR MAJOR CARDIOVASCULAR EVENTS. 1336 00:46:13,103 --> 00:46:14,905 THEN WE HAVE THOSE INDIVIDUALS 1337 00:46:14,905 --> 00:46:17,274 IN WHICH THEY HAVE POOR VASCULAR 1338 00:46:17,274 --> 00:46:20,410 AGING, SO THEY HAVE REALLY 1339 00:46:20,410 --> 00:46:20,911 POORLY CONTROLLED BLOOD 1340 00:46:20,911 --> 00:46:21,945 PRESSURE, THEY HAVE DIABETES, SO 1341 00:46:21,945 --> 00:46:24,114 WHAT WE WANT TO DO WHEN WE 1342 00:46:24,114 --> 00:46:26,883 MEASURE BLOOD PRESSURE IS TO -- 1343 00:46:26,883 --> 00:46:28,752 BUT ALSO IDEAL LIFECOURSE OF 1344 00:46:28,752 --> 00:46:29,986 AGING, SO CONDITIONS THAT ARE 1345 00:46:29,986 --> 00:46:31,755 CHRONIC, PROGRESSIVE, 1346 00:46:31,755 --> 00:46:35,559 DEBILITATING, AND IRREVERSIBLE, 1347 00:46:35,559 --> 00:46:36,827 WE DECREASE THE RISK OF 1348 00:46:36,827 --> 00:46:37,627 DEVELOPING THOSE CONDITIONS. 1349 00:46:37,627 --> 00:46:39,896 AND IT HAS BEEN FUNDAMENTAL, THE 1350 00:46:39,896 --> 00:46:43,099 USE OF CLINIC, OFFICE OR 1351 00:46:43,099 --> 00:46:44,434 CONVENTIONAL BLOOD PRESSURE TO 1352 00:46:44,434 --> 00:46:48,305 ASSESS CARDIOVASCULAR RISK, TO 1353 00:46:48,305 --> 00:46:50,140 ASSESS INDIVIDUALS' RISKS AND 1354 00:46:50,140 --> 00:46:51,575 THE INTRODUCTION OF OUT OF 1355 00:46:51,575 --> 00:46:54,010 OFFICE MEASUREMENTS HAS PROVIDED 1356 00:46:54,010 --> 00:46:56,413 NEW CLUES ABOUT THE BEHAVIORS IN 1357 00:46:56,413 --> 00:47:04,254 BLOOD PRESSURE AN. 1358 00:47:04,254 --> 00:47:05,989 SO WHAT WE MEAN BY THIS, OF 1359 00:47:05,989 --> 00:47:07,257 COURSE WE NEED TO FOCUS ON 1360 00:47:07,257 --> 00:47:09,159 TREATING THE BLOOD PRESSURE 1361 00:47:09,159 --> 00:47:11,328 LEVEL, BUT DEVICES, OUT OF 1362 00:47:11,328 --> 00:47:13,530 OFFICE DEVICES ALLOW US TO HAVE 1363 00:47:13,530 --> 00:47:19,803 NOVEL PHENOTYPES BACK IN THE END 1364 00:47:19,803 --> 00:47:21,471 OF THE 80s, WHICH BECAUSE OF 1365 00:47:21,471 --> 00:47:23,340 THE 24-HOUR AMBULATORY BLOOD 1366 00:47:23,340 --> 00:47:24,541 PRESSURE MONITORING, WE WERE 1367 00:47:24,541 --> 00:47:27,177 ABLE TO CAPTURE DAY TIME AND 1368 00:47:27,177 --> 00:47:28,678 NIGHTTIME BLOOD PRESSURE AND, 1369 00:47:28,678 --> 00:47:31,081 THEREFORE, WE WERE ABLE TO 1370 00:47:31,081 --> 00:47:33,350 DESCRIBE DIP IN CIRCADIAN 1371 00:47:33,350 --> 00:47:34,751 RHYTHMS IN BLOOD PRESSURE SUCH 1372 00:47:34,751 --> 00:47:36,419 AS NORMAL DIPPING, REVERSE 1373 00:47:36,419 --> 00:47:38,688 DIPPING, OR EXTREME DIPPING. 1374 00:47:38,688 --> 00:47:41,124 SO WE STARTED TO HAVE SOME CLUES 1375 00:47:41,124 --> 00:47:44,928 ABOUT, FOR EXAMPLE, CARDIAC 1376 00:47:44,928 --> 00:47:45,662 RHYTHMS AND BLOOD PRESSURE, BUT 1377 00:47:45,662 --> 00:47:47,530 ALSO WHEN WE COMPARE THE OUT OF 1378 00:47:47,530 --> 00:47:48,365 OFFICE MEASUREMENTS WITH THE 1379 00:47:48,365 --> 00:47:51,701 OFFICE ONES, WE ARE ALSO ABLE TO 1380 00:47:51,701 --> 00:47:53,270 CLASSIFY AND TO GIVE 1381 00:47:53,270 --> 00:47:54,271 CLASSIFICATION OF HYPERTENSION 1382 00:47:54,271 --> 00:47:55,839 SUCH AS MASKED HYPERTEANGS, 1383 00:47:55,839 --> 00:47:58,074 SUSTAINED HYPERTENSION, OR WHITE 1384 00:47:58,074 --> 00:48:00,043 COAT HYPERTENSION, WHICH THIS 1385 00:48:00,043 --> 00:48:01,411 HAS BEEN DISCUSSED YESTERDAY AS 1386 00:48:01,411 --> 00:48:07,550 WELL. 1387 00:48:07,550 --> 00:48:10,387 AND THEN BECAUSE, FOR INSTANCE, 1388 00:48:10,387 --> 00:48:11,321 24 HOUR BLOOD PRESSURE 1389 00:48:11,321 --> 00:48:12,722 MONITORING, WE'RE ABLE TO 1390 00:48:12,722 --> 00:48:14,925 CAPTURE INFORMATION EVERY 15 1391 00:48:14,925 --> 00:48:17,027 MINUTES OR 20 MINUTES OR 30 1392 00:48:17,027 --> 00:48:19,963 MINUTES DURING THE DAY TIME, AND 1393 00:48:19,963 --> 00:48:22,499 30 MINUTES OR EVERY HOUR DURING 1394 00:48:22,499 --> 00:48:23,800 THE NIGHTTIME, SO BECAUSE WE 1395 00:48:23,800 --> 00:48:25,502 STARTED HAVING REPEATED 1396 00:48:25,502 --> 00:48:27,704 MEASUREMENTS, WE WERE ABLE TO 1397 00:48:27,704 --> 00:48:28,438 QUANTIFY VARIABILITY. 1398 00:48:28,438 --> 00:48:31,841 SO THIS IS AN IMPORTANT CONCEPT 1399 00:48:31,841 --> 00:48:32,509 BECAUSE OUR CARDIOVASCULAR 1400 00:48:32,509 --> 00:48:34,744 SYSTEM IS DYNAMIC. 1401 00:48:34,744 --> 00:48:35,912 SO IF I TAKE A BLOOD PRESSURE 1402 00:48:35,912 --> 00:48:37,380 RIGHT NOW AND THEN I TAKE IT 1403 00:48:37,380 --> 00:48:38,081 AGAIN, WE KNOW THERE'S GOING TO 1404 00:48:38,081 --> 00:48:39,149 BE A VARIATION IN BLOOD 1405 00:48:39,149 --> 00:48:39,416 PRESSURE. 1406 00:48:39,416 --> 00:48:40,951 THERE'S A NORMAL VARIATION IN 1407 00:48:40,951 --> 00:48:45,555 BLOOD PRESSURE BUT THEN WITH -- 1408 00:48:45,555 --> 00:48:48,325 OF VARIABILITY, THERE WAS A 1409 00:48:48,325 --> 00:48:49,392 CUMULATIVE EVIDENCE SHOWING THAT 1410 00:48:49,392 --> 00:48:50,427 IN INDIVIDUALS WITH HIGH BLOOD 1411 00:48:50,427 --> 00:48:51,361 PRESSURE VARIABILITY, THEY WERE 1412 00:48:51,361 --> 00:48:54,264 AT THE HIGHER RISK OF TARGET 1413 00:48:54,264 --> 00:48:56,466 ORGAN DAMAGE SUCH AS SMALL 1414 00:48:56,466 --> 00:49:01,104 VESSEL DISEASE, HYPERTROPHY AND 1415 00:49:01,104 --> 00:49:06,042 ALSO MAJOR ADVERSE COMPLICATIONS 1416 00:49:06,042 --> 00:49:08,812 OR HEART ATAKE, HEART FAILURE, 1417 00:49:08,812 --> 00:49:09,913 STROKE. 1418 00:49:09,913 --> 00:49:12,315 SO THE INTRODUCTION OF OTHER OUT 1419 00:49:12,315 --> 00:49:14,484 OF OFFICE MEASUREMENTS, THEY 1420 00:49:14,484 --> 00:49:15,685 ALLOW US TO HAVE A BETTER 1421 00:49:15,685 --> 00:49:18,188 UNDERSTANDING OF THIS CONCEPT OF 1422 00:49:18,188 --> 00:49:19,422 BLOOD PRESSURE RAPIDLY. 1423 00:49:19,422 --> 00:49:23,126 AND WHEN DO WE MEASURE BLOOD 1424 00:49:23,126 --> 00:49:25,729 PRESSURE, WE CAN TAKE BLOOD 1425 00:49:25,729 --> 00:49:26,529 PRESSURE VARIABILITY 1426 00:49:26,529 --> 00:49:27,430 WITHIN SECONDS, MINUTES, WITHIN 1427 00:49:27,430 --> 00:49:29,666 A DAY, WITHIN DAYS, AND THAT'S 1428 00:49:29,666 --> 00:49:33,203 WHAT GIVES US WHETHER WE HAVE 1429 00:49:33,203 --> 00:49:36,706 VERY SHORT-TERM VARIABILITY, 1430 00:49:36,706 --> 00:49:37,173 LONG-TERM VARIABILITY. 1431 00:49:37,173 --> 00:49:39,542 SO I WANTED TO TAKE THE MESSAGE 1432 00:49:39,542 --> 00:49:43,346 THAT THE INTRODUCTION -- ALLOWS 1433 00:49:43,346 --> 00:49:44,781 US TO HAVE A BETTER 1434 00:49:44,781 --> 00:49:45,882 UNDERSTANDING TO IMPROVE THE 1435 00:49:45,882 --> 00:49:52,322 RISK STRATIFICATION. 1436 00:49:52,322 --> 00:49:55,458 THEN UP TO HERE, YOU MIGHT 1437 00:49:55,458 --> 00:49:56,926 ASK -- SO WITH THE CLINIC BLOOD 1438 00:49:56,926 --> 00:49:58,728 PRESSURE, IF WE DID OUT OF 1439 00:49:58,728 --> 00:49:59,929 OFFICE MEASUREMENTS, WE WERE 1440 00:49:59,929 --> 00:50:02,599 ABLE TO IMPROVE THE RISK OF 1441 00:50:02,599 --> 00:50:04,701 STRATIFICATION CARDIOVASCULAR 1442 00:50:04,701 --> 00:50:06,302 COMPLICATION, NEUROLOGIC 1443 00:50:06,302 --> 00:50:07,537 COMPLICATIONS TO CONTROL BLOOD 1444 00:50:07,537 --> 00:50:11,808 PRESSURE, WHY DO WE SE SEARCH FR 1445 00:50:11,808 --> 00:50:12,942 NOVEL DEVICE BASED PHENOTYPES 1446 00:50:12,942 --> 00:50:16,813 AND WHAT DO WE SEARCH IN THAT? 1447 00:50:16,813 --> 00:50:18,715 SO ESSENTIALLY, THIS IS JUST ONE 1448 00:50:18,715 --> 00:50:24,454 FOCUS OF WHY DO WE SEARCH FOR 1449 00:50:24,454 --> 00:50:28,224 NOVEL-BASED DEVICES, THIS IS AN 1450 00:50:28,224 --> 00:50:29,759 EXAMPLE OF WHY THE NEED FOR 1451 00:50:29,759 --> 00:50:31,761 CUFFLESS DEVICES. 1452 00:50:31,761 --> 00:50:35,832 NED THERE WAS AN IMPRESSIVE TALK 1453 00:50:35,832 --> 00:50:37,267 ABOUT THE APPLICABILITY OF THESE 1454 00:50:37,267 --> 00:50:40,437 DEVICES BUT I JUST WANT TO 1455 00:50:40,437 --> 00:50:44,607 EMPHASIZE THAT WITH FOR EXAMPLE 1456 00:50:44,607 --> 00:50:48,244 THE 24 -- THERE ARE LIMITATIONS. 1457 00:50:48,244 --> 00:50:49,546 SO HERE WE HAVE SOMEBODY 1458 00:50:49,546 --> 00:50:50,647 DIAGNOSED WITH HYPERTENSION, 1459 00:50:50,647 --> 00:50:51,181 OLDER ADULT. 1460 00:50:51,181 --> 00:50:52,982 THE TREATMENT OF HYPERCONTROL 1461 00:50:52,982 --> 00:51:00,990 WOULD NOT RELY ON USING JUST ONE 1462 00:51:00,990 --> 00:51:02,358 24 HOUR BLOOD PRESSURE AT THE 1463 00:51:02,358 --> 00:51:02,759 BASELINE. 1464 00:51:02,759 --> 00:51:04,160 THERE'S GOING TO BE CONTINUOUS 1465 00:51:04,160 --> 00:51:05,261 ASSESSMENTS EVERY SIX MONTHS OR 1466 00:51:05,261 --> 00:51:09,432 EVERY YEAR AND -- THIS IS JUST 1467 00:51:09,432 --> 00:51:11,734 TO GIVE AN EXAMPLE OF HOWL 1468 00:51:11,734 --> 00:51:13,236 THESE -- THE LIMITATIONS OF THE 1469 00:51:13,236 --> 00:51:14,404 CURRENT -- THE CUFFED DEVICES 1470 00:51:14,404 --> 00:51:17,373 THAT WE HAVE RIGHT NOW, WHY WE 1471 00:51:17,373 --> 00:51:19,642 NEED A TRANSITION OR WE ARE 1472 00:51:19,642 --> 00:51:23,046 LOOKING INTO TRANSITION. 1473 00:51:23,046 --> 00:51:27,150 THERE'S ALSO TOLERABILITY, TIME 1474 00:51:27,150 --> 00:51:29,586 TO ACQUIRE MEASUREMENT, AND 1475 00:51:29,586 --> 00:51:31,087 AVAILABILITY OF CUFF SIZE WHICH 1476 00:51:31,087 --> 00:51:32,088 WAS ALSO WELL DESCRIBED 1477 00:51:32,088 --> 00:51:32,622 YESTERDAY. 1478 00:51:32,622 --> 00:51:38,027 SO THE NEED FOR TRANSITION LOOK 1479 00:51:38,027 --> 00:51:39,028 INTO CONTINUED MEASUREMENTS 1480 00:51:39,028 --> 00:51:40,763 WHICH I'M GOING TO TALK A LITTLE 1481 00:51:40,763 --> 00:51:44,934 BIT MORE LATER, IMPROVE COMFORT, 1482 00:51:44,934 --> 00:51:48,938 COMFORT AND COMPLIANCE, 1483 00:51:48,938 --> 00:51:50,673 INTEGRATION -- LARGER SCALE USE. 1484 00:51:50,673 --> 00:51:53,243 IMAGINE THAT WE HAVE 24-HOUR 1485 00:51:53,243 --> 00:51:54,010 MONITORING BLOOD PRESSURE THAT 1486 00:51:54,010 --> 00:51:55,745 WE WANT TO APPLY AT THE 1487 00:51:55,745 --> 00:51:56,646 POPULATION LEVEL TO EVERYONE. 1488 00:51:56,646 --> 00:51:58,047 THAT'S NOT GOING TO BE FEASIBLE 1489 00:51:58,047 --> 00:51:59,716 OR COMPARED TO, FOR EXAMPLE, 1490 00:51:59,716 --> 00:52:02,452 THERE IS A SMART WATCH, A 1491 00:52:02,452 --> 00:52:03,653 CUFFLESS DEVICE THAT CAN DO 1492 00:52:03,653 --> 00:52:07,223 THIS, COMPARED TO THAT, THE 1493 00:52:07,223 --> 00:52:13,530 LARGEST -- IS GOING TO BE -- 1494 00:52:13,530 --> 00:52:20,870 EARLIER -- WHICH WILL RESULT IN 1495 00:52:20,870 --> 00:52:22,105 BETTER -- SO THIS WAS DISCUSSED 1496 00:52:22,105 --> 00:52:23,806 YESTERDAY, I'M GOING TO TALK A 1497 00:52:23,806 --> 00:52:25,008 LOT ABOUT THIS. 1498 00:52:25,008 --> 00:52:26,276 IT JUST TO MENTION THAT ALTHOUGH 1499 00:52:26,276 --> 00:52:30,046 THIS IS WHERE WE ARE 1500 00:52:30,046 --> 00:52:33,783 TRANSITIONING, WE NOW KNOW THE 1501 00:52:33,783 --> 00:52:36,953 OSCILLOMETRIC DEVICES IN CLINIC, 1502 00:52:36,953 --> 00:52:39,055 THE ONES THAT ARE VALIDATED FOR 1503 00:52:39,055 --> 00:52:41,024 CLINICAL USAGE, MEANING THAT THE 1504 00:52:41,024 --> 00:52:41,891 BLOOD PRESSURE INFORMATION WE 1505 00:52:41,891 --> 00:52:43,126 GET OUT OF THESE IS THE ONE THAT 1506 00:52:43,126 --> 00:52:46,329 WE CAN USE FOR MAKING DECISIONS 1507 00:52:46,329 --> 00:52:48,264 BUT AS YOU CAN SEE HERE, THERE 1508 00:52:48,264 --> 00:52:50,300 ARE OTHER TYPE OF DEVICES SUCH 1509 00:52:50,300 --> 00:52:59,776 AS FINGER CUFF, 1510 00:52:59,776 --> 00:53:00,376 PHOTOPLETHYSMGRAPHY, LET'S SEE 1511 00:53:00,376 --> 00:53:01,511 WHERE WE'RE GOING TO GO BUT 1512 00:53:01,511 --> 00:53:02,745 PROVIDE THAT THESE DEVICES CAN 1513 00:53:02,745 --> 00:53:06,316 MAKE SURE OR GET AS ACCURATE AS 1514 00:53:06,316 --> 00:53:07,050 POSSIBLE BLOOD PRESSURE 1515 00:53:07,050 --> 00:53:08,117 READINGS, WE'RE GOING TO BE ABLE 1516 00:53:08,117 --> 00:53:10,186 TO GET NOVEL PHENOTYPES AND 1517 00:53:10,186 --> 00:53:11,187 THAT'S IN THE NEXT SLIDE, 1518 00:53:11,187 --> 00:53:11,621 PLEASE. 1519 00:53:11,621 --> 00:53:17,894 SO WHAT DO WE SEARCH WITH THESE 1520 00:53:17,894 --> 00:53:18,861 DEVICES, NOT ONLY DEVICES BUT 1521 00:53:18,861 --> 00:53:19,796 THE PHENOTYPES. 1522 00:53:19,796 --> 00:53:24,601 SO THE IDENTIFICATION OF NOVEL 1523 00:53:24,601 --> 00:53:25,735 BLOOD PRESSURE TRAITS OR 1524 00:53:25,735 --> 00:53:28,037 PHENOTYPES, I BELIEVE WE'LL HAVE 1525 00:53:28,037 --> 00:53:28,371 THREE ASPECTS. 1526 00:53:28,371 --> 00:53:30,440 BLOOD PRESSURE LEVEL, OF COURSE, 1527 00:53:30,440 --> 00:53:31,808 VARIABILITY, AND MULTISENSORS. 1528 00:53:31,808 --> 00:53:33,576 I'M GOING TO GET THERE TOO. 1529 00:53:33,576 --> 00:53:34,744 WHAT I MEAN BY THAT. 1530 00:53:34,744 --> 00:53:38,114 SO BLOOD PRESSURE LEVEL OVER 1531 00:53:38,114 --> 00:53:39,382 TIME, BECAUSE GUIDELINES OR 1532 00:53:39,382 --> 00:53:40,817 CLINICAL DECISIONS ARE STILL 1533 00:53:40,817 --> 00:53:41,918 BASED ON THE MEAN BLOOD 1534 00:53:41,918 --> 00:53:43,186 PRESSURE, THE AVERAGE BLOOD 1535 00:53:43,186 --> 00:53:43,987 PRESSURE OF THE BLOOD PRESSURE 1536 00:53:43,987 --> 00:53:45,221 MEASUREMENTS THAT WE CAPTURE. 1537 00:53:45,221 --> 00:53:48,391 SO IF WE HAVE AN INCREASED 1538 00:53:48,391 --> 00:53:49,959 NUMBER OF READINGS THAT WE ARE 1539 00:53:49,959 --> 00:53:52,061 RECORDING, THE ACCURACY OF WHAT 1540 00:53:52,061 --> 00:53:53,363 THAT PERSON'S TRUE BLOOD 1541 00:53:53,363 --> 00:53:55,064 PRESSURE IS, IS GOING TO BE 1542 00:53:55,064 --> 00:53:56,933 HIGHER, SO THE DEVICES ARE GOING 1543 00:53:56,933 --> 00:54:01,004 TO BE ABLE TO GIVE US MORE 1544 00:54:01,004 --> 00:54:03,506 INFORMATION ABOUT THE 1545 00:54:03,506 --> 00:54:04,073 INDIVIDUAL'S BLOOD PRESSURE 1546 00:54:04,073 --> 00:54:04,841 LEVEL, WHICH IS THE ONE WE'RE 1547 00:54:04,841 --> 00:54:07,710 STILL USING FOR COMMON USE. 1548 00:54:07,710 --> 00:54:09,779 I WROTE HERE, NOVEL RISK FACTOR. 1549 00:54:09,779 --> 00:54:12,115 IT DOESN'T MEAN IT NO THE A RISK 1550 00:54:12,115 --> 00:54:13,583 FACTOR BECAUSE WE KNOW THAT FOR 1551 00:54:13,583 --> 00:54:16,185 DECADE, PROBABLY AROUND FIVE 1552 00:54:16,185 --> 00:54:18,554 DECADES, BLOOD PRESSURE 1553 00:54:18,554 --> 00:54:19,222 VARIABILITY HAS BEEN ASSOCIATED 1554 00:54:19,222 --> 00:54:21,457 WITH TARGET ORGAN DAMAGE, 1555 00:54:21,457 --> 00:54:21,991 CARDIOVASCULAR EVENTS AND 1556 00:54:21,991 --> 00:54:23,593 MORTALITY. 1557 00:54:23,593 --> 00:54:25,094 BUT WHAT I MEANT HERE IS THAT 1558 00:54:25,094 --> 00:54:26,596 FOR CERTAIN CONDITIONS SUCH AS 1559 00:54:26,596 --> 00:54:28,464 ALZHEIMER'S DISEASE RELATED 1560 00:54:28,464 --> 00:54:32,135 DISORDERS, COGNITIVE IMPAIRMENT 1561 00:54:32,135 --> 00:54:34,270 OR SMALL VESSEL DISEASE, WHICH 1562 00:54:34,270 --> 00:54:35,905 WAS DISCUSSED YESTERDAY, FOR 1563 00:54:35,905 --> 00:54:40,510 THESE CONDITIONS, IT SEEMS THAT 1564 00:54:40,510 --> 00:54:41,244 VARIABILITY IN BLOOD PRESSURE OR 1565 00:54:41,244 --> 00:54:42,679 VARIABILITY IN OUR 1566 00:54:42,679 --> 00:54:45,982 CARDIOVASCULAR SYSTEM MIGHT BE 1567 00:54:45,982 --> 00:54:47,817 AN IMPORTANT OR MORE IMPORTANT 1568 00:54:47,817 --> 00:54:48,685 RISK FACTOR COMPARED TO THE 1569 00:54:48,685 --> 00:54:49,852 BLOOD PRESSURE LEVEL FOR THESE 1570 00:54:49,852 --> 00:54:50,320 CONDITIONS. 1571 00:54:50,320 --> 00:54:53,823 ONE EXAMPLE WHICH WAS DISCUSSED 1572 00:54:53,823 --> 00:54:55,425 YESTERDAY FOR SMALL VESSEL 1573 00:54:55,425 --> 00:55:00,463 DISEASE AS THE BRAIN -- THESE 1574 00:55:00,463 --> 00:55:02,832 AREAS ARE MORE SUSCEPTIBLE TO 1575 00:55:02,832 --> 00:55:03,499 DRASTIC CHANGES IN BLOOD 1576 00:55:03,499 --> 00:55:04,467 PRESSURE. 1577 00:55:04,467 --> 00:55:07,003 SO IN ALSO INDIVIDUALS WITH 1578 00:55:07,003 --> 00:55:08,905 ARIZONA DISEASE AND RELATED 1579 00:55:08,905 --> 00:55:10,840 DISORDERS, THE PROBABILITY OF 1580 00:55:10,840 --> 00:55:12,508 THE BRAIN TO MAINTAIN CONSTANT 1581 00:55:12,508 --> 00:55:14,711 BLOOD FLOW IS IMPAIRED, SO IF 1582 00:55:14,711 --> 00:55:17,914 THAT INDIVIDUAL FACES BLOOD 1583 00:55:17,914 --> 00:55:19,215 PRESSURE, THEN WE MIGHT BE AT 1584 00:55:19,215 --> 00:55:21,517 HIGHER RISK OF PROGRESSION OF 1585 00:55:21,517 --> 00:55:22,418 THE SPECIFIC DISEASE. 1586 00:55:22,418 --> 00:55:27,724 SO FOR CERTAIN CONDITIONS -- 1587 00:55:27,724 --> 00:55:31,227 NOVEL RISK FACTORS, AND WE KNOW 1588 00:55:31,227 --> 00:55:32,261 FOR BLOOD PRESSURE VARIABILITY, 1589 00:55:32,261 --> 00:55:37,233 IN ORDER TO CAPTURE ENOUGH 1590 00:55:37,233 --> 00:55:39,802 INFORMATION SO VARIABILITY AS A 1591 00:55:39,802 --> 00:55:42,138 PHENOTYPE HAS SUFFICIENT 1592 00:55:42,138 --> 00:55:43,039 DIAGNOSTIC INFORMATION, WE NEED 1593 00:55:43,039 --> 00:55:45,108 TO HAVE AN ADEQUATE NUMBER OF 1594 00:55:45,108 --> 00:55:45,441 READINGS. 1595 00:55:45,441 --> 00:55:49,445 AND THAT HAPPENS FOR 24 HOUR 1596 00:55:49,445 --> 00:55:50,747 BLOOD PRESSURE IF WE HAVE ENOUGH 1597 00:55:50,747 --> 00:55:52,248 READINGS, THE VARIABILITY WE CAN 1598 00:55:52,248 --> 00:55:53,349 QUANTIFY OUT OF THAT APPROACH IS 1599 00:55:53,349 --> 00:55:55,284 NOT GOING TO BE SUFFICIENT TO 1600 00:55:55,284 --> 00:55:56,786 REACH A STATISTICAL 1601 00:55:56,786 --> 00:55:57,120 SIGNIFICANCE. 1602 00:55:57,120 --> 00:56:00,390 SO THIS CONCEPT OF THE NUMBER OF 1603 00:56:00,390 --> 00:56:02,058 RINGS THAT WE NEED TO CAPTURE 1604 00:56:02,058 --> 00:56:03,192 VARIABILITY WILL BE SIMILAR AS 1605 00:56:03,192 --> 00:56:04,961 WHEN WE DO STATUS IN WHICH WE 1606 00:56:04,961 --> 00:56:07,764 NEED TO CALCULATE THE SIMPLE -- 1607 00:56:07,764 --> 00:56:09,031 SO WE NEED TO HAVE A CERTAIN 1608 00:56:09,031 --> 00:56:11,567 NUMBER OF READINGS SO WE CAPTURE 1609 00:56:11,567 --> 00:56:15,004 ENOUGH INFORMATION FOR US TO 1610 00:56:15,004 --> 00:56:16,639 FIND SIGNIFICANT -- BUT I WANT 1611 00:56:16,639 --> 00:56:19,542 TO SAY JUST TO CAPTURE ENOUGH OF 1612 00:56:19,542 --> 00:56:20,843 THE -- OF THAT INDIVIDUAL. 1613 00:56:20,843 --> 00:56:23,880 THERE ARE CONDITIONS AS WELL 1614 00:56:23,880 --> 00:56:26,315 HERE IN WHICH 24 HOUR BLOOD 1615 00:56:26,315 --> 00:56:28,284 PRESSURE MONITORING HAS BEEN 1616 00:56:28,284 --> 00:56:29,952 ASSOCIATED WITH THE 1617 00:56:29,952 --> 00:56:37,560 QUANTIFICATION OF VARIABILITY, 1618 00:56:37,560 --> 00:56:39,796 AND THEN THE SENSORS. 1619 00:56:39,796 --> 00:56:44,667 IT WAS VERY WELL DISCUSSED FOR 1620 00:56:44,667 --> 00:56:45,501 EXAMPLE IN THE ENVIRONMENT. 1621 00:56:45,501 --> 00:56:48,838 I AM FROM VENEZUELA, MOST OF THE 1622 00:56:48,838 --> 00:56:51,307 WORLD, WE KNOW THERE'S WINTER, 1623 00:56:51,307 --> 00:56:52,175 THERE'S SUMMERTIME, AND THERE 1624 00:56:52,175 --> 00:56:53,843 ARE VARIATIONS IN THE BLOOD 1625 00:56:53,843 --> 00:56:56,612 PRESSURE RELATED TO THE SEASONAL 1626 00:56:56,612 --> 00:56:57,847 CHANGES AND THE DEVICES THAT ARE 1627 00:56:57,847 --> 00:57:00,516 GOING TO BE ABLE TO CAPTURE 1628 00:57:00,516 --> 00:57:03,386 AROUND TEMPERATURE, WE JUST DUSH 1629 00:57:03,386 --> 00:57:04,287 THAT'S GOING TO PROVIDE 1630 00:57:04,287 --> 00:57:06,556 INFORMATION FOR US TO DETERMINE 1631 00:57:06,556 --> 00:57:07,156 THAT BLOOD PRESSURE CHANGES 1632 00:57:07,156 --> 00:57:10,092 MIGHT BE RELATED NOT TO THE 1633 00:57:10,092 --> 00:57:11,060 UNDERLYING DISEASE BUT TO THE 1634 00:57:11,060 --> 00:57:16,532 ENVIRONMENTAL FACTORS. 1635 00:57:16,532 --> 00:57:22,472 THE OW POTENTIAL ADVANCEMENTS IN 1636 00:57:22,472 --> 00:57:23,005 DEVICE-BASED PHENOTYPES. 1637 00:57:23,005 --> 00:57:23,906 IT WAS MENTIONED YESTERDAY AS 1638 00:57:23,906 --> 00:57:24,340 WELL. 1639 00:57:24,340 --> 00:57:25,374 WHAT ARE WE GOING TO DO IF WE 1640 00:57:25,374 --> 00:57:27,143 HAVE A DEVICE THAT CONTINUOUSLY 1641 00:57:27,143 --> 00:57:30,246 MEASURES BLOOD PRESSURE FOR -- 1642 00:57:30,246 --> 00:57:31,781 CONTINUOUSLY, EVERY MINUTE, FOR 1643 00:57:31,781 --> 00:57:35,251 24 HOURS, FOR 7 DAYS, FOR 1644 00:57:35,251 --> 00:57:37,820 365 DAYS, HOW CAN WE ANALYZE 1645 00:57:37,820 --> 00:57:39,088 THAT INFORMATION, WHAT WE'RE 1646 00:57:39,088 --> 00:57:40,323 GOING TO DO WITH THAT AMOUNT OF 1647 00:57:40,323 --> 00:57:40,823 INFORMATION? 1648 00:57:40,823 --> 00:57:43,125 I DON'T THINK WE CAN EXPECT 1649 00:57:43,125 --> 00:57:44,894 THAT, FOR EXAMPLE, WE CONTINUE 1650 00:57:44,894 --> 00:57:47,997 USING THE CONVENTIONAL METRICS 1651 00:57:47,997 --> 00:57:49,866 OF AVERAGING OR THE MEAN BLOOD 1652 00:57:49,866 --> 00:57:51,501 PRESSURE OR CALCULATING 1653 00:57:51,501 --> 00:57:53,302 VARIABILITY AS A STANDARD 1654 00:57:53,302 --> 00:57:54,604 DEVIATION OR AVERAGE 1655 00:57:54,604 --> 00:57:56,205 VARIABILITY, BECAUSE IT'S A HUGE 1656 00:57:56,205 --> 00:57:57,340 AMOUNT OF DATA. 1657 00:57:57,340 --> 00:57:59,876 IT'S COMPLEX DATA, THE COMPLEX 1658 00:57:59,876 --> 00:58:02,445 DYNAMIC SYSTEM, BUT STILL THE 1659 00:58:02,445 --> 00:58:04,413 DEVICES ARE GOING TO BE ABLE TO 1660 00:58:04,413 --> 00:58:06,215 CAPTURE THIS INFORMATION AND, 1661 00:58:06,215 --> 00:58:08,317 FOR EXAMPLE, HELP US UNDERSTAND 1662 00:58:08,317 --> 00:58:09,952 WHETHER THERE ARE BEHAVIORS IN 1663 00:58:09,952 --> 00:58:11,153 BLOOD PRESSURE AND ONE WAY TO DO 1664 00:58:11,153 --> 00:58:13,523 IT IS TO, FOR EXAMPLE, CLUSTER 1665 00:58:13,523 --> 00:58:13,956 ANALYSIS. 1666 00:58:13,956 --> 00:58:17,793 SO HERE -- WHEN WE TALK ABOUT 1667 00:58:17,793 --> 00:58:18,494 STUDIES ASSESSING BLOOD 1668 00:58:18,494 --> 00:58:19,829 PRESSURE, THIS IS A 1669 00:58:19,829 --> 00:58:20,696 MULTIDISCIPLINARY EFFORT, 1670 00:58:20,696 --> 00:58:22,899 MEANING THAT WE NEED DIFFERENT 1671 00:58:22,899 --> 00:58:24,200 APPROACHES FOR DIFFERENT 1672 00:58:24,200 --> 00:58:26,702 SCIENCES IN ORDER TO -- WHETHER 1673 00:58:26,702 --> 00:58:28,204 WE CAN BRING THESE APPROACHES TO 1674 00:58:28,204 --> 00:58:32,675 APPLY TO THIS DATA THAT WE HAVE. 1675 00:58:32,675 --> 00:58:35,278 OFFICE BLOOD PRESSURE COMPARED 1676 00:58:35,278 --> 00:58:37,013 TO WHAT THE DEVICES CAN MEASURE 1677 00:58:37,013 --> 00:58:39,115 THE TYPE OF DATA CONTINUOUSLY 1678 00:58:39,115 --> 00:58:40,683 DOES NOT PROVIDE THAT 1679 00:58:40,683 --> 00:58:42,184 OPPORTUNITY, BUT IF WE GET 1680 00:58:42,184 --> 00:58:43,753 THERE, WE'RE GOING TO BE ABLE -- 1681 00:58:43,753 --> 00:58:45,087 AND HERE THIS IS SOME WORK WE'VE 1682 00:58:45,087 --> 00:58:48,257 BEEN DOING WHICH THE 24-HOUR 1683 00:58:48,257 --> 00:58:50,993 BLOOD PRESSURE DATA, WE'RE 1684 00:58:50,993 --> 00:58:52,695 ANALYZING THAT INFORMATION AS A 1685 00:58:52,695 --> 00:58:53,563 TIME SERIES DATA. 1686 00:58:53,563 --> 00:58:57,199 SO BECAUSE WE DO SO, WE'RE ABLE 1687 00:58:57,199 --> 00:58:58,401 TO GENERATE SOME CLUSTERS OF 1688 00:58:58,401 --> 00:59:00,269 INDIVIDUALS WHO MIGHT HAVE THE 1689 00:59:00,269 --> 00:59:02,004 SPECIFIC BEHAVIOR IN THEIR BLOOD 1690 00:59:02,004 --> 00:59:02,638 PRESSURE, IN THE GRAPHIC THAT 1691 00:59:02,638 --> 00:59:04,607 YOU CAN SEE ON YOUR RIGHT SIDE, 1692 00:59:04,607 --> 00:59:07,076 AND MAYBE FOR CERTAIN CONDITIONS 1693 00:59:07,076 --> 00:59:10,179 SUCH AS ALZHEIMER'S DISEASE, THE 1694 00:59:10,179 --> 00:59:11,314 COMPLEXITY OF THE CARDIOVASCULAR 1695 00:59:11,314 --> 00:59:14,584 SYSTEM WILL RESULT IN A 1696 00:59:14,584 --> 00:59:15,585 DIFFERENT PATTERN, A DIFFERENT 1697 00:59:15,585 --> 00:59:17,119 BEHAVIOR, AND THAT'S ANOTHER 1698 00:59:17,119 --> 00:59:17,787 PHENOTYPE. 1699 00:59:17,787 --> 00:59:19,055 THE PROBLEM IS GOING TO BE 1700 00:59:19,055 --> 00:59:21,390 ANOTHER PHENOTYPE THAT DOES NOT 1701 00:59:21,390 --> 00:59:24,126 ONLY INVOLVE VARIABILITY 1702 00:59:24,126 --> 00:59:25,261 CAPTURING BY A STANDARD 1703 00:59:25,261 --> 00:59:25,761 DEVIATION. 1704 00:59:25,761 --> 00:59:26,762 UNFORTUNATELY THE DEVICES WE 1705 00:59:26,762 --> 00:59:28,331 HAVE RIGHT NOW, WE CANNOT REALLY 1706 00:59:28,331 --> 00:59:32,268 EXPLOIT THAT, BUT I BELIEVE ONCE 1707 00:59:32,268 --> 00:59:34,036 NO DEVICES CAN ACCURATELY 1708 00:59:34,036 --> 00:59:34,737 MEASURE BLOOD PRESSURE, WE'RE 1709 00:59:34,737 --> 00:59:37,106 GOING TO BE ABLE TO GET THERE. 1710 00:59:37,106 --> 00:59:40,443 WE'RE GOING TO BE ABLE TO OFTEN 1711 00:59:40,443 --> 00:59:41,544 IMPROVE A.I. AND MACHINE 1712 00:59:41,544 --> 00:59:43,212 LEARNING MODELS BECAUSE WE KNOW 1713 00:59:43,212 --> 00:59:44,580 ESSENTIALLY MACHINE LEARNING 1714 00:59:44,580 --> 00:59:47,249 MODELS, ONCE WE INCLUDE HUGE 1715 00:59:47,249 --> 00:59:48,584 AMOUNTS OF DATA, IT'S GOING TO 1716 00:59:48,584 --> 00:59:50,186 IMPROVE THE RISK STRATIFICATION 1717 00:59:50,186 --> 00:59:50,987 OF CONDITIONS. 1718 00:59:50,987 --> 00:59:52,955 SO BY INCLUDING CONTINUOUS BLOOD 1719 00:59:52,955 --> 00:59:54,857 PRESSURE READINGS AND ALSO 1720 00:59:54,857 --> 00:59:55,958 CAPTURING OTHER TYPE OF 1721 00:59:55,958 --> 00:59:58,995 INFORMATION, WE'RE GOING TO 1722 00:59:58,995 --> 01:00:03,599 PROVE THE -- MACHINE LEARNING 1723 01:00:03,599 --> 01:00:05,201 MODELS THAT WILL RESULT IN 1724 01:00:05,201 --> 01:00:06,702 BETTER STRATIFICATION OF 1725 01:00:06,702 --> 01:00:08,404 INDIVIDUALS' RISK. 1726 01:00:08,404 --> 01:00:10,206 AND I'VE BEEN TALKING ABOUT 1727 01:00:10,206 --> 01:00:12,408 BLOOD PRESSURE, BUT THESE 1728 01:00:12,408 --> 01:00:15,111 DEVICES ARE ALSO ABLE TO CAPTURE 1729 01:00:15,111 --> 01:00:15,511 HEART RATE. 1730 01:00:15,511 --> 01:00:18,648 SO THERE'S A NOVEL OR IT BEEN 1731 01:00:18,648 --> 01:00:21,884 RECENTLY INVESTIGATED HEART RATE 1732 01:00:21,884 --> 01:00:23,185 VARIABILITY AS A NOVEL RISK 1733 01:00:23,185 --> 01:00:25,488 FACTOR FOR, FOR EXAMPLE, 1734 01:00:25,488 --> 01:00:26,622 CARDIOVASCULAR EVENTS, BUT ALSO 1735 01:00:26,622 --> 01:00:31,560 I HAVE HERE GRAPHICS FOR SMALL 1736 01:00:31,560 --> 01:00:32,128 VESSEL DISEASE. 1737 01:00:32,128 --> 01:00:37,500 SO THERE'S A HARD READ AND 1738 01:00:37,500 --> 01:00:38,567 THEN -- YOU FOLLOW THE HEARTBEAT 1739 01:00:38,567 --> 01:00:42,304 AND IT HAS A EMTEMPO. 1740 01:00:42,304 --> 01:00:42,538 TEMPO. 1741 01:00:42,538 --> 01:00:43,673 THE DISTANCE BETWEEN THE TWO, IT 1742 01:00:43,673 --> 01:00:45,207 HAS A RHYTHM, SO THERE ARE 1743 01:00:45,207 --> 01:00:46,575 CERTAIN ASPECTS OF VARIABILITY 1744 01:00:46,575 --> 01:00:49,779 IN WHICH THE TEMPO OR THE BEAT 1745 01:00:49,779 --> 01:00:51,347 BETWEEN THE TWO IS SHORTER AND 1746 01:00:51,347 --> 01:00:52,815 IS IRREGULAR, AS WE CAN SEE IN 1747 01:00:52,815 --> 01:00:53,616 THIS FIGURE. 1748 01:00:53,616 --> 01:00:56,018 SO REDUCED HEART RATE 1749 01:00:56,018 --> 01:00:56,886 VARIABILITY HAS BEEN NECESSARY 1750 01:00:56,886 --> 01:00:58,087 WITH THESE CONDITIONS BECAUSE IT 1751 01:00:58,087 --> 01:00:59,255 ALLOWS US TO CAPTURE THAT 1752 01:00:59,255 --> 01:00:59,689 INFORMATION. 1753 01:00:59,689 --> 01:01:03,492 AND HERE I STRIKED THROUGH 1754 01:01:03,492 --> 01:01:05,895 ESTIMATES BECAUSE COMPARED TO 1755 01:01:05,895 --> 01:01:07,596 WHAT NOVEL DEVICES CAN DO WITH 1756 01:01:07,596 --> 01:01:08,931 BLOOD PRESSURE, I PUT HERE 1757 01:01:08,931 --> 01:01:13,969 MEASURES HEART RATE, COMPARED TO 1758 01:01:13,969 --> 01:01:15,304 BLOOD PRESSURE, IT GIVES US MORE 1759 01:01:15,304 --> 01:01:16,338 ACCURATE INFORMATION ABOUT HEART 1760 01:01:16,338 --> 01:01:19,642 RATES WHICH WE CAN THEN ANALYZE 1761 01:01:19,642 --> 01:01:20,509 HEART RATE VARIABILITY. 1762 01:01:20,509 --> 01:01:22,178 AND THIS WILL ALSO GIVE US AN 1763 01:01:22,178 --> 01:01:24,480 OPPORTUNITY TO UNDERSTAND THE 1764 01:01:24,480 --> 01:01:26,816 DYNAMIC CONFLICTS AND FOSTER 1765 01:01:26,816 --> 01:01:28,417 BEHAVIORS WITH HIGH RATE 1766 01:01:28,417 --> 01:01:29,752 VARIABILITY OR HEART RATE BASED 1767 01:01:29,752 --> 01:01:30,886 ON THIS AMOUNT OF DATA THAT 1768 01:01:30,886 --> 01:01:31,687 WE'RE GOING TO BE ABLE TO 1769 01:01:31,687 --> 01:01:38,828 COLLECT. 1770 01:01:38,828 --> 01:01:39,695 SO SOCIAL DETERMINANTS OF 1771 01:01:39,695 --> 01:01:40,396 HEALTH. 1772 01:01:40,396 --> 01:01:42,031 I DIDN'T INCLUDE THIS SLIDE 1773 01:01:42,031 --> 01:01:42,765 BECAUSE I WANTED TO TALK ABOUT 1774 01:01:42,765 --> 01:01:43,699 SOCIAL DETERMINANTS OF HEALTH. 1775 01:01:43,699 --> 01:01:45,334 IT BECAUSE WE KNOW SOCIAL 1776 01:01:45,334 --> 01:01:46,502 DETERMINANTS OF HEALTH 1777 01:01:46,502 --> 01:01:47,503 INFLUENCES DIAGNOSIS, TREATMENT 1778 01:01:47,503 --> 01:01:48,270 AND CONTROL OF BLOOD PRESSURE. 1779 01:01:48,270 --> 01:01:52,007 AND I BELIEVE THAT THIS HAS FOR 1780 01:01:52,007 --> 01:01:53,476 HEALTH EQUITY, THE DEVICES ARE 1781 01:01:53,476 --> 01:01:55,077 GOING TO PLAY AN IMPORTANT PART 1782 01:01:55,077 --> 01:01:59,615 IN FILLING THAT ALSO, BECAUSE WE 1783 01:01:59,615 --> 01:02:01,050 TALKED BEFORE, IT WAS DISCUSSED 1784 01:02:01,050 --> 01:02:02,418 IN ENVIRONMENTAL FACTORS, BUT 1785 01:02:02,418 --> 01:02:04,453 ALSO THEY ARE GOING TO BE ABLE 1786 01:02:04,453 --> 01:02:10,860 TO CAPTURE PSYCHOLOGICAL STRESS 1787 01:02:10,860 --> 01:02:11,093 FACTORS. 1788 01:02:11,093 --> 01:02:13,429 AND JUST IMAGINE THAT 1789 01:02:13,429 --> 01:02:14,797 UNDERSERVED POPULATION FOR 1790 01:02:14,797 --> 01:02:16,165 EXAMPLE, HISPANICS, AND WE ARE 1791 01:02:16,165 --> 01:02:22,338 THE HIGHER RISK OF ALZHEIMER'S 1792 01:02:22,338 --> 01:02:23,105 DISEASE, IN THE PRESENCE OF 1793 01:02:23,105 --> 01:02:24,874 ADVERSE OUTCOMES IN LIKE WHICH 1794 01:02:24,874 --> 01:02:28,477 WE HAVE HOUSING INSECURITY, WE 1795 01:02:28,477 --> 01:02:30,813 HAVE TRANSPORTATION OR -- HOW 1796 01:02:30,813 --> 01:02:32,081 CAN YOU EXPECT THESE DEVICES 1797 01:02:32,081 --> 01:02:32,948 WILL PERFORM THERE? 1798 01:02:32,948 --> 01:02:34,183 BUT ALSO THEY WERE ABLE TO 1799 01:02:34,183 --> 01:02:35,551 CAPTURE THAT ENVIRONMENTAL 1800 01:02:35,551 --> 01:02:36,452 PSYCHOLOGICAL INFORMATION THAT 1801 01:02:36,452 --> 01:02:40,489 PROBABLY IS GOING TO HELP HOW -- 1802 01:02:40,489 --> 01:02:43,092 IN TERMS OF CONTROL, TREATMENT, 1803 01:02:43,092 --> 01:02:44,160 HOW ARE YOU GOING TO MEASURE 1804 01:02:44,160 --> 01:02:44,860 THAT INFORMATION SO THEY'RE 1805 01:02:44,860 --> 01:02:46,362 GOING TO PLAY A KEY PART HERE, 1806 01:02:46,362 --> 01:02:47,429 AND WE ALSO NEED TO CONSIDER 1807 01:02:47,429 --> 01:02:49,932 THAT WHEN IT COMES TO 1808 01:02:49,932 --> 01:02:51,600 VALIDATION, ACCESS, EDUCATION 1809 01:02:51,600 --> 01:02:53,102 AND POLICIES WHEN WE HAVE THESE 1810 01:02:53,102 --> 01:02:53,836 DEVICES. 1811 01:02:53,836 --> 01:02:55,437 JUST REMINDING THAT THE MORE WE 1812 01:02:55,437 --> 01:02:57,339 HAVE THE SMART WATCH THAT 1813 01:02:57,339 --> 01:02:57,873 MEASURES BLOOD PRESSURE 1814 01:02:57,873 --> 01:03:00,776 CONTINUOUSLY. 1815 01:03:00,776 --> 01:03:02,411 THE FASTER WE'RE GOING TO BE 1816 01:03:02,411 --> 01:03:03,913 ABLE TO ADDRESS EQUITY THAT 1817 01:03:03,913 --> 01:03:06,448 EVERYONE IS GOING TO ACCESS 1818 01:03:06,448 --> 01:03:07,416 THESE DEVICES, SO THAT'S 1819 01:03:07,416 --> 01:03:08,851 SOMETHING THAT WE ALSO NEED TO 1820 01:03:08,851 --> 01:03:09,685 THINK ABOUT. 1821 01:03:09,685 --> 01:03:11,987 BUT PROVIDED THAT IT DOES, WE'RE 1822 01:03:11,987 --> 01:03:13,022 GOING TO HAVE INFORMATION WE 1823 01:03:13,022 --> 01:03:17,393 NEED TO DIFFERENTIATE 1824 01:03:17,393 --> 01:03:18,694 VARIABILITY DUE TO UNDERLYING 1825 01:03:18,694 --> 01:03:19,929 DISEASE BUT ALSO TO 1826 01:03:19,929 --> 01:03:21,330 ENVIRONMENTAL AND PSYCHOLOGICAL 1827 01:03:21,330 --> 01:03:23,165 FACTORS. 1828 01:03:23,165 --> 01:03:24,834 SO IN CONCLUSION, NOVEL DEVICES 1829 01:03:24,834 --> 01:03:26,802 ARE PROVIDING A UNIQUE 1830 01:03:26,802 --> 01:03:30,639 OPPORTUNITY TO STUDY NOVEL 1831 01:03:30,639 --> 01:03:32,341 PHENOTYPES OF THE VASCULAR 1832 01:03:32,341 --> 01:03:33,976 SYSTEM DYSREGULATION SUCH AS 1833 01:03:33,976 --> 01:03:34,710 BLOOD PRESSURE VARIABILITY, 1834 01:03:34,710 --> 01:03:36,412 HEART RATE, VARIABILITY AND 1835 01:03:36,412 --> 01:03:42,218 CIRCADIAN RHYTHMS. 1836 01:03:42,218 --> 01:03:43,853 AND THE KEY GAPS -- THE PREVIOUS 1837 01:03:43,853 --> 01:03:44,553 ONE, PLEASE? 1838 01:03:44,553 --> 01:03:47,556 SO THE KEY GAPS IS THAT 1839 01:03:47,556 --> 01:03:49,191 VALIDATION OF CUFFLESS DEVICES 1840 01:03:49,191 --> 01:03:50,960 OR DEVICES, WE NEED TO CONSIDER 1841 01:03:50,960 --> 01:03:52,695 THAT THERE ARE DIFFERENT 1842 01:03:52,695 --> 01:03:53,529 SETTINGS AND GROUPS. 1843 01:03:53,529 --> 01:03:56,599 WE CANNOT EXPECT THAT HOW THE 1844 01:03:56,599 --> 01:03:58,400 DEVICE WILL PERFORM IN A WELL 1845 01:03:58,400 --> 01:04:01,136 CONTROLLED ENVIRONMENT TO AN 1846 01:04:01,136 --> 01:04:02,471 ENVIRONMENT WITH STRESS, ALSO 1847 01:04:02,471 --> 01:04:03,339 DIFFERENT ADVOCACY GROUPS AS 1848 01:04:03,339 --> 01:04:03,672 WELL. 1849 01:04:03,672 --> 01:04:05,808 THE METHODS TO UNDERSTAND THE 1850 01:04:05,808 --> 01:04:06,909 COLLECTION OF COMPLEX BLOOD 1851 01:04:06,909 --> 01:04:08,244 PRESSURE DATA, I THINK IF WE 1852 01:04:08,244 --> 01:04:10,412 JUST CONTINUE USING MEAN BLOOD 1853 01:04:10,412 --> 01:04:11,647 PRESSURES OR CONVENTIONAL 1854 01:04:11,647 --> 01:04:12,581 METRICS, WE'RE GOING TO BE 1855 01:04:12,581 --> 01:04:15,618 LOSING A LOT OF INFORMATION, AND 1856 01:04:15,618 --> 01:04:17,386 CHANGES NEEDED TO ADDRESS THESE 1857 01:04:17,386 --> 01:04:18,621 TECHNOLOGIES. 1858 01:04:18,621 --> 01:04:19,722 THE FUTURE OPPORTUNITIES INCLUDE 1859 01:04:19,722 --> 01:04:21,423 IMPROVE DIAGNOSIS, TREATMENT AND 1860 01:04:21,423 --> 01:04:22,791 CONTROL OF HYPERTENSION, ADDRESS 1861 01:04:22,791 --> 01:04:23,993 HEALTH EQUITY, IN THE RIGHT WAY 1862 01:04:23,993 --> 01:04:25,227 I THINK IT'S GOING TO HELP US TO 1863 01:04:25,227 --> 01:04:27,162 GET OUT INFORMATION WE NEED TO. 1864 01:04:27,162 --> 01:04:29,331 AND THE NOVEL PHENOTYPES WILL 1865 01:04:29,331 --> 01:04:30,833 EVALUATE ENVIRONMENTAL AND 1866 01:04:30,833 --> 01:04:31,934 PSYCHOLOGICAL FAK FORS WHICH I 1867 01:04:31,934 --> 01:04:33,669 JUST MENTIONED TO UNDERSTAND THE 1868 01:04:33,669 --> 01:04:35,804 REALLY COMPLEX DYNAMIC 1869 01:04:35,804 --> 01:04:37,206 BIOLOGICAL SYSTEM SO WE REALLY 1870 01:04:37,206 --> 01:04:43,245 NEED TO DIFFERENTIATE IS IT 1871 01:04:43,245 --> 01:04:44,914 BECAUSE OF UNDERLYING DISEASE OR 1872 01:04:44,914 --> 01:04:45,481 BECAUSE OF THE ENVIRONMENT. 1873 01:04:45,481 --> 01:04:48,017 SO THAT'S ALL I HAVE TO SHARE, 1874 01:04:48,017 --> 01:04:51,754 AND THANK YOU VERY MUCH. 1875 01:04:51,754 --> 01:04:52,955 >> GREAT, THANK YOU SO MUCH. 1876 01:04:52,955 --> 01:04:54,223 IF WE COULD HAVE ALL OF OUR 1877 01:04:54,223 --> 01:04:55,724 SPEAKERS GET THEIR CAMERAS ON? 1878 01:04:55,724 --> 01:04:59,895 GOOD, WE'RE ALL THERE. 1879 01:04:59,895 --> 01:05:01,997 SO DAICHI, DO YOU WANT TO KICK 1880 01:05:01,997 --> 01:05:03,032 US OFF WITH SOME QUESTIONS? 1881 01:05:03,032 --> 01:05:04,566 >> YEAH, THANK YOU SO MUCH. 1882 01:05:04,566 --> 01:05:05,167 OKAY. 1883 01:05:05,167 --> 01:05:06,835 I'VE BEEN WRITING A LOT OF NOTES 1884 01:05:06,835 --> 01:05:08,771 BUT WE DON'T HAVE MUCH TIME. 1885 01:05:08,771 --> 01:05:13,575 SO I HAVE A QUESTION FOR ROB. 1886 01:05:13,575 --> 01:05:14,877 THIS IS WHAT I'M TRYING TO 1887 01:05:14,877 --> 01:05:19,848 GRAPPLE WITH. 1888 01:05:19,848 --> 01:05:20,683 CLINIC BLOOD PRESSURE, WHETHER 1889 01:05:20,683 --> 01:05:21,951 IT'S MEASURED WELL OR NOT, IS 1890 01:05:21,951 --> 01:05:23,953 NOT IN THE REAL WORLD. 1891 01:05:23,953 --> 01:05:25,054 IT'S IN AN ARTIFICIAL 1892 01:05:25,054 --> 01:05:28,857 ENVIRONMENT. 1893 01:05:28,857 --> 01:05:30,259 AND I JUST SAW LOTS OF 1894 01:05:30,259 --> 01:05:31,126 COMPELLING DATA THAT BLOOD 1895 01:05:31,126 --> 01:05:32,761 PRESSURE OUTSIDE OF THE OFFICE 1896 01:05:32,761 --> 01:05:34,797 IS BETTER PREDICTIVE OF OUTCOMES 1897 01:05:34,797 --> 01:05:35,931 AND SO FORTH. 1898 01:05:35,931 --> 01:05:38,567 AND IT'S INTERESTING THAT YOU'RE 1899 01:05:38,567 --> 01:05:39,935 STUDYING CAR BLOOD PRESSURE AND 1900 01:05:39,935 --> 01:05:41,470 YOU'RE ALSO STUDYING BLOOD 1901 01:05:41,470 --> 01:05:42,571 PRESSURE IN MOBILE VANS. 1902 01:05:42,571 --> 01:05:44,206 BUT THAT DOESN'T FIT NEATLY 1903 01:05:44,206 --> 01:05:47,476 WITHIN AMBULATORY MONITORING OR 1904 01:05:47,476 --> 01:05:47,943 HOME MONITORING. 1905 01:05:47,943 --> 01:05:48,777 SELF MEASUREMENT OF BLOOD 1906 01:05:48,777 --> 01:05:49,878 PRESSURE AT HOME. 1907 01:05:49,878 --> 01:05:51,613 WHAT'S YOUR CONCEPTUALIZATION OF 1908 01:05:51,613 --> 01:05:52,915 THAT KIND OF BLOOD PRESSURE? 1909 01:05:52,915 --> 01:05:55,084 BECAUSE TO ME, THAT'S REAL BLOOD 1910 01:05:55,084 --> 01:05:55,351 PRESSURE. 1911 01:05:55,351 --> 01:05:55,951 IT'S THE BLOOD PRESSURE THAT 1912 01:05:55,951 --> 01:05:57,753 YOU'RE MEASURING IN THE REAL 1913 01:05:57,753 --> 01:05:59,088 WOMPLETD I JUST WANTED TO KNOW, 1914 01:05:59,088 --> 01:06:04,360 ROB, IF YOU THOUGHT ABOUT THAT. 1915 01:06:04,360 --> 01:06:06,829 >> WELL, THANK YOU FOR OF COURSE 1916 01:06:06,829 --> 01:06:08,664 THAT COMPELLING INTRIGUING 1917 01:06:08,664 --> 01:06:10,332 QUESTION AND THERE'S NO ANSWER 1918 01:06:10,332 --> 01:06:10,733 TO THAT. 1919 01:06:10,733 --> 01:06:14,036 OF COURSE, YES, WE THOUGHT ABOUT 1920 01:06:14,036 --> 01:06:15,371 IT, WE'VE ALL THOUGHT ABOUT IT 1921 01:06:15,371 --> 01:06:17,406 AND I THINK IT COMES DOWN TO A 1922 01:06:17,406 --> 01:06:18,440 PHILOSOPHICAL QUESTION OF WHAT 1923 01:06:18,440 --> 01:06:20,976 IS BLOOD PRESSURE, RIGHT, THAT 1924 01:06:20,976 --> 01:06:22,311 JESUS AND OTHER SPEAKERS HAVE 1925 01:06:22,311 --> 01:06:23,512 MENTIONED THAT IT CHANGES SECOND 1926 01:06:23,512 --> 01:06:24,713 TO SECOND AND IT'S VARIABLE 1927 01:06:24,713 --> 01:06:27,850 WITHIN DIFFERENT ORGAN SYSTEMS 1928 01:06:27,850 --> 01:06:29,351 AND DIFFERENT VASCULAR BEDS, AND 1929 01:06:29,351 --> 01:06:30,786 WE JUST BY CONVENTION MEASURE IT 1930 01:06:30,786 --> 01:06:32,187 THIS WAY AND WE KNOW IF YOU 1931 01:06:32,187 --> 01:06:33,689 MEASURE IT THIS WAY IN A CERTAIN 1932 01:06:33,689 --> 01:06:34,823 SETTING, IT SEEMS TO HAVE A 1933 01:06:34,823 --> 01:06:38,260 CRYSTAL BALL FOR YOUR FUTURE. 1934 01:06:38,260 --> 01:06:39,395 AND IT'S BEEN SAID IN THE PAST 1935 01:06:39,395 --> 01:06:40,596 THAT OBVIOUSLY THE REAL BLOOD 1936 01:06:40,596 --> 01:06:43,532 PRESSURE IS THE ONE THAT BEST IS 1937 01:06:43,532 --> 01:06:46,702 MOST ASSOCIATED WITH YOUR 1938 01:06:46,702 --> 01:06:47,536 CARDIOVASCULAR RISK AND 1939 01:06:47,536 --> 01:06:48,971 OUTCOMES, BUT THAT MAY ALSO BE 1940 01:06:48,971 --> 01:06:50,305 VARIABLE FOR DIFFERENT PEOPLE. 1941 01:06:50,305 --> 01:06:51,840 EVERYTHING WE DO IS AT A 1942 01:06:51,840 --> 01:06:53,242 POPULATION LEVEL, THEN WE 1943 01:06:53,242 --> 01:06:54,076 ATTRIBUTE TO INDIVIDUALS, AN 1944 01:06:54,076 --> 01:06:55,611 THERE'S NO SUCH THING AS 1945 01:06:55,611 --> 01:06:57,679 INDIVIDUAL LEVEL RISK. 1946 01:06:57,679 --> 01:07:02,918 WE USE A FREQUENTISM APPROACH TO 1947 01:07:02,918 --> 01:07:03,619 POPULATE PROBABILITY. 1948 01:07:03,619 --> 01:07:05,954 SO I DON'T KNOW, DAICHI. 1949 01:07:05,954 --> 01:07:07,856 I JUST KNOW THAT WHAT WE CAN DO 1950 01:07:07,856 --> 01:07:11,927 AT THE TIME BEING IS TO TRY TO 1951 01:07:11,927 --> 01:07:16,598 MIMIC AND PROVIDE READINGS THAT 1952 01:07:16,598 --> 01:07:17,900 CATEGORIZE REASONABLY WELL WITH 1953 01:07:17,900 --> 01:07:22,237 THE READINGS THAT WE KNOW ARE 1954 01:07:22,237 --> 01:07:23,672 PROGNOSTIC, AND THEN 1955 01:07:23,672 --> 01:07:24,673 SCIENTIFICALLY MOVE ON 1956 01:07:24,673 --> 01:07:27,176 AFTERWARDS SUCH AS ALL THE 1957 01:07:27,176 --> 01:07:27,943 INFORMATION THAT JESUS IS GOING 1958 01:07:27,943 --> 01:07:29,645 TO SAY, DO WE GET INCREMENTAL 1959 01:07:29,645 --> 01:07:30,612 INFORMATION AFTERWARDS? 1960 01:07:30,612 --> 01:07:32,781 MY SUPPOSITION IS LIKELY VERY 1961 01:07:32,781 --> 01:07:33,348 SMALL. 1962 01:07:33,348 --> 01:07:37,686 ONCE WE PARSE OUT THREE, FOUR, 1963 01:07:37,686 --> 01:07:39,221 FIVE, SIX WELL-DONE BLOOD 1964 01:07:39,221 --> 01:07:42,825 PRESSURES, THE OLD SMIRK, BASAL 1965 01:07:42,825 --> 01:07:43,959 BLOOD PRESSURE FROM THE 1940s, 1966 01:07:43,959 --> 01:07:45,961 ONCE WE GET THAT READING DONE, 1967 01:07:45,961 --> 01:07:47,029 THERE WILL BE A SMALL WAVEFORM 1968 01:07:47,029 --> 01:07:48,430 OF ADDITIONAL INFORMATION THAT 1969 01:07:48,430 --> 01:07:50,999 WILL GIVE US PROGNOSTIC 1970 01:07:50,999 --> 01:07:52,101 INFORMATION, BUT DAICHI, I'M NOT 1971 01:07:52,101 --> 01:07:53,502 SURE WHAT WE'RE GOING DO WITH 1972 01:07:53,502 --> 01:07:53,669 IT. 1973 01:07:53,669 --> 01:07:55,170 I'M NOT GOING TO TITRATE -- 1974 01:07:55,170 --> 01:07:55,904 >> ABSOLUTELY. 1975 01:07:55,904 --> 01:08:00,709 >> -- CONTINUES WITH US 1976 01:08:00,709 --> 01:08:02,945 MEASUREMENTS OF NITROGEN -- SO 1977 01:08:02,945 --> 01:08:04,046 THANK YOU FOR THE TALK. 1978 01:08:04,046 --> 01:08:04,713 I DON'T KNOW. 1979 01:08:04,713 --> 01:08:05,714 AND I'LL STOP WITH THAT. 1980 01:08:05,714 --> 01:08:07,015 >> I JUST WANTED TO FOLLOW UP, 1981 01:08:07,015 --> 01:08:08,550 YOU ANSWERED MY QUESTION 1982 01:08:08,550 --> 01:08:09,451 BEAUTIFULLY AND THE REASON WHY 1983 01:08:09,451 --> 01:08:11,286 I'M PRESSING ON YOU, I KNOW YOUR 1984 01:08:11,286 --> 01:08:11,720 STUDIES, OKAY? 1985 01:08:11,720 --> 01:08:14,056 THE REASON WHY I'M PRESSING ON 1986 01:08:14,056 --> 01:08:15,657 YOU IS YOU SHOWED THE DATA 1987 01:08:15,657 --> 01:08:17,359 COMPARING CAR DATA TO OFFICE 1988 01:08:17,359 --> 01:08:17,960 BLOOD PRESSURE, OF COURSE CAR 1989 01:08:17,960 --> 01:08:18,794 BLOOD PRESSURE CAN BE DONE WHEN 1990 01:08:18,794 --> 01:08:20,929 IT REALLY HOT OR COLD OUTSIDE 1991 01:08:20,929 --> 01:08:22,030 BUT THAT'S THEIR BLOOD PRESSURE. 1992 01:08:22,030 --> 01:08:24,099 SO ON THE ONE HAND YOU MAY ARGUE 1993 01:08:24,099 --> 01:08:25,300 WHY ARE YOU COMPARING TO A BLOOD 1994 01:08:25,300 --> 01:08:26,535 PRESSURE THAT'S NOT OUTSIDE? 1995 01:08:26,535 --> 01:08:30,005 BECAUSE YOU'RE GOING TO SEE 1996 01:08:30,005 --> 01:08:30,772 WITHIN PERSON DIFFERENCES, 1997 01:08:30,772 --> 01:08:32,708 THAT'S JUST THE NATURE OF IT. 1998 01:08:32,708 --> 01:08:33,542 BUT AT THE SAME TIME, YOU'RE 1999 01:08:33,542 --> 01:08:35,444 SAYING THAT, YES, A LOT OF THE 2000 01:08:35,444 --> 01:08:37,212 PROGNOSTIC DATA IS BASED ON 2001 01:08:37,212 --> 01:08:38,180 CLINIC BLOOD PRESSURE. 2002 01:08:38,180 --> 01:08:39,581 SO I'M JUST WRAPPING MYSELF 2003 01:08:39,581 --> 01:08:42,551 AROUND THAT. 2004 01:08:42,551 --> 01:08:44,419 >> I'VE GOT A SIMPLE ANSWER TO 2005 01:08:44,419 --> 01:08:44,620 THAT. 2006 01:08:44,620 --> 01:08:45,220 >> GO FOR IT. 2007 01:08:45,220 --> 01:08:47,890 GO AHEAD. 2008 01:08:47,890 --> 01:08:51,693 >> LOWER IS BETTER. 2009 01:08:51,693 --> 01:08:54,329 WHAT ABOUT THESE THRESHOLDS 2010 01:08:54,329 --> 01:08:55,430 ABOUT PERFECTION, YOU KNOW? 2011 01:08:55,430 --> 01:08:57,499 JUST LOOK AT YOUR TRENDS, AND 2012 01:08:57,499 --> 01:08:59,034 KEEP IT IN THE LOW LEVEL. 2013 01:08:59,034 --> 01:09:00,636 >> SO IT MAY BE THAT WE'RE 2014 01:09:00,636 --> 01:09:02,137 DUMBING DOWN THE INFORMATION TO 2015 01:09:02,137 --> 01:09:03,672 ACTUALLY TAKE A STEP BACK TO 2016 01:09:03,672 --> 01:09:07,776 LOOK AT THE PROGNOSTIC VALUE OF 2017 01:09:07,776 --> 01:09:08,544 THIS TRADITIONAL PAROCHIAL WAY 2018 01:09:08,544 --> 01:09:10,579 THAT WE MEASURE, BUT THAT'S WHAT 2019 01:09:10,579 --> 01:09:12,014 WE HAVE IN THE TIME BEING, AND 2020 01:09:12,014 --> 01:09:14,216 IT MAY TURN OUT AS WE KNOW THAT 2021 01:09:14,216 --> 01:09:15,517 ABPM WHICH IS IMPACT BID ALL 2022 01:09:15,517 --> 01:09:17,753 THESE FACTORS IS -- THIS TENDS 2023 01:09:17,753 --> 01:09:19,621 TO FOLLOW THAT WHEN IT'S 2024 01:09:19,621 --> 01:09:21,089 DISCORDANT FROM CLINIC READINGS, 2025 01:09:21,089 --> 01:09:25,861 SO IT'S SOMETHING ABOUT THE REAL 2026 01:09:25,861 --> 01:09:30,666 WORLD ENVIROME THAT PROVIDES 2027 01:09:30,666 --> 01:09:31,500 ADDITIONAL INFORMATION FROM THE 2028 01:09:31,500 --> 01:09:32,501 CLINIC READING WHICH IS JUST A 2029 01:09:32,501 --> 01:09:34,069 SURROGATE OF ABPM. 2030 01:09:34,069 --> 01:09:34,937 BUT THANK YOU FOR THE QUESTION. 2031 01:09:34,937 --> 01:09:36,371 IT'S REALLY INTERESTING. 2032 01:09:36,371 --> 01:09:37,206 >> ABSOLUTELY. 2033 01:09:37,206 --> 01:09:37,739 THANK YOU SO MUCH. 2034 01:09:37,739 --> 01:09:39,608 >> GREAT. 2035 01:09:39,608 --> 01:09:40,909 I THINK BEV, I'M GOING TO THROW 2036 01:09:40,909 --> 01:09:42,578 BACK AT YOU ONE OF THE GAPS THAT 2037 01:09:42,578 --> 01:09:43,545 YOU HIGHLIGHTED. 2038 01:09:43,545 --> 01:09:44,546 WHAT POLICY SOLUTIONS DO YOU 2039 01:09:44,546 --> 01:09:47,549 THINK ARE NEEDED TO INCREASE 2040 01:09:47,549 --> 01:09:48,450 EVIDENCE-BASED SMBP PROGRAMS? 2041 01:09:48,450 --> 01:09:52,921 >> WELL, I WOULD LIKE -- I MEAN, 2042 01:09:52,921 --> 01:09:54,556 HOME BLOOD PRESSURE MONITORS ARE 2043 01:09:54,556 --> 01:09:55,357 INEXPENSIVE, EVEN THE CELLULAR 2044 01:09:55,357 --> 01:09:56,725 ONES ARE NOT VERY EXPENSIVE 2045 01:09:56,725 --> 01:09:59,761 COMPARED TO MEDICATIONS, AND 2046 01:09:59,761 --> 01:10:01,163 THEY LAST FOUR YEARS ONCE 2047 01:10:01,163 --> 01:10:02,397 THEY'RE OUT OF THE SHOP AND 2048 01:10:02,397 --> 01:10:03,165 THEY'RE ACCURATE. 2049 01:10:03,165 --> 01:10:05,033 SO WHY DON'T WE JUST GIVE THEM 2050 01:10:05,033 --> 01:10:05,867 OUT TO THE PEOPLE THAT NEED IT. 2051 01:10:05,867 --> 01:10:07,336 SO WE NEED A POLICY THAT 2052 01:10:07,336 --> 01:10:09,171 MEDICARE AND MEDICAID JUST 2053 01:10:09,171 --> 01:10:13,408 ACROSS THE BOARD COVERS THIS. 2054 01:10:13,408 --> 01:10:14,743 AND THEN WE HAVE TO CONSIDER I 2055 01:10:14,743 --> 01:10:18,080 THINK -- I THINK THAT HEDUS WAS 2056 01:10:18,080 --> 01:10:20,015 STARTING TO THINK ABOUT LOWER 2057 01:10:20,015 --> 01:10:21,016 BLOOD PRESSURES BUT BACKED AWAY, 2058 01:10:21,016 --> 01:10:22,050 AND THEY'RE PROBABLY NOT GOING 2059 01:10:22,050 --> 01:10:23,885 TO BRING UP THE TOPIC AGAIN FOR 2060 01:10:23,885 --> 01:10:26,488 A COUPLE YEARS. 2061 01:10:26,488 --> 01:10:30,859 SO I THINK WE NEED TO FIGURE 2062 01:10:30,859 --> 01:10:31,927 OUT, SCIENTISTS, WE'RE NOT 2063 01:10:31,927 --> 01:10:32,928 POLICY CHANGERS. 2064 01:10:32,928 --> 01:10:34,563 WE HAVE TO FIND THE GROUPS THAT 2065 01:10:34,563 --> 01:10:34,730 ARE. 2066 01:10:34,730 --> 01:10:37,232 AND HELP THEM UNDERSTAND THAT WE 2067 01:10:37,232 --> 01:10:38,900 NEED BETTER MEASURES OF BLOOD 2068 01:10:38,900 --> 01:10:40,002 PRESSURE BECAUSE IT REALLY 2069 01:10:40,002 --> 01:10:41,503 INFLUENCES WHAT ORGANIZATIONS 2070 01:10:41,503 --> 01:10:45,507 FOCUS ON. 2071 01:10:45,507 --> 01:10:48,410 THOSE ARE TWO EASY ONES. 2072 01:10:48,410 --> 01:10:48,810 >> THANK YOU. 2073 01:10:48,810 --> 01:10:51,580 >> AND THEN EHR RISING TO THE 2074 01:10:51,580 --> 01:10:53,682 STANDARDS, RIGHT? 2075 01:10:53,682 --> 01:10:55,384 I WROTE DOWN THE WEBSITE THAT 2076 01:10:55,384 --> 01:11:05,594 YOU PRESENTED, BUT I ASKED MY -- 2077 01:11:05,594 --> 01:11:08,230 WEBSITE THAT YOU PRESENTED, 2078 01:11:08,230 --> 01:11:11,600 GETTING THAT BLOOD PRESSURE DATA 2079 01:11:11,600 --> 01:11:13,335 IN A VERY EASY TO USE WAY FOR 2080 01:11:13,335 --> 01:11:14,136 CLINICIANS AND PATIENTS. 2081 01:11:14,136 --> 01:11:19,975 >> WE'RE WORKING ON IT. 2082 01:11:19,975 --> 01:11:21,176 >> CAN I FOLLOW UP ON THAT 2083 01:11:21,176 --> 01:11:22,177 QUESTION TO YOUR EXCELLENT 2084 01:11:22,177 --> 01:11:22,744 QUESTION? 2085 01:11:22,744 --> 01:11:27,215 AND THIS IS FOR EVERYONE. 2086 01:11:27,215 --> 01:11:28,884 I THINK EVERYONE KNOWS I'M A 2087 01:11:28,884 --> 01:11:30,352 BIG, HUGE FAN OF SELF MEASURED 2088 01:11:30,352 --> 01:11:31,486 BLOOD PRESSURE SO I DON'T WANT 2089 01:11:31,486 --> 01:11:32,888 MY NEXT COMMENT TO SOUND LIKE 2090 01:11:32,888 --> 01:11:37,192 IT'S A CRITICISM. 2091 01:11:37,192 --> 01:11:38,694 BUT ONE THING THAT I STRUGGLE 2092 01:11:38,694 --> 01:11:40,362 WITH IS WE DO OUR BEST TO TRAIN 2093 01:11:40,362 --> 01:11:41,430 THE PATIENTS TO DO HOME 2094 01:11:41,430 --> 01:11:42,364 MONITORING BUT WE ACTUALLY DON'T 2095 01:11:42,364 --> 01:11:45,834 KNOW IF THEY'RE DOING IT RIGHT. 2096 01:11:45,834 --> 01:11:47,903 AND THAT ALWAYS CONCERNS ME. 2097 01:11:47,903 --> 01:11:49,204 BECAUSE OBVIOUSLY, THEY COULD 2098 01:11:49,204 --> 01:11:51,873 COME BACK TO YOU AND HAND YOU 2099 01:11:51,873 --> 01:11:53,041 ALL THE READINGS, THAT'S GREAT, 2100 01:11:53,041 --> 01:11:54,943 THEY DID ALL 12 OR ALL 48. 2101 01:11:54,943 --> 01:11:56,044 BUT YOU DON'T KNOW IF THEY DID 2102 01:11:56,044 --> 01:11:57,012 IT WELL. 2103 01:11:57,012 --> 01:12:00,349 DOES IT MATTER? 2104 01:12:00,349 --> 01:12:01,850 BECAUSE THE DATA SHOWS IT'S A 2105 01:12:01,850 --> 01:12:03,418 BETTER PREDICTOR OF OUTCOMES 2106 01:12:03,418 --> 01:12:04,052 THAN IN OFFICE. 2107 01:12:04,052 --> 01:12:08,023 I JUST WANTED TO ASK YOU. 2108 01:12:08,023 --> 01:12:12,227 >> IF I MIGHT COMMENT, THE LAST 2109 01:12:12,227 --> 01:12:14,930 PART WAS ESSENTIAL. 2110 01:12:14,930 --> 01:12:18,934 AND ANYTHING ELSE THAT COMES 2111 01:12:18,934 --> 01:12:21,269 WITH -- WE GET NOCTURNAL 2112 01:12:21,269 --> 01:12:22,637 RATINGS, PATIENTS WAKE UP AND 2113 01:12:22,637 --> 01:12:24,139 THE SAME BLOOD PRESSURE -- YOU 2114 01:12:24,139 --> 01:12:25,073 ARE NOT SURE WHETHER BLOOD 2115 01:12:25,073 --> 01:12:26,274 PRESSURE WAS TAKEN THE RIGHT 2116 01:12:26,274 --> 01:12:30,612 WAY, BUT THEN WHEN WE DO, WE 2117 01:12:30,612 --> 01:12:32,047 CONDUCT -- THAT INFORMATION 2118 01:12:32,047 --> 01:12:34,116 ASSOCIATED WITH CARDIOVASCULAR 2119 01:12:34,116 --> 01:12:36,184 OUTCOMES, THAT'S THE PART THAT 2120 01:12:36,184 --> 01:12:38,387 INTREETION ME BECAUSE THEN 2121 01:12:38,387 --> 01:12:39,154 EVIDENCE BASE USES THIS 2122 01:12:39,154 --> 01:12:40,122 INFORMATION TO THEN MAKE 2123 01:12:40,122 --> 01:12:43,325 DECISION TO DIAGNOSE PROVIDE 2124 01:12:43,325 --> 01:12:44,593 THRESHOLDS FOR EXAMPLE BASED ON 2125 01:12:44,593 --> 01:12:47,129 THAT INFORMATION. 2126 01:12:47,129 --> 01:12:48,630 I BELIEVE WE NEED TO MAKE SURE 2127 01:12:48,630 --> 01:12:49,798 THEY'RE MEASURING IT WELL BUT UP 2128 01:12:49,798 --> 01:12:50,999 TO RIGHT NOW, WHATEVER 2129 01:12:50,999 --> 01:12:52,434 INFORMATION THEY'RE CAPTURING, 2130 01:12:52,434 --> 01:12:54,369 WHEN WE ANALYZE THAT IN RELATION 2131 01:12:54,369 --> 01:12:56,138 TO EVENTS, WE'RE BEING ABLE TO 2132 01:12:56,138 --> 01:12:58,940 FIND THERE'S A SIGNIFICANT -- 2133 01:12:58,940 --> 01:13:00,142 AND THEREFORE DECISIONS ARE MADE 2134 01:13:00,142 --> 01:13:04,379 BASED ON THAT INFORMATION, SO I 2135 01:13:04,379 --> 01:13:07,182 BELIEVE WE SHOULD CONTINUE USING 2136 01:13:07,182 --> 01:13:08,216 THAT INFORMATION. 2137 01:13:08,216 --> 01:13:09,684 WHETHER THEY DID IT THE WRONG 2138 01:13:09,684 --> 01:13:11,186 WAY OR RIGHT WAY, BUT IT'S 2139 01:13:11,186 --> 01:13:12,053 INFORMATION THAT WE -- 2140 01:13:12,053 --> 01:13:14,089 >> AND THEY CAN TAKE THEIR 2141 01:13:14,089 --> 01:13:15,223 AMBULATORY MONITOR OFF AND 2142 01:13:15,223 --> 01:13:19,828 RE-WRAP IT THE WRONG WAY, RIGHT? 2143 01:13:19,828 --> 01:13:21,163 SO -- I THINK THAT GOES ACROSS 2144 01:13:21,163 --> 01:13:22,164 THE BOARD AND WE ALREADY SAW -- 2145 01:13:22,164 --> 01:13:23,632 I MEAN, I'VE BEEN ASTOUNDED, 2146 01:13:23,632 --> 01:13:24,433 WHAT I SEE IN CLINIC. 2147 01:13:24,433 --> 01:13:28,437 I KNOW YOU CAN TAKE FOREARM 2148 01:13:28,437 --> 01:13:30,071 BLOOD PRESSURES, BUT WHEN I WAS 2149 01:13:30,071 --> 01:13:31,273 GOING ON A DIFFERENT TOPIC 2150 01:13:31,273 --> 01:13:33,141 BECAUSE I WORK ON OTHER AREAS 2151 01:13:33,141 --> 01:13:34,676 BESIDES BLOOD PRESSURE, AND I 2152 01:13:34,676 --> 01:13:36,745 ASKED AN M.A. TO DEMONSTRATE HOW 2153 01:13:36,745 --> 01:13:38,013 SHE TOOK A BLOOD PRESSURE AND 2154 01:13:38,013 --> 01:13:41,349 SHE TOLD ME ON THE FOREARM. 2155 01:13:41,349 --> 01:13:42,551 LIKE, THIS IS A MEDICAL 2156 01:13:42,551 --> 01:13:44,753 ASSISTANT. 2157 01:13:44,753 --> 01:13:48,957 SO YOU KNOW, IT'S INDEMIC OR 2158 01:13:48,957 --> 01:13:51,460 EPIDEMIC PROBLEM, AND I DON'T -- 2159 01:13:51,460 --> 01:13:54,129 I THINK WE ALL NEED TO 2160 01:13:54,129 --> 01:13:55,597 BE -- YOU KNOW, I THINK PUTTING 2161 01:13:55,597 --> 01:13:58,300 THESE POSTERS IN -- MAKING -- 2162 01:13:58,300 --> 01:13:59,468 ENABLING AND ENGAGING THE 2163 01:13:59,468 --> 01:14:02,471 PATIENTS TO BE AS SMART AS WE 2164 01:14:02,471 --> 01:14:03,772 ARE, AND I THINK MOST CAN DO 2165 01:14:03,772 --> 01:14:04,372 THAT. 2166 01:14:04,372 --> 01:14:05,373 OBVIOUSLY SOME PEOPLE CAN'T. 2167 01:14:05,373 --> 01:14:07,809 BUT I THINK MOST PATIENTS CAN. 2168 01:14:07,809 --> 01:14:09,010 AND THEY WANT TO BE ABLE TO DO 2169 01:14:09,010 --> 01:14:12,981 IT RIGHT. 2170 01:14:12,981 --> 01:14:14,015 >> ABSOLUTELY. 2171 01:14:14,015 --> 01:14:15,350 AS YOU SAID, BEV, THERE'S 2172 01:14:15,350 --> 01:14:16,151 DEFINITELY TOOLS OUT THERE TO 2173 01:14:16,151 --> 01:14:16,985 HELP WITH THAT AND MAYBE MORE 2174 01:14:16,985 --> 01:14:18,987 NEED TO BE DEVELOPED. 2175 01:14:18,987 --> 01:14:20,689 SO GREAT COMMENTS, EVERYONE. 2176 01:14:20,689 --> 01:14:22,724 ROBERT, WE'VE GOT A QUESTION 2177 01:14:22,724 --> 01:14:24,392 FROM STEPHEN JURASCHEK. 2178 01:14:24,392 --> 01:14:26,027 YOUR CAR STUDY IS FASCINATING 2179 01:14:26,027 --> 01:14:28,897 WITH REALLY IMPORTANT 2180 01:14:28,897 --> 01:14:29,231 IMPLICATIONS. 2181 01:14:29,231 --> 01:14:31,867 DID YOU LOOK AT SEASON IN YOUR 2182 01:14:31,867 --> 01:14:32,968 STUDY, AND DID YOU HAVE ANY 2183 01:14:32,968 --> 01:14:35,704 CASES WITH THE CAR ENG IP OFF? 2184 01:14:35,704 --> 01:14:36,271 ENGINE OFF? 2185 01:14:36,271 --> 01:14:37,138 YOU ADDRESSED TEMPERATURE AND 2186 01:14:37,138 --> 01:14:38,974 HOW YOU CONTROL THAT, BUT HE 2187 01:14:38,974 --> 01:14:40,976 SAYS OSCILLOMETRIC DEVICES HAVE 2188 01:14:40,976 --> 01:14:42,177 UNKNOWN PERFORMANCE IN MOVING 2189 01:14:42,177 --> 01:14:43,011 VEHICLES. 2190 01:14:43,011 --> 01:14:44,246 PERHAPS THE CAR VIBRATION IS NOT 2191 01:14:44,246 --> 01:14:47,516 SO BAD WHEN IDLING. 2192 01:14:47,516 --> 01:14:49,251 >> SIMPLE ANSWERS FOR THIS. 2193 01:14:49,251 --> 01:14:50,952 WE ARE EVALUATING SECONDARY 2194 01:14:50,952 --> 01:14:54,356 ANALYSES, ALL THE IMPACT OF THE 2195 01:14:54,356 --> 01:14:56,458 EXPOSURES ON THE VARIATIONS OR 2196 01:14:56,458 --> 01:14:58,226 DIFFERENCES, WHILE THE ACTUAL 2197 01:14:58,226 --> 01:15:01,329 READINGS OF THE CAR -- AND THE 2198 01:15:01,329 --> 01:15:02,531 DIFFERENCES COMPARED TO CLINIC 2199 01:15:02,531 --> 01:15:04,032 READINGS, THOSE ARE THINGS WE'RE 2200 01:15:04,032 --> 01:15:05,166 ANALYZING AT THIS POINT IN TIME. 2201 01:15:05,166 --> 01:15:06,601 WE DID TRY TO ROLL ACROSS 2202 01:15:06,601 --> 01:15:09,070 DIFFERENT SEASONS FOR THAT 2203 01:15:09,070 --> 01:15:10,438 PARTICULAR POINT TO SEE IF IT 2204 01:15:10,438 --> 01:15:11,940 WAS MAYBE MORE OR LESS ACCURATE 2205 01:15:11,940 --> 01:15:13,441 DURING HOT OR COLD SEASONS. 2206 01:15:13,441 --> 01:15:15,377 I DON'T HAVE THOSE DATA YET. 2207 01:15:15,377 --> 01:15:16,678 OF COURSE IT WILL BE 2208 01:15:16,678 --> 01:15:17,546 UNDERPOWERED TO ACTUALLY SHOW 2209 01:15:17,546 --> 01:15:19,481 ANY SIGNIFICANCE, BUT WE CAN 2210 01:15:19,481 --> 01:15:22,017 LOOK TO SEE -- WE SPECULATE IT 2211 01:15:22,017 --> 01:15:23,351 WILL BE PERHAPS LESS ACCURATE 2212 01:15:23,351 --> 01:15:25,754 DURING THE COLD SEASONS. 2213 01:15:25,754 --> 01:15:30,425 I WAS A LITTLE RUSHED FOR TIME 2214 01:15:30,425 --> 01:15:32,093 TO DESCRIBE FULLY THE PROTOCOL. 2215 01:15:32,093 --> 01:15:33,995 IT'S A HIGH-THROUGHPUT PROTOCOL 2216 01:15:33,995 --> 01:15:36,164 TO TRY TO SCREEN LITERALLY 2217 01:15:36,164 --> 01:15:37,165 THOUSANDS IF NOT TENS OF 2218 01:15:37,165 --> 01:15:38,733 THOUSANDS OF PATIENTS IN A 2219 01:15:38,733 --> 01:15:40,468 DRIVE-UP MOBILE UNIT. 2220 01:15:40,468 --> 01:15:42,270 AND EVERYONE, THE CAR HAS BEEN 2221 01:15:42,270 --> 01:15:42,904 STOPPED FOR FIVE MINUTES, SO 2222 01:15:42,904 --> 01:15:44,205 IT'S NOT IDLING. 2223 01:15:44,205 --> 01:15:45,740 AND THERE'S A LINE OF CARS. 2224 01:15:45,740 --> 01:15:47,709 THIS WAS ORIGINALLY DESIGNED 2225 01:15:47,709 --> 01:15:49,744 AFTER COVID-19 FOR SCREENINGS OF 2226 01:15:49,744 --> 01:15:51,580 TENS OF THOUSANDS OF PATIENTS 2227 01:15:51,580 --> 01:15:53,315 WITH COVID-19, AND WE ADAPTED 2228 01:15:53,315 --> 01:15:55,750 THAT SO, HEY, WE CAN MEASURE 2229 01:15:55,750 --> 01:15:57,886 BLOOD GLUCOSE AND A1C AND LIPIDS 2230 01:15:57,886 --> 01:15:59,421 AND MAYBE WE CAN GET BLOOD 2231 01:15:59,421 --> 01:15:59,888 PRESSURES. 2232 01:15:59,888 --> 01:16:02,090 WHAT IS THE BLOOD PRESSURE IN A 2233 01:16:02,090 --> 01:16:02,257 CAR? 2234 01:16:02,257 --> 01:16:04,926 SO YOU CAN SURPRISINGLY GET A 2235 01:16:04,926 --> 01:16:06,428 PRETTY GOOD POSITION IN A CAR, 2236 01:16:06,428 --> 01:16:08,263 RIGHT, WITH AN ARMREST AND THE 2237 01:16:08,263 --> 01:16:10,231 SEATED POSITION, AS LONG AS YOU 2238 01:16:10,231 --> 01:16:12,100 USE A REASONABLE METHODOLOGY. 2239 01:16:12,100 --> 01:16:14,202 SO IT'S OF COURSE ATTENDED 2240 01:16:14,202 --> 01:16:15,170 BECAUSE SOMEONE IS RATE THERE, 2241 01:16:15,170 --> 01:16:16,938 BUT WE'RE NOT TALKING TO THEM. 2242 01:16:16,938 --> 01:16:19,274 AND WE CAN HAVE ALL THE OTHER 2243 01:16:19,274 --> 01:16:23,712 POSITION AND FACTORS, AVERAGE 2244 01:16:23,712 --> 01:16:24,613 READINGS DONE ACCORDING TO 2245 01:16:24,613 --> 01:16:25,013 GUIDELINES. 2246 01:16:25,013 --> 01:16:26,915 BUT TO ANSWER THAT, THE CARS ARE 2247 01:16:26,915 --> 01:16:29,451 ALWAYS OFF, AND WE ATTEMPT TO 2248 01:16:29,451 --> 01:16:30,852 HAVE TEMPERATURE WITHIN A 2249 01:16:30,852 --> 01:16:33,154 REASONABLE RANGE OF CLOSE TO 70, 2250 01:16:33,154 --> 01:16:34,456 BUT THERE'S STILL VARIATION IN 2251 01:16:34,456 --> 01:16:36,324 THAT, WHICH IS ALSO INTERESTING 2252 01:16:36,324 --> 01:16:38,727 TO EXPLORE. 2253 01:16:38,727 --> 01:16:42,764 SO OS IT SHOULD NOT BE IMPACTEDY 2254 01:16:42,764 --> 01:16:45,000 THE CAR BEING OFF BUT MAYBE 2255 01:16:45,000 --> 01:16:45,634 WE'LL FIND THAT IT IS. 2256 01:16:45,634 --> 01:16:46,267 >> THANK YOU. 2257 01:16:46,267 --> 01:16:49,771 >> YOU KNOW, I LIKE THAT, 2258 01:16:49,771 --> 01:16:54,809 STEPHEN SHOWED KOEPKE'S SLIDE 2259 01:16:54,809 --> 01:16:56,578 WHERE THEY DID SHOW IN THOSE 2260 01:16:56,578 --> 01:16:57,545 2,000 BLOOD PRESSURE 2261 01:16:57,545 --> 01:16:58,313 MEASUREMENTS JUST A STRONG 2262 01:16:58,313 --> 01:16:59,280 ASSOCIATION OF SEASON, AND YOU 2263 01:16:59,280 --> 01:17:02,450 COULD SEE IT GO UP AND DOWN. 2264 01:17:02,450 --> 01:17:04,686 I THINK THE SEASONALITY IS -- 2265 01:17:04,686 --> 01:17:06,287 BUT YOU KNOW, THE TEMPERATURE 2266 01:17:06,287 --> 01:17:08,590 CHANGES IN A CAR. 2267 01:17:08,590 --> 01:17:11,660 BUT SOME PEOPLE, THEIR JOB IS IN 2268 01:17:11,660 --> 01:17:15,697 A CAR TOO. 2269 01:17:15,697 --> 01:17:16,464 >> ALL RIGHT. 2270 01:17:16,464 --> 01:17:19,734 SOME MORE QUESTIONS IN THE CUE 2271 01:17:19,734 --> 01:17:20,935 FOR FOLKS. 2272 01:17:20,935 --> 01:17:22,671 JESUS, HAVE YOU IDENTIFIED ANY 2273 01:17:22,671 --> 01:17:24,472 NOVEL PHENOTYPES THAT SEEM 2274 01:17:24,472 --> 01:17:26,107 PARTICULARLY PROMISING FROM 2275 01:17:26,107 --> 01:17:28,109 ABPM, AND ANY YOU THINK MIGHT BE 2276 01:17:28,109 --> 01:17:33,248 IMPORTANT TO EXPLORE? 2277 01:17:33,248 --> 01:17:38,353 >> I WANT TO SAY YES, BUT THIS 2278 01:17:38,353 --> 01:17:42,824 IS JUST TO -- RESEARCH WE'VE 2279 01:17:42,824 --> 01:17:45,260 BEEN DOING, IT STILL NEEDS 2280 01:17:45,260 --> 01:17:47,462 REPLICATION, BUT WE'VE BEEN ABLE 2281 01:17:47,462 --> 01:17:49,297 TO IDENTIFY SPECIFICALLY, FOR 2282 01:17:49,297 --> 01:17:53,601 EXAMPLE, FOR GLAUCOMA OR FOR 2283 01:17:53,601 --> 01:17:55,136 HIPPOCAMPAL VOLUME THAT WHEN YOU 2284 01:17:55,136 --> 01:17:56,905 LOOK INTO VARIABILITY, 24 HOUR 2285 01:17:56,905 --> 01:17:58,006 BLOOD PRESSURE VARIABILITY, IF 2286 01:17:58,006 --> 01:18:01,876 WE QUANTIFY JUST STANDARD 2287 01:18:01,876 --> 01:18:03,078 DEVIATION OR ANY OF THESE 2288 01:18:03,078 --> 01:18:04,179 METRICS, BUT WE ACTUALLY LOOK 2289 01:18:04,179 --> 01:18:06,181 INTO VARIABILITY, WHEN IT DROPS, 2290 01:18:06,181 --> 01:18:08,683 THE QUANTIFICATION OF THOSE 2291 01:18:08,683 --> 01:18:10,318 DRASTIC REPETITIVE AND EXTREME 2292 01:18:10,318 --> 01:18:13,588 DROPS IN BLOOD PRESSURE OVER 24 2293 01:18:13,588 --> 01:18:15,457 HOURS HAS BEEN ASSOCIATED WITH 2294 01:18:15,457 --> 01:18:20,795 GLAUCOMA OR WITH THINNER 2295 01:18:20,795 --> 01:18:22,664 HIPPOCAMPAL VOLUME OR LOWER -- 2296 01:18:22,664 --> 01:18:24,332 WE'VE BEEN PUBLISHING ON 2297 01:18:24,332 --> 01:18:26,034 GLAUCOMA, WE HAVE A PUBLICATION 2298 01:18:26,034 --> 01:18:29,938 COMING UP WITH HIPPOCAMPAL 2299 01:18:29,938 --> 01:18:31,539 VOLUME OVER AD REGIONS OF 2300 01:18:31,539 --> 01:18:33,742 INTEREST AND WE'VE BEEN 2301 01:18:33,742 --> 01:18:36,478 COMPARING THOSE DRASTIC DROPS 2302 01:18:36,478 --> 01:18:38,980 VERSUS ALSO THE PEAKS IN BLOOD 2303 01:18:38,980 --> 01:18:39,714 PRESSURE. 2304 01:18:39,714 --> 01:18:43,017 AS IT WAS MENTIONED YESTERDAY 2305 01:18:43,017 --> 01:18:47,088 THE LOWER IS GONNA FALL. 2306 01:18:47,088 --> 01:18:51,926 SO FOR THESE CONDITIONS, THERE'S 2307 01:18:51,926 --> 01:18:55,663 ONLY VERY LITTLE BIT DRASTIC -- 2308 01:18:55,663 --> 01:18:56,598 IN BLOOD PRESSURE -- I DON'T 2309 01:18:56,598 --> 01:18:59,067 WANT TO SAY -- 2310 01:18:59,067 --> 01:19:03,471 >> WAS THAT WORSE AT NIGHT? 2311 01:19:03,471 --> 01:19:05,440 >> NO, NO, THAT'S THE TRICKY 2312 01:19:05,440 --> 01:19:06,541 PART. 2313 01:19:06,541 --> 01:19:09,477 SO EVEN IF WE QUANTIFY, LET'S 2314 01:19:09,477 --> 01:19:11,179 SAY, THE FIVE LARGEST DROPS, 2315 01:19:11,179 --> 01:19:12,480 THEY MUST OCCUR DURING THE DAY 2316 01:19:12,480 --> 01:19:13,248 TIME, BECAUSE DURING THE DAY 2317 01:19:13,248 --> 01:19:14,883 TIME, WE HAVE MORE -- THERE'S 2318 01:19:14,883 --> 01:19:17,485 MORE ACTIVITY, SO PEOPLE ARE 2319 01:19:17,485 --> 01:19:19,554 MORE SUSCEPTIBLE TO DRASTIC 2320 01:19:19,554 --> 01:19:21,322 CHANGES IN BLOOD PRESSURES, 2321 01:19:21,322 --> 01:19:24,692 ACTUALLY MOST OF THE DRASTIC 2322 01:19:24,692 --> 01:19:25,827 CHANGES THROUGH DROPS IN BLOOD 2323 01:19:25,827 --> 01:19:26,528 PRESSURE OCCURRED DURING THE DAY 2324 01:19:26,528 --> 01:19:30,331 TIME. 2325 01:19:30,331 --> 01:19:34,002 AND THIS ISN'T JUST GLAUCOMA 2326 01:19:34,002 --> 01:19:35,904 OR -- MOST OF THEM, THEY ARE 2327 01:19:35,904 --> 01:19:37,405 ACTUALLY HYPERTENSIVE SO THEY 2328 01:19:37,405 --> 01:19:40,575 ARE MORE PRONE TO DROPS IN BLOOD 2329 01:19:40,575 --> 01:19:43,111 PRESSURE. 2330 01:19:43,111 --> 01:19:45,847 >> ALSO IF WE COULD ADDRESS 2331 01:19:45,847 --> 01:19:46,414 WHICH MEDICATIONS DECREASE 2332 01:19:46,414 --> 01:19:47,448 VARIATION THE MOST AS AN 2333 01:19:47,448 --> 01:19:54,923 IMPORTANT TOPIC. 2334 01:19:54,923 --> 01:19:56,424 >> I HAVE A QUESTION UNLESS, 2335 01:19:56,424 --> 01:19:57,425 HILARY, YOU HAVE A FOLLOW-UP? 2336 01:19:57,425 --> 01:20:01,996 I DIDN'T WANT TO INTERRUPT YOU. 2337 01:20:01,996 --> 01:20:03,665 SO I'M GETTING ABOUT TWO EMAILS 2338 01:20:03,665 --> 01:20:05,400 A WEEK ASKING ME ABOUT THIS GAP, 2339 01:20:05,400 --> 01:20:06,601 AND I'M INTERESTED IN WHAT YOU 2340 01:20:06,601 --> 01:20:09,470 THINK. 2341 01:20:09,470 --> 01:20:11,005 I OBVIOUSLY WANT IMPLEMENTATION 2342 01:20:11,005 --> 01:20:12,807 OF HOME MONITORING, PARTICULARLY 2343 01:20:12,807 --> 01:20:14,375 HOME TELEMONITORRING, TO BE 2344 01:20:14,375 --> 01:20:15,877 SUCCESSFUL. 2345 01:20:15,877 --> 01:20:19,180 BUT WHAT I FOUND IS THAT THE 2346 01:20:19,180 --> 01:20:21,282 NEXUS BETWEEN DEVICE, CLOUD AND 2347 01:20:21,282 --> 01:20:22,917 EHR, IS HANDLED BY DIFFERENT 2348 01:20:22,917 --> 01:20:24,886 COMPANIES. 2349 01:20:24,886 --> 01:20:26,621 AND THAT'S ALSO DIFFERENT -- 2350 01:20:26,621 --> 01:20:27,856 THAT'S ALSO DIFFERENT THAN THE 2351 01:20:27,856 --> 01:20:29,691 HOSPITAL SYSTEM. 2352 01:20:29,691 --> 01:20:33,061 THIS OFTEN HAS PROBLEMS WITH 2353 01:20:33,061 --> 01:20:33,828 PRIVACY. 2354 01:20:33,828 --> 01:20:35,496 DO YOU HAVE KIND OF AN OUT OF 2355 01:20:35,496 --> 01:20:37,465 THE BOX SOLUTION THAT FIXES 2356 01:20:37,465 --> 01:20:40,501 THIS? 2357 01:20:40,501 --> 01:20:42,537 IF YOU UNDERSTAND WHAT I'M 2358 01:20:42,537 --> 01:20:42,971 SAYING? 2359 01:20:42,971 --> 01:20:44,239 BECAUSE I DON'T THINK THERE'S A 2360 01:20:44,239 --> 01:20:44,806 UNIVERSAL SOLUTION. 2361 01:20:44,806 --> 01:20:46,975 >> I DON'T KNOW IF I KNOW ALL 2362 01:20:46,975 --> 01:20:48,509 THAT BECAUSE I'VE GOTTEN SOME 2363 01:20:48,509 --> 01:20:50,445 STRANGE QUESTIONS ABOUT THAT 2364 01:20:50,445 --> 01:20:52,881 RECENTLY MYSELF. 2365 01:20:52,881 --> 01:20:55,183 BUT I THINK WHAT KAISER DOES, 2366 01:20:55,183 --> 01:20:58,353 THEY ORIGINALLY USED A VENDOR 2367 01:20:58,353 --> 01:21:00,321 AND THEN THEY JUST BROUGHT IT 2368 01:21:00,321 --> 01:21:01,522 IN-HOUSE, BUT THEY HAVE THE 2369 01:21:01,522 --> 01:21:02,824 RESOURCES TO DO THAT AND 2370 01:21:02,824 --> 01:21:03,958 INCREASINGLY, THEY DON'T WANT TO 2371 01:21:03,958 --> 01:21:04,926 GO TO A VENDOR. 2372 01:21:04,926 --> 01:21:06,361 THERE'S OTHER PROBLEMS WITH 2373 01:21:06,361 --> 01:21:11,099 VENDORS, YOU MIGHT SEND A 2374 01:21:11,099 --> 01:21:12,066 CONTRACT -- NOT USE IT AS MUCH 2375 01:21:12,066 --> 01:21:13,735 AS YOU THOUGHT. 2376 01:21:13,735 --> 01:21:16,771 SO I THINK HILARY MIGHT HAVE AN 2377 01:21:16,771 --> 01:21:17,872 ANSWER TOO FOR THIS WITH ONE OF 2378 01:21:17,872 --> 01:21:20,208 THE VENDORS SHE'S BEEN USING. 2379 01:21:20,208 --> 01:21:24,012 WHO HAS MORE OF AN OPEN ACCESS 2380 01:21:24,012 --> 01:21:24,545 POLICY. 2381 01:21:24,545 --> 01:21:27,048 NOT TOWARDS THE DATA, BUT IT'S 2382 01:21:27,048 --> 01:21:30,652 NOT AS FINANCIALLY MOTIVATED. 2383 01:21:30,652 --> 01:21:31,986 HILARY, CAN YOU COMMENT ON THAT? 2384 01:21:31,986 --> 01:21:33,221 >> YES, I DON'T NECESSARILY WANT 2385 01:21:33,221 --> 01:21:37,659 TO CALL OUT A VENDOR, BUT I 2386 01:21:37,659 --> 01:21:39,127 THINK -- COME ON, FEDERAL 2387 01:21:39,127 --> 01:21:40,461 EMPLOYEE, I CAN'T DO THAT. 2388 01:21:40,461 --> 01:21:41,729 >> YES, UNDERSTOOD. 2389 01:21:41,729 --> 01:21:44,365 >> WE HAVE BEEN -- YES, THIS IS 2390 01:21:44,365 --> 01:21:48,269 A HUGE PROBLEM, AND THE CLINICAL 2391 01:21:48,269 --> 01:21:50,505 SETTINGS THAT HAVE BEEN 2392 01:21:50,505 --> 01:21:51,472 SUCCESSFUL HAVE SORT OF HACKED 2393 01:21:51,472 --> 01:21:53,007 OUT THEIR SOLUTION AND MADE IT 2394 01:21:53,007 --> 01:21:53,975 SPECIFIC TO THEIR CONTEXT. 2395 01:21:53,975 --> 01:21:56,444 SO WHAT ARE THOSE BROADER 2396 01:21:56,444 --> 01:21:56,744 SOLUTIONS? 2397 01:21:56,744 --> 01:21:58,513 THERE IS ONE VENDOR THAT I CAN 2398 01:21:58,513 --> 01:22:00,481 THINK OF THAT HELPS IN THIS 2399 01:22:00,481 --> 01:22:02,250 SPACE, AND HOPEFULLY WE'RE GOING 2400 01:22:02,250 --> 01:22:04,652 TO SEE A HANDFUL MORE OF THOSE 2401 01:22:04,652 --> 01:22:06,821 THAT ARE COMING, BUT IT REALLY 2402 01:22:06,821 --> 01:22:08,723 IS A HARD ISSUE, AND SO SOME OF 2403 01:22:08,723 --> 01:22:10,224 THE STANDARDS THAT I DIDN'T 2404 01:22:10,224 --> 01:22:14,862 QUITE GET A CHANCE TO TALK ABOUT 2405 01:22:14,862 --> 01:22:16,130 YESTERDAY, FIRE STANDARDS, I DO 2406 01:22:16,130 --> 01:22:17,165 THINK THAT THIS IS GOING TO 2407 01:22:17,165 --> 01:22:20,768 HELP, BECAUSE IF ALL OF OUR 2408 01:22:20,768 --> 01:22:22,170 DEVICES AND OUR RECEIVING 2409 01:22:22,170 --> 01:22:23,938 EHRs, IF WE'RE ALL SPEAKING 2410 01:22:23,938 --> 01:22:25,673 THE SAME LANGUAGE, THAT'S GOING 2411 01:22:25,673 --> 01:22:27,809 TO HELP STREAMLINE THAT MESSAGE 2412 01:22:27,809 --> 01:22:28,676 TRANSMISSION. 2413 01:22:28,676 --> 01:22:29,744 SO IT A SLOW AND PAINFUL 2414 01:22:29,744 --> 01:22:31,079 PROCESS, BUT THERE ARE 2415 01:22:31,079 --> 01:22:32,714 DEFINITELY SORT OF BABY STEPS 2416 01:22:32,714 --> 01:22:34,148 THAT ARE HAPPENING THAT ARE 2417 01:22:34,148 --> 01:22:40,154 MOVING THAT FIELD FORWARD. 2418 01:22:40,154 --> 01:22:41,055 >> THANK YOU. 2419 01:22:41,055 --> 01:22:41,990 >> HOW ARE WE ON TIME? 2420 01:22:41,990 --> 01:22:44,158 DO WE HAVE TIME FOR -- 2421 01:22:44,158 --> 01:22:48,229 >> WE HAVE TWO MINUTES LEFT. 2422 01:22:48,229 --> 01:22:49,697 WE CAN DO ONE MORE I THINK. 2423 01:22:49,697 --> 01:22:50,098 >> LET'S SEE. 2424 01:22:50,098 --> 01:22:51,799 I HAVE A COUPLE QUESTIONS, BUT 2425 01:22:51,799 --> 01:22:53,234 IN MY HEAD, ONE OF THE THINGS 2426 01:22:53,234 --> 01:22:54,635 I'M THINKING OF IS, LIKE, COULD 2427 01:22:54,635 --> 01:22:57,372 WE LOOK AT CLIMATE CHANGE OVER 2428 01:22:57,372 --> 01:22:59,674 TIME AND SEE HOW THAT'S -- THE 2429 01:22:59,674 --> 01:23:02,143 IMPACT IT'S HAD ON SEASONALITY. 2430 01:23:02,143 --> 01:23:03,277 ANYWAY, ROBERT, THERE'S A STUDY 2431 01:23:03,277 --> 01:23:05,413 FOR YOU TO DO. 2432 01:23:05,413 --> 01:23:05,613 BUT -- 2433 01:23:05,613 --> 01:23:07,482 >> OH, NO, THAT'S ALREADY DONE. 2434 01:23:07,482 --> 01:23:09,117 >> HAS IT BEEN? 2435 01:23:09,117 --> 01:23:11,185 >> BY OTHER PEOPLE, RIGHT, YOU 2436 01:23:11,185 --> 01:23:12,420 KNOW, TODAY'S SCIENTIFIC 2437 01:23:12,420 --> 01:23:13,421 LITERATURE, BY THE TIME YOU 2438 01:23:13,421 --> 01:23:15,256 THINK OF IT, SOMEBODY HAS LIKE 2439 01:23:15,256 --> 01:23:16,891 THREE PAPERS IN PRESS OUT 2440 01:23:16,891 --> 01:23:18,559 SOMEPLACE ELSE, SO THERE'S A LOT 2441 01:23:18,559 --> 01:23:19,994 OF LITERATURE ON CLIMATE CHANGE 2442 01:23:19,994 --> 01:23:21,362 AND BLOOD PRESSURE, OF COURSE, 2443 01:23:21,362 --> 01:23:22,196 BUT GO AHEAD. 2444 01:23:22,196 --> 01:23:22,397 SORRY. 2445 01:23:22,397 --> 01:23:23,931 >> WELL, SO I'LL ASK YOU THIS, 2446 01:23:23,931 --> 01:23:25,600 THOUGH, SO AS I HEAR YOU, YOU 2447 01:23:25,600 --> 01:23:26,801 KNOW, TALK ABOUT TEMPERATURE AND 2448 01:23:26,801 --> 01:23:28,336 SEASON AND NOISE, OBVIOUSLY 2449 01:23:28,336 --> 01:23:30,872 SEASON, WE CAN'T CONTROL, BUT 2450 01:23:30,872 --> 01:23:31,205 TEMPERATURE -- 2451 01:23:31,205 --> 01:23:34,442 >> YOU CAN MOVE: I TELL PEOPLE 2452 01:23:34,442 --> 01:23:36,644 TO MOVE TO A LOW ALTITUDE PLACE 2453 01:23:36,644 --> 01:23:39,180 ON A BEACH THAT'S QUIET IN 2454 01:23:39,180 --> 01:23:39,414 HAWAII. 2455 01:23:39,414 --> 01:23:39,981 >> THERE YOU GO. 2456 01:23:39,981 --> 01:23:41,883 >> AND IT SOLVES ALL YOUR 2457 01:23:41,883 --> 01:23:42,116 PROBLEM. 2458 01:23:42,116 --> 01:23:43,384 >> THERE'S THE UNIVERSAL 2459 01:23:43,384 --> 01:23:43,851 SOLUTION. 2460 01:23:43,851 --> 01:23:44,352 I LOVE IT. 2461 01:23:44,352 --> 01:23:44,919 I LOVE IT. 2462 01:23:44,919 --> 01:23:46,354 WELL, I WORK AT CDC SO I'M 2463 01:23:46,354 --> 01:23:48,856 TRYING TO THINK ABOUT EQUITY, 2464 01:23:48,856 --> 01:23:51,926 AND YOU KNOW, WE'VE GOT SORT OF 2465 01:23:51,926 --> 01:23:53,327 OUR DISPARATE POPULATIONS LIVING 2466 01:23:53,327 --> 01:23:55,963 NEAR HIGHWAY, PROBABLY IN URBAN 2467 01:23:55,963 --> 01:23:58,332 AREAS, LIKE, IS THERE A WAY FOR 2468 01:23:58,332 --> 01:24:01,803 US TO SORT OF ATTEND TO THE 2469 01:24:01,803 --> 01:24:02,870 ENVIRONMENT, THE ENVIRONMENTAL 2470 01:24:02,870 --> 01:24:04,472 CONDITIONS AS WE THINK ABOUT 2471 01:24:04,472 --> 01:24:06,074 SOCIAL DRIVERS OF HEALTH OR -- I 2472 01:24:06,074 --> 01:24:07,642 DON'T KNOW, DO YOU HAVE ANY SORT 2473 01:24:07,642 --> 01:24:08,643 OF BIG PICTURE THOUGHTS ON THAT 2474 01:24:08,643 --> 01:24:09,911 AND THE EQUITY ISSUES? 2475 01:24:09,911 --> 01:24:12,280 >> RIGHT, IT'S A FANTASTIC 2476 01:24:12,280 --> 01:24:12,914 QUESTION, BECAUSE THESE THINGS 2477 01:24:12,914 --> 01:24:16,584 TEND TO CLUSTER, RIGHT? 2478 01:24:16,584 --> 01:24:17,618 AND CLEARLY CONTRIBUTE MASSIVELY 2479 01:24:17,618 --> 01:24:21,389 TO HEALTH DISPARITIES. 2480 01:24:21,389 --> 01:24:23,791 I THINK IT'S A LARGER SOCIETAL 2481 01:24:23,791 --> 01:24:24,158 ISSUE. 2482 01:24:24,158 --> 01:24:25,426 SO SOME OF THE QUESTIONS HAVE 2483 01:24:25,426 --> 01:24:26,527 BEEN -- OR SOME OF THE SOLUTIONS 2484 01:24:26,527 --> 01:24:28,896 HAVE BEEN SUCH AS MOVING TO 2485 01:24:28,896 --> 01:24:30,331 THINGS LIKE 15-MINUTE CITIES, 2486 01:24:30,331 --> 01:24:31,766 WHICH YOU MAY HAVE HEARD OF, 2487 01:24:31,766 --> 01:24:33,000 DIFFERENT TYPES OF URBAN DESIGN. 2488 01:24:33,000 --> 01:24:34,202 NO ONE WOULD HAVE DESIGNED OUR 2489 01:24:34,202 --> 01:24:35,770 CITIES OR OUR HEALTHCARE SYSTEM 2490 01:24:35,770 --> 01:24:39,540 THE WAY IT'S TURNED OUT TO BE AT 2491 01:24:39,540 --> 01:24:41,242 THIS POINT IN TIME, IT'S GUM AND 2492 01:24:41,242 --> 01:24:41,909 TOOTHPICKS AND SUCH. 2493 01:24:41,909 --> 01:24:43,478 SO IF YOU CHANGE THINGS SUCH AS 2494 01:24:43,478 --> 01:24:45,413 A 15-MINUTE CITY WITH 2495 01:24:45,413 --> 01:24:47,915 SUPERBLOCKS WHERE WE'RE NOT ALL 2496 01:24:47,915 --> 01:24:48,683 WITHIN -- THESE ARE DIFFERENT 2497 01:24:48,683 --> 01:24:51,586 URBAN DESIGNS THAT REDUCE NOISE 2498 01:24:51,586 --> 01:24:52,753 EXPOSURE, INCREASE GREENNESS, 2499 01:24:52,753 --> 01:24:55,490 INCREASE WALKABILITY, DECREASE 2500 01:24:55,490 --> 01:24:57,592 PARTICLE AIR POLLUTION EXPOSURE, 2501 01:24:57,592 --> 01:24:59,627 YOU CAN DECREASE HEAT WITH MORE 2502 01:24:59,627 --> 01:25:00,561 GREEN SPACES. 2503 01:25:00,561 --> 01:25:04,165 LOTS OF DECREASED -- TARMAC FOR 2504 01:25:04,165 --> 01:25:05,166 DECREASED INTENSIVE HEAT, WHICH 2505 01:25:05,166 --> 01:25:07,502 HAS IMPACTS ON HEALTH AS WELL. 2506 01:25:07,502 --> 01:25:09,737 THERE ARE THINGS THAT WE CAN DO 2507 01:25:09,737 --> 01:25:11,072 AT A SOCIETAL LEVEL, 2508 01:25:11,072 --> 01:25:16,043 PARTICULARLY FOR URBAN SETTINGS. 2509 01:25:16,043 --> 01:25:18,746 OVEN TOFTEN THE WILL IS JUST NOT 2510 01:25:18,746 --> 01:25:20,314 THERE, THE MONEY IS NOT THERE, 2511 01:25:20,314 --> 01:25:21,482 AND THEN NOT TO GET TOO 2512 01:25:21,482 --> 01:25:23,451 POLITICAL ABOUT IT, BUT, LIKE, 2513 01:25:23,451 --> 01:25:25,586 PEOPLE WILL SAY THAT, WELL, THIS 2514 01:25:25,586 --> 01:25:28,256 IS IMPACTING ON FREEDOMS AND 2515 01:25:28,256 --> 01:25:29,957 CHOICE AND UNFORTUNATELY, SO 2516 01:25:29,957 --> 01:25:31,192 MUCH OF EVERYTHING ALWAYS TURNS 2517 01:25:31,192 --> 01:25:34,829 INTO POLITICAL, AND DON'T 2518 01:25:34,829 --> 01:25:35,830 CONTROL HOW MY LIFE IS AND MY 2519 01:25:35,830 --> 01:25:38,733 CITY IS, AND SO THEY OFTEN DON'T 2520 01:25:38,733 --> 01:25:39,567 GO VERY FAR. 2521 01:25:39,567 --> 01:25:42,136 BUT I WOULD SAY ONE OF THE MAIN 2522 01:25:42,136 --> 01:25:45,306 THINGS FOR HEALTH EQUITY IS 2523 01:25:45,306 --> 01:25:47,241 BETTER URBAN DESIGN AND 2524 01:25:47,241 --> 01:25:49,544 DECREASING POINT SOURCES OF 2525 01:25:49,544 --> 01:25:52,079 EXPOSURE, WHICH WE DISCLOSED 2526 01:25:52,079 --> 01:25:53,748 INCINERATOR IN DETROIT WHICH WAS 2527 01:25:53,748 --> 01:25:54,549 CONVENIENTLY RIGHT NEXT TO A 2528 01:25:54,549 --> 01:25:58,386 WHOLE BUNCH OF LOWER 2529 01:25:58,386 --> 01:25:59,086 SOCIOECONOMIC HOUSING. 2530 01:25:59,086 --> 01:26:00,354 IT LIKE NOT A GREAT PLACE FOR 2531 01:26:00,354 --> 01:26:01,088 THIS. 2532 01:26:01,088 --> 01:26:03,291 OBVIOUSLY HIGHWAYS GO RIGHT 2533 01:26:03,291 --> 01:26:04,492 THROUGH LOW SOCIOECONOMIC 2534 01:26:04,492 --> 01:26:05,059 SETTINGS. 2535 01:26:05,059 --> 01:26:06,460 SO THERE'S A LOT OF FACTORS, AND 2536 01:26:06,460 --> 01:26:09,263 IT'S A SOCIETAL ISSUE. 2537 01:26:09,263 --> 01:26:10,731 THE LAST POINT I WANTED TO MAKE 2538 01:26:10,731 --> 01:26:11,999 WAS WE'VE ADDRESSED -- WE'VE 2539 01:26:11,999 --> 01:26:13,301 TRIED TO ADDRESS A LOT OF THE 2540 01:26:13,301 --> 01:26:14,669 PROBLEMS OF EQUITY WITH CHANGING 2541 01:26:14,669 --> 01:26:15,870 THE WAY THE WHOLE MODEL OF 2542 01:26:15,870 --> 01:26:16,804 PAYMENT IS DONE. 2543 01:26:16,804 --> 01:26:20,074 SO IF IT'S ALL CONTINGENT -- 2544 01:26:20,074 --> 01:26:21,776 WHICH EVERYONE HERE KNOWS, ALL 2545 01:26:21,776 --> 01:26:22,643 CONTINGENT ON THE STANDARD 2546 01:26:22,643 --> 01:26:24,011 SYSTEM, IT'S VERY HARD TO MOVE 2547 01:26:24,011 --> 01:26:24,545 THE NEEDLE. 2548 01:26:24,545 --> 01:26:26,847 I DON'T NEED 16 RPM MEASUREMENTS 2549 01:26:26,847 --> 01:26:28,049 TO ALL OF A SUDDEN GET A BILL 2550 01:26:28,049 --> 01:26:28,716 HERE. 2551 01:26:28,716 --> 01:26:30,518 SO WE'VE DONE CAPITATED PAYMENT 2552 01:26:30,518 --> 01:26:33,120 MODELS WITH INSURANCE CONTRACTS 2553 01:26:33,120 --> 01:26:36,457 WITH MEDICARE INSURANCES THAT WE 2554 01:26:36,457 --> 01:26:42,563 TAKE CARE OF LIVES, THE QUALITY 2555 01:26:42,563 --> 01:26:44,098 AND HAVE HYPERTENSION TREATED 2556 01:26:44,098 --> 01:26:46,734 WITH A CAPITATED MODEL WITH OUR 2557 01:26:46,734 --> 01:26:48,035 TREATMENT PARTNERS, PART OF THAT 2558 01:26:48,035 --> 01:26:49,337 IS YOU GET A HOME BLOOD 2559 01:26:49,337 --> 01:26:51,806 PRESSURE, YOU GET ARPM, YOU GET 2560 01:26:51,806 --> 01:26:53,307 A PHARMACIST THAT TAKES CARE OF 2561 01:26:53,307 --> 01:26:54,242 YOUR SYSTEM, I DON'T CARE WHAT 2562 01:26:54,242 --> 01:26:55,876 IT COSTS OVERALL AND OVERALL FOR 2563 01:26:55,876 --> 01:26:57,011 YOUR INDIVIDUAL LIFE AND OVERALL 2564 01:26:57,011 --> 01:27:02,183 THE COSTS OF COURSE ARE LOWER, 2565 01:27:02,183 --> 01:27:03,618 YOU'RE INCENTIVIZED NOT TO ORDER 2566 01:27:03,618 --> 01:27:05,353 TONS OF TESTS OR INCENTIVIZED 2567 01:27:05,353 --> 01:27:07,955 NOT TO COME IN TO GET CLINIC 2568 01:27:07,955 --> 01:27:10,358 MEASUREMENTS OR TO GET -- IT'S 2569 01:27:10,358 --> 01:27:11,826 ACTUALLY A SANE WAY TO DO IT AND 2570 01:27:11,826 --> 01:27:13,461 MOST OF THE INSURERS AND PAYORS 2571 01:27:13,461 --> 01:27:16,230 ARE HAPPY TO APPROACH AND TAKE 2572 01:27:16,230 --> 01:27:18,699 PREVENTION OUT OF THAT MODEL OF 2573 01:27:18,699 --> 01:27:20,434 REGULAR HEALTHCARE, WHEN HALF 2574 01:27:20,434 --> 01:27:23,571 THE ADULT POPULATION IS 2575 01:27:23,571 --> 01:27:24,739 HYPERTENSION, TREATING IT AS A 2576 01:27:24,739 --> 01:27:25,773 REGULAR RARE DISEASE LIKE YOU 2577 01:27:25,773 --> 01:27:28,142 HAVE TO GO SEE A DOCTOR AND GET 2578 01:27:28,142 --> 01:27:29,710 PAID FOR THIS DISEASE IS JUST 2579 01:27:29,710 --> 01:27:30,544 ABSOLUTELY SILLY. 2580 01:27:30,544 --> 01:27:32,847 AND I THINK PAYMENT STRUCTURE 2581 01:27:32,847 --> 01:27:34,982 FOR THESE VERY, VERY PREVALENT 2582 01:27:34,982 --> 01:27:36,517 POPULATION HEALTH PROBLEMS NEEDS 2583 01:27:36,517 --> 01:27:38,185 TO CHANGE, AND WE CAN DO A 2584 01:27:38,185 --> 01:27:40,354 BETTER JOB OF HANDING OUT BLOOD 2585 01:27:40,354 --> 01:27:41,689 PRESSURE CUFFS, IT JUST HOW YOU 2586 01:27:41,689 --> 01:27:43,791 DO THIS IN SOCIETY, I THINK BEV 2587 01:27:43,791 --> 01:27:44,592 MENTIONED THAT EARLIER. 2588 01:27:44,592 --> 01:27:48,162 THAT'S JUST WHAT WE DO IN OUR 2589 01:27:48,162 --> 01:27:53,467 CLINICAL PRACTICE NOW. 2590 01:27:53,467 --> 01:27:54,702 >> HEAR, HEAR. 2591 01:27:54,702 --> 01:27:55,970 WELL, THANK YOU TO OUR 2592 01:27:55,970 --> 01:27:58,139 PANELISTS. 2593 01:27:58,139 --> 01:28:01,142 I THINK WE ARE UP FOR A BREAK. 2594 01:28:01,142 --> 01:28:02,476 MAYBE WE CAN PASS IT BACK TO 2595 01:28:02,476 --> 01:28:04,145 PAULA? 2596 01:28:04,145 --> 01:28:07,148 >> WELL, YES, WE ARE AT THE 2597 01:28:07,148 --> 01:28:10,951 BREAK, AND LET US RECONVENE IN 2598 01:28:10,951 --> 01:28:50,039 LIKE 6 MINUTES. 2599 01:28:50,039 --> 01:28:51,641 IN TERMS OF PREVENTION AMONG 2600 01:28:51,641 --> 01:28:53,576 BLACK MEN THROUGHOUT NEW YORK 2601 01:28:53,576 --> 01:28:55,912 CITY AND BEYOND, THIS ENGAGED A 2602 01:28:55,912 --> 01:28:58,347 LOT OF COMMUNITY RESEARCH 2603 01:28:58,347 --> 01:29:01,784 NETWORKS, OVER 200 OF THEM 2604 01:29:01,784 --> 01:29:03,386 INCLUDING CHURCHES, BARBER 2605 01:29:03,386 --> 01:29:06,088 SHOPS, AND ULTIMATELY MORE THAN 2606 01:29:06,088 --> 01:29:06,856 20,000 NEW WORKERS ARE PART OF 2607 01:29:06,856 --> 01:29:10,226 THIS RESEARCH, TO WELCOME, 2608 01:29:10,226 --> 01:29:10,559 DR. RAVENELL. 2609 01:29:10,559 --> 01:29:11,227 TAKE IT AWAY. 2610 01:29:11,227 --> 01:29:18,367 >> THANK YOU FOR THE INVITATION 2611 01:29:18,367 --> 01:29:18,935 TO JOIN YOU TODAY. 2612 01:29:18,935 --> 01:29:20,236 TODAY I'M GOING TO BE TALKING 2613 01:29:20,236 --> 01:29:21,237 ABOUT COMMUNITY CENTERED 2614 01:29:21,237 --> 01:29:23,039 APPROACHES TO BP ASSESSMENT AND 2615 01:29:23,039 --> 01:29:29,679 HYPERTENSION MANAGEMENT. 2616 01:29:29,679 --> 01:29:33,416 I ONLY HAVE A SINGLE DISCLOSURE, 2617 01:29:33,416 --> 01:29:35,551 I'M FUNDED BY THE AMERICAN HEART 2618 01:29:35,551 --> 01:29:36,886 ASSOCIATION CURRENTLY TO DO A 2619 01:29:36,886 --> 01:29:38,220 HYPERTENSION PREVENTION STUDY. 2620 01:29:38,220 --> 01:29:40,957 SO IN MY 13 MINUTES, I'D LIKE TO 2621 01:29:40,957 --> 01:29:43,926 COVER THE FOLLOWING OBJECTIVES: 2622 01:29:43,926 --> 01:29:44,894 DISCUSS HIGH QUALITY 2623 01:29:44,894 --> 01:29:45,895 BROMOPROPANE ASSESSMENT IN THE 2624 01:29:45,895 --> 01:29:47,263 COMMUNITY CONTEXT, BRIEFLY 2625 01:29:47,263 --> 01:29:49,265 REVIEW THE HISTORY OF 2626 01:29:49,265 --> 01:29:49,899 COMMUNITY-BASED BLOOD PRESSURE 2627 01:29:49,899 --> 01:29:52,268 ASSESSMENT AND HYPERTENSION 2628 01:29:52,268 --> 01:29:53,269 MANAGEMENT, DISCUSS SOME 2629 01:29:53,269 --> 01:29:54,904 SUCCESSFUL EXAMPLES OF COMMUNITY 2630 01:29:54,904 --> 01:29:55,404 CENTERED BLOOD PRESSURE 2631 01:29:55,404 --> 01:29:56,505 ASSESSMENT AND MANAGEMENT 2632 01:29:56,505 --> 01:29:58,441 PROGRAMS, AND THEN SUMMARIZE 2633 01:29:58,441 --> 01:29:59,842 SOME OF THE RESEARCH GAPS AND 2634 01:29:59,842 --> 01:30:10,052 FUTURE OPPORTUNITIES. 2635 01:30:10,052 --> 01:30:13,656 SO THIS QUOTATION COMES FROM DRD 2636 01:30:13,656 --> 01:30:17,760 COLLEAGUES FROM THEIR SCIENTIFIC 2637 01:30:17,760 --> 01:30:18,661 STATEMENT ON BLOOD PRESSURE 2638 01:30:18,661 --> 01:30:20,162 MEASUREMENT IN HUMANS FROM 2005 2639 01:30:20,162 --> 01:30:29,071 THAT WAS RECENTLY UPDATED BY DRT 2640 01:30:29,071 --> 01:30:29,572 SAYS BLOOD PRESSURE 2641 01:30:29,572 --> 01:30:30,539 DETERMINATION CONTINUES TO BE 2642 01:30:30,539 --> 01:30:31,607 ONE OF THE MOST IMPORTANT 2643 01:30:31,607 --> 01:30:32,775 MEASUREMENTS IN ALL OF CLINICAL 2644 01:30:32,775 --> 01:30:34,143 MEDICINE AND IS STILL ONE OF THE 2645 01:30:34,143 --> 01:30:36,212 MOST INACCURATELY PERFORMED. 2646 01:30:36,212 --> 01:30:36,812 ACCURATE MEASUREMENT OF BLOOD 2647 01:30:36,812 --> 01:30:38,881 PRESSURE IS ESSENTIAL TO 2648 01:30:38,881 --> 01:30:40,082 CLASSIFY INDIVIDUALS, TO 2649 01:30:40,082 --> 01:30:41,083 ASCERTAIN BLOOD PRESSURE RELATED 2650 01:30:41,083 --> 01:30:42,585 RISK AND TO GUIDE MANAGEMENT, 2651 01:30:42,585 --> 01:30:44,854 AND THAT'S REALLY WHY WHAT WE'RE 2652 01:30:44,854 --> 01:30:45,454 TALKING ABOUT IS SO IMPORTANT 2653 01:30:45,454 --> 01:30:46,555 BECAUSE IT REALLY DOES GUIDE 2654 01:30:46,555 --> 01:30:52,995 WHAT WE DO NEXT. 2655 01:30:52,995 --> 01:30:55,264 SO THIS IS A TABLE THAT IS IN 2656 01:30:55,264 --> 01:31:02,271 THE MOST RECENT STATEMENT BY DRT 2657 01:31:02,271 --> 01:31:03,572 BLOOD PRESSURE MEASUREMENT IN 2658 01:31:03,572 --> 01:31:06,342 HUMANS AND I WON'T GO THROUGH 2659 01:31:06,342 --> 01:31:08,077 THE WHOLE THING BUT BASICALLY 2660 01:31:08,077 --> 01:31:12,148 WHAT THIS DESCRIBES IS, IT'S AN 2661 01:31:12,148 --> 01:31:16,252 OVERVIEW OF THE STEPS TO MEASURE 2662 01:31:16,252 --> 01:31:17,620 BLOOD PRESSURE PROPERLY, AND IT 2663 01:31:17,620 --> 01:31:18,454 INCLUDES PREPARING THE PATIENT, 2664 01:31:18,454 --> 01:31:20,256 IT INCLUDES THE DOS AND DON'TS 2665 01:31:20,256 --> 01:31:21,857 OF WHAT PATIENTS SHOULD DO IN 2666 01:31:21,857 --> 01:31:22,892 PREPARATION FOR GETTING THEIR 2667 01:31:22,892 --> 01:31:25,528 BLOOD PRESSURE TAKEN PROPERLY, 2668 01:31:25,528 --> 01:31:26,829 POSITIONING, CUFF SELECTION, 2669 01:31:26,829 --> 01:31:28,097 MEASUREMENT TECHNIQUE, AND 2670 01:31:28,097 --> 01:31:30,866 DOCUMENTING AND COMMUNICATING 2671 01:31:30,866 --> 01:31:32,368 WITH THE PATIENT. 2672 01:31:32,368 --> 01:31:37,406 THESE STEPS ARE A WAY TO 2673 01:31:37,406 --> 01:31:38,741 OPERATIONALIZE BASICALLY THE 2674 01:31:38,741 --> 01:31:41,143 CORRECT WAY TO MEASURE ACCURATE 2675 01:31:41,143 --> 01:31:42,344 BLOOD PRESSURE. 2676 01:31:42,344 --> 01:31:44,046 AND THERE'S BASICALLY ONE 2677 01:31:44,046 --> 01:31:45,347 CORRECT WAY, WHETHER YOU'RE IN 2678 01:31:45,347 --> 01:31:48,484 AN OFFICE OR WHETHER YOU'RE IN A 2679 01:31:48,484 --> 01:31:50,052 COMMUNITY CONTEXT, AND AS WE'VE 2680 01:31:50,052 --> 01:31:52,088 HEARD FROM MANY PRESENTERS 2681 01:31:52,088 --> 01:31:53,489 THROUGHOUT THE LAST TWO DAYS, 2682 01:31:53,489 --> 01:31:56,759 THE DEVIL REALLY IS IN THE 2683 01:31:56,759 --> 01:31:58,694 DETAILS. 2684 01:31:58,694 --> 01:32:03,199 AND SO THIS QUOTATION THAT YOU 2685 01:32:03,199 --> 01:32:06,068 SEE AS THE TITLE OF THE SLIDE, 2686 01:32:06,068 --> 01:32:10,606 THE STANDARD IS THE STANDARD. 2687 01:32:10,606 --> 01:32:12,775 THIS COMES FROM -- THOSE OF YOU 2688 01:32:12,775 --> 01:32:18,481 WHO MIGHT LIVE IN PIT B PITTSBUR 2689 01:32:18,481 --> 01:32:21,684 MIGHT BE FANS OF THE PITTSBURGH 2690 01:32:21,684 --> 01:32:22,785 STEELERS KNOW THAT THIS IS 2691 01:32:22,785 --> 01:32:23,752 BASICALLY SOMETHING THAT THEIR 2692 01:32:23,752 --> 01:32:25,621 HEAD COACH SAYS, WHICH BASICALLY 2693 01:32:25,621 --> 01:32:27,423 SAYS IT DOESN'T MATTER WHAT THE 2694 01:32:27,423 --> 01:32:29,125 CONTEXT IS, THERE'S BASICALLY 2695 01:32:29,125 --> 01:32:32,194 ONE STANDARD, AND I THINK THAT 2696 01:32:32,194 --> 01:32:33,329 APPLIES TO BLOOD PRESSURE 2697 01:32:33,329 --> 01:32:34,230 MEASUREMENT, WHETHER WE'RE IN AN 2698 01:32:34,230 --> 01:32:36,765 OFFICE OR WHETHER WE'RE IN A 2699 01:32:36,765 --> 01:32:39,802 BARBERSHOP, THERE ARE STILL 2700 01:32:39,802 --> 01:32:41,637 IMPORTANCE TENETS TO MEASURE THE 2701 01:32:41,637 --> 01:32:43,572 BLOOD PRESSURE PROPERLY. 2702 01:32:43,572 --> 01:32:44,473 AND THE KEY TO MAKING SURE THAT 2703 01:32:44,473 --> 01:32:48,811 THAT HAPPENS IS ADEQUATE 2704 01:32:48,811 --> 01:32:53,349 TRAINING AND RETRAINING. 2705 01:32:53,349 --> 01:32:54,517 ONE OF THE IMPORTANT PARTS OF 2706 01:32:54,517 --> 01:32:57,887 THE STATEMENT ON MEASUREMENT OF 2707 01:32:57,887 --> 01:32:58,921 BLOOD PRESSURE IN HUMANS 2708 01:32:58,921 --> 01:32:59,722 INCLUDES THE IMPORTANCE OF 2709 01:32:59,722 --> 01:33:03,192 TRAINING. 2710 01:33:03,192 --> 01:33:04,426 THE REPORT SAYS THE TRAINING 2711 01:33:04,426 --> 01:33:06,529 GIVEN TO LAY OBSERVERS SHOULD BE 2712 01:33:06,529 --> 01:33:07,630 AS COMPREHENSIVE AND SIMILAR TO 2713 01:33:07,630 --> 01:33:10,065 THAT RECOMMENDED FOR HEALTHCARE 2714 01:33:10,065 --> 01:33:11,700 PROFESSIONALS IN AMBULATORY AND 2715 01:33:11,700 --> 01:33:14,203 COMMUNITY SETTINGS. 2716 01:33:14,203 --> 01:33:15,971 AND WE BELIEVE THAT WITH CAREFUL 2717 01:33:15,971 --> 01:33:19,408 TRAINING, EVEN VOLUNTEERS IN 2718 01:33:19,408 --> 01:33:20,376 LARGE POPULATIONS CAN MEASURE 2719 01:33:20,376 --> 01:33:23,479 BLOOD PRESSURE ACCURATELY, AND 2720 01:33:23,479 --> 01:33:25,047 SO THE TRAINING INCLUDES MAKING 2721 01:33:25,047 --> 01:33:27,816 SURE THAT FOLKS ARE USING A 2722 01:33:27,816 --> 01:33:29,018 VALIDATED DEVICE, MAKING SURE 2723 01:33:29,018 --> 01:33:31,554 THAT THE PATIENT IS PROPERLY 2724 01:33:31,554 --> 01:33:33,255 POSITIONED, SELECTING THE 2725 01:33:33,255 --> 01:33:34,623 APPROPRIATE ARM CUFF, OBTAINING 2726 01:33:34,623 --> 01:33:36,592 A VALID AND RELIABLE 2727 01:33:36,592 --> 01:33:37,593 MEASUREMENT, RECORDING THE 2728 01:33:37,593 --> 01:33:40,262 MEASUREMENT ACCURATELY, AND 2729 01:33:40,262 --> 01:33:41,197 REPORTING ABNORMAL VALUES 2730 01:33:41,197 --> 01:33:42,131 PROPERLY. 2731 01:33:42,131 --> 01:33:44,633 SO THERE ARE SOME SCREEN SHOTS 2732 01:33:44,633 --> 01:33:46,435 HERE OF PART OF VARIOUS TRAINING 2733 01:33:46,435 --> 01:33:48,404 MANUALS THAT WE HAVE DONE OVER 2734 01:33:48,404 --> 01:33:50,839 THE YEARS THAT MAKE SURE THAT 2735 01:33:50,839 --> 01:33:53,842 OUR OPERATORS, WHETHER THEY BE 2736 01:33:53,842 --> 01:33:55,978 RESEARCH ASSISTANTS OR COMMUNITY 2737 01:33:55,978 --> 01:33:57,680 VOLUNTEERS, THAT THEY ARE 2738 01:33:57,680 --> 01:33:59,615 FAMILIAR WITH HOW TO USE A 2739 01:33:59,615 --> 01:34:01,317 VALIDATED MONITOR THAT THEY ARE 2740 01:34:01,317 --> 01:34:03,852 FAMILIAR WITH HOW TO SELECT THE 2741 01:34:03,852 --> 01:34:08,023 APPROPRIATE SIZE CUFF, AND HOW 2742 01:34:08,023 --> 01:34:10,292 TO PROPERLY PLACE THE CUFF SO 2743 01:34:10,292 --> 01:34:12,194 THAT IT FITS APPROPRIATELY SO 2744 01:34:12,194 --> 01:34:13,529 THAT WE CAN GET A GOOD 2745 01:34:13,529 --> 01:34:19,535 MEASUREMENT. 2746 01:34:19,535 --> 01:34:22,104 SO THIS SLIDE JUST SUMMARIZES 2747 01:34:22,104 --> 01:34:24,073 SOME OF THE SEMINAL EVENTS IN 2748 01:34:24,073 --> 01:34:27,810 COMMUNITY-BASED BROMOPROPANE 2749 01:34:27,810 --> 01:34:28,611 COMMUNITY-BASED BLOOD PRESSURE 2750 01:34:28,611 --> 01:34:29,345 ASSESSMENTS. 2751 01:34:29,345 --> 01:34:29,979 THE FIRST PANEL IS BASICALLY 2752 01:34:29,979 --> 01:34:31,046 SOMETHING I FOUND IN PREPARATION 2753 01:34:31,046 --> 01:34:33,916 FOR THIS TALK, WHICH IS A 2754 01:34:33,916 --> 01:34:38,053 SCREENSHOT OF THE PUBLIC USE 2755 01:34:38,053 --> 01:34:40,756 DATA TAPE DOCUMENTATION FOR THE 2756 01:34:40,756 --> 01:34:44,660 FIRST NATIONAL HEALTH 2757 01:34:44,660 --> 01:34:45,995 EXAMINATION SURVEY, WHICH 2758 01:34:45,995 --> 01:34:50,666 STARTED BACK IN 1960 TO NE 1962. 2759 01:34:50,666 --> 01:34:54,236 THIS WAS SUCH AN IMPORTANT 2760 01:34:54,236 --> 01:34:55,104 DEVELOPMENT BECAUSE IT REALLY 2761 01:34:55,104 --> 01:34:59,174 WAS AN IMPORTANT, RIGOROUS 2762 01:34:59,174 --> 01:35:00,843 EPIDEMIOLOGIC ASSESSMENT OF THE 2763 01:35:00,843 --> 01:35:05,414 PREVALENCE OF MANY CONDITIONS IN 2764 01:35:05,414 --> 01:35:07,483 THIS COUNTRY, HYPERTENSION BEING 2765 01:35:07,483 --> 01:35:08,484 ONE OF THE MOST IMPORTANT. 2766 01:35:08,484 --> 01:35:13,589 SO AMONG OVER 6,000 INDIVIDUALS 2767 01:35:13,589 --> 01:35:15,157 WHO UNDERWENT THESE DETAILED 2768 01:35:15,157 --> 01:35:16,392 HEALTH INFORMATION SURVEYS, THEY 2769 01:35:16,392 --> 01:35:20,329 FOUND OVER 1900 CASES OF 2770 01:35:20,329 --> 01:35:20,929 HYPERTENSION. 2771 01:35:20,929 --> 01:35:22,898 AS YOU KNOW IN THE 1960s, IT 2772 01:35:22,898 --> 01:35:24,066 REALLY WAS A TIME WHEN WE WERE 2773 01:35:24,066 --> 01:35:24,900 LEARNING A LOT ABOUT 2774 01:35:24,900 --> 01:35:25,934 HYPERTENSION, INCLUDING ABOUT 2775 01:35:25,934 --> 01:35:28,637 THE BENEFITS OF TREATING 2776 01:35:28,637 --> 01:35:30,272 HYPERTENSION STUDIES SUCH AS THE 2777 01:35:30,272 --> 01:35:32,007 VA COOPERATIVE STUDIES AND 2778 01:35:32,007 --> 01:35:36,512 OTHERS REALLY GAVE RISE TO MUCH 2779 01:35:36,512 --> 01:35:37,680 OF THE KNOWLEDGE THAT WE HAVE 2780 01:35:37,680 --> 01:35:40,182 NOW, BUT ALSO GAVE RISE TO MANY 2781 01:35:40,182 --> 01:35:42,918 COMMUNITY-BASED EFFORTS 2782 01:35:42,918 --> 01:35:43,519 INCLUDING IN THE SECOND PANEL 2783 01:35:43,519 --> 01:35:46,121 WHO WE SEE FEATURED IS THE LATE 2784 01:35:46,121 --> 01:35:48,490 GREAT DR. ELI SAUNDERS, WHO 2785 01:35:48,490 --> 01:35:54,730 REALLY STARTED EARLY ON TO DO 2786 01:35:54,730 --> 01:35:55,331 COMMUNITY-ENGAGED WORK IN 2787 01:35:55,331 --> 01:35:56,965 RESPONSE TO OUR KNOWLEDGE THAT 2788 01:35:56,965 --> 01:35:58,967 HYPERTENSION DISPROPORTIONATELY 2789 01:35:58,967 --> 01:36:00,069 IMPACTS BLACK COMMUNITIES, AND 2790 01:36:00,069 --> 01:36:01,437 THAT THE ONLY WAY THAT WE WERE 2791 01:36:01,437 --> 01:36:06,008 GOING TO GET ON TOP OF THIS 2792 01:36:06,008 --> 01:36:07,376 PREDICAMENT IS TO MOVE OUTSIDE 2793 01:36:07,376 --> 01:36:08,977 OF CLINICAL SETTINGS AND INTO 2794 01:36:08,977 --> 01:36:09,678 COMMUNITY SETTINGS. 2795 01:36:09,678 --> 01:36:10,913 A BIG PART OF MOVING THAT 2796 01:36:10,913 --> 01:36:13,649 FORWARD WAS ALSO THE NATIONAL 2797 01:36:13,649 --> 01:36:15,050 HIGH BLOOD PRESSURE EDUCATION 2798 01:36:15,050 --> 01:36:17,986 PROGRAM, WHICH STARTED BACK IN 2799 01:36:17,986 --> 01:36:21,623 1972. 2800 01:36:21,623 --> 01:36:23,392 DR. ED ROCCELLA WAS REALLY AT 2801 01:36:23,392 --> 01:36:24,860 THE FOREFRONT OF THAT WORK, BUT 2802 01:36:24,860 --> 01:36:28,464 AS PART OF THAT, THERE WAS A 2803 01:36:28,464 --> 01:36:31,066 HUGE EMPHASIS ON COMMUNITY-BASED 2804 01:36:31,066 --> 01:36:33,435 PROGRAMS IN VARIOUS WAYS OF 2805 01:36:33,435 --> 01:36:34,970 MAKING COMMUNITIES MORE AWAIRL 2806 01:36:34,970 --> 01:36:39,742 OMORE AWARE OFTHE PROBLEM OF HYD 2807 01:36:39,742 --> 01:36:40,843 REALLY MOVE FORWARD OUT OF 2808 01:36:40,843 --> 01:36:41,610 OFFICE BLOOD PRESSURE 2809 01:36:41,610 --> 01:36:43,379 MEASUREMENT. 2810 01:36:43,379 --> 01:36:47,716 AND THEN THE LAST PANEL ON HERE 2811 01:36:47,716 --> 01:36:49,985 FEATURES DR. KEITH FERDINAND'S 2812 01:36:49,985 --> 01:36:51,987 WORK, LESSONS LEARNED FROM THE 2813 01:36:51,987 --> 01:36:53,389 HEALTHY HEART COMMUNITY 2814 01:36:53,389 --> 01:36:54,623 PREVENTION PROJECT IN REACHING 2815 01:36:54,623 --> 01:36:55,391 THE AFRICAN AMERICAN POPULATION. 2816 01:36:55,391 --> 01:36:56,925 THIS REALLY BUILT ON SOME OF THE 2817 01:36:56,925 --> 01:36:59,962 GREAT WORK OF DR. ELI SAUNDERS 2818 01:36:59,962 --> 01:37:03,132 AND DR. WAYNE KONG IN BALTIMORE, 2819 01:37:03,132 --> 01:37:08,003 BUT DR. FERDINAND'S WORK REALLY 2820 01:37:08,003 --> 01:37:11,640 WAS ONE OF THE FIRST DOCUMENTED 2821 01:37:11,640 --> 01:37:14,977 EFFORTS OF UTILIZING BARBERSHOPS 2822 01:37:14,977 --> 01:37:15,844 TO INCREASE HYPERTENSION 2823 01:37:15,844 --> 01:37:17,546 AWARENESS AND IMPROVE 2824 01:37:17,546 --> 01:37:19,481 HYPERTENSION MANAGEMENT 2825 01:37:19,481 --> 01:37:20,883 UTILIZING BLACK -- UTILIZING 2826 01:37:20,883 --> 01:37:23,185 BLACK BARBER SHOPS. 2827 01:37:23,185 --> 01:37:25,487 DR. FE FERDINAND'S PROJECT IN 2828 01:37:25,487 --> 01:37:28,056 BARBER SHOPS WAS CALLED "CUT 2829 01:37:28,056 --> 01:37:29,158 YOUR PRESSURE," WHERE THEY 2830 01:37:29,158 --> 01:37:31,326 TAUGHT BEAUTICIANS AND TAUGHT 2831 01:37:31,326 --> 01:37:32,895 BARBERS HOW TO MEASURE BLOOD 2832 01:37:32,895 --> 01:37:34,997 PRESSURE IN A STANDARDIZED WAY, 2833 01:37:34,997 --> 01:37:37,299 AND ALSO HOW TO CONVEY THAT 2834 01:37:37,299 --> 01:37:39,168 INFORMATION TO THEIR CUSTOMERS 2835 01:37:39,168 --> 01:37:41,970 SO THAT THEY COULD RECEIVE 2836 01:37:41,970 --> 01:37:46,442 APPROPRIATE MANAGEMENT. 2837 01:37:46,442 --> 01:37:48,544 AND THE GREAT WORK OF 2838 01:37:48,544 --> 01:37:51,246 DR. FERDINAND GAVE RISE TO "CUT 2839 01:37:51,246 --> 01:37:53,148 YOUR PRESSURE 2," WHICH I WAS 2840 01:37:53,148 --> 01:37:56,151 PRIVILEGED TO BE A PART OF WITH 2841 01:37:56,151 --> 01:37:57,619 DR. RON VICTOR, WHO PASSED AWAY 2842 01:37:57,619 --> 01:38:00,055 SEVERAL YEARS AGO, BUT THAT WORK 2843 01:38:00,055 --> 01:38:02,891 IN DALLAS REALLY BUILT ON THE 2844 01:38:02,891 --> 01:38:08,130 WORK OF DR. SAUNDERS AND 2845 01:38:08,130 --> 01:38:09,465 DR. FERDINAND, AND IT WAS BASED 2846 01:38:09,465 --> 01:38:13,101 ON A PROTOCOL TOAS I MENTIONED 2847 01:38:13,101 --> 01:38:14,536 WITH CUT YOUR PRESSURE ONE IN 2848 01:38:14,536 --> 01:38:16,538 NEW ORLEANS, WHERE BARBERS WERE 2849 01:38:16,538 --> 01:38:17,739 TAUGHT HOW TO MEASURE BLOOD 2850 01:38:17,739 --> 01:38:19,608 PRESSURE, BUT ALSO HOW TO REFER 2851 01:38:19,608 --> 01:38:22,544 THEIR CUSTOMERS TO THE DOCTOR IF 2852 01:38:22,544 --> 01:38:26,915 THEIR BLOOD PRESSURE WAS HIGH, 2853 01:38:26,915 --> 01:38:28,417 WITH THE IDEA BEING THE 2854 01:38:28,417 --> 01:38:29,651 FREQUENCY WITH WHICH BLACK MEN 2855 01:38:29,651 --> 01:38:33,355 GO TO BARBERS, WHICH IN OUR 2856 01:38:33,355 --> 01:38:34,690 FORMATIVE WORK WE FOUND TO BE 2857 01:38:34,690 --> 01:38:35,591 ROUGHLY EVERY TWO WEEKS, THAT 2858 01:38:35,591 --> 01:38:37,826 THAT WAS A GREAT FREQUENCY FOR 2859 01:38:37,826 --> 01:38:43,165 US TO MONITOR THE IMPACT OF ANY 2860 01:38:43,165 --> 01:38:44,967 THERAPY THAT WAS STARTED AS A 2861 01:38:44,967 --> 01:38:45,868 RESULT OF OUR REFERRAL TO 2862 01:38:45,868 --> 01:38:48,470 THE DOCTOR UPON IDENTIFYING 2863 01:38:48,470 --> 01:38:52,441 ABNORMAL BLOOD PRESSURES. 2864 01:38:52,441 --> 01:38:56,845 AND SO THIS IS DR. VICTOR 2865 01:38:56,845 --> 01:38:58,180 PICTURED HERE, AND THIS REMINDS 2866 01:38:58,180 --> 01:39:01,149 ME OF WHEN HE WAS RECRUITING ME 2867 01:39:01,149 --> 01:39:02,818 TO DALLAS, TEXAS AND WAS TELLING 2868 01:39:02,818 --> 01:39:04,019 ME ABOUT SOME OF THE GREAT WORK 2869 01:39:04,019 --> 01:39:06,855 THAT HE HAD STARTED WITH 2870 01:39:06,855 --> 01:39:07,923 DR. FERDINAND, AND HE SAID, 2871 01:39:07,923 --> 01:39:09,558 WE'RE GOING TO GET THIS WORK 2872 01:39:09,558 --> 01:39:11,360 PUBLISHED IN THE NEW ENGLAND 2873 01:39:11,360 --> 01:39:12,528 JOURNAL, SO IT WAS WONDERFUL TO 2874 01:39:12,528 --> 01:39:17,633 SEE THAT COME TO FRUITION IN 2875 01:39:17,633 --> 01:39:21,103 2018, A CLUSTER RANDOMIZED TRIAL 2876 01:39:21,103 --> 01:39:22,304 OF BLOOD PRESSURE REDUCTION IN 2877 01:39:22,304 --> 01:39:24,740 BLACK BARBERSHOPS, WHERE HE WAS 2878 01:39:24,740 --> 01:39:29,044 ABLE TO PUBLISH THAT BY ADDING 2879 01:39:29,044 --> 01:39:30,679 PHARMACISTS INTO THIS MODEL, 2880 01:39:30,679 --> 01:39:34,583 THAT IT COULD HAVE A DRAMATIC 2881 01:39:34,583 --> 01:39:35,884 IMPACT ON BLOOD PRESSURE 2882 01:39:35,884 --> 01:39:37,119 REDUCTION AND HYPERTENSION 2883 01:39:37,119 --> 01:39:39,054 CONTROL. 2884 01:39:39,054 --> 01:39:45,594 AND SO WORKING WITH 52 BARBER 2885 01:39:45,594 --> 01:39:47,129 SHOPS, THEY WERE ABLE TO SHOW IN 2886 01:39:47,129 --> 01:39:51,066 THE BOTTOM LINE HERE THAT WE 2887 01:39:51,066 --> 01:39:54,736 COULD ACHIEVE A 27-POINT DROP IN 2888 01:39:54,736 --> 01:39:55,938 SYSTOLIC BLOOD PRESSURE BY 2889 01:39:55,938 --> 01:39:57,573 MEASURING BLOOD PRESSURE IN THE 2890 01:39:57,573 --> 01:39:59,374 BARBERSHOP, BY GETTING THEM 2891 01:39:59,374 --> 01:40:01,810 CONNECTED TO A PHARMACIST TO 2892 01:40:01,810 --> 01:40:05,113 START THERAPY WHEN APPROPRIATE 2893 01:40:05,113 --> 01:40:05,948 RIGHT AWAY, BUT ALSO TO MAKE 2894 01:40:05,948 --> 01:40:07,516 SURE THEY WERE CONNECT TODAY 2895 01:40:07,516 --> 01:40:09,084 PRIMARY CARE FOR ONGOING 2896 01:40:09,084 --> 01:40:09,518 MANAGEMENT. 2897 01:40:09,518 --> 01:40:11,286 AND THEY WERE ABLE TO ACHIEVE AN 2898 01:40:11,286 --> 01:40:14,456 INTERVENTION EFFECT OF NEARLY 22 2899 01:40:14,456 --> 01:40:18,060 POINTS OF SYSTOLIC DROP IN THE 2900 01:40:18,060 --> 01:40:21,229 SIX MONTHS FOLLOWING ENROLLMENT 2901 01:40:21,229 --> 01:40:24,566 INTO THE STUDY. 2902 01:40:24,566 --> 01:40:26,068 THERE HAVE BEEN OTHER RANDOMIZED 2903 01:40:26,068 --> 01:40:29,905 TRIALS TO SHOW THAT THERE CAN BE 2904 01:40:29,905 --> 01:40:33,642 SUCCESSFUL COMMUNITY-BASED 2905 01:40:33,642 --> 01:40:37,479 EFFORTS. 2906 01:40:37,479 --> 01:40:40,616 DR. GBENGA OGEDEGBE SHOWED IN A 2907 01:40:40,616 --> 01:40:42,050 RANDOMIZED TRIAL OF 32 CLCHS, 2908 01:40:42,050 --> 01:40:51,827 TH32 CHURCHESTHAT WE COULD TRAIS 2909 01:40:51,827 --> 01:40:53,095 TO BE ESSENTIALLY FUNCTION AS 2910 01:40:53,095 --> 01:40:53,829 COMMUNITY HEALTH WORKERS AND TO 2911 01:40:53,829 --> 01:40:55,163 NOT ONLY FOCUS ON BLOOD PRESSURE 2912 01:40:55,163 --> 01:40:57,199 MEASUREMENT BUT ALSO LIFESTYLE 2913 01:40:57,199 --> 01:40:58,533 COUNSELING AND IN THAT STUDY THE 2914 01:40:58,533 --> 01:41:00,135 INTERVENTION GROUPS SAW A 2915 01:41:00,135 --> 01:41:00,869 SIGNIFICANT DECREASE IN BLOOD 2916 01:41:00,869 --> 01:41:04,306 PRESSURE AND INCREASE IN BLOOD 2917 01:41:04,306 --> 01:41:05,340 PRESSURE CONTROL AT SIX MONTHS 2918 01:41:05,340 --> 01:41:06,475 COMPARED TO CHURCHES THAT ONLY 2919 01:41:06,475 --> 01:41:09,978 HAD A HEALTH EDUCATION CONTROL. 2920 01:41:09,978 --> 01:41:12,314 AND SO CURRENTLY, WHAT WE ARE 2921 01:41:12,314 --> 01:41:16,118 WORKING ON THREUM A G THROUGH AT 2922 01:41:16,118 --> 01:41:18,186 FUNDED BY THE AMERICAN HEART 2923 01:41:18,186 --> 01:41:19,621 ASSOCIATION IS CAN SOME OF THESE 2924 01:41:19,621 --> 01:41:21,390 MODELS WORK NOT JUST TO IMPROVE 2925 01:41:21,390 --> 01:41:22,324 HYPERTENSION CONTROL BUT ALSO 2926 01:41:22,324 --> 01:41:23,692 FOR HYPERTENSION PREVENTION. 2927 01:41:23,692 --> 01:41:25,260 SO THE RESTORE NETWORK IS A 2928 01:41:25,260 --> 01:41:26,328 HEALTH EQUITY RESEARCH NETWORK 2929 01:41:26,328 --> 01:41:28,563 THAT AIMS TO ADDRESS SOCIAL 2930 01:41:28,563 --> 01:41:33,435 DETERMINANTS TO PREVENT 2931 01:41:33,435 --> 01:41:36,071 HYPERTENSION, AND THIS STUDY 2932 01:41:36,071 --> 01:41:37,706 AIMS TO PARTNER WITH BLACK 2933 01:41:37,706 --> 01:41:39,875 COMMUNITIES TO MITIGATE THE 2934 01:41:39,875 --> 01:41:40,809 IMPACT OF SOCIAL DETERMINANTS OF 2935 01:41:40,809 --> 01:41:42,044 HEALTH ON BLOOD PRESSURE TO 2936 01:41:42,044 --> 01:41:43,712 DEVELOP AND EVALUATE STRATEGIES 2937 01:41:43,712 --> 01:41:47,516 TO IMPLEMENT EVIDENCE-BASED 2938 01:41:47,516 --> 01:41:48,884 LIFESTYLE INTERVENTIONS TO LOWER 2939 01:41:48,884 --> 01:41:52,054 BLOOD PRESSURE TO DISSEMINATE -- 2940 01:41:52,054 --> 01:41:53,689 TO POLICYMAKERS AND STAKEHOLDERS 2941 01:41:53,689 --> 01:41:55,090 AND TO ENSURE SUSTAINABILITY AND 2942 01:41:55,090 --> 01:41:56,758 TO TRAIN THE NEXT GENERATION OF 2943 01:41:56,758 --> 01:41:57,626 EARLY CAREER SCIENTISTS. 2944 01:41:57,626 --> 01:41:59,061 SO THERE ARE FIVE DIFFERENT 2945 01:41:59,061 --> 01:42:00,062 PROJECTS THAT ARE HAPPENING IN 2946 01:42:00,062 --> 01:42:01,997 FIVE DIFFERENT CITIES USING FIVE 2947 01:42:01,997 --> 01:42:04,566 DIFFERENT APPROACHES TO 2948 01:42:04,566 --> 01:42:05,167 MEASURING BLOOD PRESSURE AS A 2949 01:42:05,167 --> 01:42:08,437 WAY TO IDENTIFY ELEVATED BLOOD 2950 01:42:08,437 --> 01:42:09,771 PRESSURE, AND TO HOPEFULLY 2951 01:42:09,771 --> 01:42:12,808 PREVENT THE DEVELOPMENT OF 2952 01:42:12,808 --> 01:42:13,275 HYPERTENSION. 2953 01:42:13,275 --> 01:42:15,610 THESE STUDIES ARE ONGOING, AND 2954 01:42:15,610 --> 01:42:18,513 WE HOPE IN THE NEXT YEAR OR SO 2955 01:42:18,513 --> 01:42:20,949 TO HAVE INFORMATION ABOUT 2956 01:42:20,949 --> 01:42:21,983 MEASURING BLOOD PRESSURE IN 2957 01:42:21,983 --> 01:42:23,919 THESE DIVERSE SETTINGS, 2958 01:42:23,919 --> 01:42:25,654 INCLUDING BARBER SHOPS, 2959 01:42:25,654 --> 01:42:32,127 CHURCHES, MOBILE VANS, FEDER 2960 01:42:32,127 --> 01:42:33,261 FEDERALLY -- HEALTH CENTERS AND 2961 01:42:33,261 --> 01:42:35,630 AN INTERVENTION BY DR. STEVE 2962 01:42:35,630 --> 01:42:37,232 JURASCHEK, BY UTILIZING AMAZON 2963 01:42:37,232 --> 01:42:39,735 GO FRESH AS A WAY TO PREVENT 2964 01:42:39,735 --> 01:42:42,104 HYPERTENSION. 2965 01:42:42,104 --> 01:42:45,507 SO THERE ARE SEVERAL KEY 2966 01:42:45,507 --> 01:42:47,476 KNOWLEDGE GAPS THAT WE CAN 2967 01:42:47,476 --> 01:42:50,212 CERTAINLY WORK ON TO IMPROVE OUR 2968 01:42:50,212 --> 01:42:53,582 KNOWLEDGE OF HOW TO BEST UTILIZE 2969 01:42:53,582 --> 01:42:54,616 STRATEGIES FOR COMMUNITY-BASED 2970 01:42:54,616 --> 01:42:55,984 BLOOD PRESSURE ASSESSMENT, SO 2971 01:42:55,984 --> 01:42:57,719 FIRST WHAT IS THE ROLE OF 2972 01:42:57,719 --> 01:42:58,820 COMMUNITY-BASED BLOOD PRESSURE 2973 01:42:58,820 --> 01:42:59,755 ASSESSMENT GOING FORWARD? 2974 01:42:59,755 --> 01:43:02,924 TWO, HOW DO WE SUSTAIN AND SCALE 2975 01:43:02,924 --> 01:43:03,492 COMMUNITY-BASED APPROACHES? 2976 01:43:03,492 --> 01:43:05,293 THREE, HOW CAN WE LEVERAGE 2977 01:43:05,293 --> 01:43:07,963 EVOLVING TECHNOLOGIES, INCLUDING 2978 01:43:07,963 --> 01:43:08,897 BLOOD PRESSURE TELL MONITORING, 2979 01:43:08,897 --> 01:43:13,668 TELEMONITOR, ANDHOW DO WE OPTIMY 2980 01:43:13,668 --> 01:43:16,271 CLINICAL LINKAGES AFTER BLOOD 2981 01:43:16,271 --> 01:43:18,907 PRESSURE ASSESSMENT REALIZING 2982 01:43:18,907 --> 01:43:19,541 ASSESSING BLOOD PRESSURE IN THE 2983 01:43:19,541 --> 01:43:20,342 COMMUNITY IS ONLY THE FIRST 2984 01:43:20,342 --> 01:43:21,877 STEP, REALLY GETTING FOLKS 2985 01:43:21,877 --> 01:43:23,044 CONNECTED TO SUSTAINED CARE IS 2986 01:43:23,044 --> 01:43:24,579 REALLY THE ULTIMATE GOAL FOR 2987 01:43:24,579 --> 01:43:27,783 IMPROVING BLOOD PRESSURE CONTROL 2988 01:43:27,783 --> 01:43:29,151 AND ADVANCING HEALTH EQUITY. 2989 01:43:29,151 --> 01:43:30,318 SO THANK YOU SO MUCH FOR YOUR 2990 01:43:30,318 --> 01:43:31,319 TIME AND ATTENTION AND I LOOK 2991 01:43:31,319 --> 01:43:33,088 FORWARD TO THE PANEL AT THE END. 2992 01:43:33,088 --> 01:43:36,958 >> SO THANKS, PROFESSOR 2993 01:43:36,958 --> 01:43:37,626 RAVENELL, THAT WAS GREAT. 2994 01:43:37,626 --> 01:43:39,461 APPRECIATE THAT. 2995 01:43:39,461 --> 01:43:41,096 I KNEW RON VICTOR AS WELL, GOOD 2996 01:43:41,096 --> 01:43:41,530 GUY. 2997 01:43:41,530 --> 01:43:50,906 I WANT TO INTRODUCE FROM YVONNE 2998 01:43:50,906 --> 01:43:52,440 COMMODORE-MENSAH ALSO AN 2999 01:43:52,440 --> 01:43:55,811 ASSOCIATE PROFESSOR AT HOPKINS, 3000 01:43:55,811 --> 01:43:57,412 ALSO FROM THE RESTORE STUDY, HER 3001 01:43:57,412 --> 01:43:59,848 RESEARCH FOCUSES ON REDUCING 3002 01:43:59,848 --> 01:44:03,185 CARDIOVASCULAR DISEASE RISK 3003 01:44:03,185 --> 01:44:04,286 AFRICAN POPULATIONS IN THE U.S. 3004 01:44:04,286 --> 01:44:06,221 AND AFRICA THROUGH 3005 01:44:06,221 --> 01:44:07,022 COMMUNITY-ENGAGED RESEARCH AND 3006 01:44:07,022 --> 01:44:07,522 IMPLEMENTATION SCIENCE. 3007 01:44:07,522 --> 01:44:08,857 >> THANK YOU SO MUCH FOR THAT 3008 01:44:08,857 --> 01:44:09,491 INTRODUCTION, AND THANK YOU TO 3009 01:44:09,491 --> 01:44:11,126 THE ORGANIZERS FOR THE 3010 01:44:11,126 --> 01:44:14,996 OPPORTUNITY TO BE HERE TODAY. 3011 01:44:14,996 --> 01:44:16,331 AND WE'LL GET STARTED TALKING 3012 01:44:16,331 --> 01:44:17,432 ABOUT IMPLEMENTATION CHALLENGES 3013 01:44:17,432 --> 01:44:20,769 AND SUCCESSES IN REMOTE BP 3014 01:44:20,769 --> 01:44:24,940 MONITORING. 3015 01:44:24,940 --> 01:44:26,441 THE ONLY DISCLOSURE I HAVE IS 3016 01:44:26,441 --> 01:44:28,977 THAT MY WORK IS ALSO FUNDED BY 3017 01:44:28,977 --> 01:44:31,713 THE NIH, SPECIFICALLY THE NIMHD. 3018 01:44:31,713 --> 01:44:34,316 I'LL BE TALKING ABOUT THE 3019 01:44:34,316 --> 01:44:35,183 LINKED-HEARTS PROGRAM, WHICH 3020 01:44:35,183 --> 01:44:36,852 STANDS FOR CARDIOMETABOLIC 3021 01:44:36,852 --> 01:44:39,221 HEALTH PROGRAM LINKED WITH 3022 01:44:39,221 --> 01:44:41,556 COMMUNITY HEALTH WORKERS AND 3023 01:44:41,556 --> 01:44:43,225 MOBILE HEALTH TELEMONITORRING TO 3024 01:44:43,225 --> 01:44:49,497 REDUCE HEALTH DISPARITIES. 3025 01:44:49,497 --> 01:44:50,866 SO BEFORE GOING ANY FURTHER, I'D 3026 01:44:50,866 --> 01:44:53,568 LIKE TO ACKNOWLEDGE THE TEAM 3027 01:44:53,568 --> 01:44:55,537 THAT MAKES THIS WORK POSSIBLE. 3028 01:44:55,537 --> 01:44:57,205 ONE OF THE THINGS WE'RE REALLY 3029 01:44:57,205 --> 01:44:59,074 PROUD OF IS THE DIVERSITY OF OUR 3030 01:44:59,074 --> 01:45:01,309 TEAM NOT JUST IN TERMS OF THE 3031 01:45:01,309 --> 01:45:03,778 BACKGROUND BUT ALSO IN TERMS OF 3032 01:45:03,778 --> 01:45:06,314 HAVING PREDOCTORAL, POSTDOCTORAL 3033 01:45:06,314 --> 01:45:09,317 TRAINEES AND ENDOCRINOLOGISTS, 3034 01:45:09,317 --> 01:45:10,218 NEPHROLOGISTS, PRIMARY CARE 3035 01:45:10,218 --> 01:45:12,053 CLINICIANS AND PUBLIC HEALTH 3036 01:45:12,053 --> 01:45:18,059 RESEARCHERS AS WELL. 3037 01:45:18,059 --> 01:45:20,128 SO LINKED-HEARTS SEEKS TO 3038 01:45:20,128 --> 01:45:21,997 COMPARE THE EFFECT OF THE LINKED 3039 01:45:21,997 --> 01:45:23,498 HEARTS PROGRAM VERSUS HOME BLOOD 3040 01:45:23,498 --> 01:45:27,002 PRESSURE MONITORING ALONE, AND 3041 01:45:27,002 --> 01:45:29,170 IMPROVING BLOOD PRESSURE 3042 01:45:29,170 --> 01:45:29,404 CONTROL. 3043 01:45:29,404 --> 01:45:31,740 AND WE'RE LOOKING AT OUTCOMES AT 3044 01:45:31,740 --> 01:45:33,575 6 AND 12 MONTHS AMONG 3045 01:45:33,575 --> 01:45:35,844 INDIVIDUALS WITH UNCONTROLLED 3046 01:45:35,844 --> 01:45:37,712 HYPERTENSION PLUS DIABETES OR 3047 01:45:37,712 --> 01:45:40,248 CHRONIC KIDNEY DISEASE. 3048 01:45:40,248 --> 01:45:43,351 SO THAT'S OUR PRIMARY AIM. 3049 01:45:43,351 --> 01:45:46,788 FOR OUR SECONDARY AIM, WE'RE 3050 01:45:46,788 --> 01:45:48,056 EVALUATING THE REACH ADOPTION 3051 01:45:48,056 --> 01:45:49,624 MAINTENANCE OF THE INTERVENTION 3052 01:45:49,624 --> 01:45:50,859 AT 12 AND 24 MONTHS, AND WE'RE 3053 01:45:50,859 --> 01:45:52,527 DOING THIS AMONG ADULTS, LIKE I 3054 01:45:52,527 --> 01:45:54,763 SAID, WITH UNCONTROLLED 3055 01:45:54,763 --> 01:45:57,666 HYPERTENSION, AND DIABETES OR 3056 01:45:57,666 --> 01:45:58,767 CKD, AND THE SETTING IS 3057 01:45:58,767 --> 01:46:00,001 COMMUNITY HEALTH CENTERS OR 3058 01:46:00,001 --> 01:46:04,339 PRIMARY CARE CLINICS, AN IN THE 3059 01:46:04,339 --> 01:46:08,376 MARYLAND D.C. AREA, WE'RE USING 3060 01:46:08,376 --> 01:46:10,478 A HYBRID TYPE I EFFECTIVENESS 3061 01:46:10,478 --> 01:46:11,112 IMPLEMENTATION DESIGN AND IN 3062 01:46:11,112 --> 01:46:13,214 TERMS OF THE EFFECTIVENESS AIM, 3063 01:46:13,214 --> 01:46:14,849 LIKE I SAID WE'RE COMPARING THE 3064 01:46:14,849 --> 01:46:15,917 SUPERIORITY OF THE INTERVENTION, 3065 01:46:15,917 --> 01:46:18,720 THE LINKED-HEARTS PROGRAM TO 3066 01:46:18,720 --> 01:46:19,821 ENHANCED USUAL CARE, WHICH IS 3067 01:46:19,821 --> 01:46:21,623 HOME BLOOD PRESSURE MONITORING 3068 01:46:21,623 --> 01:46:28,730 ALONE. 3069 01:46:28,730 --> 01:46:33,134 SO WE ARE RANDOMIZING ACTUALLY 3070 01:46:33,134 --> 01:46:35,670 18 SITES, IN THE ENHANCED USUAL 3071 01:46:35,670 --> 01:46:37,739 CARE ARM, NINE IN THE 3072 01:46:37,739 --> 01:46:38,940 INTERVENTION ARM, AND WE'RE 3073 01:46:38,940 --> 01:46:40,442 RECRUITING BLACK, WHITE OR 3074 01:46:40,442 --> 01:46:42,844 HISPANIC ADULTS. 3075 01:46:42,844 --> 01:46:44,145 CONDUCTING THESE ASSESSMENTS AND 3076 01:46:44,145 --> 01:46:45,847 THE FOLLOW-UP TIMES ARE 6, 12 3077 01:46:45,847 --> 01:46:47,282 AND 18 MONTHS AND YOU CAN SEE 3078 01:46:47,282 --> 01:46:48,116 THE EXCLUSION CRITERIA LISTED ON 3079 01:46:48,116 --> 01:46:50,051 THE SCREEN AND THE PRIMARY 3080 01:46:50,051 --> 01:46:51,386 OUTCOME IS BLOOD PRESSURE 3081 01:46:51,386 --> 01:46:54,389 CONTROL DEFINED AS LESS THAN 3082 01:46:54,389 --> 01:46:56,524 140/90. 3083 01:46:56,524 --> 01:46:58,393 SO IN TERMS OF THE ACTUAL LINKED 3084 01:46:58,393 --> 01:46:59,461 HEARTS INTERVENTION, I WANTED TO 3085 01:46:59,461 --> 01:47:01,663 SPEND A LITTLE MORE TIME TALKING 3086 01:47:01,663 --> 01:47:03,064 ABOUT EACH OF THE COMPONENTS OF 3087 01:47:03,064 --> 01:47:05,367 THIS MULTILEVEL INTERVENTION. 3088 01:47:05,367 --> 01:47:07,102 SO LINKED HEARTS INCLUDES HOME 3089 01:47:07,102 --> 01:47:08,870 BLOOD PRESSURE MONITORING. 3090 01:47:08,870 --> 01:47:11,006 IT ALSO INCLUDES THE USE OF A 3091 01:47:11,006 --> 01:47:15,377 MOBILE HEALTH APPLICATION CALLED 3092 01:47:15,377 --> 01:47:17,112 SPHMIGMO AND I'LL TALK MORE 3093 01:47:17,112 --> 01:47:18,580 ABOUT IT IN THE SUBSEQUENT 3094 01:47:18,580 --> 01:47:20,115 SLIDES AND WE ALSO ENGAGED 3095 01:47:20,115 --> 01:47:21,783 PHARMACISTS SO WE KNOW THE 3096 01:47:21,783 --> 01:47:23,284 EVIDENCE SUGGESTS THAT 3097 01:47:23,284 --> 01:47:24,586 PHARMACIES-LED INTERVENTIONS 3098 01:47:24,586 --> 01:47:25,220 IMPROVE BLOOD PRESSURE CONTROL, 3099 01:47:25,220 --> 01:47:29,524 SO WE HAVE A KOSM COMBO OF COMY 3100 01:47:29,524 --> 01:47:31,092 HEALTH WORKER PLUS PHARMACIST 3101 01:47:31,092 --> 01:47:32,193 WORKING TOGETHER TO PROVIDE 3102 01:47:32,193 --> 01:47:33,261 ADDITIONAL SUPPORT, IN ADDITION 3103 01:47:33,261 --> 01:47:35,096 TO HOME BLOOD PRESSURE 3104 01:47:35,096 --> 01:47:35,764 MONITORING, TO IMPROVE BLOOD 3105 01:47:35,764 --> 01:47:36,865 PRESSURE CONTROL. 3106 01:47:36,865 --> 01:47:37,866 AND ONE THING I WANT TO 3107 01:47:37,866 --> 01:47:41,369 HIGHLIGHT IS THAT WHEN IT COMES 3108 01:47:41,369 --> 01:47:42,737 TO COMMUNITY HEALTH WORKER, 3109 01:47:42,737 --> 01:47:43,738 WE'VE ALREADY TALKED ABOUT THE 3110 01:47:43,738 --> 01:47:45,440 IMPORTANCE OF PROVIDING TRAINING 3111 01:47:45,440 --> 01:47:47,742 TO PATIENTS IN TERMS OF ACCURATE 3112 01:47:47,742 --> 01:47:48,710 BLOOD PRESSURE MEASUREMENT, SO 3113 01:47:48,710 --> 01:47:50,145 WHAT WE'RE DOING IN THE LINKED 3114 01:47:50,145 --> 01:47:51,479 HEARTS TRIAL IS WHEN 3115 01:47:51,479 --> 01:47:53,915 PARTICIPANTS ARE ENROLLED, FOR 3116 01:47:53,915 --> 01:47:55,550 YOUR BASELINE VISIT, THE 3117 01:47:55,550 --> 01:47:57,352 COMMUNITY HEALTH WORKER MEETS 3118 01:47:57,352 --> 01:48:00,055 THEM AT THE CLINIC OR AT A 3119 01:48:00,055 --> 01:48:01,122 PUBLIC PLACE, PROVIDES THE HOME 3120 01:48:01,122 --> 01:48:02,757 BLOOD PRESSURE DEVICE, TEACHES 3121 01:48:02,757 --> 01:48:05,760 THEM HOW TO CORRECTLY MEASURE 3122 01:48:05,760 --> 01:48:07,028 THE BLOOD PRESSURE, TALKS ABOUT 3123 01:48:07,028 --> 01:48:09,464 THE IMPORTANCE OF ACCURATE 3124 01:48:09,464 --> 01:48:12,901 MEASUREMENT, ALSO HELPS THEM TO 3125 01:48:12,901 --> 01:48:20,008 DOWNLOAD THE SPHY DPGMO APP, SIT 3126 01:48:20,008 --> 01:48:22,844 DOWN WITH THEM, ASK THEM TO PULL 3127 01:48:22,844 --> 01:48:24,479 OUT THEIR PHONE, TEACH THEM HOW 3128 01:48:24,479 --> 01:48:26,448 TO DOWNLOAD THE APP BUT TO SIT 3129 01:48:26,448 --> 01:48:35,090 WITH THEM, TEACH THEM -- SO THE 3130 01:48:35,090 --> 01:48:35,824 FIRST INTERVENTION VISIT IS 3131 01:48:35,824 --> 01:48:37,225 REALLY HAPPENING IN PERSON BUT 3132 01:48:37,225 --> 01:48:38,660 THE SUBSEQUENT VISITS ARE 3133 01:48:38,660 --> 01:48:43,465 HAPPENING REMOTE LELY VIA TELL 3134 01:48:43,465 --> 01:48:47,936 HEATELEHEALTH VISITS. 3135 01:48:47,936 --> 01:48:49,671 WE'VE ALL TALKED ABOUT AND AWARE 3136 01:48:49,671 --> 01:48:51,673 OF THE IMPORTANCE OF USING 3137 01:48:51,673 --> 01:48:52,540 VALIDATED BLOOD PRESSURE 3138 01:48:52,540 --> 01:49:00,482 DEVICES, WE'RE USING THE ARMAND 3139 01:49:00,482 --> 01:49:05,787 SERIES -- THIS IS THE SPHYGMO 3140 01:49:05,787 --> 01:49:07,255 APP. 3141 01:49:07,255 --> 01:49:10,325 WHAT YOU CAN SEE IS THE PROVIDER 3142 01:49:10,325 --> 01:49:12,393 INTERFACE WHERE YOU CAN SEE 3, 3143 01:49:12,393 --> 01:49:17,465 7, 30-DAY AVERAGES AS WELL. 3144 01:49:17,465 --> 01:49:18,800 SO IN TERMS OF THE ORIGINAL 3145 01:49:18,800 --> 01:49:20,135 PLAN, OUR GOAL WAS TO HAVE THESE 3146 01:49:20,135 --> 01:49:22,036 BLOOD PRESSURE READINGS DIRECTLY 3147 01:49:22,036 --> 01:49:26,975 INNOVATED INTO THE EMR SO THAT 3148 01:49:26,975 --> 01:49:28,576 WAS THE PLAN, BUT IN TERMS OF 3149 01:49:28,576 --> 01:49:29,611 THE REALITY, THAT DID NOT 3150 01:49:29,611 --> 01:49:29,944 HAPPEN. 3151 01:49:29,944 --> 01:49:30,912 AND IT DIDN'T HAPPEN FOR A LOT 3152 01:49:30,912 --> 01:49:31,679 OF REASONS. 3153 01:49:31,679 --> 01:49:35,049 SO HALF OF THE SITE THAT WERE 3154 01:49:35,049 --> 01:49:37,085 ENGAGED WITH OUR COMMUNITY 3155 01:49:37,085 --> 01:49:40,188 HEALTH TERES CENTERS AND THEY T 3156 01:49:40,188 --> 01:49:41,022 CLEAR THEY DIDN'T HAVE 3157 01:49:41,022 --> 01:49:41,923 INFRASTRUCTURE OR ALSO COULDN'T 3158 01:49:41,923 --> 01:49:43,091 AFFORD THE COST OF THIS DIRECT 3159 01:49:43,091 --> 01:49:43,791 INTEGRATION, AND THIS IS 3160 01:49:43,791 --> 01:49:44,626 SOMETHING THAT WOULD HAVE HAD TO 3161 01:49:44,626 --> 01:49:47,862 BE COVERED BY THE GRANT, AND WE 3162 01:49:47,862 --> 01:49:49,364 DIDN'T HAVE THE RIGHT RESOURCES 3163 01:49:49,364 --> 01:49:52,233 TO BE ABLE TO AFFORD THE COST OF 3164 01:49:52,233 --> 01:49:54,202 INTEGRATION INTO THE EMR, SO THE 3165 01:49:54,202 --> 01:49:57,038 REALITY OF WHAT WE DID WAS THEN 3166 01:49:57,038 --> 01:49:58,840 THE COMMUNITY HEALTH WORKERS 3167 01:49:58,840 --> 01:50:00,441 ENTERED THE -- OR ENTERING THE 3168 01:50:00,441 --> 01:50:02,143 AVERAGES INTO THE EMR AND 3169 01:50:02,143 --> 01:50:03,711 THEY'RE ALSO PROVIDED ACCESS TO 3170 01:50:03,711 --> 01:50:06,514 THE EMR, SO THE IDEAL VERSION IS 3171 01:50:06,514 --> 01:50:08,383 TO BE ABLE TO DIRECTLY INTEGRATE 3172 01:50:08,383 --> 01:50:09,984 THAT BUT COST WAS A MAJOR 3173 01:50:09,984 --> 01:50:16,624 BARRIER. 3174 01:50:16,624 --> 01:50:19,994 STO WHSO WHAT ARE SOME IMPLEMENN 3175 01:50:19,994 --> 01:50:20,261 SUCCESSES? 3176 01:50:20,261 --> 01:50:21,396 WE LEARNED A LOT. 3177 01:50:21,396 --> 01:50:23,231 ONE IS THAT WE FOUND THAT 3178 01:50:23,231 --> 01:50:24,332 BECAUSE THE PHARMACIST HAS 3179 01:50:24,332 --> 01:50:26,601 ACCESS TO THE HOME BLOON 3180 01:50:26,601 --> 01:50:31,606 READBLOODPRESSURE READINGS, THEE 3181 01:50:31,606 --> 01:50:33,942 TO ADDRESS TREATMENT INERTIA, SO 3182 01:50:33,942 --> 01:50:34,909 BLOOD PRESSURE IS UNCONTROLLED, 3183 01:50:34,909 --> 01:50:36,077 THE PHARMACIST IS REACHING OUT 3184 01:50:36,077 --> 01:50:38,313 TO THE PRIMARY CARE CLINICIAN TO 3185 01:50:38,313 --> 01:50:39,347 SAY IS THERE SOMETHING WE CAN 3186 01:50:39,347 --> 01:50:40,582 DO, CAN WE MODIFY THE DOSAGE OF 3187 01:50:40,582 --> 01:50:43,518 THE MEDICATION, THE SIDE EFFECTS 3188 01:50:43,518 --> 01:50:45,353 THAT ARE BEING -- THIS IS 3189 01:50:45,353 --> 01:50:46,888 ADDRESSING SOME OF THE 3190 01:50:46,888 --> 01:50:47,789 MEDICATION-RELATED ISSUES. 3191 01:50:47,789 --> 01:50:49,023 WE ALSO ARE PROVIDING TECHNICAL 3192 01:50:49,023 --> 01:50:49,390 SUPPORT. 3193 01:50:49,390 --> 01:50:50,592 WE HAVE A DEDICATED RESEARCH 3194 01:50:50,592 --> 01:50:52,260 ASSISTANT WHO IS READY WHEN 3195 01:50:52,260 --> 01:50:53,461 PARTICIPANTS HAVE ANY 3196 01:50:53,461 --> 01:50:54,562 APP-RELATED OR BLOOD PRESSURE 3197 01:50:54,562 --> 01:50:55,263 DEVICE-RELATED CHALLENGES. 3198 01:50:55,263 --> 01:50:56,898 AND WE NO THAT PEOPLE DO GET 3199 01:50:56,898 --> 01:50:57,765 FRUSTRATED WHEN TECHNOLOGY 3200 01:50:57,765 --> 01:50:59,500 DOESN'T WORK AS IT SHOULD, AND 3201 01:50:59,500 --> 01:51:01,169 SO WE HAVE A DEDICATED PERSON 3202 01:51:01,169 --> 01:51:01,903 FOR THAT. 3203 01:51:01,903 --> 01:51:02,904 AND ALSO TEAM WORK. 3204 01:51:02,904 --> 01:51:06,307 SO HAVING THIS PHARMACIST 3205 01:51:06,307 --> 01:51:06,908 COMMUNITY HEALTH WORKER TEAM 3206 01:51:06,908 --> 01:51:09,077 THAT IS WORKING COLLABORATIVELY 3207 01:51:09,077 --> 01:51:10,511 TO IMPROVE BLOOD PRESSURE 3208 01:51:10,511 --> 01:51:11,646 CONTROL HAS BEEN TREMENDOUSLY 3209 01:51:11,646 --> 01:51:12,847 HELPFUL. 3210 01:51:12,847 --> 01:51:13,514 AND THE COMMUNITY HEALTH WORKERS 3211 01:51:13,514 --> 01:51:15,083 AND THE PHARMACISTS BOTH HAVE 3212 01:51:15,083 --> 01:51:16,951 ACCESS TO THE SAME INFORMATION 3213 01:51:16,951 --> 01:51:20,221 AND CAN ACT APPROPRIATELY. 3214 01:51:20,221 --> 01:51:21,623 AND ALSO THE ABILITY TO SHARE 3215 01:51:21,623 --> 01:51:23,491 INFORMATION WITH THE PROVIDER, 3216 01:51:23,491 --> 01:51:24,926 SO AGAIN IF THE COMMUNITY HEALTH 3217 01:51:24,926 --> 01:51:26,394 WORKER OR THE PHARMACIST NOTICES 3218 01:51:26,394 --> 01:51:27,462 THAT, AGAIN, BLOOD PRESSURE 3219 01:51:27,462 --> 01:51:29,731 CONTROL IS NOT ACHIEVED OR BLOOD 3220 01:51:29,731 --> 01:51:31,899 PRESSURE IS ELEVATED, THIS 3221 01:51:31,899 --> 01:51:33,368 COMMUNICATION THAT HAPPENS 3222 01:51:33,368 --> 01:51:34,602 BETWEEN OUR COMMUNITY HEALTH 3223 01:51:34,602 --> 01:51:35,703 WORKERS, THE PHARMACIST AND THE 3224 01:51:35,703 --> 01:51:37,238 PRIMARY CARE CLINICIANS. 3225 01:51:37,238 --> 01:51:40,141 AND WE'RE ALSO USING THE APP 3226 01:51:40,141 --> 01:51:41,442 AMONG PEOPLE WHO SPEAK ENGLISH 3227 01:51:41,442 --> 01:51:42,110 AND SPANISH. 3228 01:51:42,110 --> 01:51:43,878 I DIDN'T MENTION THE APP IS 3229 01:51:43,878 --> 01:51:46,914 AVAILABLE IN ENGLISH, SPANISH, 3230 01:51:46,914 --> 01:51:48,049 MANDARIN, CHINESE, AS WELL AS 3231 01:51:48,049 --> 01:51:51,319 FRENCH. 3232 01:51:51,319 --> 01:51:52,487 SO THE LANGUAGE IS NOT ONLY 3233 01:51:52,487 --> 01:51:53,788 AVAILABLE FOR ENGLISH SPEAKERS 3234 01:51:53,788 --> 01:51:54,989 BUT ALSO PEOPLE WHO SPEAK 3235 01:51:54,989 --> 01:52:02,063 SPANISH AS WELL. 3236 01:52:02,063 --> 01:52:03,631 SO WHAT ARE SOME CHALLENGES? 3237 01:52:03,631 --> 01:52:04,265 TECHNOLOGY. 3238 01:52:04,265 --> 01:52:05,300 TECHNOLOGY IS GREAT WHEN IT 3239 01:52:05,300 --> 01:52:06,334 WORKS, NOT GREAT WHEN IT DOESN'T 3240 01:52:06,334 --> 01:52:07,502 WORK AS IT SHOULD. 3241 01:52:07,502 --> 01:52:09,637 SO THERE HAVE BEEN INSTANCES 3242 01:52:09,637 --> 01:52:15,176 WHERE THE APP HAS DISCONNECTED 3243 01:52:15,176 --> 01:52:23,418 AND IT'S NOT SYNCED 3244 01:52:23,418 --> 01:52:26,654 APPROPRIATELY, SO THEY'VE HAD TO 3245 01:52:26,654 --> 01:52:27,722 DISCONNECT AND RECONNECT SO 3246 01:52:27,722 --> 01:52:28,723 THAT'S BEEN FRUSTRATING BUT LIKE 3247 01:52:28,723 --> 01:52:31,225 I SAID, WE HAVE A TEAM MEMBER 3248 01:52:31,225 --> 01:52:33,294 DEDICATED TO ADDRESSING THESE 3249 01:52:33,294 --> 01:52:33,561 BARRIERS. 3250 01:52:33,561 --> 01:52:35,496 ALSO THE RIGHT CUFF SIZE, WE 3251 01:52:35,496 --> 01:52:37,498 HAVE MEDIUM TO LARGE AND EXTRA 3252 01:52:37,498 --> 01:52:38,733 LARGE, BUT THERE HAVE BEEN 3253 01:52:38,733 --> 01:52:39,701 INSTANCES WHERE MAYBE 3254 01:52:39,701 --> 01:52:41,169 PARTICIPANTS HAVE LOST WEIGHT 3255 01:52:41,169 --> 01:52:42,670 AND SO WHAT WE'RE DOING NOW IS 3256 01:52:42,670 --> 01:52:44,372 WHEN PEOPLE ARE BETWEEN THE 3257 01:52:44,372 --> 01:52:45,973 LARGE AND EXTRA LARGE, WE'RE 3258 01:52:45,973 --> 01:52:47,909 PROVIDING BOTH CUFFS SO THAT IF 3259 01:52:47,909 --> 01:52:49,010 THERE ARE ANY CHANGES, THEY CAN 3260 01:52:49,010 --> 01:52:51,012 USE THE RIGHT CUFF SIZE. 3261 01:52:51,012 --> 01:52:52,647 BUT ALSO COORDINATING DELIVERY 3262 01:52:52,647 --> 01:52:56,150 OF BLOOD PRESSURE DEVICES TO 3263 01:52:56,150 --> 01:52:58,820 PARTICIPANTS, THERE HAVE BEEN 3264 01:52:58,820 --> 01:53:00,621 INSTANCES WHERE WE'VE MAILED THE 3265 01:53:00,621 --> 01:53:02,724 DEVICES AND SOMETIMES 3266 01:53:02,724 --> 01:53:03,458 PARTICIPANTS MAY SAY THEY DIDN'T 3267 01:53:03,458 --> 01:53:04,659 RECEIVE IT, THE IDEAL WOULD BE 3268 01:53:04,659 --> 01:53:06,060 TO MEET WITH THEM IN THE CLINIC, 3269 01:53:06,060 --> 01:53:07,662 BUT SOMETIMES WE JUST CAN'T GET 3270 01:53:07,662 --> 01:53:10,131 AHOLD OF PEOPLE, SO THERE HAVE 3271 01:53:10,131 --> 01:53:11,766 BEEN CHALLENGES WITH THAT. 3272 01:53:11,766 --> 01:53:12,834 BUT ALSO STABLE INTERNET, 3273 01:53:12,834 --> 01:53:14,702 BECAUSE WE'RE USING A MOBILE 3274 01:53:14,702 --> 01:53:16,137 HEALTH AM KAI THERE ARE PEOPLE 3275 01:53:16,137 --> 01:53:19,273 WHO'VE REPORTED CHALLENGES WITH 3276 01:53:19,273 --> 01:53:20,441 INTERNET ACCESS AND THERE ARE 3277 01:53:20,441 --> 01:53:22,977 PEOPLE WHO RESIST USING THE APP 3278 01:53:22,977 --> 01:53:25,146 BECAUSE OF PRIVACY CONCERNS, AND 3279 01:53:25,146 --> 01:53:26,781 ALSO THE FEAR OR CONCERN OF 3280 01:53:26,781 --> 01:53:27,949 BEING TRACKED. 3281 01:53:27,949 --> 01:53:30,485 AND THIS IS SOMETHING THAT WE'VE 3282 01:53:30,485 --> 01:53:31,986 NOTICED WHEN WORKING WITH 3283 01:53:31,986 --> 01:53:33,254 PARTICIPANTS ON THE EASTERN 3284 01:53:33,254 --> 01:53:34,756 SHORE, AND IN MORE RURAL 3285 01:53:34,756 --> 01:53:35,323 POPULATIONS. 3286 01:53:35,323 --> 01:53:37,592 BUT ALSO OLDER ADULTS IN TERMS 3287 01:53:37,592 --> 01:53:41,996 OF TECHNOLOGY, SOME OF THE OLDER 3288 01:53:41,996 --> 01:53:42,897 PARTICIPANTS HAVE NOT BEEN AS 3289 01:53:42,897 --> 01:53:44,365 OPEN TO USING THE APP AND HAVE 3290 01:53:44,365 --> 01:53:45,600 SAID THEY PREFER TO ACTUALLY 3291 01:53:45,600 --> 01:53:47,568 WRITE DOWN THEIR READINGS, SO 3292 01:53:47,568 --> 01:53:49,337 WORKING WITH THEM TO TAKE PHOTOS 3293 01:53:49,337 --> 01:53:51,038 AND SEND US THE PHOTOS. 3294 01:53:51,038 --> 01:53:52,507 SO WE DON'T WANT TO FORCE PEOPLE 3295 01:53:52,507 --> 01:53:55,209 TO USE TECHNOLOGY IF THEY'RE 3296 01:53:55,209 --> 01:53:56,244 AVERSE TO IT, SO FINDING WAYS TO 3297 01:53:56,244 --> 01:54:02,150 WORK AROUND THAT. 3298 01:54:02,150 --> 01:54:04,051 SO JUST WRAPPING UP IN TERMS OF 3299 01:54:04,051 --> 01:54:07,422 KNOWLEDGE GAPS AND FUTURE 3300 01:54:07,422 --> 01:54:08,256 OPPORTUNITIES, FIRST LIKE I 3301 01:54:08,256 --> 01:54:10,124 ALLUDED TO EARLIER, AS 3302 01:54:10,124 --> 01:54:12,493 INTEGRATION INTO THE EMR, THAT 3303 01:54:12,493 --> 01:54:13,795 IS THE IDEAL SCENARIO, BUT IT 3304 01:54:13,795 --> 01:54:16,564 ALSO COMES WITH SOME CHALLENGES 3305 01:54:16,564 --> 01:54:18,466 IN TERMS OF TECHNICAL SUPPORT 3306 01:54:18,466 --> 01:54:19,700 AND ALSO THE COST IMPLICATIONS 3307 01:54:19,700 --> 01:54:20,802 AS WELL. 3308 01:54:20,802 --> 01:54:24,572 SO BEYOND ENGLISH, SPANISH, CLIE 3309 01:54:24,572 --> 01:54:25,706 NIECE AND FRENCH, THERE ARE 3310 01:54:25,706 --> 01:54:27,542 PATIENTS WHO SPEAK OTHER 3311 01:54:27,542 --> 01:54:30,812 LANGUAGES, SO FOR THOSE 3312 01:54:30,812 --> 01:54:31,813 PATIENTS, WHAT OTHER OPTIONS 3313 01:54:31,813 --> 01:54:34,582 EXIST THAT ALLOW THEM TO USE THE 3314 01:54:34,582 --> 01:54:36,517 APP IN THEIR PREFERRED LANGUAGE. 3315 01:54:36,517 --> 01:54:37,318 ALSO CUFF SIZES. 3316 01:54:37,318 --> 01:54:39,353 THERE ARE PEOPLE WHO ARE USING 3317 01:54:39,353 --> 01:54:41,155 THE EXTRA LARGE CUFF BUT BECAUSE 3318 01:54:41,155 --> 01:54:43,758 OF THE CONICAL SHAPE, ARE HAVING 3319 01:54:43,758 --> 01:54:45,193 ISSUES IN TERMS OF GETTING 3320 01:54:45,193 --> 01:54:47,094 PROPER READINGS, SO THAT'S 3321 01:54:47,094 --> 01:54:48,196 SOMETHING THAT NEEDS TO BE 3322 01:54:48,196 --> 01:54:50,031 ADDRESSED IN THE FUTURE. 3323 01:54:50,031 --> 01:54:51,966 BUT THEN THERE ARE ALSO 3324 01:54:51,966 --> 01:54:53,000 OPPORTUNITIES, SO ONE OF THE 3325 01:54:53,000 --> 01:54:54,502 THINGS WE'VE BEEN TALKING ABOUT 3326 01:54:54,502 --> 01:54:56,237 IS, WHAT ARE SOME INCENTIVES, 3327 01:54:56,237 --> 01:55:00,942 HOW DO WE INCENTIVIZE MEASURING 3328 01:55:00,942 --> 01:55:01,742 BLOOD PRESSURE AT HOME? 3329 01:55:01,742 --> 01:55:04,612 THERE ARE POINTS THAT COULD BE 3330 01:55:04,612 --> 01:55:05,913 AWARDED TO PATIENTS TO ENCOURAGE 3331 01:55:05,913 --> 01:55:07,515 THEM, WHAT ARE SOME REWARDS THAT 3332 01:55:07,515 --> 01:55:12,086 COULD BE INTEGRATED INTO SOME OF 3333 01:55:12,086 --> 01:55:12,820 THESE MOBILE HEALTH APPLICATIONS 3334 01:55:12,820 --> 01:55:14,088 THAT WILL ENCOURAGE THEM TO 3335 01:55:14,088 --> 01:55:16,491 MONITOR THE BLOOD PRESSURE 3336 01:55:16,491 --> 01:55:17,625 OFTEN, BUT ALSO WHAT ARE 3337 01:55:17,625 --> 01:55:19,360 OPPORTUNITIES IN TERMS OF THE 3338 01:55:19,360 --> 01:55:21,229 USE OF ARTIFICIAL INTELLIGENCE 3339 01:55:21,229 --> 01:55:23,464 IN TERMS OF FOLLOW-UP MESSAGING, 3340 01:55:23,464 --> 01:55:25,032 AND ALSO LIKE I SAID EARLIER, 3341 01:55:25,032 --> 01:55:28,302 WHAT OTHER LANGUAGES COULD BE 3342 01:55:28,302 --> 01:55:29,637 INTEGRATED IN A LOT OF THESE 3343 01:55:29,637 --> 01:55:31,539 MOBILE HEALTH APPLICATIONS. 3344 01:55:31,539 --> 01:55:34,275 AND THEN THE LAST PIECE IS 3345 01:55:34,275 --> 01:55:35,209 INTEGRATION OF BLOOD PRESSURE 3346 01:55:35,209 --> 01:55:36,611 CLINICAL GUIDELINES. 3347 01:55:36,611 --> 01:55:39,514 SO LIKE I SAID AS THE PATIENT 3348 01:55:39,514 --> 01:55:43,584 FACING PIECE OF THE SPHYGMO AP 3349 01:55:43,584 --> 01:55:45,486 BUT ALSO THE PROVIDER PORTAL, 3350 01:55:45,486 --> 01:55:47,154 WHAT ARE SOME OPPORTUNITIES TO 3351 01:55:47,154 --> 01:55:48,189 INTEGRATE CURRENT GUIDELINES, 3352 01:55:48,189 --> 01:55:50,458 AND ALTHOUGH THE 2017 GUIDELINES 3353 01:55:50,458 --> 01:55:52,260 ARE STILL BEING DEBATED, HOW DO 3354 01:55:52,260 --> 01:55:54,695 WE INTEGRATE THE GUIDELINES SO 3355 01:55:54,695 --> 01:55:57,632 THAT THE CLINICIANS HAVE THIS 3356 01:55:57,632 --> 01:55:58,699 INFORMATION READILY AVAILABLE 3357 01:55:58,699 --> 01:56:03,037 AND THAT COULD ALSO INFORM HOW 3358 01:56:03,037 --> 01:56:04,038 BLOOD PRESSURE CONTROL IS 3359 01:56:04,038 --> 01:56:06,774 ACHIEVED AND HOW THEY TAKE 3360 01:56:06,774 --> 01:56:09,844 ACTION TO REDUCE BLOOD PRESSURE. 3361 01:56:09,844 --> 01:56:10,878 I BELIEVE THAT'S IT. 3362 01:56:10,878 --> 01:56:11,946 THANK YOU SO MUCH FOR YOUR TIME 3363 01:56:11,946 --> 01:56:16,150 AND ATTENTION. 3364 01:56:16,150 --> 01:56:17,885 >> SO THANK YOU, I'M GOING TO 3365 01:56:17,885 --> 01:56:22,023 HAND THE REINS OVER TO MY FRIEND 3366 01:56:22,023 --> 01:56:24,859 KEITH FERDINAND TO INTRODUCE THE 3367 01:56:24,859 --> 01:56:25,826 NEXT TWO SPEAKERS. 3368 01:56:25,826 --> 01:56:26,961 >> THANK YOU, RAY. 3369 01:56:26,961 --> 01:56:28,229 SO THE NEXT SPEAKER IS GOING TO 3370 01:56:28,229 --> 01:56:30,565 BE ON AVOIDING BIAS IN RECORDED 3371 01:56:30,565 --> 01:56:34,168 BLOOD PRESSURE BY KATHRYN FOTI. 3372 01:56:34,168 --> 01:56:36,370 DR. FOTI IS AT UAB IN 3373 01:56:36,370 --> 01:56:37,138 BIRMINGHAM. 3374 01:56:37,138 --> 01:56:38,439 SHE ALSO WORKS WITH THE RESTORE 3375 01:56:38,439 --> 01:56:39,774 NETWORK AND HER RESEARCH IS 3376 01:56:39,774 --> 01:56:41,108 FOCUSED ON MONITORING AND 3377 01:56:41,108 --> 01:56:47,214 IMPROFFERRING THE PRIMPROVING TD 3378 01:56:47,214 --> 01:56:48,215 CONTROL OF HYPERTENSION NOT ONLY 3379 01:56:48,215 --> 01:56:50,418 IN THE UNITED STATES BUT 3380 01:56:50,418 --> 01:56:51,852 GLOANLLY AND HAS DONE EXTENSIVE 3381 01:56:51,852 --> 01:56:52,320 WORK WITH THE CDC. 3382 01:56:52,320 --> 01:56:53,621 >> THANK YOU FOR HAVING ME. 3383 01:56:53,621 --> 01:56:54,755 IT'S REALLY A PLEASURE TO BE 3384 01:56:54,755 --> 01:57:03,764 PART OF THIS WORKSHOP. 3385 01:57:03,764 --> 01:57:05,833 CAN WE ADVANCE THE SLIDES, 3386 01:57:05,833 --> 01:57:06,267 PLEASE? 3387 01:57:06,267 --> 01:57:08,636 I THINK WE CAN KEEP GOING, ONE 3388 01:57:08,636 --> 01:57:11,472 MORE. 3389 01:57:11,472 --> 01:57:13,908 I HAVE NO DISCLOSURES BUT LISTED 3390 01:57:13,908 --> 01:57:19,580 MY SOURCES OF FUNDING HERE. 3391 01:57:19,580 --> 01:57:20,781 IN BORROWING FROM YVONNE, I'D 3392 01:57:20,781 --> 01:57:22,083 LIKE TO START BY ACKNOWLEDGING 3393 01:57:22,083 --> 01:57:23,217 MY COLLABORATORS ON THE WORK 3394 01:57:23,217 --> 01:57:25,453 THAT YOU'LL SEE TODAY. 3395 01:57:25,453 --> 01:57:28,956 AS WELL AS OUR FUNDING SUPPORT 3396 01:57:28,956 --> 01:57:30,458 FROM RESOLVED TO SAVE LIVES. 3397 01:57:30,458 --> 01:57:31,792 WHAT I'M SHOWING YOU TODAY 3398 01:57:31,792 --> 01:57:35,396 REALLY CAME ABOUT AS A RESULT OF 3399 01:57:35,396 --> 01:57:38,799 SEFESEVERAL OF OWRP COLLABORATOR 3400 01:57:38,799 --> 01:57:39,767 WORKING IN HYPERTENSION CONTROL 3401 01:57:39,767 --> 01:57:41,502 PROGRAM, NOTICING PATTERNS IN 3402 01:57:41,502 --> 01:57:42,103 THEIR RECORDED BLOOD PRESSURE 3403 01:57:42,103 --> 01:57:43,704 DATA THAT WERE SUGGESTIVE OF 3404 01:57:43,704 --> 01:57:44,939 REPORTING BIASES AND THEY ASKED 3405 01:57:44,939 --> 01:57:46,440 FOR TOOLS TO BETTER DETECT AND 3406 01:57:46,440 --> 01:57:47,608 ULTIMATELY PREVENT BIAS FROM 3407 01:57:47,608 --> 01:57:48,042 OCCURRING. 3408 01:57:48,042 --> 01:57:48,909 SO THIS PRESENTATION IS NOT 3409 01:57:48,909 --> 01:57:50,645 MEANT TO NAME OR SHAME ANYONE, 3410 01:57:50,645 --> 01:57:52,580 RATHER TO RAISE AWARENESS OF 3411 01:57:52,580 --> 01:57:54,582 RECORDING BIASES AND AS OUR 3412 01:57:54,582 --> 01:57:56,884 PARTNERS DID, ENCOURAGE RIGOROUS 3413 01:57:56,884 --> 01:57:57,652 REVIEW OF BLOOD PRESSURE 3414 01:57:57,652 --> 01:57:58,853 MEASUREMENTS AND DATA 3415 01:57:58,853 --> 01:58:03,491 TRANSPARENCY. 3416 01:58:03,491 --> 01:58:05,326 SO IN THIS TALK, I'LL FIRST 3417 01:58:05,326 --> 01:58:06,627 PROVIDE SOME BACKGROUND ON 3418 01:58:06,627 --> 01:58:10,865 CERTAIN TYPES OF REPORTING 3419 01:58:10,865 --> 01:58:11,966 BIASES, TERMINAL DIGIT 3420 01:58:11,966 --> 01:58:13,768 PREFERENCE AND THRESHOLD BIAS IN 3421 01:58:13,768 --> 01:58:14,402 PARTICULAR. 3422 01:58:14,402 --> 01:58:16,070 I'LL FOCUS THE MAJORITY OF THE 3423 01:58:16,070 --> 01:58:17,438 PRESENTATION ON THRESHOLD BIAS 3424 01:58:17,438 --> 01:58:20,775 INCLUDING KE SCRIBING A METHOD 3425 01:58:20,775 --> 01:58:22,576 WE DEVELOPED FOR DETECTING 3426 01:58:22,576 --> 01:58:24,011 THRESHOLD BIAS AND THEN SHOW HOW 3427 01:58:24,011 --> 01:58:25,279 WE'VE APPLIED IT IN CLINICAL 3428 01:58:25,279 --> 01:58:26,714 PRACTICE AND CLINICAL TRIAL 3429 01:58:26,714 --> 01:58:28,115 DATASETS AND THEN DISCUSS 3430 01:58:28,115 --> 01:58:28,983 POTENTIAL SOLUTIONS AND 3431 01:58:28,983 --> 01:58:29,283 CONCLUSIONS. 3432 01:58:29,283 --> 01:58:30,751 SO I THINK WE'RE ALL AT THIS 3433 01:58:30,751 --> 01:58:32,386 WORKSHOP BECAUSE WE RECOGNIZE 3434 01:58:32,386 --> 01:58:33,821 THAT ACCURATE BLOOD PRESSURE 3435 01:58:33,821 --> 01:58:34,422 MEASUREMENTS ARE ESSENTIAL FOR 3436 01:58:34,422 --> 01:58:36,457 THE DIAGNOSIS AND TREATMENT OF 3437 01:58:36,457 --> 01:58:36,791 HYPERTENSION. 3438 01:58:36,791 --> 01:58:38,626 AND AS WE'VE HEARD OVER THE LAST 3439 01:58:38,626 --> 01:58:40,027 TWO DAYS, BLOOD PRESSURE 3440 01:58:40,027 --> 01:58:40,828 MEASUREMENT ERROR CAN BE 3441 01:58:40,828 --> 01:58:43,330 INTRODUCED IN ANY NUMBER OF 3442 01:58:43,330 --> 01:58:46,934 WAYS, REALLY IN ANY STEP OF THE 3443 01:58:46,934 --> 01:58:49,603 BLOOD PRESSURE MEASUREMENT 3444 01:58:49,603 --> 01:58:50,337 PROCEDURE INCLUDING RECORDING. 3445 01:58:50,337 --> 01:58:52,406 SO EVEN IF YOU HAVE YOUR 3446 01:58:52,406 --> 01:58:53,874 VALIDATED DEVICE AND ARE DOING 3447 01:58:53,874 --> 01:58:55,142 EVERYTHING CORRECTLY THE BLOOD 3448 01:58:55,142 --> 01:58:56,510 PRESSURE COULD STILL BE 3449 01:58:56,510 --> 01:58:57,478 MISRECORDED. 3450 01:58:57,478 --> 01:58:59,113 ERRORS CAN OCCUR EVEN WHEN 3451 01:58:59,113 --> 01:58:59,680 AUTOMATED DEVICES ARE USED. 3452 01:58:59,680 --> 01:59:01,315 I THINK WE'VE SEEN SOME EXAMPLES 3453 01:59:01,315 --> 01:59:02,249 OF STUDIES WHERE THE 3454 01:59:02,249 --> 01:59:03,918 INTRODUCTION OF AUTOMATED 3455 01:59:03,918 --> 01:59:05,953 DEVICES HAS REDUCED TERMINAL 3456 01:59:05,953 --> 01:59:08,155 DIGIT PREFERENCE, BUT I THINK 3457 01:59:08,155 --> 01:59:09,557 RESEARCH STUDIES DONE IN THE 3458 01:59:09,557 --> 01:59:10,424 CONTEXT OF QUALITY IMPROVEMENT 3459 01:59:10,424 --> 01:59:12,226 PROGRAMS MAY NOT REPRESENT 3460 01:59:12,226 --> 01:59:13,627 TYPICAL CLINICAL PRACTICE, AND 3461 01:59:13,627 --> 01:59:16,363 ALSO KEEPING IN MIND THAT EVEN 3462 01:59:16,363 --> 01:59:18,799 WITH AB AUTOMATED DEVICE, 3463 01:59:18,799 --> 01:59:19,934 SOMEONE STILL HAS TO TRANSCRIBE 3464 01:59:19,934 --> 01:59:21,235 THE READING FROM THE DEVICE INTO 3465 01:59:21,235 --> 01:59:24,405 THE MEDICAL RECORD IN MOST 3466 01:59:24,405 --> 01:59:27,174 SITUATIONS. 3467 01:59:27,174 --> 01:59:28,442 SO ONE TYPE OF BIAS THAT I THINK 3468 01:59:28,442 --> 01:59:29,443 THIS AUDIENCE IS FAMILIAR WITH 3469 01:59:29,443 --> 01:59:30,845 AND WE TALKED ABOUT DURING THIS 3470 01:59:30,845 --> 01:59:32,646 WORKSHOP ALREADY IS TERMINAL 3471 01:59:32,646 --> 01:59:33,147 DIGIT PREFERENCE. 3472 01:59:33,147 --> 01:59:35,116 THIS REFERS TO A TENDENCY BY THE 3473 01:59:35,116 --> 01:59:37,318 OBSERVER TO RECORD MEASUREMENTS 3474 01:59:37,318 --> 01:59:39,320 USING CERTAIN END DIGITS MORE 3475 01:59:39,320 --> 01:59:40,121 FREQUENTLY THAN OTHERS SO AS 3476 01:59:40,121 --> 01:59:41,288 SHOWN ON THE RIGHT, THIS USUALLY 3477 01:59:41,288 --> 01:59:45,793 PRENPRESENTS AS AN EXCESS OF END 3478 01:59:45,793 --> 01:59:47,194 DIGIT ZEROS. 3479 01:59:47,194 --> 01:59:50,131 AND IN THIS EXAMPLE, 38% OF ALL 3480 01:59:50,131 --> 01:59:51,599 THE SYSTOLIC BLOOD PRESSURE 3481 01:59:51,599 --> 01:59:52,800 MEASUREMENTS SHOWN END IN ZERO. 3482 01:59:52,800 --> 01:59:56,003 THIS IS AS COMPARED TO AN 3483 01:59:56,003 --> 01:59:57,538 EXPECTED 10% OF MEASUREMENTS 3484 01:59:57,538 --> 02:00:00,674 WITH AN AUTOMATED DEVICE OR 20% 3485 02:00:00,674 --> 02:00:02,109 IF TAKEN WITH A MANUAL DEVICE 3486 02:00:02,109 --> 02:00:04,078 AND ONLY EVEN DIGITS ARE 3487 02:00:04,078 --> 02:00:06,413 RECORDED. 3488 02:00:06,413 --> 02:00:08,616 ANOTHER TYPE OF RECORDING BIAS 3489 02:00:08,616 --> 02:00:10,618 IS THRESHOLD BIAS, AND THIS 3490 02:00:10,618 --> 02:00:12,119 REFERS TO A TENDENCY BY THE 3491 02:00:12,119 --> 02:00:13,654 OBSERVER TO RECORD MEASUREMENTS 3492 02:00:13,654 --> 02:00:15,589 AT VALUES JUST BELOW SPECIFIC 3493 02:00:15,589 --> 02:00:16,724 THRESHOLDS OF INTEREST. 3494 02:00:16,724 --> 02:00:19,193 FOR EXAMPLE, FOR HYPERTENSION 3495 02:00:19,193 --> 02:00:19,760 DIAGNOSIS OR BLOOD PRESSURE 3496 02:00:19,760 --> 02:00:21,462 CONTROL. 3497 02:00:21,462 --> 02:00:23,030 THE HISTOGRAM ON THE RIGHT ARE 3498 02:00:23,030 --> 02:00:24,198 CLINICAL DATA FROM A 3499 02:00:24,198 --> 02:00:24,865 HYPERTENSION CONTROL PROGRAM. 3500 02:00:24,865 --> 02:00:26,167 THERE'S A BLOOD PRESSURE GOAL OF 3501 02:00:26,167 --> 02:00:29,804 LESS THAN 140/90. 3502 02:00:29,804 --> 02:00:31,705 AND WHAT YOU SEE IN THIS SLIDE 3503 02:00:31,705 --> 02:00:33,607 IS A CLUSTER OF MEASUREMENTS 3504 02:00:33,607 --> 02:00:37,545 JUST BELOW A SYSTOLIC OF 140. 3505 02:00:37,545 --> 02:00:38,746 RIGHT AT 140, WE HAVE THIS 3506 02:00:38,746 --> 02:00:40,481 DROPOFF OR DISCONTINUITY IN THE 3507 02:00:40,481 --> 02:00:41,048 DISTRIBUTION. 3508 02:00:41,048 --> 02:00:42,016 WE REFER TO THIS SORT OF 3509 02:00:42,016 --> 02:00:43,150 CASUALLY AMONG OUR RESEARCH TEAM 3510 02:00:43,150 --> 02:00:44,685 AS THE CLIFF AND THEN A MUCH 3511 02:00:44,685 --> 02:00:48,656 LOWER FREAK SIG FREQUENCY OF MES 3512 02:00:48,656 --> 02:00:49,590 ABOVE 140. 3513 02:00:49,590 --> 02:00:50,891 UNLIKE WITH TERMINAL DIGIT 3514 02:00:50,891 --> 02:00:52,059 PREFERENCE, WE REALLY DON'T HAVE 3515 02:00:52,059 --> 02:00:53,727 ESTABLISHED METHODS FOR 3516 02:00:53,727 --> 02:00:54,528 DETECTING THRESHOLD BIAS OTHER 3517 02:00:54,528 --> 02:00:56,230 THAN VISUALLY LOOKING AT A 3518 02:00:56,230 --> 02:00:56,764 HISTOGRAM. 3519 02:00:56,764 --> 02:00:59,200 THIS IS A RELATIVELY CLEAR-CUT 3520 02:00:59,200 --> 02:01:01,268 EXAMPLE, I THINK, BUT IT'S NOT 3521 02:01:01,268 --> 02:01:02,303 ALWAYS QUITE SO STRAIGHTFORWARD 3522 02:01:02,303 --> 02:01:04,104 SO WE'LL COME BACK TO METHODS 3523 02:01:04,104 --> 02:01:05,739 FOR DETECTING THRESHOLD BIAS 3524 02:01:05,739 --> 02:01:08,609 SHORTLY. 3525 02:01:08,609 --> 02:01:09,577 AND THESE ERRORS IN BLOOD 3526 02:01:09,577 --> 02:01:10,477 PRESSURE RECORDING ARE NOT 3527 02:01:10,477 --> 02:01:10,711 BENIGN. 3528 02:01:10,711 --> 02:01:12,913 THEY HAVE IMPLICATIONS FOR THE 3529 02:01:12,913 --> 02:01:14,114 CORRECT DIAGNOSIS AND TREATMENT 3530 02:01:14,114 --> 02:01:16,150 OF HYPERTENSION. 3531 02:01:16,150 --> 02:01:19,920 PREVIOUS RESEARCH HAS SHOWN THAT 3532 02:01:19,920 --> 02:01:21,622 PATIENTS AT PRACTICES WITH 3533 02:01:21,622 --> 02:01:23,057 HIGHER LEVELS OF TERMINAL DIGIT 3534 02:01:23,057 --> 02:01:24,925 PREFERENCE MAY BE LESS LIKELY TO 3535 02:01:24,925 --> 02:01:26,594 HAVE AN ANTIHYPERTENSIVE 3536 02:01:26,594 --> 02:01:28,128 PRESCRIPTION AND MORE LIKELY TO 3537 02:01:28,128 --> 02:01:29,496 HAVE A CARDIOVASCULAR EVENT. 3538 02:01:29,496 --> 02:01:32,233 THERE ARE MANY FEWER STUDIES OF 3539 02:01:32,233 --> 02:01:33,234 THRESHOLD BIAS IN THE 3540 02:01:33,234 --> 02:01:34,335 LITERATURE, HOWEVER IN ONE PAPER 3541 02:01:34,335 --> 02:01:36,303 BY WINGFIELD AT ALL WHAT THEY 3542 02:01:36,303 --> 02:01:38,138 FOUND WAS THAT WOMEN WHOSE 3543 02:01:38,138 --> 02:01:40,140 DIASTOLIC BLOOD PRESSURE WAS 3544 02:01:40,140 --> 02:01:42,476 RECORDED AT 88 OR 89 ACTUALLY 3545 02:01:42,476 --> 02:01:44,078 HAD HIGHER CARDIOVASCULAR 3546 02:01:44,078 --> 02:01:45,145 DISEASE AND TOTAL MORTALITY THAN 3547 02:01:45,145 --> 02:01:47,781 THOSE WITH LOWER OR HIGHER 3548 02:01:47,781 --> 02:01:48,883 DIASTOLIC BLOOD PRESSURES 3549 02:01:48,883 --> 02:01:50,618 RECORDED SUGGESTING THAT THOSE 3550 02:01:50,618 --> 02:01:53,687 WOMEN WHOSE DBP WAS RECORDED AS 3551 02:01:53,687 --> 02:01:55,222 88 OR 89 WERE UNDERTREATED. 3552 02:01:55,222 --> 02:01:56,490 AGAIN GIVEN THAT THRESHOLD BIAS 3553 02:01:56,490 --> 02:01:58,525 IS RELATIVELY UNDERSTUDIED, I'LL 3554 02:01:58,525 --> 02:01:59,760 SPEND SOME TIME ON THIS 3555 02:01:59,760 --> 02:02:01,028 PARTICULAR ISSUE, THIS CONCEPT 3556 02:02:01,028 --> 02:02:02,263 HAS BEEN DESCRIBED AT LEAST AS 3557 02:02:02,263 --> 02:02:05,099 EARLY AS THE 1960s, HOWEVER, 3558 02:02:05,099 --> 02:02:06,901 THE EXTENT OF THRESHOLD BIAS IN 3559 02:02:06,901 --> 02:02:08,535 CLINICAL PRACTICE AND CLINICAL 3560 02:02:08,535 --> 02:02:10,537 RESEARCH IS UNKNOWN, AND AS 3561 02:02:10,537 --> 02:02:12,339 MENTIONED BEFORE, WE DON'T HAVE 3562 02:02:12,339 --> 02:02:13,173 ESTABLISHED METHODS FOR 3563 02:02:13,173 --> 02:02:13,774 DETECTING IT. 3564 02:02:13,774 --> 02:02:15,276 AND WHILE THE ROOT CAUSES HAVE 3565 02:02:15,276 --> 02:02:17,811 NOT BEEN SYSTEMATICALLY STUDIED, 3566 02:02:17,811 --> 02:02:19,480 BASED ON THE PAPERS THAT ARE IN 3567 02:02:19,480 --> 02:02:20,748 THE LITERATURE AND IN TALKING 3568 02:02:20,748 --> 02:02:23,017 WITH PARTNERS WORKING IN THE 3569 02:02:23,017 --> 02:02:25,019 FIELD, THIS MAY ARISE DUE TO 3570 02:02:25,019 --> 02:02:26,887 INCENTIVES TO IMPROVE BLOOD 3571 02:02:26,887 --> 02:02:27,655 PRESSURE CONTROL. 3572 02:02:27,655 --> 02:02:29,623 THERE'S ONE PUBLISHED PAPER 3573 02:02:29,623 --> 02:02:32,026 AFTER THE INTRODUCTION OF THE 3574 02:02:32,026 --> 02:02:33,494 QUALITY IN OUTCOMES FRAMEWORK IN 3575 02:02:33,494 --> 02:02:37,531 THE U.S. K. THAT DOCUMENTED SORT 3576 02:02:37,531 --> 02:02:38,766 OF THE INTRODUCTION OF THRESHOLD 3577 02:02:38,766 --> 02:02:40,567 BIAS SO IT MAY BE AN UNINTENDED 3578 02:02:40,567 --> 02:02:41,702 CONSEQUENCE OF QUALITY PROGRAMS. 3579 02:02:41,702 --> 02:02:43,337 IT ALSO MAY ARISE BASED ON A 3580 02:02:43,337 --> 02:02:44,705 DESIRE TO AVOID MEDICATION 3581 02:02:44,705 --> 02:02:46,240 TITRATION OR PERHAPS CLINICIAN 3582 02:02:46,240 --> 02:02:47,408 ASSUMPTIONS ABOUT A PATIENT'S 3583 02:02:47,408 --> 02:02:48,909 BLOOD PRESSURE, SO IF A YOUNGER 3584 02:02:48,909 --> 02:02:51,879 PATIENT HAS A SYSTOLIC OF 3585 02:02:51,879 --> 02:02:53,647 142 MAYBE IT GETS RECORDED OF 3586 02:02:53,647 --> 02:02:54,481 138 BECAUSE THEY'RE THOUGHT TO 3587 02:02:54,481 --> 02:02:57,184 BE YOUNG AND HEALTHY. 3588 02:02:57,184 --> 02:02:58,419 SO NEXT I'D LIKE TO SHARE SOME 3589 02:02:58,419 --> 02:03:00,387 WORK WE'VE BEEN DOING IN OUR 3590 02:03:00,387 --> 02:03:03,090 GROUP TO DEVELOP A METHOD FOR 3591 02:03:03,090 --> 02:03:03,924 DETECTING THRESHOLD BIAS. 3592 02:03:03,924 --> 02:03:05,225 SIMILAR TO TERMINAL DIGIT 3593 02:03:05,225 --> 02:03:06,860 PREFERENCE WHERE WE HAVE A 3594 02:03:06,860 --> 02:03:08,796 REFERENCE DISTRIBUTION OR SOME 3595 02:03:08,796 --> 02:03:09,830 EXPECTED PERCENT OF MEASUREMENTS 3596 02:03:09,830 --> 02:03:13,367 TO COMPARE TO, WE NEED SOME 3597 02:03:13,367 --> 02:03:14,335 EXPECTED BLOOD PRESSURE 3598 02:03:14,335 --> 02:03:15,336 DISTRIBUTION AGAINST WHICH TO 3599 02:03:15,336 --> 02:03:16,637 EVALUATE THE POTENTIAL FOR 3600 02:03:16,637 --> 02:03:17,004 THRESHOLD BIAS. 3601 02:03:17,004 --> 02:03:19,073 WHAT WE'VE DONE IS TO USE 3602 02:03:19,073 --> 02:03:20,140 POPULATION-BASED SURVEILLANCE 3603 02:03:20,140 --> 02:03:20,607 DATA FOR THIS. 3604 02:03:20,607 --> 02:03:22,376 AND THE REASON WE'RE USING 3605 02:03:22,376 --> 02:03:23,677 SURVEILLANCE DATA IS BECAUSE IN 3606 02:03:23,677 --> 02:03:25,145 A SURVEILLANCE STUDY, THERE'S NO 3607 02:03:25,145 --> 02:03:26,347 BLOOD PRESSURE GOAL, AND THERE'S 3608 02:03:26,347 --> 02:03:29,116 NO INCENTIVE FOR MISRECORDING SO 3609 02:03:29,116 --> 02:03:30,684 WE CAN LOOK AT THE DISTRIBUTION 3610 02:03:30,684 --> 02:03:32,619 OF BLOOD PRESSURE IN ADULTS WITH 3611 02:03:32,619 --> 02:03:33,721 TREATED HYPERTENSION AND GET A 3612 02:03:33,721 --> 02:03:34,588 SENSE OF WHAT THAT SHOULD LOOK 3613 02:03:34,588 --> 02:03:36,290 LIKE IN THE ABSENCE OF BIAS. 3614 02:03:36,290 --> 02:03:38,492 AND IN THE ABSENCE OF BIAS, WE 3615 02:03:38,492 --> 02:03:39,660 EXPECT THAT BLOOD PRESSURE 3616 02:03:39,660 --> 02:03:41,161 DISTRIBUTION IS GOING TO BE A 3617 02:03:41,161 --> 02:03:42,196 NICE SMOOTH CURVE, IT WON'T HAVE 3618 02:03:42,196 --> 02:03:44,264 THAT CLIFF THAT I SHOWED YOU 3619 02:03:44,264 --> 02:03:49,670 EARLIER, THERE WILL BE APR 3620 02:03:49,670 --> 02:03:52,673 APPROXIMATELY NORMAL OR LOG MORE 3621 02:03:52,673 --> 02:03:56,910 MNORMAL IN SHAPE. 3622 02:03:56,910 --> 02:03:59,179 THEN WHAT WE'VE DONE NEXT IS 3623 02:03:59,179 --> 02:04:00,447 DEVELOP A METRIC THAT WE CALL 3624 02:04:00,447 --> 02:04:02,716 THE THRESHOLD RATIO AND 3625 02:04:02,716 --> 02:04:04,018 ESSENTIALLY TAKING THE NUMBER OF 3626 02:04:04,018 --> 02:04:05,586 MEASUREMENTS JUST BELOW VERSUS 3627 02:04:05,586 --> 02:04:06,053 JUST ABOVE. 3628 02:04:06,053 --> 02:04:07,321 IF WE HAVE A BLOOD PRESSURE GOAL 3629 02:04:07,321 --> 02:04:09,289 OF LESS THAN 140 OVER 90, FOR 3630 02:04:09,289 --> 02:04:11,358 EXAMPLE, WE WOULD DEFINE THE 3631 02:04:11,358 --> 02:04:13,193 SYSTOLIC THRESHOLD RATIO AS THE 3632 02:04:13,193 --> 02:04:16,630 NUMBER OF MEASUREMENTS DIVIDED 3633 02:04:16,630 --> 02:04:19,199 BY THE NUMBER OF MEASUREMENTS 3634 02:04:19,199 --> 02:04:19,733 140 TO 149. 3635 02:04:19,733 --> 02:04:22,102 NOW OBVIOUSLY IF WE HAVE A 3636 02:04:22,102 --> 02:04:22,936 DIASTOLIC BLOOD PRESSURE GOAL OF 3637 02:04:22,936 --> 02:04:27,074 LESS THAN 9 90 -- DIVIDED BY THE 3638 02:04:27,074 --> 02:04:31,011 NUMBER OF MEASUREMENTS 90 TO 94. 3639 02:04:31,011 --> 02:04:32,746 JUST TO UNDERSCORE WHY WE'RE 3640 02:04:32,746 --> 02:04:34,548 INTERESTED IN THIS METRIC OF THE 3641 02:04:34,548 --> 02:04:37,151 THRESHOLD RATIO, IN THE 3642 02:04:37,151 --> 02:04:39,219 HISTOGRAM ON THE LEFT, THESE WHY 3643 02:04:39,219 --> 02:04:40,387 JUST SIMULATED DATA BUT MIGHT BE 3644 02:04:40,387 --> 02:04:42,122 WHAT A SURVEILLANCE DATASET 3645 02:04:42,122 --> 02:04:42,823 WOULD LOOK LIKE. 3646 02:04:42,823 --> 02:04:44,992 IF WE WERE TO CALCULATE THE 3647 02:04:44,992 --> 02:04:46,627 THRESHOLD RATIO, SO AGAIN, 3648 02:04:46,627 --> 02:04:51,165 NUMBER OF MEASUREMENTS, 130-139 3649 02:04:51,165 --> 02:04:54,168 DIVIDED BY 140-149, THAT 3650 02:04:54,168 --> 02:04:55,669 MEASUREMENTS IS GOING TO BE 3651 02:04:55,669 --> 02:04:57,304 1 BUT IT WILL BE CLOSE TO IT. 3652 02:04:57,304 --> 02:04:58,672 IN CONTRAST ON THE RIGHT IN THE 3653 02:04:58,672 --> 02:05:00,407 SETTING OF THRESHOLD BIAS, WE 3654 02:05:00,407 --> 02:05:02,176 HAVE A LARGE NUMBER OF 3655 02:05:02,176 --> 02:05:04,044 MEASUREMENTS BETWEEN 130 AND ONE 3656 02:05:04,044 --> 02:05:07,514 39 AND A MUCH SMALLER NUMBER OF 3657 02:05:07,514 --> 02:05:08,449 MEASUREMENTS BETWEEN 140 AND 149 3658 02:05:08,449 --> 02:05:10,584 SO WE'LL HAVE A MUCH HIGHER 3659 02:05:10,584 --> 02:05:13,153 THRESHOLD RATIO WHICH WE CAN 3660 02:05:13,153 --> 02:05:13,687 THEN COMPARE. 3661 02:05:13,687 --> 02:05:15,622 SO COMING BACK TO OUR METHOD 3662 02:05:15,622 --> 02:05:16,857 ITSELF, THE NEXT THING WE DID 3663 02:05:16,857 --> 02:05:18,092 WAS TRY TO UNDERSTAND THE 3664 02:05:18,092 --> 02:05:20,227 PROBABILITY OF OBSERVING HIGHER 3665 02:05:20,227 --> 02:05:22,396 RATIOS THAT MIGHT INDICATE 3666 02:05:22,396 --> 02:05:23,864 THRESHOLD BIAS IN A CLINICAL 3667 02:05:23,864 --> 02:05:25,265 DATASET BASED ON WHAT WE SEE IN 3668 02:05:25,265 --> 02:05:26,600 THE SURVEILLANCE DATA, AND WE 3669 02:05:26,600 --> 02:05:27,968 USED A BOOTSTRAPPING APPROACH 3670 02:05:27,968 --> 02:05:32,072 FOR THIS. 3671 02:05:32,072 --> 02:05:34,174 THEN FINALLY WE CALCULATE THE 3672 02:05:34,174 --> 02:05:35,242 OBSERVED THRESHOLD RATIO IN THE 3673 02:05:35,242 --> 02:05:36,376 CLINICAL DATASETS AND AGAIN 3674 02:05:36,376 --> 02:05:37,845 COMPARE THAT TO THE PROBABILITY 3675 02:05:37,845 --> 02:05:39,446 BASED ON THE SURVEILLANCE DATA. 3676 02:05:39,446 --> 02:05:40,714 AND I'LL WALK THROUGH A COUPLE 3677 02:05:40,714 --> 02:05:41,915 OF EXAMPLES NEXT OF HOW WE'VE 3678 02:05:41,915 --> 02:05:43,150 APPLIED THIS METHOD AND SORT OF 3679 02:05:43,150 --> 02:05:44,351 DESCRIBE EACH OF THESE STEPS IN 3680 02:05:44,351 --> 02:05:45,786 DETAIL AS WE GO SO YOU CAN 3681 02:05:45,786 --> 02:05:49,623 VISUALIZE THEM. 3682 02:05:49,623 --> 02:05:50,757 SO THE FIRST EXAMPLE I'LL SHOW 3683 02:05:50,757 --> 02:05:53,160 YOU IS OF A CLINICAL PRACTICE 3684 02:05:53,160 --> 02:05:57,531 DATASET THAT WE EVALUATED. 3685 02:05:57,531 --> 02:05:58,765 THESE CLINICAL DATA CAME TO US 3686 02:05:58,765 --> 02:06:00,834 FROM ONE OF OUR PARTNERS WORKING 3687 02:06:00,834 --> 02:06:02,202 IN ANOTHER COUNTRY, SO THE 3688 02:06:02,202 --> 02:06:03,370 SURVEILLANCE DATA THAT WE USED 3689 02:06:03,370 --> 02:06:04,505 AS THE REFERENCE IN THIS CASE 3690 02:06:04,505 --> 02:06:07,841 CAME FROM THEIR WHO STEP SURVEY, 3691 02:06:07,841 --> 02:06:09,009 THE BLOOD PRESSURES HERE ALL 3692 02:06:09,009 --> 02:06:10,644 TAKEN WITH AN OSCILLOMETRIC 3693 02:06:10,644 --> 02:06:11,612 DEVICE. 3694 02:06:11,612 --> 02:06:12,379 I'LL FOCUS ON THE STOILINGS 3695 02:06:12,379 --> 02:06:14,047 BLOOD PRESSURES JUST FOR THE 3696 02:06:14,047 --> 02:06:16,016 SAKE OF TIME. 3697 02:06:16,016 --> 02:06:16,783 SYSTOLIC. 3698 02:06:16,783 --> 02:06:18,118 SO IF WE CALCULATE THE THRESHOLD 3699 02:06:18,118 --> 02:06:19,820 RATIO IN THIS SURVEILLANCE DATA, 3700 02:06:19,820 --> 02:06:21,755 SO AGAIN TAKING THE NUMBER OF 3701 02:06:21,755 --> 02:06:23,590 MEASUREMENTS 130 TO 139 SHOWN IN 3702 02:06:23,590 --> 02:06:25,492 THE PINK BARS DIVIDED BY THE 3703 02:06:25,492 --> 02:06:28,328 NUMBER OF MEASUREMENTS 140 TO 3704 02:06:28,328 --> 02:06:29,963 149 SHOWN IN THE BLUE BARS, THIS 3705 02:06:29,963 --> 02:06:32,533 RATIO HERE IS 1.10. 3706 02:06:32,533 --> 02:06:34,134 THEN WHAT WE DID WAS TO SORT OF 3707 02:06:34,134 --> 02:06:35,502 DRAW FROM THESE SURVEILLANCE 3708 02:06:35,502 --> 02:06:38,305 DATA, SO WE USED BOOTSTRAPPING 3709 02:06:38,305 --> 02:06:39,673 WITH THEN THOUSAND RANDOM DRAWS, 3710 02:06:39,673 --> 02:06:43,310 WE LOOKED AT SEVERAL 3711 02:06:43,310 --> 02:06:43,877 DIFFERENT -- TRYING TO 3712 02:06:43,877 --> 02:06:44,945 UNDERSTAND THE PROBABILITY OF 3713 02:06:44,945 --> 02:06:47,014 OBSERVING HIGHER RATIOS THAT 3714 02:06:47,014 --> 02:06:49,016 MIGHT INDICATE THRESHOLD BIAS IN 3715 02:06:49,016 --> 02:06:56,490 OUR SURVEY LABS SURVEILLANCE D. 3716 02:06:56,490 --> 02:06:58,392 YOU MAY BE MORE CONSERVATIVE IN 3717 02:06:58,392 --> 02:07:02,996 TERMS OF PLAGUING RATIOS -- THE 3718 02:07:02,996 --> 02:07:04,798 TAKEAWAY HERE IS IF WE SEE A 3719 02:07:04,798 --> 02:07:07,901 RATIO OF 2.5 TO 3, IT'S VERY YOU 3720 02:07:07,901 --> 02:07:11,605 UNLIKELY TO BE OBSERVED IN THE 3721 02:07:11,605 --> 02:07:12,873 SURVEILLANCE DATA THAT MAY 3722 02:07:12,873 --> 02:07:18,612 INDICATE THAT BIAS IS OCCURRING. 3723 02:07:18,612 --> 02:07:19,947 LOOKING AT THE CLINICAL PRACTICE 3724 02:07:19,947 --> 02:07:21,682 DATASET, THESE ARE DATA FROM 3725 02:07:21,682 --> 02:07:22,282 JUST ONE HEALTHCARE FACILITY 3726 02:07:22,282 --> 02:07:23,750 THAT HAS OVER 10,000 3727 02:07:23,750 --> 02:07:24,084 OBSERVATIONS. 3728 02:07:24,084 --> 02:07:25,852 THE THRESHOLD RATIO WE 3729 02:07:25,852 --> 02:07:32,292 CALCULATED HERE IS 3.56. 3730 02:07:32,292 --> 02:07:33,627 AND IF WE COME BACK TO THE TABLE 3731 02:07:33,627 --> 02:07:35,195 OF PROBABILITIES BASED ON THE 3732 02:07:35,195 --> 02:07:38,632 SURVEILLANCE DATA, WE SEE THE 3733 02:07:38,632 --> 02:07:43,870 THRESHOLD RATIO OF 3.56, THIS 3734 02:07:43,870 --> 02:07:44,938 LIKELY INDICATE THERE'S SOME 3735 02:07:44,938 --> 02:07:45,472 BIAS OCCURRING. 3736 02:07:45,472 --> 02:07:46,907 I THINK WE CAN ALSO SEE THAT 3737 02:07:46,907 --> 02:07:47,941 PRETTY WELL VISUALLY IN THIS 3738 02:07:47,941 --> 02:07:49,843 PARTICULAR EXAMPLE. 3739 02:07:49,843 --> 02:07:52,879 SO AFTER LOOKING AT A NUMBER OF 3740 02:07:52,879 --> 02:07:53,880 CLINICAL PRACTICE DATASETS, OUR 3741 02:07:53,880 --> 02:07:56,984 RESEARCH TEAM WAS INTERESTED IN 3742 02:07:56,984 --> 02:07:58,018 LOOKING AT OTHER TYPES OF DATA, 3743 02:07:58,018 --> 02:07:59,219 IN PARTICULAR, CLINICAL TRIALS 3744 02:07:59,219 --> 02:08:00,954 WHICH ALSO HAVE A BLOOD PRESSURE 3745 02:08:00,954 --> 02:08:04,658 CONTROL GOAL. 3746 02:08:04,658 --> 02:08:05,892 AND THE CLINICAL TRIAL EXAMPLE 3747 02:08:05,892 --> 02:08:07,394 THAT I'LL SHOW YOU COMES FROM 3748 02:08:07,394 --> 02:08:09,229 THE U.S., SO THESE SURVEILLANCE 3749 02:08:09,229 --> 02:08:11,665 DATA THAT ARE USED AS THE 3750 02:08:11,665 --> 02:08:13,200 REFERENCE HERE IN THE NATIONAL 3751 02:08:13,200 --> 02:08:14,401 HEALTH AND NUTRITIONAL 3752 02:08:14,401 --> 02:08:16,570 EXAMINATION SURVEY, THESE ARE 3753 02:08:16,570 --> 02:08:19,873 THE MEASUREMENTS FROM 2017 TO 3754 02:08:19,873 --> 02:08:21,775 2020. 3755 02:08:21,775 --> 02:08:25,245 THE THRESHOLD RATIO WE 3756 02:08:25,245 --> 02:08:26,980 CALCULATED HERE IS 1.39. 3757 02:08:26,980 --> 02:08:28,081 AND AGAIN USING OUR 3758 02:08:28,081 --> 02:08:29,149 BOOTSTRAPPING APPROACH, WE FOUND 3759 02:08:29,149 --> 02:08:32,286 THAT RATIOS OF 2.5 OR 3 OR EVEN 3760 02:08:32,286 --> 02:08:34,354 HIGHER ARE UNLIKELY TO BE FOUND 3761 02:08:34,354 --> 02:08:35,756 IN SURVEILLANCE DATA. 3762 02:08:35,756 --> 02:08:40,160 RATIOS OF 1.8 OR 2 MAY BE MORE 3763 02:08:40,160 --> 02:08:43,597 INTERMEDIATE MAY WARRANT SOME 3764 02:08:43,597 --> 02:08:44,298 ADDITIONAL REVIEW, WHEREAS A 3765 02:08:44,298 --> 02:08:47,334 RATIO OF 1.5 IS COMPATIBLE WITH 3766 02:08:47,334 --> 02:08:49,670 THE SURV SURVEILLANCE DATA. 3767 02:08:49,670 --> 02:08:51,238 THIS SHOWS DATA FROM A 3768 02:08:51,238 --> 02:08:52,339 HYPERTENSION TREATMENT TRIAL. 3769 02:08:52,339 --> 02:08:53,774 THE DATA ARE FROM THE STANDARD 3770 02:08:53,774 --> 02:08:54,608 TREATMENT ARM OF THE TRIAL, 3771 02:08:54,608 --> 02:08:55,742 WHICH HAS SYSTOLIC BLOOD 3772 02:08:55,742 --> 02:08:57,344 PRESSURE GOAL OF LESS THAN 140. 3773 02:08:57,344 --> 02:08:59,179 WE TOOK THE DATA FROM THE STUDY 3774 02:08:59,179 --> 02:09:01,682 VISIT CLOSEST TO THE MEAN 3775 02:09:01,682 --> 02:09:03,283 OVERALL FOLLOW-UP TIME AND HERE 3776 02:09:03,283 --> 02:09:09,556 THE THRESHOLD RATIO IS 2.26. 3777 02:09:09,556 --> 02:09:12,392 COME BACK TO OUR TABLE OF 3778 02:09:12,392 --> 02:09:14,161 PROBABILITIES OUTLINED IN THE 3779 02:09:14,161 --> 02:09:15,595 BLACK BOX WHERE THIS RATIO WOULD 3780 02:09:15,595 --> 02:09:17,030 FALL, I THINK THIS MIGHT WARRANT 3781 02:09:17,030 --> 02:09:17,798 REVIEW OF BLOOD PRESSURE 3782 02:09:17,798 --> 02:09:19,933 REPORTING PROCEDURES, OR IT'S 3783 02:09:19,933 --> 02:09:21,134 POSSIBLE THAT THERE'S SOME BIAS 3784 02:09:21,134 --> 02:09:21,535 OCCURRING. 3785 02:09:21,535 --> 02:09:23,203 I KNOW SOMEONE MAY COMMENT WHILE 3786 02:09:23,203 --> 02:09:26,106 TRIAL POPULATIONS ARE DIFFERENT 3787 02:09:26,106 --> 02:09:27,541 FROM SURVEILLANCE POPULATIONS OR 3788 02:09:27,541 --> 02:09:29,076 THAT THIS MIGHT REPRESENT 3789 02:09:29,076 --> 02:09:29,843 OPTIMAL BLOOD PRESSURE CONTROL, 3790 02:09:29,843 --> 02:09:31,211 I THINK I WOULD ASK THE 3791 02:09:31,211 --> 02:09:33,146 CLINICIANS, HOW PRECISELY IS 3792 02:09:33,146 --> 02:09:34,214 BLOOD PRESSURE TYPICALLY 3793 02:09:34,214 --> 02:09:34,514 CONTROLLED? 3794 02:09:34,514 --> 02:09:36,149 AND AGAIN, THIS METHOD IS ALSO 3795 02:09:36,149 --> 02:09:37,617 NOT MEANT TO PROVE THAT THERE'S 3796 02:09:37,617 --> 02:09:38,752 BIAS OCCURRING, RATHER TO PROMPT 3797 02:09:38,752 --> 02:09:42,489 FOR REVIEW OF PROCEDURES AND 3798 02:09:42,489 --> 02:09:43,357 ENCOURAGE QUALITY CONTROL 3799 02:09:43,357 --> 02:09:49,363 THROUGHOUT A STUDY. 3800 02:09:49,363 --> 02:09:51,765 SO IN TERMS OF POTENTIAL 3801 02:09:51,765 --> 02:09:55,268 SOLUTIONS, ONE WAY TO AVOID 3802 02:09:55,268 --> 02:09:55,969 THRESHOLD BIAS AND OTHER TYPES 3803 02:09:55,969 --> 02:09:58,205 OF RECORDING BIAS AS WELL IS TO 3804 02:09:58,205 --> 02:09:59,473 USE DEVICES THAT HAVE THE 3805 02:09:59,473 --> 02:10:00,674 CAPABILITY TO AUTOMATICALLY 3806 02:10:00,674 --> 02:10:01,108 UPLOAD DATA. 3807 02:10:01,108 --> 02:10:04,077 THERE WAS JUST A NICE PAPER BY 3808 02:10:04,077 --> 02:10:05,412 WU ET AL. FROM CHINA THAT I 3809 02:10:05,412 --> 02:10:06,346 THINK PROVIDES A FLIES EXAMPLE 3810 02:10:06,346 --> 02:10:08,782 OF THIS. 3811 02:10:08,782 --> 02:10:09,416 NICE EXAMPLE OF 3812 02:10:09,416 --> 02:10:10,484 THIS HOWEVER THESE ARE NOT 3813 02:10:10,484 --> 02:10:11,585 WIDELY AVAILABLE AND ACCESSIBLE, 3814 02:10:11,585 --> 02:10:14,087 SO IN THE INTERIM, ROUTINE 3815 02:10:14,087 --> 02:10:17,791 REVIEW OF HISTOGRAMS OF 3816 02:10:17,791 --> 02:10:19,659 MEASUREMENTS IN BOTH CLINICAL 3817 02:10:19,659 --> 02:10:20,761 PRACTICE AND CLINIC BASED 3818 02:10:20,761 --> 02:10:23,130 RESEARCH MAY BE ONE POTENTIAL 3819 02:10:23,130 --> 02:10:23,597 SOLUTION. 3820 02:10:23,597 --> 02:10:25,599 SO IN CONCLUSION BOTH VISUAL 3821 02:10:25,599 --> 02:10:26,666 INSPECTION AND STATISTICAL 3822 02:10:26,666 --> 02:10:28,068 METHODS MAY BE USEFUL FOR 3823 02:10:28,068 --> 02:10:29,536 DETECTING THRESHOLD BIAS AS WELL 3824 02:10:29,536 --> 02:10:30,570 AS OTHER TYPES OF BIASES. 3825 02:10:30,570 --> 02:10:31,772 WE IDENTIFIED SEVERAL DATASETS 3826 02:10:31,772 --> 02:10:33,440 WITH THE POTENTIAL FOR THRESHOLD 3827 02:10:33,440 --> 02:10:36,843 BIAS, AGAIN I'M UNDERSCORING 3828 02:10:36,843 --> 02:10:37,544 POTENTIAL HERE. 3829 02:10:37,544 --> 02:10:39,012 OUR METHODS SHOULD BE TESTED IN 3830 02:10:39,012 --> 02:10:41,715 OTHER SETTINGS AND FURTHER 3831 02:10:41,715 --> 02:10:42,315 REFINED. 3832 02:10:42,315 --> 02:10:43,250 THIS IS A WORK IN PROGRESS, 3833 02:10:43,250 --> 02:10:44,317 WE'RE WORKING ON A PAPER RIGHT 3834 02:10:44,317 --> 02:10:44,918 NOW. 3835 02:10:44,918 --> 02:10:45,886 I THINK THE META CONCLUSIONS 3836 02:10:45,886 --> 02:10:47,187 HERE IS THERE'S A NEED FOR 3837 02:10:47,187 --> 02:10:49,189 RENEWED EMPHASIS ON HIGH QUALITY 3838 02:10:49,189 --> 02:10:50,056 BLOOD PRESSURE MEASUREMENTS 3839 02:10:50,056 --> 02:10:54,828 INCLUDING ACCURATE REPORTING. 3840 02:10:54,828 --> 02:10:56,563 THIS IS MY LAST SLIDE ON THE KEY 3841 02:10:56,563 --> 02:10:57,998 KNOWLEDGE GAPS AND FUTURE 3842 02:10:57,998 --> 02:10:58,965 OPPORTUNITIES. 3843 02:10:58,965 --> 02:11:00,233 KEY GAPS CURRENTLY INCLUDE A LOW 3844 02:11:00,233 --> 02:11:01,768 AWARENESS OF THRESHOLD BIAS, AS 3845 02:11:01,768 --> 02:11:03,203 WELL AS A MISPERCEPTION THAT 3846 02:11:03,203 --> 02:11:04,738 RECORDING BIASES ARE ELIMINATED 3847 02:11:04,738 --> 02:11:06,106 WITH AUTOMATED DEVICES. 3848 02:11:06,106 --> 02:11:08,508 AND A NEED FOR QUALITY 3849 02:11:08,508 --> 02:11:09,576 IMPROVEMENT PROGRAMS THAT 3850 02:11:09,576 --> 02:11:12,779 ADDRESS THAT REPORTING PIECE. 3851 02:11:12,779 --> 02:11:13,480 FUTURE OPPORTUNITIES INCLUDE 3852 02:11:13,480 --> 02:11:15,248 TESTING THE METHOD FOR DETECTING 3853 02:11:15,248 --> 02:11:16,316 THRESHOLD BIAS IN OTHER SETTINGS 3854 02:11:16,316 --> 02:11:18,051 AS I MENTIONED AND CONTINUING TO 3855 02:11:18,051 --> 02:11:18,819 REFINE IT. 3856 02:11:18,819 --> 02:11:20,287 AS WELL AS EXAMINING ROOT CAUSES 3857 02:11:20,287 --> 02:11:22,022 OF THRESHOLD BIAS AND FINALLY 3858 02:11:22,022 --> 02:11:24,624 DEVELOPING STRATEGIES TO PREVENT 3859 02:11:24,624 --> 02:11:25,992 IT, OF QUALITY ASSURANCE AND 3860 02:11:25,992 --> 02:11:26,760 QUALITY CONTROL PROCEDURES IN 3861 02:11:26,760 --> 02:11:28,862 BOTH CLINICAL PRACTICE AND 3862 02:11:28,862 --> 02:11:29,863 CLINIC-BASED RESEARCH. 3863 02:11:29,863 --> 02:11:31,298 AS MENTIONED THIS MAY INCLUDE 3864 02:11:31,298 --> 02:11:32,499 ROUTINE DATA MONITORING AND 3865 02:11:32,499 --> 02:11:33,567 MAYBE EVEN TAKING IT A STEP 3866 02:11:33,567 --> 02:11:35,702 FURTHER TO PUBLISH HISTOGRAMS OF 3867 02:11:35,702 --> 02:11:36,369 BLOOD PRESSURE MEASUREMENTS WHEN 3868 02:11:36,369 --> 02:11:37,571 REPORTING DATA. 3869 02:11:37,571 --> 02:11:38,672 THANK YOU VERY MUCH, HAPPY TO 3870 02:11:38,672 --> 02:11:43,610 TAKE QUESTIONS AT THE END. 3871 02:11:43,610 --> 02:11:46,146 >> THANK YOU VERY MUCH. 3872 02:11:46,146 --> 02:11:47,247 OUR NEXT PRESENTATION IS GOING 3873 02:11:47,247 --> 02:11:49,883 TO BE BY C. BARRETT BOWLING, IF 3874 02:11:49,883 --> 02:11:51,852 WE CAN HAVE -- THERE YOU GO, 3875 02:11:51,852 --> 02:11:53,487 ASSOCIATE PROFESSOR OF MEDICINE 3876 02:11:53,487 --> 02:11:54,554 AND ASSOCIATE PROFESSOR OF 3877 02:11:54,554 --> 02:11:56,256 PUBLIC HEALTH AND SCIENCES AT 3878 02:11:56,256 --> 02:11:56,556 DUKE. 3879 02:11:56,556 --> 02:11:58,725 HE HAS WORKED FOR YEARS IN THE 3880 02:11:58,725 --> 02:11:59,893 DIAGNOSIS, TREATMENT AND 3881 02:11:59,893 --> 02:12:02,462 FUNCTIONAL HEALTH STATUS, UNIQUE 3882 02:12:02,462 --> 02:12:03,497 AMONG OLDER ADULTS. 3883 02:12:03,497 --> 02:12:05,365 HE'S GOING TO ADDRESS 3884 02:12:05,365 --> 02:12:10,370 AGE-RELATED CHALLENGES IN BLOOD 3885 02:12:10,370 --> 02:12:11,605 PRESSURE ASSESSMENT. 3886 02:12:11,605 --> 02:12:11,905 DR. BOWLING? 3887 02:12:11,905 --> 02:12:12,372 >> THANK YOU SO MUCH. 3888 02:12:12,372 --> 02:12:13,807 THANK YOU FOR THE INTRODUCTION 3889 02:12:13,807 --> 02:12:16,142 AND THANK YOU FOR THE INVITATION 3890 02:12:16,142 --> 02:12:17,611 TO PARTICIPATE IN THIS 3891 02:12:17,611 --> 02:12:18,645 OUTSTANDING WORKSHOP. 3892 02:12:18,645 --> 02:12:20,213 I'VE ALREADY LEARNED A LOT. 3893 02:12:20,213 --> 02:12:22,215 I'M GOING TO FOCUS ON OLDER 3894 02:12:22,215 --> 02:12:23,016 ADULT FOR THIS SESSION. 3895 02:12:23,016 --> 02:12:24,851 WE CAN GO ON TO THE NEXT SLIDE, 3896 02:12:24,851 --> 02:12:28,288 PLEASE. 3897 02:12:28,288 --> 02:12:29,589 AND REALLY I'M GOING TO THINK 3898 02:12:29,589 --> 02:12:30,624 ABOUT KIND OF THE TWO MAJOR 3899 02:12:30,624 --> 02:12:32,659 CHALLENGES THAT WE FACE IN 3900 02:12:32,659 --> 02:12:33,426 GERIATRIC MEDICINE. 3901 02:12:33,426 --> 02:12:34,961 SO WHEN I TAKE CARE OF PATIENTS 3902 02:12:34,961 --> 02:12:37,697 IN THE CLINIC, WHEN I SEE OLDER 3903 02:12:37,697 --> 02:12:39,399 ADULTS, I OFTEN FIND MYSELF 3904 02:12:39,399 --> 02:12:41,034 ASKING MYSELF, WHAT IS IT ABOUT 3905 02:12:41,034 --> 02:12:42,235 GETTING OLDER THAT MAKES 3906 02:12:42,235 --> 02:12:43,236 DIAGNOSIS AND MANAGEMENT OF 3907 02:12:43,236 --> 02:12:45,138 CHRONIC CONDITIONS DIFFICULT OR 3908 02:12:45,138 --> 02:12:46,606 IN OTHER WORDS, WHAT'S GOING TO 3909 02:12:46,606 --> 02:12:49,943 GET IN THE WAY HERE OF TRYING TO 3910 02:12:49,943 --> 02:12:51,545 APPLY AND FOLLOW GUIDELINES. 3911 02:12:51,545 --> 02:12:53,580 THIS IS AN IMPLEMENTATION 3912 02:12:53,580 --> 02:12:53,847 CHALLENGE. 3913 02:12:53,847 --> 02:12:54,981 IT'S A CHALLENGE THAT WE MIGHT 3914 02:12:54,981 --> 02:12:56,349 THINK ABOUT AT THE INDIVIDUAL 3915 02:12:56,349 --> 02:12:57,384 OLDER ADULT LEVEL, WE MIGHT 3916 02:12:57,384 --> 02:12:58,952 THINK ABOUT IT FOR OUR ENTIRE 3917 02:12:58,952 --> 02:13:00,053 CLINIC POPULATION OR WE MIGHT 3918 02:13:00,053 --> 02:13:01,655 THINK ABOUT IT ACROSS OUR HEALTH 3919 02:13:01,655 --> 02:13:03,056 SYSTEM, BUT IT'S AN 3920 02:13:03,056 --> 02:13:04,257 IMPLEMENTATION CHALLENGE. 3921 02:13:04,257 --> 02:13:05,292 ANOTHER QUESTION THAT I FIND 3922 02:13:05,292 --> 02:13:06,660 MYSELF ASKING IS, DO THE 3923 02:13:06,660 --> 02:13:07,894 FINDINGS FROM CLINICAL ROW 3924 02:13:07,894 --> 02:13:11,665 SEARESEARC 3925 02:13:11,665 --> 02:13:13,433 STUDIES APPLY TO MY PATIENTS? 3926 02:13:13,433 --> 02:13:14,601 ARE THESE GENERALIZABLE TO THE 3927 02:13:14,601 --> 02:13:15,702 PEOPLE I'M SEEING AND TAKING 3928 02:13:15,702 --> 02:13:16,136 CARE OF? 3929 02:13:16,136 --> 02:13:17,337 AND THIS IS AN EVIDENCE 3930 02:13:17,337 --> 02:13:18,271 GENERATION CHALLENGE AND IT'S A 3931 02:13:18,271 --> 02:13:19,539 CHALLENGE THAT OFTENTIMES DUE TO 3932 02:13:19,539 --> 02:13:20,740 THE UNDERREPRESENTATION OF OLDER 3933 02:13:20,740 --> 02:13:27,581 ADULTS IN RESEARCH. 3934 02:13:27,581 --> 02:13:28,782 WITH THESE TWO CHALLENGES IN 3935 02:13:28,782 --> 02:13:30,283 MIND, WHAT I HOPE TO DO IS THAT 3936 02:13:30,283 --> 02:13:32,252 BY THE END, YOU'LL BE ABLE TO 3937 02:13:32,252 --> 02:13:33,286 DESCRIBE SOME CHALLENGES AND 3938 02:13:33,286 --> 02:13:35,889 POTENTIAL SOLUTIONS TO OPTIMIZE 3939 02:13:35,889 --> 02:13:37,057 OUT OF CLINIC BLOOD PRESSURE 3940 02:13:37,057 --> 02:13:38,658 ASSESSMENT IN OLDER ADULTS, AND 3941 02:13:38,658 --> 02:13:40,260 ALSO TO BE ABLE TO IDENTIFY SOME 3942 02:13:40,260 --> 02:13:41,528 BARRIERS AND POTENTIAL SOLUTIONS 3943 02:13:41,528 --> 02:13:43,063 TO THE UNDERREPRESENTATION OF 3944 02:13:43,063 --> 02:13:45,465 OLDER ADULTS IN BLOOD PRESSURE 3945 02:13:45,465 --> 02:13:45,899 ASSESSMENT STUDIES. 3946 02:13:45,899 --> 02:13:46,800 ALONG THE WAY, WE'RE GOING TO 3947 02:13:46,800 --> 02:13:48,969 THINK ABOUT A LOT OF GAPS AS 3948 02:13:48,969 --> 02:13:49,936 WELL THAT MAYBE NEED TO BE 3949 02:13:49,936 --> 02:13:55,041 ADDRESSED. 3950 02:13:55,041 --> 02:13:56,643 SO WE'LL START WITH WHAT WE DO 3951 02:13:56,643 --> 02:13:57,143 KNOW. 3952 02:13:57,143 --> 02:13:58,612 AND WE DO KNOW THAT A LOT OF 3953 02:13:58,612 --> 02:14:00,213 OLDER ADULTS ARE CHECKING THEIR 3954 02:14:00,213 --> 02:14:01,047 BLOOD PRESSURE AT HOME. 3955 02:14:01,047 --> 02:14:02,882 AS THESE DATA COME FROM THE 3956 02:14:02,882 --> 02:14:04,084 BEHAVIORAL RISK FACTOR 3957 02:14:04,084 --> 02:14:05,518 SURVEILLANCE SYSTEM, THERE WAS A 3958 02:14:05,518 --> 02:14:07,520 SPECIAL MODULE ON SELF-MEASURED 3959 02:14:07,520 --> 02:14:09,889 BLOOD PRESSURE THAT INCLUDED 3960 02:14:09,889 --> 02:14:11,257 OVER 66,000 OLDER ADULTS OR 3961 02:14:11,257 --> 02:14:14,294 ADULTS WITH HYPERTENSION, AND 3962 02:14:14,294 --> 02:14:15,762 WHAT THEY SHOWED IS THAT OLDER 3963 02:14:15,762 --> 02:14:16,763 ADULTS ARE MORE LIKELY TO CHECK 3964 02:14:16,763 --> 02:14:17,931 THEIR BLOOD PRESSURE BUT THEY'RE 3965 02:14:17,931 --> 02:14:18,932 LESS LIKELY TO COMMUNICATE IT 3966 02:14:18,932 --> 02:14:20,567 BACK TO THEIR PROVIDERS USING 3967 02:14:20,567 --> 02:14:20,867 TECHNOLOGY. 3968 02:14:20,867 --> 02:14:22,035 THAT'S SHOWN IN THAT FIGURE 3969 02:14:22,035 --> 02:14:23,670 HERE, WHERE YOU SEE THAT THERE'S 3970 02:14:23,670 --> 02:14:25,538 A PROGRESSIVE INCREASE IN THE 3971 02:14:25,538 --> 02:14:26,840 PERCENTAGE OF PARTICIPANTS WHO 3972 02:14:26,840 --> 02:14:27,540 REPORTED CHECKING THEIR BLOOD 3973 02:14:27,540 --> 02:14:30,810 PRESSURE AT OLDER AGES. 3974 02:14:30,810 --> 02:14:32,612 THAT GOES UP WITH OLDER AGES BUT 3975 02:14:32,612 --> 02:14:34,014 THE NUMBER WHO SHARE IT VIA 3976 02:14:34,014 --> 02:14:36,316 EMAIL OR INTERNET GOES DOWN. 3977 02:14:36,316 --> 02:14:37,550 OVERALL, ALL PARTICIPANTS WERE 3978 02:14:37,550 --> 02:14:40,320 MOST LIKELY TO SHARE THEIR 3979 02:14:40,320 --> 02:14:40,720 RESULTS IN PERSON. 3980 02:14:40,720 --> 02:14:42,555 SO I THINK THE TAKE-HOME HERE IS 3981 02:14:42,555 --> 02:14:44,090 THAT REALLY OLDER ADULTS ARE 3982 02:14:44,090 --> 02:14:45,025 CHECKING THEIR BLOOD PRESSURE AT 3983 02:14:45,025 --> 02:14:45,925 HOME. 3984 02:14:45,925 --> 02:14:47,327 HOW THEY PREFER TO COMMUNICATE 3985 02:14:47,327 --> 02:14:51,798 THAT TO PEOPLE MAY DIFFER ACROSS 3986 02:14:51,798 --> 02:14:52,699 AGE GROUPS. 3987 02:14:52,699 --> 02:14:54,768 A GAP I HAVE TO KIND OF POINT 3988 02:14:54,768 --> 02:14:55,702 OUT IS NOT NECESSARILY SPECIFIC 3989 02:14:55,702 --> 02:14:57,470 TO THIS STUDY BUT FOR MANY 3990 02:14:57,470 --> 02:14:58,638 STUDIES THAT THINK ABOUT AGE, IS 3991 02:14:58,638 --> 02:15:00,373 THAT HERE AGE IS DEFINED AS 3992 02:15:00,373 --> 02:15:02,342 65 YEARS AND OLDER AND WHAT WE 3993 02:15:02,342 --> 02:15:03,376 KNOW IN GERIATRICS IS THAT 3994 02:15:03,376 --> 02:15:04,544 THERE'S A WIDE RANGE OF 3995 02:15:04,544 --> 02:15:05,879 FUNCTIONAL ABILITIES, COGNITIVE 3996 02:15:05,879 --> 02:15:07,981 ABILITIES, HEALTH STATUS AND 3997 02:15:07,981 --> 02:15:09,649 HEALTH PREFERENCES IN OLDER AGE, 3998 02:15:09,649 --> 02:15:10,950 SO BY LUMPING PEOPLE WHO ARE 3999 02:15:10,950 --> 02:15:12,886 OLDER ALL INTO 65, OFTENTIMES 4000 02:15:12,886 --> 02:15:14,587 YOU MAY MISS SOME OF THAT 4001 02:15:14,587 --> 02:15:15,088 HETEROGENEITY. 4002 02:15:15,088 --> 02:15:20,093 AND SO I THINK THERE IS MAYBE AN 4003 02:15:20,093 --> 02:15:22,128 OPPORTUNITY TO LOOK MORE INTO 4004 02:15:22,128 --> 02:15:23,763 OLDEST OLD AND TO TRY AND 4005 02:15:23,763 --> 02:15:24,998 UNDERSTAND THE USE OF HOME BLOOD 4006 02:15:24,998 --> 02:15:27,634 PRESSURE MONITORING. 4007 02:15:27,634 --> 02:15:28,968 SO WHILE THEY ARE CHECKING THEIR 4008 02:15:28,968 --> 02:15:29,903 BLOOD PRESSURE, THEY MAY NOT BE 4009 02:15:29,903 --> 02:15:31,871 DOING IT NECESSARILY IN A WAY 4010 02:15:31,871 --> 02:15:35,241 THAT IS ACTUALLY HELPFUL FOR 4011 02:15:35,241 --> 02:15:35,775 CLINICAL DECISION-MAKING. 4012 02:15:35,775 --> 02:15:36,976 THEY MAY NOT MEASURE IT OFTEN 4013 02:15:36,976 --> 02:15:37,544 ENOUGH. 4014 02:15:37,544 --> 02:15:39,612 THESE RESULTS COME FROM THE 4015 02:15:39,612 --> 02:15:40,847 NATIONAL HEALTHY POLL ON AGING, 4016 02:15:40,847 --> 02:15:43,283 INCLUDE OVER 2,000 PEOPLE 50 TO 4017 02:15:43,283 --> 02:15:43,817 80 YEARS OLD. 4018 02:15:43,817 --> 02:15:45,118 I THINK WE SAW SOME OF THESE 4019 02:15:45,118 --> 02:15:45,719 RESULTS EARLIER. 4020 02:15:45,719 --> 02:15:47,554 HERE I'M GOING TO SHOW IT IN A 4021 02:15:47,554 --> 02:15:49,389 DIFFERENT WAY, THINKING ABOUT, 4022 02:15:49,389 --> 02:15:50,423 WELL, ABOUT HALF OF PEOPLE 4023 02:15:50,423 --> 02:15:52,592 REGULARLY MONITOR THEIR BLOOD 4024 02:15:52,592 --> 02:15:54,427 PRESSURE, BUT OF THOSE, ABOUT 4025 02:15:54,427 --> 02:15:57,130 50% ONLY DO IT ONCE A WEEK. 4026 02:15:57,130 --> 02:15:58,865 AND SO HERE REALLY THINKING 4027 02:15:58,865 --> 02:16:01,234 ABOUT IS IT ENOUGH OR IS IT DONE 4028 02:16:01,234 --> 02:16:03,403 AT A TIME AT WHICH IT WOULD BE 4029 02:16:03,403 --> 02:16:04,637 HELPFUL FOR CLINICAL 4030 02:16:04,637 --> 02:16:05,205 DECISION-MAKING. 4031 02:16:05,205 --> 02:16:06,272 AND SO I THINK THERE IS A 4032 02:16:06,272 --> 02:16:09,542 KNOWLEDGE GAP ON HOW TO BOTH 4033 02:16:09,542 --> 02:16:10,577 OBTAIN, WHAT IS THE APPROPRIATE 4034 02:16:10,577 --> 02:16:12,779 TIMING, AND HOW TO OBTAIN THOSE, 4035 02:16:12,779 --> 02:16:16,049 SO THAT THERE ARE RELATIVE TO A 4036 02:16:16,049 --> 02:16:17,650 CLINIC VISIT OR RELATIVE TO 4037 02:16:17,650 --> 02:16:19,052 CHANGES THROUGHOUT THE DAY AS 4038 02:16:19,052 --> 02:16:20,386 WE'VE HEARD IN OTHER TALKS THAT 4039 02:16:20,386 --> 02:16:22,989 MIGHT REALLY IMPACT 4040 02:16:22,989 --> 02:16:23,590 DECISION-MAKING AROUND BLOOD 4041 02:16:23,590 --> 02:16:29,629 PRESSURE TREATMENT. 4042 02:16:29,629 --> 02:16:32,232 SO IN ADDITION TO KNOWING OLDER 4043 02:16:32,232 --> 02:16:33,700 ADULTS ARE DOING THIS, WE ALSO 4044 02:16:33,700 --> 02:16:34,868 KIND OF -- THERE'S SOME 4045 02:16:34,868 --> 02:16:35,702 INFORMATION ABOUT WHAT PROVIDERS 4046 02:16:35,702 --> 02:16:37,871 AND SPECIFICALLY PRIMARY CARE 4047 02:16:37,871 --> 02:16:39,506 PROVIDERS THINK ABOUT HOME BLOOD 4048 02:16:39,506 --> 02:16:41,808 PRESSURE READINGS, AND A LOT OF 4049 02:16:41,808 --> 02:16:43,376 THIS COMES FROM QUALITATIVE 4050 02:16:43,376 --> 02:16:46,012 ANALYSES THAT HAVE USED SEMI 4051 02:16:46,012 --> 02:16:46,579 STRUCTURED DATA. 4052 02:16:46,579 --> 02:16:48,281 THIS IS JUST ONE EXAMPLE THAT 4053 02:16:48,281 --> 02:16:50,350 SURVEYED AND INTERVIEWED PRIMARY 4054 02:16:50,350 --> 02:16:52,018 CARE PHYSICIANS. 4055 02:16:52,018 --> 02:16:53,853 I REALLY FOUND THESE BARRIERS TO 4056 02:16:53,853 --> 02:16:55,989 USING HOME BLOOD PRESSURE GO ON 4057 02:16:55,989 --> 02:16:57,891 TO IMPACT THE FACT THAT OLDER -- 4058 02:16:57,891 --> 02:16:59,692 THAT THESE AREN'T BEING USED IN 4059 02:16:59,692 --> 02:17:00,560 CLINICAL DECISION-MAKING. 4060 02:17:00,560 --> 02:17:02,228 SO I THINK THE TWO QUOTES THAT 4061 02:17:02,228 --> 02:17:03,463 ARE SHOWN HERE, NOT BEING ABLE 4062 02:17:03,463 --> 02:17:05,131 TO ALWAYS TRUST THE HOME VALUES, 4063 02:17:05,131 --> 02:17:06,533 WHETHER IT'S I'M NOT SURE ABOUT 4064 02:17:06,533 --> 02:17:07,967 THE DEVICE OR I'M NOT SURE ABOUT 4065 02:17:07,967 --> 02:17:09,335 HOW THE PATIENT IS DOING IT ARE 4066 02:17:09,335 --> 02:17:10,069 BIG BARRIERS. 4067 02:17:10,069 --> 02:17:11,805 AND I THINK WE HEARD THAT TYPE 4068 02:17:11,805 --> 02:17:14,307 OF SENTIMENT ECHOED BOTH 4069 02:17:14,307 --> 02:17:14,808 YESTERDAY AND TODAY. 4070 02:17:14,808 --> 02:17:16,543 AND THE SECOND QUOTE, THERE'S 4071 02:17:16,543 --> 02:17:17,343 TALK ABOUT ENCOURAGING PATIENTS 4072 02:17:17,343 --> 02:17:19,646 TO USE MYCHART FOR UPLOADING 4073 02:17:19,646 --> 02:17:20,013 BLOOD PRESSURES. 4074 02:17:20,013 --> 02:17:21,981 IF THE MEDIAN AGE IS 82, THEY'RE 4075 02:17:21,981 --> 02:17:23,650 GOING TO HAVE MORE CHALLENGES 4076 02:17:23,650 --> 02:17:26,085 THAN A YOUNGER POPULATION AT 4077 02:17:26,085 --> 02:17:27,120 EVEN GETTING ACCESS. 4078 02:17:27,120 --> 02:17:28,721 SO THIS REMINDED ME OF ONE OF 4079 02:17:28,721 --> 02:17:29,856 THE SPEAKERS YESTERDAY TALKED 4080 02:17:29,856 --> 02:17:32,258 ABOUT ADVOCATING FOR A YOUNGER 4081 02:17:32,258 --> 02:17:33,626 FAMILY MEMBER IN THEIR LIFE 4082 02:17:33,626 --> 02:17:36,162 THROUGH MYCHART, AND CONNECTING 4083 02:17:36,162 --> 02:17:37,197 WITH THEIR PROVIDERS. 4084 02:17:37,197 --> 02:17:39,265 HERE THIS MIGHT BE AN EVEN MAJOR 4085 02:17:39,265 --> 02:17:41,067 CHALLENGE FOR THE INDIVIDUAL 4086 02:17:41,067 --> 02:17:42,669 OLDER ADULT OR THE PEOPLE THAT 4087 02:17:42,669 --> 02:17:44,804 ARE PROVIDING THEIR CARE. 4088 02:17:44,804 --> 02:17:47,440 I DO THINK AN AREA OF KNOWLEDGE 4089 02:17:47,440 --> 02:17:49,008 GAPS AROUND THIS IS THERE'S LESS 4090 02:17:49,008 --> 02:17:50,443 DATA ON PATIENT AND CAREGIVER 4091 02:17:50,443 --> 02:17:52,946 PERCEIVED BARRIERS. 4092 02:17:52,946 --> 02:17:54,581 DR. GREEN SHOWED SOME RESULTS 4093 02:17:54,581 --> 02:17:55,748 TODAY FROM THE PATIENT 4094 02:17:55,748 --> 02:17:56,749 PERSPECTIVE, AND THERE WERE SOME 4095 02:17:56,749 --> 02:17:57,817 OLDER ADULTS IN THE QUOTES THAT 4096 02:17:57,817 --> 02:18:00,320 SHE SHOWED, SO I'M EXCITED TO 4097 02:18:00,320 --> 02:18:01,221 SEE THAT FULL REPORT. 4098 02:18:01,221 --> 02:18:02,555 I'LL ALSO BE INTERESTED TO KNOW 4099 02:18:02,555 --> 02:18:05,625 WHAT CARE PARTNERS OR CAREGIVERS 4100 02:18:05,625 --> 02:18:06,492 QUESTION ABOUT THE POTENTIAL 4101 02:18:06,492 --> 02:18:07,293 BARRIERS OF THIS TYPE OF WORK. 4102 02:18:07,293 --> 02:18:08,695 SO I THINK SOME MORE WORK TO BE 4103 02:18:08,695 --> 02:18:09,229 DONE. 4104 02:18:09,229 --> 02:18:11,397 REALLY TO KIND OF -- FROM THE 4105 02:18:11,397 --> 02:18:13,499 OLDER PATIENTS' PERSPECTIVE 4106 02:18:13,499 --> 02:18:15,034 ABOUT BARRIERS TO HOME BLOOD 4107 02:18:15,034 --> 02:18:22,075 PRESSURE. 4108 02:18:22,075 --> 02:18:24,677 SO WITH ALL OF THIS IN MIND, AND 4109 02:18:24,677 --> 02:18:25,879 WITH REVIEWING THE EXTENSIVE 4110 02:18:25,879 --> 02:18:28,514 LITERATURE ON BARRIERS TO 4111 02:18:28,514 --> 02:18:29,549 CHRONIC DISEASE MANAGEMENT MORE 4112 02:18:29,549 --> 02:18:31,718 GENERALLY OR MORE BROADLY, WE'VE 4113 02:18:31,718 --> 02:18:33,019 PUT TOGETHER A KIND OF 4114 02:18:33,019 --> 02:18:34,420 PRELIMINARY MODEL TO HELP THINK 4115 02:18:34,420 --> 02:18:35,455 THROUGH WHAT MIGHT BE SOME OF 4116 02:18:35,455 --> 02:18:39,392 THE AGE-RO-RELATED BARRIERS TO T 4117 02:18:39,392 --> 02:18:41,561 OF OFFICE BLOOD PRESSURE 4118 02:18:41,561 --> 02:18:41,861 MONITORING. 4119 02:18:41,861 --> 02:18:42,929 A LOT OF THIS EVIDENCE COMES 4120 02:18:42,929 --> 02:18:44,030 FROM OTHER CHRONIC DISEASE 4121 02:18:44,030 --> 02:18:45,498 MODELS WHERE I THINK IT HAS BEEN 4122 02:18:45,498 --> 02:18:47,100 STUDIED MORE EXTENSIVELY. 4123 02:18:47,100 --> 02:18:48,368 AND SO THOSE ARE SHOWN HERE IN 4124 02:18:48,368 --> 02:18:49,269 THIS FIGURE. 4125 02:18:49,269 --> 02:18:50,336 THEY INCLUDE COGNITIVE 4126 02:18:50,336 --> 02:18:52,171 IMPAIRMENT, HEALTH LITERACY, 4127 02:18:52,171 --> 02:18:53,973 FUNCTIONAL IMPAIRMENT, FINANCIAL 4128 02:18:53,973 --> 02:18:57,543 BARRIERS, TECHNOLOGY ANXIETY, 4129 02:18:57,543 --> 02:19:04,851 UNDERREPRESENT TAITION INATION,S 4130 02:19:04,851 --> 02:19:06,119 WITH VISUAL, OTHER SENSORY 4131 02:19:06,119 --> 02:19:07,687 IMPAIRMENT, AND ISSUED AROUND 4132 02:19:07,687 --> 02:19:08,955 INTERNET ACCESS. 4133 02:19:08,955 --> 02:19:10,523 SO YOU MIGHT BE LOOKING AT ALL 4134 02:19:10,523 --> 02:19:12,859 OF THESE POTENTIAL BARRIERS AND 4135 02:19:12,859 --> 02:19:14,427 KAY WELL THESE COULD OCCUR AT 4136 02:19:14,427 --> 02:19:16,963 ANY AGE BUT I THINK THE ONE 4137 02:19:16,963 --> 02:19:18,798 POINT I REALLY WANT TO MAKE HERE 4138 02:19:18,798 --> 02:19:20,967 IS THAT OLDER ADULTS BECAUSE OF 4139 02:19:20,967 --> 02:19:23,469 THESE THINGS ARE COMONL AND MAY 4140 02:19:23,469 --> 02:19:24,737 BECOME MORE COMMON AT OLDER AGE, 4141 02:19:24,737 --> 02:19:27,106 SO THE COMBINATION OF THEM 4142 02:19:27,106 --> 02:19:28,841 BECOMES MORE COMMON AND SO 4143 02:19:28,841 --> 02:19:30,510 HAVING VISUAL IMPAIRMENT, SOME 4144 02:19:30,510 --> 02:19:32,011 FUNCTIONAL IMPAIRMENT AND ISSUED 4145 02:19:32,011 --> 02:19:33,646 AROUND HEALTH LITERACY REALLY 4146 02:19:33,646 --> 02:19:38,818 ARE COMPOUNDED OR MAGNIFIED AND 4147 02:19:38,818 --> 02:19:43,589 OFTENTIMES A GERIATRIC PRINCIPLE 4148 02:19:43,589 --> 02:19:45,158 THAT WE HAVE CHALLENGES OR 4149 02:19:45,158 --> 02:19:46,893 PROBLEMS IN OLDER AGE OR 4150 02:19:46,893 --> 02:19:47,994 OFTENTIMES MULTIFACTORIAL. 4151 02:19:47,994 --> 02:19:51,264 REALLY WHAT THE GOAL IS, IS 4152 02:19:51,264 --> 02:19:52,332 ABOUT TRYING TO MAKE SURE THAT 4153 02:19:52,332 --> 02:19:54,634 WHAT IS DONE OR WHAT IS 4154 02:19:54,634 --> 02:19:56,569 ACCURATE, IN A TIMELY WAY, THAT 4155 02:19:56,569 --> 02:19:57,537 THE TIMES THAT IT'S ACHIEVED ARE 4156 02:19:57,537 --> 02:19:59,439 THE MOST LIKELY TO BE USED IN 4157 02:19:59,439 --> 02:20:00,206 CLINICAL DECISION-MAKING AND 4158 02:20:00,206 --> 02:20:01,741 THAT WAY IT'S ACTIONABLE. 4159 02:20:01,741 --> 02:20:04,677 THERE'S REALLY LIMITED EMPIRICAL 4160 02:20:04,677 --> 02:20:06,212 EVIDENCE AROUND HYPERTENSION IN 4161 02:20:06,212 --> 02:20:08,348 GENERAL OR SELF-MEASURED BLOOD 4162 02:20:08,348 --> 02:20:09,515 PRESSURE OR HOME OR OUT OF 4163 02:20:09,515 --> 02:20:11,417 OFFICE BLOOD PRESSURE MEASURES 4164 02:20:11,417 --> 02:20:15,588 ABOUT THESE SPECIFIC BARRIERS. 4165 02:20:15,588 --> 02:20:20,727 BUT I THINK THERE IS SOME FACE 4166 02:20:20,727 --> 02:20:21,527 VALIDITY TO THESE. 4167 02:20:21,527 --> 02:20:22,829 IF YOU BELIEVE THAT, WHICH I 4168 02:20:22,829 --> 02:20:25,732 THINK WE DO, THAT THERE ALSO 4169 02:20:25,732 --> 02:20:26,833 THEN ARE POTENTIAL STRATEGIES 4170 02:20:26,833 --> 02:20:28,501 THAT REALLY DRAW FROM A 4171 02:20:28,501 --> 02:20:29,902 GERIATRIC APPROACH TO CARE OR 4172 02:20:29,902 --> 02:20:31,904 WHAT'S KIND OF NOW BEING CALLED 4173 02:20:31,904 --> 02:20:33,439 AN AGE-FRIENDLY APPROACH TO CARE 4174 02:20:33,439 --> 02:20:34,874 TO HELP ADDRESS THEM, AND THOSE 4175 02:20:34,874 --> 02:20:36,075 ARE SHOWN IN THIS TABLE. 4176 02:20:36,075 --> 02:20:37,143 SO WE MAY THINK ABOUT SOME OF 4177 02:20:37,143 --> 02:20:38,945 THE AGE-RELATED CHALLENGES AND 4178 02:20:38,945 --> 02:20:41,147 THEN POTENTIAL SOLUTIONS, SO AN 4179 02:20:41,147 --> 02:20:42,882 EXAMPLE AROUND FUNCTIONAL 4180 02:20:42,882 --> 02:20:44,851 LIMITATIONS OR PROBLEMS WITH 4181 02:20:44,851 --> 02:20:46,319 MOBILITY, DEXTERITY, FINE MOTOR 4182 02:20:46,319 --> 02:20:47,653 SKILLS, SOME POTENTIAL SOLUTION 4183 02:20:47,653 --> 02:20:49,389 IS TO INVOLVE FAMILY AND CARE 4184 02:20:49,389 --> 02:20:51,891 PARTNER, OR TO REFER PATIENTS TO 4185 02:20:51,891 --> 02:20:53,126 OCCUPATIONAL THERAPY, WHERE 4186 02:20:53,126 --> 02:20:55,094 THERE'S A LOT OF GREAT SELF 4187 02:20:55,094 --> 02:20:57,263 MANAGEMENT WORK DONE BY OUR 4188 02:20:57,263 --> 02:20:58,931 OCCUPATIONAL THERAPY COLLEAGUES. 4189 02:20:58,931 --> 02:21:00,333 COGNITIVE IMPAIRMENT, OFTENTIMES 4190 02:21:00,333 --> 02:21:01,534 COGNITION IS NOT EVEN ASSESSED, 4191 02:21:01,534 --> 02:21:03,703 SO WE DON'T KNOW THE EXTENT TO 4192 02:21:03,703 --> 02:21:05,338 WHICH IT MIGHT IMPACT THAT GREAT 4193 02:21:05,338 --> 02:21:07,440 TEACHING THAT MAYBE WE'RE DOING 4194 02:21:07,440 --> 02:21:09,642 ONE-ON-ONE WITH A PATIENT. 4195 02:21:09,642 --> 02:21:12,612 AND THEN THERE ARE 4196 02:21:12,612 --> 02:21:14,213 OPPORTUNITIES, SIMPLIFY 4197 02:21:14,213 --> 02:21:15,181 SCHEDULES, INVOLVE FAMILY CARE 4198 02:21:15,181 --> 02:21:16,215 PARTNERS. 4199 02:21:16,215 --> 02:21:17,483 OTHER EXAMPLES HERE SHOWN FOR 4200 02:21:17,483 --> 02:21:19,952 VISUAL IMPAIRMENT, NOT HOW I DID 4201 02:21:19,952 --> 02:21:21,654 ON THAT PRIOR SLIDE BUT THIS 4202 02:21:21,654 --> 02:21:23,890 IDEA OF MULTI-MORBIDITY OR JUST 4203 02:21:23,890 --> 02:21:25,625 GENERAL COMPLEXITY I THINK IS 4204 02:21:25,625 --> 02:21:26,459 ONE THAT ALSO HAS TO BE 4205 02:21:26,459 --> 02:21:26,759 EMPHASIZED. 4206 02:21:26,759 --> 02:21:28,895 THESE PROGRAMS THAT FOCUS ON 4207 02:21:28,895 --> 02:21:29,695 BLOOD PRESSURE ARE GREAT, BUT 4208 02:21:29,695 --> 02:21:31,197 BLOOD PRESSURE IS ONLY GOING TO 4209 02:21:31,197 --> 02:21:32,265 BE ONE PROBLEM THAT AN OLDER 4210 02:21:32,265 --> 02:21:34,067 ADULT HAS AND HOW DOES IT FIT 4211 02:21:34,067 --> 02:21:35,701 INTO ALL OF THE MEDICAL PROBLEMS 4212 02:21:35,701 --> 02:21:37,270 THEY HAVE, AND CAN YOU TIE IT 4213 02:21:37,270 --> 02:21:38,905 BACK TO WHAT REALLY MATTERS MOST 4214 02:21:38,905 --> 02:21:40,006 TO THEM? 4215 02:21:40,006 --> 02:21:42,909 AND THEN ALSO SOME SOLUTIONS 4216 02:21:42,909 --> 02:21:44,343 POTENTIALLY AROUND DIGITAL 4217 02:21:44,343 --> 02:21:48,481 HEALTH, HEALTH LITERACY, HOW 4218 02:21:48,481 --> 02:21:49,949 COMFORTABLE THEY ARE WITH USING 4219 02:21:49,949 --> 02:21:51,050 TECHNOLOGY. 4220 02:21:51,050 --> 02:21:52,351 I GUESS ACROSS ALL OF THESE, A 4221 02:21:52,351 --> 02:21:56,089 COUPLE OF THEMES THAT COME FROM 4222 02:21:56,089 --> 02:21:56,689 GERIATRIC CARE ARE THAT THIS 4223 02:21:56,689 --> 02:22:00,426 TYPE OF WORK HAS TO INVOLVE TEAM 4224 02:22:00,426 --> 02:22:01,527 INTERDISCIPLINARY TEAMS, AND 4225 02:22:01,527 --> 02:22:03,463 THAT OFTENTIMES THIS WORK -- 4226 02:22:03,463 --> 02:22:05,031 THIS REALLY HAS TO BE 4227 02:22:05,031 --> 02:22:06,566 INDIVIDUALIZED AT A PATIENT 4228 02:22:06,566 --> 02:22:06,899 LEVEL. 4229 02:22:06,899 --> 02:22:09,769 SO WHILE I THINK THAT THERE'S 4230 02:22:09,769 --> 02:22:13,706 SOME FACE VALIDITY AND THERE'S 4231 02:22:13,706 --> 02:22:14,807 CLEARLY EVIDENCE THAT THESE 4232 02:22:14,807 --> 02:22:15,708 STRATEGIES WORK IN GENERAL FOR 4233 02:22:15,708 --> 02:22:17,743 CARE OF OLDER ADULTS, WE DON'T 4234 02:22:17,743 --> 02:22:19,011 HAVE PRAGMATIC TRIALS OR 4235 02:22:19,011 --> 02:22:19,979 IMPLEMENTATION STUDIES SPECIFIC 4236 02:22:19,979 --> 02:22:21,380 TO OLDER ADULTS AROUND BLOOD 4237 02:22:21,380 --> 02:22:28,621 PRESSURE ASSESSMENT. 4238 02:22:28,621 --> 02:22:29,689 SO I'M GOING TO SWITCH GEARS A 4239 02:22:29,689 --> 02:22:30,756 LITTLE BIT AND TALK ABOUT THE 4240 02:22:30,756 --> 02:22:32,692 INCLUSION OF OLDER ADULTS OR 4241 02:22:32,692 --> 02:22:33,392 REPRESENTATION OF OLDER ADULTS 4242 02:22:33,392 --> 02:22:34,327 AS ONE OF THE FACTORS THAT MAY 4243 02:22:34,327 --> 02:22:36,863 BE CONTRIBUTING TO CHALLENGES OF 4244 02:22:36,863 --> 02:22:38,464 UNDERSTANDING SELF MEASURED 4245 02:22:38,464 --> 02:22:38,898 BLOOD PRESSURE. 4246 02:22:38,898 --> 02:22:40,299 WE KNOW THE PREVALENCE OF 4247 02:22:40,299 --> 02:22:41,634 HYPERTENSION AND CARDIOVASCULAR 4248 02:22:41,634 --> 02:22:43,336 DISEASE INCREASES IN OLDER AGE 4249 02:22:43,336 --> 02:22:45,638 BECAUSE OLDER ADULTS MAY NOT BE 4250 02:22:45,638 --> 02:22:47,573 INCLUDED IN RESEARCH STUDIES, 4251 02:22:47,573 --> 02:22:49,408 THIS RESEARCH MIGHT NOT BE 4252 02:22:49,408 --> 02:22:50,409 GENERALIZABLE TO THOSE WHO NEED 4253 02:22:50,409 --> 02:22:53,546 IT THE MOST. 4254 02:22:53,546 --> 02:22:55,648 YOU'RE PROBABLY FAMILIAR WITH 4255 02:22:55,648 --> 02:22:58,618 THE INCLUSION ACROSS THE 4256 02:22:58,618 --> 02:22:59,418 LIFESPAN POLICY AT THE NIH WHICH 4257 02:22:59,418 --> 02:23:01,154 REALLY SAYS YOU CAN'T HAVE AGE 4258 02:23:01,154 --> 02:23:02,788 CUTOFFS FOR RESEARCH STUDIES. 4259 02:23:02,788 --> 02:23:03,623 YOU MAY NOT BE AWARE THAT 4260 02:23:03,623 --> 02:23:05,091 ANOTHER PART OF THAT POLICY IS 4261 02:23:05,091 --> 02:23:06,859 THAT YOU HAVE TO SUBMIT DATA ON 4262 02:23:06,859 --> 02:23:13,432 AGE AT ENROLLMENT ON AN ANNUAL 4263 02:23:13,432 --> 02:23:15,835 BASIS IF YOU'RE ENROLLING 4264 02:23:15,835 --> 02:23:18,104 PARTICIPANTS IN AN NIH FUNDED 4265 02:23:18,104 --> 02:23:18,671 STUDY. 4266 02:23:18,671 --> 02:23:20,873 THESE DATA COME FROM FY 22 AND 4267 02:23:20,873 --> 02:23:22,708 WHAT WE'RE LOOKING AT IS THE 4268 02:23:22,708 --> 02:23:24,377 PERCENTAGE OF PEOPLE IN ALL 4269 02:23:24,377 --> 02:23:26,445 CLINICAL RESEARCH STUDIES WHO 4270 02:23:26,445 --> 02:23:28,114 WERE 65 YEARS AND OLDER OR ALL 4271 02:23:28,114 --> 02:23:30,750 WHO ARE 80 YEARS AND OLDER. 4272 02:23:30,750 --> 02:23:32,752 AND BOTH -- ALL RESEARCH STUDYS 4273 02:23:32,752 --> 02:23:35,221 THAT ENROLLED DURING '22. 4274 02:23:35,221 --> 02:23:36,923 THEN SPECIFICALLY IN CLINICAL 4275 02:23:36,923 --> 02:23:37,590 TRIALS AND WHAT YOU KIND OF SEE 4276 02:23:37,590 --> 02:23:40,893 IN BOTH OF THESE SITUATIONS IS A 4277 02:23:40,893 --> 02:23:46,065 PRETTY BIG DROPOFF AT AGE 80. 4278 02:23:46,065 --> 02:23:51,170 TAKING A LOOK AT TIERP TENSION N 4279 02:23:51,170 --> 02:23:53,339 STUDIES, THE INCLUSION OF PEOPLE 4280 02:23:53,339 --> 02:23:54,607 65 AND OLDER WAS ACTUALLY A 4281 02:23:54,607 --> 02:23:56,876 LITTLE BIT HIGHER THAN OVERALL 4282 02:23:56,876 --> 02:23:57,777 CLINICAL RESEARCH OR CLINICAL 4283 02:23:57,777 --> 02:24:00,746 TRIAL WHICH MIGHT BE GIVEN THE 4284 02:24:00,746 --> 02:24:02,281 PREVALENCE OF HYPERTENSION AT 4285 02:24:02,281 --> 02:24:03,282 OLDER AGES BUT THIS DOESN'T 4286 02:24:03,282 --> 02:24:05,051 REALLY TELL THE FULL STORY 4287 02:24:05,051 --> 02:24:06,852 BECAUSE THIS IS KIND OF LIKE A 4288 02:24:06,852 --> 02:24:08,054 SNAPSHOT OF ALL STUDIES BEING 4289 02:24:08,054 --> 02:24:09,422 DONE. 4290 02:24:09,422 --> 02:24:11,123 SO IF YOU TOOK LOOK AT ALL 4291 02:24:11,123 --> 02:24:13,693 PEOPLE ENROLLED IN RESEARCH 4292 02:24:13,693 --> 02:24:14,493 STUDIES, THAT'S HOW YOU GET THIS 4293 02:24:14,493 --> 02:24:15,294 NUMBER. 4294 02:24:15,294 --> 02:24:16,062 ANOTHER WAY TO THINK ABOUT IT 4295 02:24:16,062 --> 02:24:20,800 WOULD BE TO LINE UP ALL THE 4296 02:24:20,800 --> 02:24:21,634 RESEARCH STUDIES FROM THOSE THAT 4297 02:24:21,634 --> 02:24:22,868 HAD THE FEWEST PERCENTAGE OF 4298 02:24:22,868 --> 02:24:25,137 OLDER ADULTS TO THOSE THAT HAD 4299 02:24:25,137 --> 02:24:26,439 THE MOST AND FIND THE MIDDLE 4300 02:24:26,439 --> 02:24:28,908 POINT OR THE MEDIAN. 4301 02:24:28,908 --> 02:24:30,710 WHAT YOU CAN SEE FOR CLINICAL 4302 02:24:30,710 --> 02:24:32,578 RESEARCH IN GENERAL AND CLINICAL 4303 02:24:32,578 --> 02:24:34,780 TRIALS, AND THE ENROLLMENT, WHAT 4304 02:24:34,780 --> 02:24:37,450 AN AVERAGE STUDY ROLLS IS LESS 4305 02:24:37,450 --> 02:24:39,085 THAN 1% OF OLDER ADULTS. 4306 02:24:39,085 --> 02:24:40,686 FOR HYPERTENSION, MUCH BETTER 4307 02:24:40,686 --> 02:24:44,624 BUT STILL EVEN LOWER THAN WHAT 4308 02:24:44,624 --> 02:24:45,825 YOU SEE WHEN YOU'RE KIND OF 4309 02:24:45,825 --> 02:24:47,560 LOOKING AT THIS OVERALL NUMBER. 4310 02:24:47,560 --> 02:24:49,495 SO AVERAGE STUDY ENROLLS FEWER 4311 02:24:49,495 --> 02:24:51,797 THAN 12% OR FEWER OLDER ADULTS 4312 02:24:51,797 --> 02:24:53,366 AND THAT'S A PROBLEM BECAUSE 4313 02:24:53,366 --> 02:24:56,002 MOST RESEARCH STUDIES ARE 4314 02:24:56,002 --> 02:24:59,238 ADDRESSING DIFFERENT RESEARCH 4315 02:24:59,238 --> 02:25:00,706 QUESTIONS. 4316 02:25:00,706 --> 02:25:02,675 SO MANY ARE GOING TO BE LEFT OUT 4317 02:25:02,675 --> 02:25:04,243 OF RESEARCH STUDIES ABOUT THAT 4318 02:25:04,243 --> 02:25:05,544 ARE ADDRESSING SPECIFIC 4319 02:25:05,544 --> 02:25:06,012 QUESTIONS. 4320 02:25:06,012 --> 02:25:07,213 SOME HAVE ARGUED THERE MAY BE 4321 02:25:07,213 --> 02:25:09,348 EVEN A BETTER WAY TO MEASURE 4322 02:25:09,348 --> 02:25:10,816 REPRESENTATION AT THE 4323 02:25:10,816 --> 02:25:12,385 PARTICIPATION TO PREVALENCE 4324 02:25:12,385 --> 02:25:14,520 RATIO WITH OUR RATIO OF 4325 02:25:14,520 --> 02:25:16,355 PARTICIPATION IN A STUDIES TO 4326 02:25:16,355 --> 02:25:17,356 PREVALENCE IN THE POPULATION. 4327 02:25:17,356 --> 02:25:21,961 IF YOUR PREVALENCE IS BETWEEN .E 4328 02:25:21,961 --> 02:25:24,297 REPRESENTATION. 4329 02:25:24,297 --> 02:25:25,731 IF YOU TRY TO APPLY THAT TO 4330 02:25:25,731 --> 02:25:30,536 OLDER POPULATIONS AND 4331 02:25:30,536 --> 02:25:33,606 HYPERTENSION STUDIES, THE PPR 4332 02:25:33,606 --> 02:25:36,809 RANGES SOMEWHERE FROM .2 TO .7. 4333 02:25:36,809 --> 02:25:40,079 SO I THINK THERE'S NOT A LOT OF 4334 02:25:40,079 --> 02:25:41,981 DATA THAT HELP GUIDE US ON THIS. 4335 02:25:41,981 --> 02:25:45,918 A FEW STUDIES SPECIFIC TO 4336 02:25:45,918 --> 02:25:46,686 SELF-MONITORING BLOOD PRESSURE. 4337 02:25:46,686 --> 02:25:48,421 IN A STUDY -- WELL, WE ALREADY 4338 02:25:48,421 --> 02:25:49,622 SAW SOME RESULTS OF THIS STUDY 4339 02:25:49,622 --> 02:25:51,290 EARLIER TODAY WITH DR. GREEN, 4340 02:25:51,290 --> 02:25:52,558 BUT THIS IS LOOKING AT THE 4341 02:25:52,558 --> 02:25:55,928 NUMBER OF OLDER ADULTS. 4342 02:25:55,928 --> 02:25:59,265 21% OF PEOPLE THAT WERE PART OF 4343 02:25:59,265 --> 02:26:00,966 THESE META ANALYSIS WERE GREATER 4344 02:26:00,966 --> 02:26:02,535 THAN 80. 4345 02:26:02,535 --> 02:26:05,705 AND SO ALSO SOME STUDIES HAD AGE 4346 02:26:05,705 --> 02:26:09,575 CUTOFFS GREATER THAN 80. 4347 02:26:09,575 --> 02:26:11,544 REALLY THERE'S A LOT LESS THAT 4348 02:26:11,544 --> 02:26:12,778 WE KNOW ABOUT EMERGING 4349 02:26:12,778 --> 02:26:14,280 TECHNOLOGY, AND IF WE TRY TO 4350 02:26:14,280 --> 02:26:16,349 PULL SOME FROM THE ENROLLMENT 4351 02:26:16,349 --> 02:26:17,283 STATISTICS, WE REALLY KIND OF 4352 02:26:17,283 --> 02:26:18,784 SEE THAT THE MEDIAN INCLUSION IN 4353 02:26:18,784 --> 02:26:20,820 STUDIES AROUND ASSISTIVE 4354 02:26:20,820 --> 02:26:21,987 TECHNOLOGY, BIOTECHNOLOGY AND 4355 02:26:21,987 --> 02:26:24,323 TELEHEALTH HAVE A LOW MEDIAN 4356 02:26:24,323 --> 02:26:28,194 INCLUSION OF OLDER ADULTS. 4357 02:26:28,194 --> 02:26:29,695 WE TRY TO DO SOME WORK TO HELP 4358 02:26:29,695 --> 02:26:31,130 DEVELOP A FRAMEWORK TO IMPROVE 4359 02:26:31,130 --> 02:26:32,631 THE INCLUSION OF OLDER ADULTS IN 4360 02:26:32,631 --> 02:26:33,132 RESEARCH. 4361 02:26:33,132 --> 02:26:35,935 WE REALLY DID THIS IN AN 4362 02:26:35,935 --> 02:26:36,769 ENGAGEMENT STRATEGY WHERE WE 4363 02:26:36,769 --> 02:26:38,337 TALKED TO OLDER ADULTS, TO 4364 02:26:38,337 --> 02:26:39,772 RESEARCHERS AND STAFF AND TRIED 4365 02:26:39,772 --> 02:26:40,773 TO UNDERSTAND WHAT WERE THE 4366 02:26:40,773 --> 02:26:41,607 CHALLENGES, AND THEN COME UP 4367 02:26:41,607 --> 02:26:43,809 WITH A WAY TO COMMUNICATE THE 4368 02:26:43,809 --> 02:26:45,311 BEST PRACTICES THAT ARE USED BY 4369 02:26:45,311 --> 02:26:47,146 MANY RESEARCHERS TO ENROLL OLDER 4370 02:26:47,146 --> 02:26:48,214 ADULTS IN RESEARCH. 4371 02:26:48,214 --> 02:26:49,215 AND THAT'S SHOWN ON THE NEXT 4372 02:26:49,215 --> 02:26:52,718 SLIDE. 4373 02:26:52,718 --> 02:26:56,355 MORE INFORMATION ABOUT THE 5Ts 4374 02:26:56,355 --> 02:27:05,631 FRAMEWORK CAN BE FOUND AT 4375 02:27:05,631 --> 02:27:07,266 5T.FRAMEWORK -- AS A TARGET 4376 02:27:07,266 --> 02:27:09,969 POPULATION, THE TEAM, TIME -- 4377 02:27:09,969 --> 02:27:13,105 TIPS TO ACCOMMODATE AND TOOLS. 4378 02:27:13,105 --> 02:27:14,774 AND HERE'S JUST SOME EXAMPLES OF 4379 02:27:14,774 --> 02:27:14,974 THOSE. 4380 02:27:14,974 --> 02:27:16,041 AGAIN, THESE ARE AVAILABLE ON 4381 02:27:16,041 --> 02:27:21,380 OUR WEBSITE. 4382 02:27:21,380 --> 02:27:23,249 SO A LOT OF OLDER ADULTS MEASURE 4383 02:27:23,249 --> 02:27:24,517 THEIR BLOOD PRESSURE OUTSIDE OF 4384 02:27:24,517 --> 02:27:26,519 CLINIC SETTINGS, BUT THOSE 4385 02:27:26,519 --> 02:27:28,087 MEASUREMENTS DON'T ALWAYS END UP 4386 02:27:28,087 --> 02:27:28,821 IMPACTING CLINICAL 4387 02:27:28,821 --> 02:27:29,588 DECISION-MAKING. 4388 02:27:29,588 --> 02:27:31,157 WE EVEN HEARD ABOUT SOME 4389 02:27:31,157 --> 02:27:32,091 FRUSTRATIONS AROUND THAT EARLIER 4390 02:27:32,091 --> 02:27:33,025 TODAY. 4391 02:27:33,025 --> 02:27:34,593 WE COULD POTENTIALLY IMPROVE 4392 02:27:34,593 --> 02:27:35,561 IMPLEMENTATION BY ADDRESSING 4393 02:27:35,561 --> 02:27:37,029 AGE-RELATED BARRIERS, AS WELL AS 4394 02:27:37,029 --> 02:27:38,631 ADDRESSING THE BARRIERS TO 4395 02:27:38,631 --> 02:27:44,403 PARTICIPATION IN RESEARCH. 4396 02:27:44,403 --> 02:27:45,771 HERE ARE SOME GAPS THAT REALLY 4397 02:27:45,771 --> 02:27:47,473 KIND OF FOLLOW THAT. 4398 02:27:47,473 --> 02:27:49,275 OLDER ADULTS, CARE PARTNERS 4399 02:27:49,275 --> 02:27:51,377 BARRIERS TO OUT OF OFFICE BLOOD 4400 02:27:51,377 --> 02:27:52,478 PRESSURE ASSESSMENTS ARE NOT 4401 02:27:52,478 --> 02:27:53,245 WELL CHARACTERIZED. 4402 02:27:53,245 --> 02:27:56,048 EVIDENEVIDENCE-BASED IMPLEMENTAN 4403 02:27:56,048 --> 02:27:59,485 STRATEGIES TO IMPROVE BLOOD 4404 02:27:59,485 --> 02:28:00,553 PRESSURE USE SPECIFICALLY FOR 4405 02:28:00,553 --> 02:28:02,488 OLDER ADULTS ARE LACKING. 4406 02:28:02,488 --> 02:28:05,090 WE CAN CONDUCT PRAGMATIC TRIALS 4407 02:28:05,090 --> 02:28:06,926 TO INCORPORATE AGE-FRIENDLY 4408 02:28:06,926 --> 02:28:11,764 STRATEGIES, TEST IMPLEMENTA 4409 02:28:11,764 --> 02:28:12,364 IMPLEMENTATION -- AND WE CAN 4410 02:28:12,364 --> 02:28:13,566 ALSO ENSURE THAT EMERGING BLOOD 4411 02:28:13,566 --> 02:28:14,266 PRESSURE TECHNOLOGIES ADDRESS 4412 02:28:14,266 --> 02:28:15,968 THE NEEDS OF OLDER ADULTS RATHER 4413 02:28:15,968 --> 02:28:20,506 THAN CREATING NEW BARRIERS. 4414 02:28:20,506 --> 02:28:24,076 THATHANK YOU. 4415 02:28:24,076 --> 02:28:24,443 >> THANK YOU. 4416 02:28:24,443 --> 02:28:31,450 CAN ALL THE PARTICIPANTS GET ON 4417 02:28:31,450 --> 02:28:33,752 THE -- I WOULD FIRST LIKE TO ASK 4418 02:28:33,752 --> 02:28:35,421 A QUESTION TO DR. RAVENELL AND 4419 02:28:35,421 --> 02:28:36,455 LEAD WITH A COMMENT. 4420 02:28:36,455 --> 02:28:37,556 JOE, THANK YOU SO MUCH FOR GOING 4421 02:28:37,556 --> 02:28:42,161 THROUGH A BRIEF HISTORY, THOSE 4422 02:28:42,161 --> 02:28:44,129 WARRIORS, THE LATE GREAT 4423 02:28:44,129 --> 02:28:47,566 DR. SAUNDERS, THE LATE GREAT DR, 4424 02:28:47,566 --> 02:28:50,302 YOU MENTIONED ME BUT MY WIFE 4425 02:28:50,302 --> 02:28:52,638 WHO'S A PH.D. IN NURSING 4426 02:28:52,638 --> 02:28:53,739 DR. DAPHNE FERDINAND DID MUCH OF 4427 02:28:53,739 --> 02:28:54,073 THE WORK. 4428 02:28:54,073 --> 02:28:56,175 HOW DO YOU KEEP THOSE BARBERS 4429 02:28:56,175 --> 02:28:57,209 ENGAGED? 4430 02:28:57,209 --> 02:28:59,245 I KNOW IN A CLINICAL TRIAL, YOU 4431 02:28:59,245 --> 02:29:00,713 HAVE THE TIME, MONEY AND EFFORTS 4432 02:29:00,713 --> 02:29:02,915 BUT IN A REAL CLINICAL SET, 4433 02:29:02,915 --> 02:29:04,517 BARBERS HAVE TO MAKE MONEY, THEY 4434 02:29:04,517 --> 02:29:05,651 HAVE TO WORK AND CUT. 4435 02:29:05,651 --> 02:29:07,553 HOW DO YOU KEEP THEM ENGAGED AND 4436 02:29:07,553 --> 02:29:08,854 HOW DO YOU CHECK ON THE QUALITY 4437 02:29:08,854 --> 02:29:09,622 OF THE BLOOD PRESSURES THEY'RE 4438 02:29:09,622 --> 02:29:09,822 DOING? 4439 02:29:09,822 --> 02:29:11,457 >> THANK YOU FOR THE QUESTION, 4440 02:29:11,457 --> 02:29:13,792 DR. FERDINAND. 4441 02:29:13,792 --> 02:29:17,363 AND SO A COUPLE THINGS. 4442 02:29:17,363 --> 02:29:18,097 MONEY IS REALLY IMPORTANT. 4443 02:29:18,097 --> 02:29:21,400 ALL OF US NEED TO BE PAID FOR 4444 02:29:21,400 --> 02:29:24,637 OUR TIME AND FOR OUR WORK. 4445 02:29:24,637 --> 02:29:26,605 AND BARBERS ARE NO DIFFERENT. 4446 02:29:26,605 --> 02:29:28,240 WHAT WE SAW IN ALL THESE STUDIES 4447 02:29:28,240 --> 02:29:31,410 IS THAT IF WE CAN INCENTIVIZE 4448 02:29:31,410 --> 02:29:32,378 BARBERS APPROPRIATELY, THEY WILL 4449 02:29:32,378 --> 02:29:34,446 DO IT. 4450 02:29:34,446 --> 02:29:36,715 WE ALSO KNOW ONCE WE STOP PAYING 4451 02:29:36,715 --> 02:29:38,117 THE BARBERS, THEY WILL NOT DO 4452 02:29:38,117 --> 02:29:39,285 IT. 4453 02:29:39,285 --> 02:29:43,355 AND SO I THINK IT BECOMES A -- 4454 02:29:43,355 --> 02:29:46,225 LARGELY A POLICY QUESTION AND I 4455 02:29:46,225 --> 02:29:48,327 DO THINK THAT WE HAVE TO GET OUR 4456 02:29:48,327 --> 02:29:48,994 PAYORS INVOLVED. 4457 02:29:48,994 --> 02:29:50,696 WE HAVE TO GET OUR HEALTH 4458 02:29:50,696 --> 02:29:52,898 SYSTEMS ENVOFLED TO HELP FOOT 4459 02:29:52,898 --> 02:29:55,301 THE BILL, IN THE SAME WAY THAT 4460 02:29:55,301 --> 02:29:57,636 WE WOULDN'T EXPECT OUR NURSES OR 4461 02:29:57,636 --> 02:29:58,571 COMMUNITY HEALTH WORKERS TO GO 4462 02:29:58,571 --> 02:30:00,239 OUT THERE AND TO DO THIS ON A 4463 02:30:00,239 --> 02:30:02,041 VOLUNTEER BASIS, WE HAVE TO LOOK 4464 02:30:02,041 --> 02:30:05,144 AT OUR BARBERS IN THE SAME VEIN. 4465 02:30:05,144 --> 02:30:06,512 WE LARGELY TRAIN THEM TO BE 4466 02:30:06,512 --> 02:30:12,017 COMMUNITY HEALTH WORKERS AND 4467 02:30:12,017 --> 02:30:14,353 SORT OF COMMUNITY BLOOD PRESSURE 4468 02:30:14,353 --> 02:30:16,455 SPECIALISTS, MODELED AFTER YOUR 4469 02:30:16,455 --> 02:30:17,089 WORK IN NEW ORLEANS. 4470 02:30:17,089 --> 02:30:20,059 SO WE HAVE TO FIGURE OUT A WAY 4471 02:30:20,059 --> 02:30:21,560 TO FUND THE BARBERS IF WE'RE 4472 02:30:21,560 --> 02:30:22,928 GOING TO KEEP THIS GOING. 4473 02:30:22,928 --> 02:30:25,598 >> GREAT ANSWER. 4474 02:30:25,598 --> 02:30:26,565 RAY, YOU HAVE SOME THINGS YOU 4475 02:30:26,565 --> 02:30:27,967 WANT TO FOLLOW UP WITH? 4476 02:30:27,967 --> 02:30:29,969 >> WE'LL STAY WITH YOU, JOE, IF 4477 02:30:29,969 --> 02:30:31,370 THAT'S OKAY. 4478 02:30:31,370 --> 02:30:34,306 THERE'S A QUESTION FROM STEVE 4479 02:30:34,306 --> 02:30:36,442 JURASCHEK HERE THAT HAS TO DO 4480 02:30:36,442 --> 02:30:38,544 WITH ASKING YOU ABOUT HOW DO WE 4481 02:30:38,544 --> 02:30:40,980 BALANCE THE NEED FOR TIMELY 4482 02:30:40,980 --> 02:30:43,716 ACCESSIBLE SCREENING WITH 4483 02:30:43,716 --> 02:30:46,518 CONCERNS OVER MAYBE MISSING THE 4484 02:30:46,518 --> 02:30:48,520 DIAGNOSIS, EITHER OVERDIAGNOSING 4485 02:30:48,520 --> 02:30:51,523 HIHIGH BLOOD PRESSURE OR TELLING 4486 02:30:51,523 --> 02:30:53,192 SOMEONE YOU'RE FINE, MEANWHILE, 4487 02:30:53,192 --> 02:30:56,629 THEY'RE NOT. 4488 02:30:56,629 --> 02:30:57,630 HE SUGGESTS IS FOLLOW-UP LINKAGE 4489 02:30:57,630 --> 02:31:01,667 THE KEY, EDUCATION VALUABLE? 4490 02:31:01,667 --> 02:31:03,402 >> I THINK LINK IS ABSOLUTELY 4491 02:31:03,402 --> 02:31:03,636 KEY. 4492 02:31:03,636 --> 02:31:05,871 WE KNOW THAT SCREENING PROGRAMS 4493 02:31:05,871 --> 02:31:08,340 WRIT LARGE WITHOUT FOLLOW-UP 4494 02:31:08,340 --> 02:31:09,742 REALLY JUST DON'T DO A WHOLE 4495 02:31:09,742 --> 02:31:10,643 HECK OF A LOT. 4496 02:31:10,643 --> 02:31:13,712 SO WE HAVE TO MAKE SURE THAT 4497 02:31:13,712 --> 02:31:14,947 WHEN THEY'RE SCREENING, THAT 4498 02:31:14,947 --> 02:31:16,181 THERE'S ALSO APPROPRIATE LINKAGE 4499 02:31:16,181 --> 02:31:16,415 TO CARE. 4500 02:31:16,415 --> 02:31:17,750 AT THE ENOF THE DAY, THE REASON 4501 02:31:17,750 --> 02:31:20,185 THAT WE ARE GOING OUT THERE TO 4502 02:31:20,185 --> 02:31:22,521 IDENTIFY FOLKS WITH ELEVATED OR 4503 02:31:22,521 --> 02:31:23,589 WITH HIGH BLOOD PRESSURE IS TO 4504 02:31:23,589 --> 02:31:25,691 GET THEM INTO CARE SO THAT WE 4505 02:31:25,691 --> 02:31:28,127 CAN PREVENT THOSE AWFUL 4506 02:31:28,127 --> 02:31:30,462 CONSEQUENCES THAT I LEARNED FROM 4507 02:31:30,462 --> 02:31:31,797 DR. ELI SAUNDERS THAT BACK IN 4508 02:31:31,797 --> 02:31:32,931 THE 1960s, WE WERE JUST 4509 02:31:32,931 --> 02:31:34,433 STARTING WITH THE NATIONAL 4510 02:31:34,433 --> 02:31:41,640 HEALTH EXAMINATION SURVEY, AND 4511 02:31:41,640 --> 02:31:42,675 V.A. COOPERATIVE TRIALS THAT THE 4512 02:31:42,675 --> 02:31:44,610 STROKE RATE AMONG BLACK MEN WAS 4513 02:31:44,610 --> 02:31:45,978 900 TIMES HIGHER THAN AMONG 4514 02:31:45,978 --> 02:31:47,613 WHITE MEN, LARGELY DUE TO 4515 02:31:47,613 --> 02:31:48,747 UNCONTROLLED HYPERTENSION. 4516 02:31:48,747 --> 02:31:50,082 SO THE WHOLE REASON FOR US DOING 4517 02:31:50,082 --> 02:31:52,618 THIS IS TO GET PEOPLE INTO CARE, 4518 02:31:52,618 --> 02:31:54,386 AND SO WE CAN SCREEN PEOPLE IN 4519 02:31:54,386 --> 02:31:55,821 THE COMMUNITY, WE CAN EVEN 4520 02:31:55,821 --> 02:31:57,790 SCREEN PEOPLE IN HOSPITAL 4521 02:31:57,790 --> 02:31:58,691 SETTINGS BUT WE HAVE TO HAVE 4522 02:31:58,691 --> 02:32:02,361 SOME FOLLOW-UP LINKAGE TO LONG 4523 02:32:02,361 --> 02:32:04,396 TERM HOPEFULLY PRIME RAO CARE 4524 02:32:04,396 --> 02:32:05,531 BECAUSE WE KNOW AS HAS BEEN 4525 02:32:05,531 --> 02:32:09,201 MENTIONED BEFORE, HYPERTENSION 4526 02:32:09,201 --> 02:32:10,869 CLUSTERS WITH A WHOLE BUNCH OF 4527 02:32:10,869 --> 02:32:11,937 OTHER THINGS THAT CAN ALSO 4528 02:32:11,937 --> 02:32:13,172 BENEFIT FROM ATTENTION FROM 4529 02:32:13,172 --> 02:32:13,706 PRIMARY CARE PROVIDERS. 4530 02:32:13,706 --> 02:32:14,306 >> THANKS SO MUCH. 4531 02:32:14,306 --> 02:32:16,175 LET ME TURN TO YOU, YVONNE, AND 4532 02:32:16,175 --> 02:32:17,176 ASK YOU A QUESTION. 4533 02:32:17,176 --> 02:32:18,243 ONE OF THE THINGS I LEARNED FROM 4534 02:32:18,243 --> 02:32:20,679 MY COLLEAGUE, BRENT EGAN, IS 4535 02:32:20,679 --> 02:32:22,047 THAT THERE'S NOTHING LIKE 4536 02:32:22,047 --> 02:32:23,382 GETTING NEAR THE END OF THE 4537 02:32:23,382 --> 02:32:24,717 STUDY TO TELL YOU ALL THE THINGS 4538 02:32:24,717 --> 02:32:27,753 THAT YOU WOULD DO OVER 4539 02:32:27,753 --> 02:32:28,487 DIFFERENTLY IF YOU HAD THE 4540 02:32:28,487 --> 02:32:31,924 OPPORTUNITY TO DO IT AGAIN. 4541 02:32:31,924 --> 02:32:33,826 IT LOOKS TO ME LIKE FLEXIBILITY 4542 02:32:33,826 --> 02:32:35,260 IS THE SOUL OF THE ENTERPRISE OF 4543 02:32:35,260 --> 02:32:38,464 LINKED HEARTS. 4544 02:32:38,464 --> 02:32:42,801 IF THERE WAS ONE THING IN LINK 4545 02:32:42,801 --> 02:32:43,836 HEARTS FOR EXAMPLE TO DO 4546 02:32:43,836 --> 02:32:45,871 DIFFERENTLY, WHAT WOULD YOU DO 4547 02:32:45,871 --> 02:32:47,005 DIFFERENTLY AS ONE OF THOSE 4548 02:32:47,005 --> 02:32:49,408 TECHNICAL ISSUES YOU WOULD 4549 02:32:49,408 --> 02:32:51,910 ADDRESS FOREMOST ON YOUR LIST? 4550 02:32:51,910 --> 02:32:52,578 >> THANK YOU FOR THAT QUESTION. 4551 02:32:52,578 --> 02:32:54,046 I THINK I ALLUDED TO THIS 4552 02:32:54,046 --> 02:32:54,947 EARLIER WHEN I TALKED ABOUT 4553 02:32:54,947 --> 02:32:56,148 ISSUES WITH USING THE BLOOD 4554 02:32:56,148 --> 02:32:58,884 PRESSURE DEVICES AS WELL AS THE 4555 02:32:58,884 --> 02:32:59,551 APP. 4556 02:32:59,551 --> 02:33:01,587 SO THIS IS SOMETHING THAT WE 4557 02:33:01,587 --> 02:33:05,224 DISCOVERED LATER ON. 4558 02:33:05,224 --> 02:33:07,559 OUR EXPECTATION IS THAT THE 4559 02:33:07,559 --> 02:33:09,027 COMMUNITY HEALTH WORKERS WOULD 4560 02:33:09,027 --> 02:33:10,295 MEET WITH THE PARTICIPANTS, 4561 02:33:10,295 --> 02:33:12,164 TEACH THEM HOW TO USE THE APP, 4562 02:33:12,164 --> 02:33:15,934 THE APP SHOULD WORK AS IT 4563 02:33:15,934 --> 02:33:17,336 SHOULD, THINGS WILL BE CONNECTED 4564 02:33:17,336 --> 02:33:18,704 AND THROUGHOUT THE TRIAL, AND 4565 02:33:18,704 --> 02:33:20,172 LATER ON WE LEARNED THERE WERE 4566 02:33:20,172 --> 02:33:21,406 SOME DISCONNECTIONS THAT WERE 4567 02:33:21,406 --> 02:33:22,541 HAING. 4568 02:33:22,541 --> 02:33:23,742 WERE 4569 02:33:23,742 --> 02:33:24,009 HAPPENING. 4570 02:33:24,009 --> 02:33:25,410 THAT TIME THE COMMUNITY HEALTH 4571 02:33:25,410 --> 02:33:27,212 WORKERS SPENT TROUBLESHOOTING 4572 02:33:27,212 --> 02:33:28,514 THE APP-RELATED ISSUES REALLY 4573 02:33:28,514 --> 02:33:29,948 WASTED A LOT OF TIME THAT 4574 02:33:29,948 --> 02:33:32,251 COMMUNITY HEALTH WORKERS COULD 4575 02:33:32,251 --> 02:33:33,118 HAVE USED ON WHAT THEY WERE 4576 02:33:33,118 --> 02:33:35,254 SUPPOSED TO BE DOING IN TERMS OF 4577 02:33:35,254 --> 02:33:35,854 EDUCATING PARTICIPANTS ABOUT, 4578 02:33:35,854 --> 02:33:38,323 YOU KNOW, TAKING THEIR 4579 02:33:38,323 --> 02:33:41,593 MEDICATIONS AS DESCRIBED AND 4580 02:33:41,593 --> 02:33:42,594 ADHERING TO LIFESTYLE 4581 02:33:42,594 --> 02:33:43,595 RECOMMENDATIONS. 4582 02:33:43,595 --> 02:33:46,165 SO I WISH FROM THE GET-GO, WE 4583 02:33:46,165 --> 02:33:49,034 HAD DATED RESEARCH ASSISTANCE 4584 02:33:49,034 --> 02:33:53,605 WHOSE SOLE JOB WAS TO HELP WITH 4585 02:33:53,605 --> 02:33:54,606 TECHNOLOGY OF RELATED ISSUES IN 4586 02:33:54,606 --> 02:33:55,908 TERMS OF HOW THIS EXTENDS TO 4587 02:33:55,908 --> 02:33:59,978 HEALTH SYSTEMS OR CLINICAL CARE, 4588 02:33:59,978 --> 02:34:01,446 THAT THERE'S SOMEONE, IF AN SMBP 4589 02:34:01,446 --> 02:34:02,414 PROGRAM IS DEVELOPED, THAT 4590 02:34:02,414 --> 02:34:04,483 THERE'S A DEDICATED PERSON WHOSE 4591 02:34:04,483 --> 02:34:06,218 JOB IT IS TO ADDRESS SOME OF 4592 02:34:06,218 --> 02:34:08,921 THESE TECHNOLOGY-RELATED 4593 02:34:08,921 --> 02:34:12,891 CHALLENGES, AND NOT HAD IT FALL 4594 02:34:12,891 --> 02:34:14,393 ON THE COMMUNITY HEALTH WORKERS, 4595 02:34:14,393 --> 02:34:16,161 YES, DIGITAL NAVIGATORS, I LOVE 4596 02:34:16,161 --> 02:34:17,462 THAT TERM, THANK YOU, HILARY. 4597 02:34:17,462 --> 02:34:18,797 THIS IS SOMETHING AFTER TALKING 4598 02:34:18,797 --> 02:34:19,665 WITH THE COMMUNITY HEALTH 4599 02:34:19,665 --> 02:34:20,799 WORKERS ABOUT THEIR WORKLOAD, 4600 02:34:20,799 --> 02:34:22,668 WHAT'S TAKING UP ALL OF THEIR 4601 02:34:22,668 --> 02:34:24,303 TIME, TECHNOLOGY, THE APP, IT 4602 02:34:24,303 --> 02:34:28,607 KEPT COMING UP, THAT THEY FELT 4603 02:34:28,607 --> 02:34:29,808 LIKE THEY WERE SPENDING SO MUCH 4604 02:34:29,808 --> 02:34:30,843 TIME TRYING TO FIGURE OUT WHAT'S 4605 02:34:30,843 --> 02:34:32,578 GOING ON WITH THE APP AND NOT 4606 02:34:32,578 --> 02:34:33,245 SPENDING TIME WITH THE 4607 02:34:33,245 --> 02:34:33,812 PARTICIPANTS. 4608 02:34:33,812 --> 02:34:34,913 SO THAT'S WHAT I WOULD SAY. 4609 02:34:34,913 --> 02:34:37,249 >> YOU KNOW, WE WERE DOING A 4610 02:34:37,249 --> 02:34:42,788 STUDY WITH HOME BLOOD MONITORS 4611 02:34:42,788 --> 02:34:46,425 USING -- WE FOUND IOS AND IPHONE 4612 02:34:46,425 --> 02:34:49,228 IS DIFFERENT THAN AN ANDROID OR 4613 02:34:49,228 --> 02:34:52,297 GALAXY, SO THAT JUST CREATED ALL 4614 02:34:52,297 --> 02:34:53,866 SORTS OF HAVOC IN THE FIRST 4615 02:34:53,866 --> 02:34:55,167 COUPLE MONTHS OF GETTING GOING. 4616 02:34:55,167 --> 02:34:57,135 SO KEITH, TURNING BACK TO YOU, I 4617 02:34:57,135 --> 02:34:58,303 HAVE A COUPLE OTHER QUESTIONS 4618 02:34:58,303 --> 02:35:00,606 BUT I DON'T WANT TO -- 4619 02:35:00,606 --> 02:35:02,040 >> I HAVE A PRETTY 4620 02:35:02,040 --> 02:35:02,574 STRAIGHTFORWARD QUESTION. 4621 02:35:02,574 --> 02:35:04,109 I DON'T UNDERSTAND BIAS IN THE 4622 02:35:04,109 --> 02:35:04,543 MACHINE. 4623 02:35:04,543 --> 02:35:07,613 IT SEEMS TO ME MACHINES SHOULD 4624 02:35:07,613 --> 02:35:10,616 BE SOMEONE WHO DOES NOT KNOW A 4625 02:35:10,616 --> 02:35:13,185 PERSON, A THING THAT DOES NOT 4626 02:35:13,185 --> 02:35:14,119 KNOW A PERSON. 4627 02:35:14,119 --> 02:35:16,555 YOU SAID 10%, ZERO, THAT SOUNDS 4628 02:35:16,555 --> 02:35:20,259 NORMAL TO ME, BUT ZERO TO 9, 10% 4629 02:35:20,259 --> 02:35:21,593 IS WHAT YOU WOULD EXPECT BY THE 4630 02:35:21,593 --> 02:35:22,794 ROLL OF THE DICE. 4631 02:35:22,794 --> 02:35:26,231 NOW THE 1/100, THE 0/0, THAT IS 4632 02:35:26,231 --> 02:35:28,800 SOMETHING I'D LIKE TO KNOW. 4633 02:35:28,800 --> 02:35:30,335 WHAT'S THE CHANCE OF GETTING THE 4634 02:35:30,335 --> 02:35:31,670 ZERO TO ZERO? 4635 02:35:31,670 --> 02:35:34,406 >> OH, I WOULD HAVE TO DO THE 4636 02:35:34,406 --> 02:35:35,040 MATH. 4637 02:35:35,040 --> 02:35:36,475 THERE'S A LOT MORE COMBINATIONS 4638 02:35:36,475 --> 02:35:37,843 ON BOTH THE SYSTOLIC AND THE 4639 02:35:37,843 --> 02:35:40,412 DIASTOLIC ENDING IN ZERO. 4640 02:35:40,412 --> 02:35:40,679 >> RIGHT. 4641 02:35:40,679 --> 02:35:43,348 >> YEAH. 4642 02:35:43,348 --> 02:35:45,617 >> HOW IS IT BIAS IF IT'S 10% 4643 02:35:45,617 --> 02:35:45,817 ZERO? 4644 02:35:45,817 --> 02:35:47,286 I THINK THE DATA WOULD REFLECT 4645 02:35:47,286 --> 02:35:48,987 THAT IF THE MACHINE WAS 4646 02:35:48,987 --> 02:35:50,722 MEASURING NUMBERS, I DON'T SEE 4647 02:35:50,722 --> 02:35:51,223 WHERE THAT'S BIAS. 4648 02:35:51,223 --> 02:35:53,191 >> WE WOULD EXPECT IN THE 4649 02:35:53,191 --> 02:35:55,961 ABSENCE OF ANY BIAS THE MACHINE 4650 02:35:55,961 --> 02:35:56,929 JUST DOING ITS THING, THAT 10% 4651 02:35:56,929 --> 02:35:58,563 OF ALL MEASUREMENTS ARE GOING TO 4652 02:35:58,563 --> 02:36:01,800 END, OR AT LEAST ONE OF THE -- 4653 02:36:01,800 --> 02:36:03,769 ARE GOING TO END IN ZERO, YES. 4654 02:36:03,769 --> 02:36:05,304 >> I THOUGHT YOU INCLUDED THAT 4655 02:36:05,304 --> 02:36:07,806 AS A BIAS IN YOUR REPORTING. 4656 02:36:07,806 --> 02:36:09,274 >> THAT WAS NOT MY -- MORE OF 4657 02:36:09,274 --> 02:36:10,909 THE HUMAN SIDE OF THE 4658 02:36:10,909 --> 02:36:13,345 TRANSCRIBING THE NUMBERS. 4659 02:36:13,345 --> 02:36:15,147 I DIDN'T NEED TO INTEND THE 4660 02:36:15,147 --> 02:36:16,281 MACHINE ITSELF IS BIASED, 4661 02:36:16,281 --> 02:36:17,549 ALTHOUGH THERE IS ONE PAPER 4662 02:36:17,549 --> 02:36:18,317 SOMEONE SHARED WITH ME LOOKING 4663 02:36:18,317 --> 02:36:19,785 AT SOME OF THE ALGORITHMS, WHAT 4664 02:36:19,785 --> 02:36:21,320 THE DEVICE IS DOING, SOMETIMES 4665 02:36:21,320 --> 02:36:22,087 THEY DON'T RECORD CERTAIN 4666 02:36:22,087 --> 02:36:23,488 NUMBERS AS OFTEN, BUT IN 4667 02:36:23,488 --> 02:36:24,756 GENERAL, NO, I THINK WE EXPECT 4668 02:36:24,756 --> 02:36:26,858 THE MACHINES IN THE ABSENCE OF 4669 02:36:26,858 --> 02:36:28,160 BIAS ARE GOING TO GIVE YOU ABOUT 4670 02:36:28,160 --> 02:36:29,962 10% OF MEASUREMENTS ENDING IN 4671 02:36:29,962 --> 02:36:31,596 EACH END DIGIT. 4672 02:36:31,596 --> 02:36:33,065 >> GOT IT. 4673 02:36:33,065 --> 02:36:33,765 DR. BOWLING, ONE QUICK 4674 02:36:33,765 --> 02:36:34,166 FOLLOW-UP. 4675 02:36:34,166 --> 02:36:35,834 I LOVE YOUR WORK WITH OLDER 4676 02:36:35,834 --> 02:36:36,068 PERSONS. 4677 02:36:36,068 --> 02:36:37,869 I THINK IF YOU LOOK AT THE 4678 02:36:37,869 --> 02:36:38,904 TECHNOLOGY, IT'S REALLY 4679 02:36:38,904 --> 02:36:41,073 DIFFICULT FOR OLDER PERSONS TO 4680 02:36:41,073 --> 02:36:42,674 NAVIGATE THE TECHNOLOGY. 4681 02:36:42,674 --> 02:36:44,876 SO HOW DO YOU KEEP THEM ENGAGED 4682 02:36:44,876 --> 02:36:46,845 IF YOU DON'T HAVE SOME AUTOMATIC 4683 02:36:46,845 --> 02:36:50,849 WAY OF EITHER BLUETOOTHING OR 4684 02:36:50,849 --> 02:36:52,084 SENDING THROUGH THE WIRELESS OR 4685 02:36:52,084 --> 02:36:53,552 THROUGH THE WEB TO GET THOSE 4686 02:36:53,552 --> 02:36:55,020 NUMBERS, HOW DO YOU KEEP THE 4687 02:36:55,020 --> 02:36:56,121 PATIENTS ENGAGED? 4688 02:36:56,121 --> 02:36:57,856 >> IT'S A GREAT QUESTION. 4689 02:36:57,856 --> 02:36:59,858 AND I THINK WHAT WE SOMETIMES 4690 02:36:59,858 --> 02:37:02,427 SEE IS THAT RESEARCH TEAMS 4691 02:37:02,427 --> 02:37:04,396 EXCLUDE OLDER ADULTS FOR THAT 4692 02:37:04,396 --> 02:37:06,365 PURPOSE AND I THINK THAT IS THE 4693 02:37:06,365 --> 02:37:07,699 WRONG ANSWER. 4694 02:37:07,699 --> 02:37:10,002 WHAT WE HEAR FROM OLDER ADULTS 4695 02:37:10,002 --> 02:37:12,804 IS THEY WANT FLEX IBILITY IN HOW 4696 02:37:12,804 --> 02:37:14,206 THEY ENGAGE WITH TECHNOLOGY, AND 4697 02:37:14,206 --> 02:37:18,276 SO IT'S NOT ALL OR NONE. 4698 02:37:18,276 --> 02:37:21,179 AND IT HAS TO BE KIND OF 4699 02:37:21,179 --> 02:37:23,582 INDIVIDUALIZED FOR WHAT THEIR 4700 02:37:23,582 --> 02:37:24,316 LEVEL OF KNOWLEDGE AND WHAT 4701 02:37:24,316 --> 02:37:26,051 THEIR LEVEL -- HOW COMFORTABLE 4702 02:37:26,051 --> 02:37:27,719 THEY ARE WITH IT. 4703 02:37:27,719 --> 02:37:32,090 WE ALSO HEARD THAT THAT KIND 4704 02:37:32,090 --> 02:37:34,059 OF -- THAT OPPORTUNITY TO 4705 02:37:34,059 --> 02:37:35,394 CUSTOMIZE AND TO ENGAGE WITH 4706 02:37:35,394 --> 02:37:36,128 RESEARCH TEAMS IS REALLY ONE OF 4707 02:37:36,128 --> 02:37:37,629 THE THINGS THAT THEY LIKE ABOUT 4708 02:37:37,629 --> 02:37:38,730 PARTICIPATING IN RESEARCH. 4709 02:37:38,730 --> 02:37:40,999 SO IT'S ALSO A MOTIVATOR TO 4710 02:37:40,999 --> 02:37:42,567 BEING IN A RESEARCH STUDY. 4711 02:37:42,567 --> 02:37:44,136 AND SO IF YOU COME TO AN OLDER 4712 02:37:44,136 --> 02:37:45,737 ADULT AND SAY HERE'S WHAT WE'RE 4713 02:37:45,737 --> 02:37:46,972 GOING TO DO, THERE'S NO WAY -- 4714 02:37:46,972 --> 02:37:49,274 NO OTHER ALTERNATIVES, THEY'RE 4715 02:37:49,274 --> 02:37:50,776 MUCH LESS LIKELY TO PARTICIPATE 4716 02:37:50,776 --> 02:37:51,243 IN THAT RESEARCH. 4717 02:37:51,243 --> 02:37:53,945 SO I THINK THAT BY BUILDING IN 4718 02:37:53,945 --> 02:37:55,680 SOME FLEXIBILITY, YOU ALSO HAVE 4719 02:37:55,680 --> 02:37:59,785 THE CHANCE OF INCREASING 4720 02:37:59,785 --> 02:38:00,118 PARTICIPATION. 4721 02:38:00,118 --> 02:38:00,952 BUT THESE ARE DEFINITELY 4722 02:38:00,952 --> 02:38:01,253 CHALLENGES. 4723 02:38:01,253 --> 02:38:02,487 AND I THINK THE OTHER THING TO 4724 02:38:02,487 --> 02:38:04,089 JUST THINK ABOUT OLDER ADULTS, 4725 02:38:04,089 --> 02:38:06,258 AND AS WE TALK ABOUT OLDER 4726 02:38:06,258 --> 02:38:07,926 ADULTS LIKE THEY'RE ONE GROUP, 4727 02:38:07,926 --> 02:38:09,528 ALL OLDER ADULTS ARE LIKE THIS, 4728 02:38:09,528 --> 02:38:10,462 BUT REALLY, THERE'S THIS WIDE 4729 02:38:10,462 --> 02:38:13,765 RANGE OF EXPERIENCES, LIFE 4730 02:38:13,765 --> 02:38:15,233 EXPERIENCES AND HOW THEY GOT TO 4731 02:38:15,233 --> 02:38:17,636 WHERE THEY ARE RIGHT NOW SO WE 4732 02:38:17,636 --> 02:38:19,304 HAVE TO KIND OF KEEP THAT IN 4733 02:38:19,304 --> 02:38:20,172 MIND. 4734 02:38:20,172 --> 02:38:20,739 >> DR. TOWNSEND IS GOING TO 4735 02:38:20,739 --> 02:38:21,940 FINISH OUT THE QUESTION AND I'M 4736 02:38:21,940 --> 02:38:22,707 GOING TO MAKE TWO COMMENTS. 4737 02:38:22,707 --> 02:38:24,242 ONE OF THEM IS SOMEWHAT 4738 02:38:24,242 --> 02:38:25,243 FACETIOUS, BUT YOU HAVE TO 4739 02:38:25,243 --> 02:38:26,945 RECOGNIZE A LOT OF OLDER PEOPLE 4740 02:38:26,945 --> 02:38:27,813 DIDN'T GROW UP WITH THIS 4741 02:38:27,813 --> 02:38:28,814 TECHNOLOGY SO YOU SAY THINGS 4742 02:38:28,814 --> 02:38:29,915 LIKE CLICK HERE, INTO HERE, GO 4743 02:38:29,915 --> 02:38:31,683 TO THIS WEBSITE, AND IT SOUNDS 4744 02:38:31,683 --> 02:38:32,984 EASY TO A YOUNGER PERSON BUT 4745 02:38:32,984 --> 02:38:33,819 THEY DON'T KNOW WHAT YOU'RE 4746 02:38:33,819 --> 02:38:35,954 TALKING ABOUT. 4747 02:38:35,954 --> 02:38:36,555 THEY DON'T KNOW WHAT YOU'RE 4748 02:38:36,555 --> 02:38:36,888 TALKING ABOUT. 4749 02:38:36,888 --> 02:38:37,155 ALL RIGHT. 4750 02:38:37,155 --> 02:38:40,892 HERE'S THE SERIOUS STATEMENT. 4751 02:38:40,892 --> 02:38:49,634 WHAT DR. RAVENELL IS DOING AND 4752 02:38:49,634 --> 02:38:50,969 DR. MENSAH, SAUNDERS, DOCTORS 4753 02:38:50,969 --> 02:38:52,804 WOULD SIT IN EMERGENCY ROOMS AND 4754 02:38:52,804 --> 02:38:54,239 CLINICS TO WAIT FOR PEOPLE TO 4755 02:38:54,239 --> 02:38:56,208 COME IN WHEN THEY'RE SICK. 4756 02:38:56,208 --> 02:38:57,175 THAT'S WHAT THE DOCTOR DID. 4757 02:38:57,175 --> 02:38:59,077 FOR A DOCTOR TO GO OUT TO A 4758 02:38:59,077 --> 02:39:01,413 BARBERSHOP OR CHURCH AND 4759 02:39:01,413 --> 02:39:02,848 INTERVENE IN THOSE SETTINGS, 4760 02:39:02,848 --> 02:39:04,583 PEOPLE THOUGHT WE WERE CRAZY. 4761 02:39:04,583 --> 02:39:06,651 SO I'M GLAD TO SEE THIS WORK IS 4762 02:39:06,651 --> 02:39:07,486 BRINGING FRUITION. 4763 02:39:07,486 --> 02:39:09,354 YOU NEED TO CONTINUE THIS WORK 4764 02:39:09,354 --> 02:39:09,921 AND RECOGNIZE THAT THERE ARE 4765 02:39:09,921 --> 02:39:10,922 PEOPLE WHO STILL THINK IT'S A 4766 02:39:10,922 --> 02:39:12,424 WASTE OF TIME. 4767 02:39:12,424 --> 02:39:13,959 RAY, I'LL LET YOU END WITH THE 4768 02:39:13,959 --> 02:39:14,726 LAST COUPLE QUESTIONS. 4769 02:39:14,726 --> 02:39:16,461 >> BUILDING ON WHAT KEITH JUST 4770 02:39:16,461 --> 02:39:17,662 SAID, THERE'S A QUESTION FROM 4771 02:39:17,662 --> 02:39:22,267 HILARY WALL ABOUT EXPANDING THE 4772 02:39:22,267 --> 02:39:23,101 BARBERSHOP EXPERIENCE INTO THE 4773 02:39:23,101 --> 02:39:25,504 REAL WORLD -- REAL WORLD -- 4774 02:39:25,504 --> 02:39:26,471 EXPANDING -- LET ME LEAVE IT AT 4775 02:39:26,471 --> 02:39:28,540 THAT, NOT JUST THAT IT'S NOT -- 4776 02:39:28,540 --> 02:39:29,708 >> BARBERSHOPS ARE REAL. 4777 02:39:29,708 --> 02:39:31,710 >> BACK UP HERE, TOWNSEND. 4778 02:39:31,710 --> 02:39:33,745 SO YOU PROBABLY SAW THE QUESTION 4779 02:39:33,745 --> 02:39:35,413 IN THE Q & A, BUT IT HAD TO DO 4780 02:39:35,413 --> 02:39:37,048 WITH THE HUB, AND THE 4781 02:39:37,048 --> 02:39:39,317 METHODOLOGY TO IMPLEMENT AND HOW 4782 02:39:39,317 --> 02:39:41,086 TO FIND YOUR WAY INTO THESE 4783 02:39:41,086 --> 02:39:43,321 COMMUNITIES, AND HOW TO ENGAGE 4784 02:39:43,321 --> 02:39:44,389 AT THAT LEVEL. 4785 02:39:44,389 --> 02:39:46,725 SO DO YOU HAVE ANY ADVICE FOR, 4786 02:39:46,725 --> 02:39:48,093 LIKE, SOMEBODY IN PHILADELPHIA, 4787 02:39:48,093 --> 02:39:50,061 LIKE ME, TRYING TO DO THIS SORT 4788 02:39:50,061 --> 02:39:52,797 OF THING, MAYBE NOT AS MUCH IN A 4789 02:39:52,797 --> 02:39:57,502 BARBERSHOP, MAYBE -- A 4790 02:39:57,502 --> 02:40:01,540 DELICATESSEN, SOME OTHER 4791 02:40:01,540 --> 02:40:02,807 PHILADELPHIA ARCHITECTURAL 4792 02:40:02,807 --> 02:40:03,175 GATHERING POINT? 4793 02:40:03,175 --> 02:40:03,808 >> YES, SO I DEFINITELY 4794 02:40:03,808 --> 02:40:05,243 APPRECIATE THE QUESTION 4795 02:40:05,243 --> 02:40:08,780 BASICALLY ABOUT A COMMUNITY HUB 4796 02:40:08,780 --> 02:40:11,016 AS THE SORT OF CENTRAL POINT FOR 4797 02:40:11,016 --> 02:40:13,718 MUCH OF THIS WORK TO BE ABLE TO 4798 02:40:13,718 --> 02:40:16,121 TRAIN BARBERS, FOR INSTANCE, OR 4799 02:40:16,121 --> 02:40:19,257 OTHER COMMUNITY LEADERS TO 4800 02:40:19,257 --> 02:40:20,458 CORRECTLY ASSESS BLOOD PRESSURE. 4801 02:40:20,458 --> 02:40:22,527 AND SO THERE'S NO EASY ANSWER TO 4802 02:40:22,527 --> 02:40:23,528 THAT QUESTION. 4803 02:40:23,528 --> 02:40:25,797 BUT WHAT I WILL SAY IS, IN ALL 4804 02:40:25,797 --> 02:40:28,633 OF OUR EXPERIENCES, WE HAVE MADE 4805 02:40:28,633 --> 02:40:30,735 THE HUB WHEREVER PEOPLE ARE. 4806 02:40:30,735 --> 02:40:32,571 AND SO WHAT I MEAN BY THAT IS, 4807 02:40:32,571 --> 02:40:34,706 IF WE WANTED BARBERS TO BE 4808 02:40:34,706 --> 02:40:38,043 PROPERLY TRAINED ON 4809 02:40:38,043 --> 02:40:39,344 HYPERTENSION, ON BLOOD PRESSURE 4810 02:40:39,344 --> 02:40:40,946 MEASUREMENT, WE WENT TO THOSE 4811 02:40:40,946 --> 02:40:44,182 BARBERSHOPS AND WE WENT TO THEM, 4812 02:40:44,182 --> 02:40:45,483 WE DIDN'T EXPECT THEM TO COME TO 4813 02:40:45,483 --> 02:40:45,984 US. 4814 02:40:45,984 --> 02:40:47,953 HOW WE SCALE THAT IS A WHOLE 4815 02:40:47,953 --> 02:40:48,753 OTHER QUESTION, BUT I DO THINK 4816 02:40:48,753 --> 02:40:51,122 WE HAVE THE MOST IMPACT WHEN WE 4817 02:40:51,122 --> 02:40:56,695 GO TO WHERE PEOPLE ARE. 4818 02:40:56,695 --> 02:40:57,862 >> LET ME ASK ANYONE WHO'S 4819 02:40:57,862 --> 02:40:59,631 WILLING TO POTENTIALLY TAKE THIS 4820 02:40:59,631 --> 02:41:00,832 ON, SINCE WE'RE LOOKING AT 4821 02:41:00,832 --> 02:41:02,968 TRYING TO DO MORE COMMUNITY 4822 02:41:02,968 --> 02:41:05,737 BASE, GET OUT THERE, MEASURE AND 4823 02:41:05,737 --> 02:41:07,305 HOPEFULLY MANAGE ELEVATED BLOOD 4824 02:41:07,305 --> 02:41:10,375 PRESSURES IN THE COMMUNITY. 4825 02:41:10,375 --> 02:41:12,210 AT PENN, WE HAVE A LOT OF 4826 02:41:12,210 --> 02:41:13,411 PROGRAMS THAT OUR MEDICAL 4827 02:41:13,411 --> 02:41:13,979 STUDENTS DO. 4828 02:41:13,979 --> 02:41:16,081 SO WHAT DO YOU SEE AS LIKE THE 4829 02:41:16,081 --> 02:41:21,519 ROLE FOR MEDICAL STUDENTS OR 4830 02:41:21,519 --> 02:41:24,322 PHARM D STUDENTS, OR NURSING 4831 02:41:24,322 --> 02:41:24,956 STUDENTS, ET CETERA, BECAUSE ONE 4832 02:41:24,956 --> 02:41:26,224 OF THE PROBLEMS OBVIOUSLY IS BY 4833 02:41:26,224 --> 02:41:27,826 THE TIME YOU GET THEM TRAINED TO 4834 02:41:27,826 --> 02:41:30,228 BE ABLE TO DO RESEARCH, THEY'RE 4835 02:41:30,228 --> 02:41:31,563 IN A COURSE WHERE THEY CAN'T 4836 02:41:31,563 --> 02:41:32,998 SPEND THE TIME OR THEY GRADUATE 4837 02:41:32,998 --> 02:41:35,300 AND GO ON TO SOMETHING ELSE, SO 4838 02:41:35,300 --> 02:41:38,203 I'M JUST CURIOUS, WHAT YOU SEE, 4839 02:41:38,203 --> 02:41:40,005 HOW FAR DOWN IN OUR FOOD CHAIN 4840 02:41:40,005 --> 02:41:41,406 IN MEDICINE WE SHOULD BE GOING 4841 02:41:41,406 --> 02:41:43,508 TO ENGAGE THE NEXT GENERATION OF 4842 02:41:43,508 --> 02:41:45,377 DOCTORS, NURSES, PHARMACISTS, ET 4843 02:41:45,377 --> 02:41:46,511 CETERA, IN DOING THESE KIND OF 4844 02:41:46,511 --> 02:41:48,179 THINGS THAT ARE SO 4845 02:41:48,179 --> 02:41:50,415 COMMUNITY-MINDED AND SO 4846 02:41:50,415 --> 02:41:50,749 IMPORTANT? 4847 02:41:50,749 --> 02:41:53,151 >> I CAN JUST SUPER QUICKLY JUMP 4848 02:41:53,151 --> 02:41:53,318 IN. 4849 02:41:53,318 --> 02:41:54,853 WE HAVE DEFINITELY ENGAGED WITH 4850 02:41:54,853 --> 02:41:57,989 MEDICAL STUDENTS IN GOING OUT TO 4851 02:41:57,989 --> 02:41:59,357 BARBER SHOPS AND CHURCHES TO 4852 02:41:59,357 --> 02:41:59,858 MEASURE BLOOD PRESSURE. 4853 02:41:59,858 --> 02:42:00,592 THEY ARE ACTUALLY TERRIFIC AT 4854 02:42:00,592 --> 02:42:00,959 IT. 4855 02:42:00,959 --> 02:42:02,193 THEY LOVE DOING IT. 4856 02:42:02,193 --> 02:42:04,129 OF COURSE THE ISSUE OF 4857 02:42:04,129 --> 02:42:07,132 CONTINUITY IS ONE THAT'S 4858 02:42:07,132 --> 02:42:11,069 PROBABLY THE BIGGEST CHALLENGE. 4859 02:42:11,069 --> 02:42:14,205 BUT I THINK WITH APPROPRIATE 4860 02:42:14,205 --> 02:42:16,741 INFRASTRUCTURE AND FUNDING, WE 4861 02:42:16,741 --> 02:42:22,180 CAN FIND WAYS TO MAKE THE 4862 02:42:22,180 --> 02:42:23,682 CONTINUITY WORK BUT WE TO WANT 4863 02:42:23,682 --> 02:42:25,116 TO MAKE SURE THAT WHEN WE'RE 4864 02:42:25,116 --> 02:42:27,085 GOING OUT THERE TO MEASURE BLOOD 4865 02:42:27,085 --> 02:42:27,886 PRESSURE THAT WE'RE, AGAIN, NOT 4866 02:42:27,886 --> 02:42:29,454 JUST SCREENING BUT ALSO MAKING 4867 02:42:29,454 --> 02:42:30,955 LINKAGES POSSIBLE SO THAT WE 4868 02:42:30,955 --> 02:42:37,162 DON'T DO MORE HARM THAN GOOD. 4869 02:42:37,162 --> 02:42:39,764 >> LET ME ASK KATHRYN. 4870 02:42:39,764 --> 02:42:41,499 >> I WAS JUST GOING TO SHARE AN 4871 02:42:41,499 --> 02:42:42,934 EXPERIENCE AT HOPKINS. 4872 02:42:42,934 --> 02:42:45,904 WE RECEIVED AN AMA GRANT TO 4873 02:42:45,904 --> 02:42:47,605 ACTUALLY TRAIN MEDICAL STUDENTS, 4874 02:42:47,605 --> 02:42:49,674 NURSING STUDENTS IN ACCURATE 4875 02:42:49,674 --> 02:42:50,909 BLOOD PRESSURE MEASUREMENT AS AN 4876 02:42:50,909 --> 02:42:52,477 ONLINE COMPONENT THAT THEY ALSO 4877 02:42:52,477 --> 02:42:54,679 HAD TO DO SOME IN-PERSON 4878 02:42:54,679 --> 02:42:56,247 TRAINING, BUT BEYOND THAT, WE 4879 02:42:56,247 --> 02:42:58,183 HAD THE OPPORTUNITY TO ENGAGE 4880 02:42:58,183 --> 02:43:02,220 THAT IN OUR COMMUNITY-BASED 4881 02:43:02,220 --> 02:43:03,121 PROJECTS. 4882 02:43:03,121 --> 02:43:04,122 IN BALTIMORE WHERE THEY HAD THE 4883 02:43:04,122 --> 02:43:05,623 OPPORTUNITY TO ACTUALLY 4884 02:43:05,623 --> 02:43:06,458 PRACTICE, WHERE WE'RE TALKING 4885 02:43:06,458 --> 02:43:07,892 ABOUT HOW TO ACTUALLY TAKE 4886 02:43:07,892 --> 02:43:08,493 ACTION. 4887 02:43:08,493 --> 02:43:11,096 WHAT IF SOMEONE'S BLOOD PRESSURE 4888 02:43:11,096 --> 02:43:12,163 IS HIGH, WHAT ARE THE NEXT 4889 02:43:12,163 --> 02:43:12,464 STEPS. 4890 02:43:12,464 --> 02:43:13,898 WE ACTUALLY HAD AN INCIDENT 4891 02:43:13,898 --> 02:43:15,934 WHERE SOMEONE'S BLOOD PRESSURE 4892 02:43:15,934 --> 02:43:16,735 WAS ELEVATED AND THE STUDENTS 4893 02:43:16,735 --> 02:43:17,836 ACTUALLY WALKED THE PERSON TO 4894 02:43:17,836 --> 02:43:19,204 THE EMERGENCY ROOM BECAUSE IT 4895 02:43:19,204 --> 02:43:21,606 WAS SO HIGH, AND SO THAT'S WORK 4896 02:43:21,606 --> 02:43:23,041 THAT WE'RE ALSO DOING HERE AT 4897 02:43:23,041 --> 02:43:23,274 HOPKINS. 4898 02:43:23,274 --> 02:43:24,943 THANK YOU. 4899 02:43:24,943 --> 02:43:27,011 >> LET ME MAKE ONE COMMENT. 4900 02:43:27,011 --> 02:43:27,979 MEDICINE, I THINK, IS GOING 4901 02:43:27,979 --> 02:43:28,546 BACKWARDS. 4902 02:43:28,546 --> 02:43:29,848 THE CLINICIANS, THE DOCTORS, THE 4903 02:43:29,848 --> 02:43:31,750 NURSE PRACTITIONERS ARE NOW 4904 02:43:31,750 --> 02:43:35,653 PRACTICING IN 15-MINUTE VISITS 4905 02:43:35,653 --> 02:43:38,156 FOR 99214, OUTPUTS MONITORED BY 4906 02:43:38,156 --> 02:43:38,957 BUSINESS PEOPLE TO MAKE SURE 4907 02:43:38,957 --> 02:43:39,958 THEY'RE SEEING ENOUGH PEOPLE 4908 02:43:39,958 --> 02:43:40,392 QUICKLY. 4909 02:43:40,392 --> 02:43:42,627 WE'RE NOT GOING TO CONTROL 50, 4910 02:43:42,627 --> 02:43:44,195 60% OF THE POPULATION WHO'S OVER 4911 02:43:44,195 --> 02:43:46,297 50 YEARS OF AGE AND HYPERTENSION 4912 02:43:46,297 --> 02:43:47,365 ESPECIALLY IN THE BLACK 4913 02:43:47,365 --> 02:43:49,200 COMMUNITY, BY WAITING FOR 4914 02:43:49,200 --> 02:43:50,969 DOCTORS IN 15-MINUTE VISITS TWO 4915 02:43:50,969 --> 02:43:52,103 TO THREE TIMES A YEAR TO DO 4916 02:43:52,103 --> 02:43:56,274 ANYTHING. 4917 02:43:56,274 --> 02:43:57,242 >> OKAY. 4918 02:43:57,242 --> 02:43:59,978 SO BACK TO YOU, KATHRYN. 4919 02:43:59,978 --> 02:44:01,646 I SERVE ON A COUPLE OF DIFFERENT 4920 02:44:01,646 --> 02:44:03,515 JOURNALS AS, YOU KNOW, HELPING 4921 02:44:03,515 --> 02:44:05,250 WITH EDITOR-TYPE STUFF, AND ONE 4922 02:44:05,250 --> 02:44:09,621 OF THE THINGS THAT I VALUE BY 4923 02:44:09,621 --> 02:44:11,256 OUR STATISTICIANS EXTREMELY FOR 4924 02:44:11,256 --> 02:44:13,024 IS BEING ABLE TO LOOK AT A LARGE 4925 02:44:13,024 --> 02:44:14,259 POPULATION SURVEY, FOR EXAMPLE, 4926 02:44:14,259 --> 02:44:15,927 FOR SOMETHING LIKE BLOOD 4927 02:44:15,927 --> 02:44:17,095 PRESSURE AND CHRONIC KIDNEY 4928 02:44:17,095 --> 02:44:18,163 DISEASE OR SOMETHING LIKE THAT. 4929 02:44:18,163 --> 02:44:19,831 AND ARE THERE -- IS THERE A TIP 4930 02:44:19,831 --> 02:44:22,634 OR TWO YOU CAN GIVE ME AS A 4931 02:44:22,634 --> 02:44:23,301 REVIEWER POTENTIALLY FOR WHEN I 4932 02:44:23,301 --> 02:44:26,571 SEE THESE KIND OF ARTICLES THAT 4933 02:44:26,571 --> 02:44:28,706 MIGHT HELP ME TO FOCUS IN ON, 4934 02:44:28,706 --> 02:44:29,774 HEY, LISTEN, THIS IS A LARGE 4935 02:44:29,774 --> 02:44:30,875 ENOUGH STUDY THAT MAYBE THERE'S 4936 02:44:30,875 --> 02:44:33,611 SOME UNDERLYING BIAS HERE THAT 4937 02:44:33,611 --> 02:44:34,279 MIGHT SCREW THE RESULTS. 4938 02:44:34,279 --> 02:44:35,346 IS THERE SOMETHING THAT YOU LOOK 4939 02:44:35,346 --> 02:44:36,815 AT WHEN YOU GET ONE OF THESE 4940 02:44:36,815 --> 02:44:37,916 ARTICLES THAT YOU CAN SAY YOU 4941 02:44:37,916 --> 02:44:40,051 KNOW WHAT, THIS MIGHT HAVE A 4942 02:44:40,051 --> 02:44:40,585 PROBLEM. 4943 02:44:40,585 --> 02:44:41,753 >> THAT'S A GREAT QUESTION. 4944 02:44:41,753 --> 02:44:46,324 AND I THINK IT'S EASIER TO SEE 4945 02:44:46,324 --> 02:44:47,692 THE ISSUE WHEN YOU CAN SEE THE 4946 02:44:47,692 --> 02:44:47,892 DATA. 4947 02:44:47,892 --> 02:44:50,862 SO I THINK IF THERE WERE 4948 02:44:50,862 --> 02:44:52,297 STANDARDS IN TERMS OF REPORTING 4949 02:44:52,297 --> 02:44:53,665 CLINICAL TRIALS OR EVEN RESEARCH 4950 02:44:53,665 --> 02:44:55,066 STUDIES WHERE YOU ASK FOR THE 4951 02:44:55,066 --> 02:44:55,800 HISTOGRAM OF THE BLOOD PRESSURE 4952 02:44:55,800 --> 02:44:57,168 MEASUREMENTS AT DIFFERENT STUDY 4953 02:44:57,168 --> 02:44:58,970 VISITS OVER TIME, YOU KNOW, 4954 02:44:58,970 --> 02:45:00,338 MAYBE THOSE WERE INCLUDED AS A 4955 02:45:00,338 --> 02:45:01,439 SUPPLEMENT OR THEY'RE PART OF 4956 02:45:01,439 --> 02:45:02,874 YOUR SORT OF REPORTING 4957 02:45:02,874 --> 02:45:04,108 CHECKLIST, I THINK THAT COULD BE 4958 02:45:04,108 --> 02:45:06,277 REALLY VALUABLE IN JUST 4959 02:45:06,277 --> 02:45:07,245 PROMOTING TRANSPARENCY IN THE 4960 02:45:07,245 --> 02:45:08,913 FIELD AT LARGE. 4961 02:45:08,913 --> 02:45:10,548 I THINK WHEN YOU'RE LOOKING AT 4962 02:45:10,548 --> 02:45:12,817 PROPORTIONS, I THINK JUST 4963 02:45:12,817 --> 02:45:13,718 QUESTIONING THE RESULTS AND 4964 02:45:13,718 --> 02:45:14,686 THINKING ABOUT THE POTENTIAL 4965 02:45:14,686 --> 02:45:18,523 SOURCES OF PI BIASES, I THINK TE 4966 02:45:18,523 --> 02:45:20,225 ARE THINGS WE MAY NOT EVEN 4967 02:45:20,225 --> 02:45:22,660 RILIZE ARE HAPPENING, SO 4968 02:45:22,660 --> 02:45:24,262 UNDERSTANDING WHICH MECHANISMS 4969 02:45:24,262 --> 02:45:26,030 BY WHICH BIASES MAY BE 4970 02:45:26,030 --> 02:45:27,198 OCCURRING, IF YOU CAN SEE ALL 4971 02:45:27,198 --> 02:45:28,700 THE DATA AND LOOK AT A HISTOGRAM 4972 02:45:28,700 --> 02:45:30,368 THAT MAY BE QUICKEST WAY TO TELL 4973 02:45:30,368 --> 02:45:31,870 IF THERE MAY BE AN ISSUE. 4974 02:45:31,870 --> 02:45:32,704 >> I HAVE A QUESTION FOR 4975 02:45:32,704 --> 02:45:33,137 DR. BOWLING. 4976 02:45:33,137 --> 02:45:37,442 A LOT OF THE OLDER CLIENTS ARE 4977 02:45:37,442 --> 02:45:38,943 NOW GOING ON THE INTERNET AND 4978 02:45:38,943 --> 02:45:40,912 YOU CAN CLICK SOMETHING OR YOUR 4979 02:45:40,912 --> 02:45:43,448 DAUGHTER CAN GET ONE OF THESE 4980 02:45:43,448 --> 02:45:45,783 FDA-APPROVED WRIST DEVICES OR 4981 02:45:45,783 --> 02:45:46,217 WATCHES, ET CETERA. 4982 02:45:46,217 --> 02:45:48,586 HOW DO YOU EDUCATE YOUR PATIENTS 4983 02:45:48,586 --> 02:45:50,388 OR HOW DO YOU THINK WE CAN ALL 4984 02:45:50,388 --> 02:45:52,457 EDUCATE OUR PATIENTS THAT JUST 4985 02:45:52,457 --> 02:45:54,425 BECAUSE SOMETHING WAS FDA -- AND 4986 02:45:54,425 --> 02:45:57,929 IT'S NOT REALLY FDA-APPROVED, 4987 02:45:57,929 --> 02:45:59,230 BUT THESE DEVICES ARE OUT THERE, 4988 02:45:59,230 --> 02:46:00,698 WHAT DO YOU DO WITH THEM, HOW DO 4989 02:46:00,698 --> 02:46:01,699 YOU HANDLE THAT INFORMATION? 4990 02:46:01,699 --> 02:46:02,867 >> YEAH, IT'S A GOOD QUESTION. 4991 02:46:02,867 --> 02:46:06,838 AND I THINK WHERE IT OFTEN COMES 4992 02:46:06,838 --> 02:46:09,240 FROM IS FAMILY ENGAGED AND 4993 02:46:09,240 --> 02:46:11,709 CARING FAMILY MEMBERS WHO WANT 4994 02:46:11,709 --> 02:46:14,512 THE KIND OF BEST FOR THEIR LOVED 4995 02:46:14,512 --> 02:46:15,246 ONE. 4996 02:46:15,246 --> 02:46:17,315 I THINK IT OFTENTIMES IN 4997 02:46:17,315 --> 02:46:20,552 GERIATRIC CARE IN GENERAL, IS TO 4998 02:46:20,552 --> 02:46:21,352 STEP BACK AND SAY LET'S NOT TALK 4999 02:46:21,352 --> 02:46:22,820 ABOUT THIS ONE DEVICE OR THIS 5000 02:46:22,820 --> 02:46:24,322 ONE PILL THAT WE'RE TAKING, BUT 5001 02:46:24,322 --> 02:46:26,190 KIND OF TRY TO STEP BACK AND SAY 5002 02:46:26,190 --> 02:46:27,458 WHAT'S MOST IMPORTANT HERE. 5003 02:46:27,458 --> 02:46:28,660 THINK ABOUT WHAT MATTERS FOR 5004 02:46:28,660 --> 02:46:29,961 THIS PATIENT. 5005 02:46:29,961 --> 02:46:31,696 AND THEN KIND OF COME UP WITH A 5006 02:46:31,696 --> 02:46:33,998 PLAN THAT ADDRESSES THE BEST IT 5007 02:46:33,998 --> 02:46:34,632 CAN. 5008 02:46:34,632 --> 02:46:35,733 AND SOMETIMES THAT MIGHT BE 5009 02:46:35,733 --> 02:46:39,437 USING TECHNOLOGY DEVICES. 5010 02:46:39,437 --> 02:46:41,906 I'M WORRIED ABOUT THE DEVICES 5011 02:46:41,906 --> 02:46:43,808 JUST FROM WHAT WE'VE HEARD ABOUT 5012 02:46:43,808 --> 02:46:48,346 CUFFLESS AT THE V DEVICES JUST T 5013 02:46:48,346 --> 02:46:49,948 WE HEARD YESTERDAY BUT IF WE PUT 5014 02:46:49,948 --> 02:46:52,250 IT IN THAT FRAMEWORK, JUST 5015 02:46:52,250 --> 02:46:53,151 SOLVING ONE QUESTION AT A TIME 5016 02:46:53,151 --> 02:46:54,452 THAT AN OLDER PATIENT AND THEIR 5017 02:46:54,452 --> 02:46:56,220 FAMILY HAS, WE SHOULD REALLY PUT 5018 02:46:56,220 --> 02:46:57,088 IT IN A CONTEXT FOR THEM. 5019 02:46:57,088 --> 02:46:58,423 I THINK THAT OFTENTIMES HELPS US 5020 02:46:58,423 --> 02:46:59,924 TO GET TO THE RIGHT ANSWER FOR 5021 02:46:59,924 --> 02:47:01,826 THEM. 5022 02:47:01,826 --> 02:47:02,927 AND YOU'RE RIGHT, THAT REALLY 5023 02:47:02,927 --> 02:47:04,095 DOESN'T -- IS THAT GOING TO MAKE 5024 02:47:04,095 --> 02:47:05,630 ME -- KEEP ME OUT OF THE 5025 02:47:05,630 --> 02:47:07,065 HOSPITAL, KEEP ME OUT OF THE 5026 02:47:07,065 --> 02:47:08,633 NURSING HOME, YOU KNOW, FOR WHAT 5027 02:47:08,633 --> 02:47:10,868 MATTERS MOST TO YOU, HOW LIKELY 5028 02:47:10,868 --> 02:47:12,604 IS THIS APPROACH GOING TO HELP 5029 02:47:12,604 --> 02:47:13,838 YOU ADDRESS THAT. 5030 02:47:13,838 --> 02:47:15,707 AND OFTENTIMES I THINK WHEN WE 5031 02:47:15,707 --> 02:47:17,141 TALK WITH OLDER ADULTS AND THEIR 5032 02:47:17,141 --> 02:47:18,376 FAMILY MEMBERS, THEY'RE 5033 02:47:18,376 --> 02:47:19,744 REALLY -- THE FAMILY MEMBERS ARE 5034 02:47:19,744 --> 02:47:21,079 WORRIED ABOUT SAFETY. 5035 02:47:21,079 --> 02:47:22,513 AND ARE THEY GOING TO FALL, ARE 5036 02:47:22,513 --> 02:47:24,248 THEY GOING TO -- YOU KNOW, IS 5037 02:47:24,248 --> 02:47:25,550 SOMETHING BAD GOING TO HAPPEN. 5038 02:47:25,550 --> 02:47:26,784 AND IF WE CAN'T KIND OF LINK 5039 02:47:26,784 --> 02:47:28,786 THESE KIND OF NEW APPROACHES TO 5040 02:47:28,786 --> 02:47:32,457 AVOIDING THAT, IT'S HARD FOR US 5041 02:47:32,457 --> 02:47:34,225 TO KIND OF SAY THIS FITS WITH 5042 02:47:34,225 --> 02:47:35,960 WHAT'S MOST IMPORTANT TO YOU. 5043 02:47:35,960 --> 02:47:36,961 >> RAY, THERE'S BEEN A LOT OF 5044 02:47:36,961 --> 02:47:37,895 QUESTIONS AND COMMENTS ABOUT 5045 02:47:37,895 --> 02:47:41,265 GETTING THESE NUMBERS FROM THE 5046 02:47:41,265 --> 02:47:42,367 COMMUNITY-BASED MEASUREMENTS 5047 02:47:42,367 --> 02:47:43,434 INTO THE ELECTRONIC HEALTH 5048 02:47:43,434 --> 02:47:44,268 RECORDS. 5049 02:47:44,268 --> 02:47:46,437 THAT IS A CONCERN. 5050 02:47:46,437 --> 02:47:47,372 THERE'S A CONCERN THAT THE 5051 02:47:47,372 --> 02:47:48,806 NUMBERS ARE JUST KIND OF 5052 02:47:48,806 --> 02:47:51,676 FLOATING OUT THERE AND NO ONE IS 5053 02:47:51,676 --> 02:47:52,610 REALLY LOOKING AT THEM. 5054 02:47:52,610 --> 02:47:54,379 IN NEW ORLEANS, WE DID USE 5055 02:47:54,379 --> 02:47:57,181 BLUETOOTH, SOME OF THE SAME 5056 02:47:57,181 --> 02:47:59,917 DEVICES THAT DR. COMMODORE 5057 02:47:59,917 --> 02:48:01,486 MENSAH IS USING AND WITH 5058 02:48:01,486 --> 02:48:02,086 BLUETOOTH, IT WILL COME BACK 5059 02:48:02,086 --> 02:48:03,254 WITH US EVEN WITHOUT THE PATIENT 5060 02:48:03,254 --> 02:48:05,056 DOING ANYTHING, THEY CAN BE 5061 02:48:05,056 --> 02:48:06,124 AUTOMATED WHERE YOU COULD SEE 5062 02:48:06,124 --> 02:48:06,758 THOSE RESULTS. 5063 02:48:06,758 --> 02:48:08,493 AND IN THAT PARTICULAR CASE, IT 5064 02:48:08,493 --> 02:48:10,595 OFTEN IMPROVES BLOOD PRESSURE 5065 02:48:10,595 --> 02:48:12,063 CONTROL EVEN WITHOUT THE 5066 02:48:12,063 --> 02:48:13,264 INTERVENING WITH CHANGE IN 5067 02:48:13,264 --> 02:48:13,798 PHARMACOTHERAPY. 5068 02:48:13,798 --> 02:48:15,633 IT'S ALMOST LIKE A HAWTHORNE 5069 02:48:15,633 --> 02:48:16,901 EFFECT, JUST HAVING THOSE 5070 02:48:16,901 --> 02:48:18,636 NUMBERS COME BACK TO US AND KNOW 5071 02:48:18,636 --> 02:48:19,837 WE'RE KIND OF LOOKING AT THEM, 5072 02:48:19,837 --> 02:48:21,139 THEY DO BETTER. 5073 02:48:21,139 --> 02:48:22,340 DO YOU HAVE ANY OTHER QUESTIONS, 5074 02:48:22,340 --> 02:48:23,741 RAY, BEFORE WE CLOSE? 5075 02:48:23,741 --> 02:48:30,648 >> NO, JUST ONE QUICK ONE FROM M 5076 02:48:30,648 --> 02:48:32,016 MARWAH ABDALLA, ONE OF THE 5077 02:48:32,016 --> 02:48:33,051 CO-CHAIRS OF THIS ENTIRE 5078 02:48:33,051 --> 02:48:33,484 SESSION. 5079 02:48:33,484 --> 02:48:36,020 BACK TO YOU, JOE, WHEN THE 5080 02:48:36,020 --> 02:48:37,288 FUNDING DOES END, DO YOU HAVE 5081 02:48:37,288 --> 02:48:38,156 ANY EXPERIENCE WITH WHAT HAPPENS 5082 02:48:38,156 --> 02:48:39,290 WITH THE PATIENTS? 5083 02:48:39,290 --> 02:48:41,225 DOES IT BREAK TRUST AND THINGS 5084 02:48:41,225 --> 02:48:43,227 LIKE THAT, IF SUDDENLY THEIR 5085 02:48:43,227 --> 02:48:45,063 BARBERSHOP GUY OR GAL IS SAYING, 5086 02:48:45,063 --> 02:48:47,532 I'M HERE TO CUT YOUR HAIR, WE 5087 02:48:47,532 --> 02:48:48,199 GAVE THE BLOOD PRESSURE MACHINE 5088 02:48:48,199 --> 02:48:49,634 BACK, YOU'RE GOING TO HAVE TO 5089 02:48:49,634 --> 02:48:52,170 GET YOUR HEALTHCARE AT YOUR -- 5090 02:48:52,170 --> 02:48:52,437 WHEREVER? 5091 02:48:52,437 --> 02:48:54,806 >> YES, IT'S VERY CHALLENGING 5092 02:48:54,806 --> 02:48:57,542 WHEN THESE PROGRAMS END BECAUSE 5093 02:48:57,542 --> 02:48:58,843 WE OFTEN DON'T HAVE THE 5094 02:48:58,843 --> 02:49:01,179 PERSONNEL TO CONTINUE TO DO 5095 02:49:01,179 --> 02:49:02,680 THEIR WORK. 5096 02:49:02,680 --> 02:49:07,452 AND BARBERS HAVE VOTEED WITH 5097 02:49:07,452 --> 02:49:09,854 THEIR FEET THAT WHEN THEY'RE NOT 5098 02:49:09,854 --> 02:49:11,255 GETTING PAID, THEY'RE NOT GOING 5099 02:49:11,255 --> 02:49:12,223 TO MEASURE BLOOD PRESSURE AND 5100 02:49:12,223 --> 02:49:12,657 RIGHTLY SO. 5101 02:49:12,657 --> 02:49:14,826 THEY GO TO WORK EVERY DAY TO BE 5102 02:49:14,826 --> 02:49:16,060 ABLE TO MAKE A LIVING. 5103 02:49:16,060 --> 02:49:19,931 SO WE HAVE TO FIND A WAY TO MAKE 5104 02:49:19,931 --> 02:49:21,365 SURE THAT FUNDING DOES NOT END. 5105 02:49:21,365 --> 02:49:22,867 >> CAN I MAKE A COMMENT? 5106 02:49:22,867 --> 02:49:24,135 I THINK ONE OF THE THINGS YOU 5107 02:49:24,135 --> 02:49:30,541 MIGHT BE DOING, AND 5108 02:49:30,541 --> 02:49:31,309 COMMODORE-MENSAH, YOU'RE DOING 5109 02:49:31,309 --> 02:49:33,444 THE SAME, EMPOWERING THE 5110 02:49:33,444 --> 02:49:35,646 PATIENTS SO WHEN THEY GO BACK TO 5111 02:49:35,646 --> 02:49:36,547 THEIR CLINICIAN AND THEY SAY 5112 02:49:36,547 --> 02:49:37,515 YOUR BLOOD PRESSURE IS A LITTLE 5113 02:49:37,515 --> 02:49:39,250 HIGH AND THEY SAY WELL WHAT IS 5114 02:49:39,250 --> 02:49:41,085 MY NUMBER? 5115 02:49:41,085 --> 02:49:42,320 SOMETIMES THE DOCTOR IS GOING TO 5116 02:49:42,320 --> 02:49:43,121 GET FRUSTRATED BECAUSE THEY 5117 02:49:43,121 --> 02:49:44,355 DON'T WANT THE PATIENT TO BE AN 5118 02:49:44,355 --> 02:49:45,523 INFORMED AND EDUCATED PERSON, 5119 02:49:45,523 --> 02:49:46,491 BUT IF YOU CAN JUST STAY OUT 5120 02:49:46,491 --> 02:49:48,192 THERE AND EDUCATE PATIENTS, EVEN 5121 02:49:48,192 --> 02:49:49,327 IF YOUR PROGRAM IS NOT OP GOING, 5122 02:49:49,327 --> 02:49:51,229 I THINK YOU NOW HAVE A CADRE OF 5123 02:49:51,229 --> 02:49:52,730 INDIVIDUALS WHO CAN CHALLENGE 5124 02:49:52,730 --> 02:49:54,465 THEIR SO-CALLED PRIMARY CARE 5125 02:49:54,465 --> 02:49:56,768 PROVIDER TO DO THE RIGHT THING. 5126 02:49:56,768 --> 02:49:58,369 AND WE KNOW THERE'S REAL BIAS IN 5127 02:49:58,369 --> 02:50:00,104 THE SYSTEM WHERE DOCTORS DO TELL 5128 02:50:00,104 --> 02:50:01,472 PEOPLE A THING LIKE WELL, YOUR 5129 02:50:01,472 --> 02:50:02,840 PRESSURE IS A LITTLE HIGH TODAY. 5130 02:50:02,840 --> 02:50:04,976 >> YES, ABSOLUTELY, 5131 02:50:04,976 --> 02:50:05,309 DR. FERDINAND. 5132 02:50:05,309 --> 02:50:05,743 THANK YOU FOR THAT. 5133 02:50:05,743 --> 02:50:07,645 AND YOU KNOW, ONE OF THE 5134 02:50:07,645 --> 02:50:09,013 CHALLENGES THAT WE SAW BACK WHEN 5135 02:50:09,013 --> 02:50:11,849 WE WERE DOING THIS WORK WAS THE 5136 02:50:11,849 --> 02:50:13,951 NOTION OF A DIFFERENT OUT OF 5137 02:50:13,951 --> 02:50:15,186 OFFICE THRESHOLD COMPARED TO 5138 02:50:15,186 --> 02:50:17,455 OFFICE THRESHOLD WAS VERY 5139 02:50:17,455 --> 02:50:18,389 COMMON, YOU KNOW, TO THOSE OF US 5140 02:50:18,389 --> 02:50:20,858 WHO WERE IN THE HYPERTENSION 5141 02:50:20,858 --> 02:50:22,326 BUSINESS, BUT WAS NOT WELL-KNOWN 5142 02:50:22,326 --> 02:50:24,262 TO OUR PRIMARY CARE DOCTORS. 5143 02:50:24,262 --> 02:50:26,697 SO OUR BARBERS WOULD BE TELLING 5144 02:50:26,697 --> 02:50:27,632 OUR -- WOULD BE TELLING 5145 02:50:27,632 --> 02:50:28,366 CUSTOMERS THAT THEIR BLOOD 5146 02:50:28,366 --> 02:50:29,834 PRESSURE IS HIGH, THEY WOULD GO 5147 02:50:29,834 --> 02:50:31,369 TO THEIR DOCTOR WHO WOULD SAY, 5148 02:50:31,369 --> 02:50:32,870 YOUR BLOOD PRESSURE IS JUST FINE 5149 02:50:32,870 --> 02:50:37,575 BECAUSE IT'S LESS THAN 140/90. 5150 02:50:37,575 --> 02:50:38,976 AND SO WE'RE SORT OF LIVING 5151 02:50:38,976 --> 02:50:40,978 THROUGH THAT CURRENTLY, WHERE 5152 02:50:40,978 --> 02:50:43,214 MANY DOCTORS HAVE NOT YET 5153 02:50:43,214 --> 02:50:47,051 ADOPTED THE 2017 AMERICAN HEART 5154 02:50:47,051 --> 02:50:48,886 ASSOCIATION, AMERICAN CARDIOLOGY 5155 02:50:48,886 --> 02:50:52,690 THRESHOLDS, AND WE'RE PREACHING 5156 02:50:52,690 --> 02:50:53,925 130/80 BUT MANY PRACTITIONERS 5157 02:50:53,925 --> 02:51:00,598 ARE STILL ALLOWING 140/90 TO GO 5158 02:51:00,598 --> 02:51:01,165 UNTREATED. 5159 02:51:01,165 --> 02:51:01,632 SO THANK YOU. 5160 02:51:01,632 --> 02:51:04,235 >> WELL, I THINK IT'S KNOCKING 5161 02:51:04,235 --> 02:51:05,469 AT 2:00 EASTERN TIME HERE. 5162 02:51:05,469 --> 02:51:07,205 SO THAT'S OUR TIME FOR A BREAK 5163 02:51:07,205 --> 02:51:08,673 AND MAYBE THOSE OF YOU THAT ARE 5164 02:51:08,673 --> 02:51:11,008 A LITTLE HYPOGLYCEMIC BY NOW 5165 02:51:11,008 --> 02:51:12,543 MIGHT WANT TO ATTEND TO THAT. 5166 02:51:12,543 --> 02:51:14,712 SO I WANT TO THANK OUR FOUR 5167 02:51:14,712 --> 02:51:16,180 PRESENTERS FOR I THINK IT WAS A 5168 02:51:16,180 --> 02:51:17,949 GREAT SESSION, CERTAINLY HAD 5169 02:51:17,949 --> 02:51:18,616 ENOUGH Q & A. 5170 02:51:18,616 --> 02:51:19,984 WE DIDN'T GET TO ONE OR TWO OF 5171 02:51:19,984 --> 02:51:21,552 THE QUESTIONS, SO THANKS, 5172 02:51:21,552 --> 02:51:23,230 EVERYONE, FOR PARTICIPATING. 5173 02:51:23,230 --> 02:51:24,765 SO LOOKING FORWARD 5174 02:51:24,765 --> 02:51:26,033 TO HEARING OUR REPORT OUTS FROM 5175 02:51:26,033 --> 02:51:28,436 EACH OF THE MODERATORS AND EACH 5176 02:51:28,436 --> 02:51:28,803 OF THE SESSIONS. 5177 02:51:28,803 --> 02:51:32,006 IT'S A PLEASURE TO INTRODUCE 5178 02:51:32,006 --> 02:51:34,341 TAMMY AND RAMA WITH A 5179 02:51:34,341 --> 02:51:35,242 STIMULATING CONVERSATION ABOUT 5180 02:51:35,242 --> 02:51:38,779 THE PRACTICAL OR IMPRACTICAL USE 5181 02:51:38,779 --> 02:51:39,447 OF EMERGING DEVICES. 5182 02:51:39,447 --> 02:51:42,750 SO I'LL LET RAMA AND TAMMY, AND 5183 02:51:42,750 --> 02:51:44,919 JOSH, IF YOU WOULDN'T MIND 5184 02:51:44,919 --> 02:51:46,554 SHARING FOR THEM THE DOCUMENT 5185 02:51:46,554 --> 02:51:49,757 THAT THEY JUST SENT YOU. 5186 02:51:49,757 --> 02:52:00,167 OR I THINK IT'S ANTOINE. 5187 02:52:28,429 --> 02:52:30,331 CAN YOU CONFIRM YOU RECEIVED THE 5188 02:52:30,331 --> 02:52:33,367 DOCUMENT? 5189 02:52:33,367 --> 02:52:35,536 >> YES, THE DOCUMENT HAS BEEN 5190 02:52:35,536 --> 02:52:35,803 RECEIVED. 5191 02:52:35,803 --> 02:52:37,671 JUST WAITING FOR AV TO SHARE. 5192 02:52:37,671 --> 02:52:45,379 >> OKAY, THANK YOU. 5193 02:52:45,379 --> 02:52:49,850 OWOKAY, RAMA AND TAMMY. 5194 02:52:49,850 --> 02:52:52,853 >> RAMA, DO YOU WANT TO GO 5195 02:52:52,853 --> 02:52:53,120 FIRST? 5196 02:52:53,120 --> 02:52:55,189 I THINK THAT WOULD PROBABLY BE 5197 02:52:55,189 --> 02:52:55,623 BEST. 5198 02:52:55,623 --> 02:52:59,660 >> IF YOU COULD JUST LOOK AT THE 5199 02:52:59,660 --> 02:53:01,962 GREEN, WE HAVE A LOT OF STUFF 5200 02:53:01,962 --> 02:53:03,497 THAT, YOU KNOW, WE'LL NEED TO 5201 02:53:03,497 --> 02:53:05,799 RECONSIDER LATER, BUT WE WERE 5202 02:53:05,799 --> 02:53:09,603 AIALITTLE BIT UNDER DURESS DOWNE 5203 02:53:09,603 --> 02:53:09,837 STRETCH. 5204 02:53:09,837 --> 02:53:12,072 ANYWAY, I THINK THAT AT LEAST AS 5205 02:53:12,072 --> 02:53:13,073 OF -- YOU KNOW, IN THE TIME 5206 02:53:13,073 --> 02:53:17,378 PERIOD WE HAD, THESE WERE THE 5207 02:53:17,378 --> 02:53:18,178 THREE -- THE INSTRUCTIONS SAID 5208 02:53:18,178 --> 02:53:20,047 TO COME UP WITH AT LEAST THREE 5209 02:53:20,047 --> 02:53:22,816 KEY QUESTIONS. 5210 02:53:22,816 --> 02:53:24,251 AND THESE WERE THE THREE 5211 02:53:24,251 --> 02:53:25,252 QUESTIONS THE GROUP CAME UP 5212 02:53:25,252 --> 02:53:25,819 WITH. 5213 02:53:25,819 --> 02:53:27,988 QUESTION ONE, HOW TO VALIDATE 5214 02:53:27,988 --> 02:53:29,857 THESE DEVICES FOR ACCURACY. 5215 02:53:29,857 --> 02:53:31,959 LIKE THAT'S -- I THINK IT'S A 5216 02:53:31,959 --> 02:53:33,160 CRUCIAL QUESTION. 5217 02:53:33,160 --> 02:53:35,596 HOW TO USE THE DEVICES ONCE 5218 02:53:35,596 --> 02:53:37,831 THEY'RE VALIDATED IN CLINICAL 5219 02:53:37,831 --> 02:53:40,467 PRACTICE. 5220 02:53:40,467 --> 02:53:41,635 AND WHAT ARE THE USE CASES FROM 5221 02:53:41,635 --> 02:53:43,137 THE PROVIDER PERSPECTIVE. 5222 02:53:43,137 --> 02:53:45,139 AND THIRDLY, WHAT ARE THE 5223 02:53:45,139 --> 02:53:47,741 SPECIAL POPULATIONS. 5224 02:53:47,741 --> 02:53:52,346 SO THOSE WERE, I THINK, THE 5225 02:53:52,346 --> 02:53:54,481 THREE QUESTIONS THAT EMERGED, 5226 02:53:54,481 --> 02:53:56,116 CAME TO THE SURFACE. 5227 02:53:56,116 --> 02:53:57,585 AND UNDERNEATH, IF YOU COULD 5228 02:53:57,585 --> 02:54:01,322 SCROLL DOWN, PLEASE, SO HOW TO 5229 02:54:01,322 --> 02:54:03,023 VALIDATE THESE DEVICES FOR 5230 02:54:03,023 --> 02:54:03,290 ACCURACY. 5231 02:54:03,290 --> 02:54:04,525 THESE WERE SOME OF THE BARRIERS. 5232 02:54:04,525 --> 02:54:05,626 I THINK THERE'S MANY. 5233 02:54:05,626 --> 02:54:07,661 THERE'S EVEN MORE THAN WHAT WE 5234 02:54:07,661 --> 02:54:08,162 HAVE. 5235 02:54:08,162 --> 02:54:09,330 COULD YOU SCROLL UP A LITTLE 5236 02:54:09,330 --> 02:54:11,298 BIT, PLEASE, TO CAPTURE THE 5237 02:54:11,298 --> 02:54:12,933 ONE -- HERE IT IS. 5238 02:54:12,933 --> 02:54:14,268 SO HERE ARE SOME OF THE BARRIERS 5239 02:54:14,268 --> 02:54:18,072 WE IDENTIFIED. 5240 02:54:18,072 --> 02:54:19,106 THERE'S A MULTITUDE OF DEVICES 5241 02:54:19,106 --> 02:54:20,841 AND THEY ALL HAVE DIFFERENT 5242 02:54:20,841 --> 02:54:21,408 FUNCTIONS, DIFFERENT 5243 02:54:21,408 --> 02:54:22,376 CALIBRATIONS, AND SO 5244 02:54:22,376 --> 02:54:23,577 UNDERSTANDING HOW THEY WORK IS A 5245 02:54:23,577 --> 02:54:26,780 HUGE BARRIER. 5246 02:54:26,780 --> 02:54:31,151 AND MAKING THE VALIDATION 5247 02:54:31,151 --> 02:54:34,955 PRACTICAL TO MANUFACTURES YET 5248 02:54:34,955 --> 02:54:36,390 MEANINGFUL TO THE USERS, RIGHT, 5249 02:54:36,390 --> 02:54:42,329 AND HAVING REGULATORY AND 5250 02:54:42,329 --> 02:54:44,365 GUIDELINES COINCIDE, WHAT 5251 02:54:44,365 --> 02:54:45,666 YARDSTICK IS USED FOR ACCURACY. 5252 02:54:45,666 --> 02:54:47,701 SO IF REGULATORY WANTS A CLEAR A 5253 02:54:47,701 --> 02:54:53,273 DEVICE, IT WOULD BE IDEAL IF THE 5254 02:54:53,273 --> 02:54:54,341 CLINICIANS WERE ON BOARD AND 5255 02:54:54,341 --> 02:54:56,043 VICE VERSA. 5256 02:54:56,043 --> 02:55:01,415 AND DEFINING THESE ARE 5257 02:55:01,415 --> 02:55:02,916 FUNDAMENTALLY BP CHANGE 5258 02:55:02,916 --> 02:55:04,151 MEASUREMENT DEVICES SO DEFINING 5259 02:55:04,151 --> 02:55:05,152 THE TYPES OF BLOOD PRESSURE 5260 02:55:05,152 --> 02:55:07,688 CHANGES THAT ARE NEEDED FOR THE 5261 02:55:07,688 --> 02:55:07,988 VALIDATION. 5262 02:55:07,988 --> 02:55:11,191 IT'S A SUPER HARD PROBLEM. 5263 02:55:11,191 --> 02:55:12,926 THAT CONNECTS TO TRACTABILITY 5264 02:55:12,926 --> 02:55:16,330 AND MEANINGFULNESS, THAT 5265 02:55:16,330 --> 02:55:18,632 TRADEOFF. 5266 02:55:18,632 --> 02:55:19,433 DETERMINING WHAT REFERENCE TO 5267 02:55:19,433 --> 02:55:20,801 USE WHEN THERE IS NO REFERENCE. 5268 02:55:20,801 --> 02:55:22,736 THAT WILL INVARIABLY COME UP AT 5269 02:55:22,736 --> 02:55:27,174 LEAST IN THESE CURRENT DEVICES. 5270 02:55:27,174 --> 02:55:31,211 AND ADDRESSING ALL THE DIFFERENT 5271 02:55:31,211 --> 02:55:32,112 CATEGORIES AND TECHNOLOGIES THAT 5272 02:55:32,112 --> 02:55:35,983 ARE E EMERGING, THAT CONNECTS BK 5273 02:55:35,983 --> 02:55:37,685 TO UNDERSTANDING HOW ALL THE 5274 02:55:37,685 --> 02:55:38,986 DEVICES WORK AND ADDRESSING EACH 5275 02:55:38,986 --> 02:55:40,721 ONE OF THEM. 5276 02:55:40,721 --> 02:55:44,525 AS ONE EXAMPLE, THESE OPTICAL OR 5277 02:55:44,525 --> 02:55:47,361 PPG DEVICES, HOW DO WE EVALUATE 5278 02:55:47,361 --> 02:55:49,029 THEM FOR SKIN COLOR, IF YOU'RE 5279 02:55:49,029 --> 02:55:50,931 LOOKING AT THE BACK OF THEIR 5280 02:55:50,931 --> 02:55:53,367 WRIST, FOR EXAMPLE, DEVICE, YOU 5281 02:55:53,367 --> 02:55:55,169 KNOW, IT'S NOT THE PALMAR SIDE 5282 02:55:55,169 --> 02:55:56,537 OF THE HAND OR ANYTHING AND 5283 02:55:56,537 --> 02:55:58,739 THERE'S A LOT OF MELANIN THERE, 5284 02:55:58,739 --> 02:55:59,373 SO THAT WILL BE A CONCERN AND 5285 02:55:59,373 --> 02:56:02,142 HOW DO WE HANDLE THAT. 5286 02:56:02,142 --> 02:56:05,245 THAT'S NOT IN ANY OF THE 5287 02:56:05,245 --> 02:56:07,114 PREVIOUS IEE STANDARD OR EVEN 5288 02:56:07,114 --> 02:56:09,483 THE ESH RECOMMENDATIONS, UP TO 5289 02:56:09,483 --> 02:56:10,718 NOW IT'S BEEN IGNORED, I 5290 02:56:10,718 --> 02:56:15,289 BELIEVE. 5291 02:56:15,289 --> 02:56:16,056 COULD YOU SCROLL DOWN? 5292 02:56:16,056 --> 02:56:18,292 SO HOW TO USE THE DEVICES, THAT 5293 02:56:18,292 --> 02:56:20,561 WAS THE -- NO, THESE ARE -- 5294 02:56:20,561 --> 02:56:21,228 YEAH, RIGHT HERE. 5295 02:56:21,228 --> 02:56:25,566 SO HOW TO USE THE DEVICES. 5296 02:56:25,566 --> 02:56:27,301 SO I THINK A BARRIER IS TO 5297 02:56:27,301 --> 02:56:29,002 SOMEHOW LEVERAGE THE POTENTIALLY 5298 02:56:29,002 --> 02:56:30,170 NUMEROUS SERIAL MEASUREMENTS OF 5299 02:56:30,170 --> 02:56:35,042 BLOOD PRESSURE VARIATIONS THAT 5300 02:56:35,042 --> 02:56:36,343 COULD COME OUT OF THESE DEVICES 5301 02:56:36,343 --> 02:56:39,179 AND TO TRY TO COUPLE THEM TO THE 5302 02:56:39,179 --> 02:56:40,414 CONTEXTUAL INFORMATION, THAT WAS 5303 02:56:40,414 --> 02:56:43,917 TALKED ABOUT IN SOME OF THE 5304 02:56:43,917 --> 02:56:44,351 SESSIONS. 5305 02:56:44,351 --> 02:56:47,621 YOU KNOW, LIKE WHEN BLOOD 5306 02:56:47,621 --> 02:56:49,323 PRESSURE CHANGES, KNOWING THAT 5307 02:56:49,323 --> 02:56:54,361 IT OCCURRED AFTER A MEAL, FOR 5308 02:56:54,361 --> 02:56:56,497 EXAMPLE, OR IT WAS FOLLOWED BY A 5309 02:56:56,497 --> 02:56:58,232 FALL. 5310 02:56:58,232 --> 02:57:02,936 AND ALSO IN TERMS OF USE, WE 5311 02:57:02,936 --> 02:57:04,238 SHOULD DETERMINE THE BENEFITS 5312 02:57:04,238 --> 02:57:08,575 AND RISKS FOR THE PROVIDER AND 5313 02:57:08,575 --> 02:57:09,543 USER. 5314 02:57:09,543 --> 02:57:10,310 YOU KNOW, FOR THE PROVIDER, 5315 02:57:10,310 --> 02:57:11,311 GETTING INFORMATION OVERLOAD, 5316 02:57:11,311 --> 02:57:14,214 FOR THE USER, OVERREACTING TO A 5317 02:57:14,214 --> 02:57:15,015 MEASUREMENT. 5318 02:57:15,015 --> 02:57:17,117 LIKE FOR EXAMPLE, IF THEY SEE 5319 02:57:17,117 --> 02:57:23,023 THEIR BLOOD PRESSURE IS LOW, 5320 02:57:23,023 --> 02:57:25,092 I'LL JUST SKIP MY MEDS, YOU 5321 02:57:25,092 --> 02:57:26,160 KNOW, THINGS LIKE THAT. 5322 02:57:26,160 --> 02:57:27,261 AND DETERMINING HOW TO ENSURE 5323 02:57:27,261 --> 02:57:28,629 THAT PEOPLE USE THE DEVICE 5324 02:57:28,629 --> 02:57:28,929 CORRECTLY. 5325 02:57:28,929 --> 02:57:30,998 MUCH OF THIS WORKSHOP IS GETTING 5326 02:57:30,998 --> 02:57:32,366 PEOPLE TO USE THE CUFF DEVICE 5327 02:57:32,366 --> 02:57:33,534 CORRECTLY, AND THAT COULD VERY 5328 02:57:33,534 --> 02:57:35,302 WELL APPLY HERE WITH CUFFLESS 5329 02:57:35,302 --> 02:57:38,071 DEVICES. 5330 02:57:38,071 --> 02:57:39,473 IN TERMS OF OUR THIRD KEY 5331 02:57:39,473 --> 02:57:42,543 QUESTION ABOUT WHAT ARE THE 5332 02:57:42,543 --> 02:57:46,346 SPECIAL -- HANDLING SPECIAL 5333 02:57:46,346 --> 02:57:47,014 POPULATIONS, WE DON'T KNOW WHAT 5334 02:57:47,014 --> 02:57:50,584 THEY ARE. 5335 02:57:50,584 --> 02:57:52,619 IN CUFFLESS DEVICES, THEY'RE 5336 02:57:52,619 --> 02:57:54,388 MACHINE LEARNING BASED, THEY'RE 5337 02:57:54,388 --> 02:57:55,289 DATA-DRIVEN, WE DON'T KNOW WHAT 5338 02:57:55,289 --> 02:57:56,056 THE TRAINING DATA ARE. 5339 02:57:56,056 --> 02:57:57,591 MAYBE THE TRAINING DATA HAS VERY 5340 02:57:57,591 --> 02:58:00,460 FEW CHILDREN IN IT, FOR EXAMPLE. 5341 02:58:00,460 --> 02:58:02,329 OR MAYBE IT HAS VERY FEW PEOPLE 5342 02:58:02,329 --> 02:58:03,430 WITH DARK SKIN OR SOMETHING. 5343 02:58:03,430 --> 02:58:04,932 SO WE DON'T KNOW WHAT THE 5344 02:58:04,932 --> 02:58:10,237 SPECIAL POPULATIONS ARE. 5345 02:58:10,237 --> 02:58:12,306 IN A LOT OF WAYS IT'S DETERMINED 5346 02:58:12,306 --> 02:58:13,507 BY THE DATA THAT WAS USED TO 5347 02:58:13,507 --> 02:58:17,177 BUILD THE DEVICE. 5348 02:58:17,177 --> 02:58:18,879 YOU KNOW, IN THAT LIGHT, GETTING 5349 02:58:18,879 --> 02:58:19,479 TRANSPARENCY FROM THE 5350 02:58:19,479 --> 02:58:20,681 MANUFACTURERS AND PERHAPS EVEN A 5351 02:58:20,681 --> 02:58:24,551 DESCRIPTION OF THE DATA, THAT 5352 02:58:24,551 --> 02:58:26,553 WOULD HELP A LOT IN EFFICIENT 5353 02:58:26,553 --> 02:58:28,455 DETERMINATION OF SPECIAL 5354 02:58:28,455 --> 02:58:29,089 POPULATIONS, BUT CERTAINLY IT'S 5355 02:58:29,089 --> 02:58:29,990 A BARRIER. 5356 02:58:29,990 --> 02:58:30,657 THEY DON'T WANT TO SHARE 5357 02:58:30,657 --> 02:58:33,393 ANYTHING IN GENERAL. 5358 02:58:33,393 --> 02:58:36,830 SO I THINK THAT THOSE ARE THE 5359 02:58:36,830 --> 02:58:38,298 THREE QUESTIONS AND SOME OF THE 5360 02:58:38,298 --> 02:58:38,565 BARRIERS. 5361 02:58:38,565 --> 02:58:40,167 IF WE HAVE -- YOU KNOW, WE CAN 5362 02:58:40,167 --> 02:58:41,268 SPEND MORE TIME THINKING ABOUT 5363 02:58:41,268 --> 02:58:44,238 THOSE BARRIERS, AND THESE WERE 5364 02:58:44,238 --> 02:58:45,505 SOME OF THE FUTURE DIRECTIONS ON 5365 02:58:45,505 --> 02:58:47,808 ALL OF THEM, ALL THE QUESTIONS 5366 02:58:47,808 --> 02:58:50,344 AND BARRIERS. 5367 02:58:50,344 --> 02:58:52,246 I THINK THE MOST IMPORTANT ONES 5368 02:58:52,246 --> 02:58:55,349 ARE FOCUSING ON GETTING ALL 5369 02:58:55,349 --> 02:58:56,550 STAKEHOLDERS, MANUFACTURERS, 5370 02:58:56,550 --> 02:58:59,786 PROVIDERS, USERS, TOGETHER, AND 5371 02:58:59,786 --> 02:59:00,787 ESPECIALLY COLLABORATING WITH 5372 02:59:00,787 --> 02:59:03,323 THE MANUFACTURER, SO INSTEAD OF 5373 02:59:03,323 --> 02:59:06,260 LOOKING AT THEM AS ADVERSARIES, 5374 02:59:06,260 --> 02:59:08,061 LOOKING AT THEM AS OUR PARTNERS 5375 02:59:08,061 --> 02:59:10,964 TO TRY TO GET THEIR DEVICES INTO 5376 02:59:10,964 --> 02:59:11,932 PRACTICE. 5377 02:59:11,932 --> 02:59:13,634 AND YOU KNOW, I THINK A SECOND 5378 02:59:13,634 --> 02:59:14,968 AND RELATED VERY IMPORTANT THING 5379 02:59:14,968 --> 02:59:17,137 IS GETTING MORE CLINICIANS 5380 02:59:17,137 --> 02:59:20,807 INVOLVED IN TERMS OF THE NEEDS, 5381 02:59:20,807 --> 02:59:23,810 WE DO, NOT I, I DO, BUT SO DOES 5382 02:59:23,810 --> 02:59:25,545 TAMMY AND EVERYONE ELSE, RAISING 5383 02:59:25,545 --> 02:59:27,281 CONCERNS, ENSURING WHICH TYPES 5384 02:59:27,281 --> 02:59:28,715 OF CLINICAL TESTING IS NEEDED 5385 02:59:28,715 --> 02:59:31,585 AND WHICH TYPES ARE NOT, SO I 5386 02:59:31,585 --> 02:59:33,253 THINK THE MAIN FUTURE DIRECTION 5387 02:59:33,253 --> 02:59:35,789 AND STRATEGY WE HAVE IS GETTING 5388 02:59:35,789 --> 02:59:39,927 THE STAKEHOLDERS IN APPROPRIATE 5389 02:59:39,927 --> 02:59:40,861 PROPORTIONS TOGETHER TO TRY TO 5390 02:59:40,861 --> 02:59:45,465 GET THESE DEVICES INTO PATIENTS' 5391 02:59:45,465 --> 02:59:48,101 HANDS AND IMPROVING 5392 02:59:48,101 --> 02:59:49,036 HYPERTENSION, AWARENESS AND 5393 02:59:49,036 --> 02:59:49,970 CONTROL RATES. 5394 02:59:49,970 --> 02:59:50,904 SOME OF THE OTHER THINGS WE HAD 5395 02:59:50,904 --> 02:59:55,142 TALKED ABOUT IN TERMS OF LIKE 5396 02:59:55,142 --> 02:59:56,810 USE AND STUFF IS FOCUSING ON 5397 02:59:56,810 --> 02:59:58,078 HYPERTENSION BRANDING, NOT FROM 5398 02:59:58,078 --> 03:00:00,080 THE EXPERTS BUT LIKE FROM 5399 03:00:00,080 --> 03:00:03,917 PUBLIC, AND EDUCATION WITH THE 5400 03:00:03,917 --> 03:00:06,086 DEVICES TO BRING TO SOCIETY. 5401 03:00:06,086 --> 03:00:08,055 WHEN WE DESIGN TRIALS, THAT IT 5402 03:00:08,055 --> 03:00:12,192 TAKES A HUMAN CENTERED APPROACH 5403 03:00:12,192 --> 03:00:15,228 WHERE THE PARTICIPANT HAS TO USE 5404 03:00:15,228 --> 03:00:18,031 THE DEVICE THEMSELVES. 5405 03:00:18,031 --> 03:00:19,333 SO -- AND ALSO TO CONSIDER 5406 03:00:19,333 --> 03:00:21,902 IMPLEMENTATION OF NEW DEVICES IN 5407 03:00:21,902 --> 03:00:23,470 THE IMPLEMENTATION OF OLD 5408 03:00:23,470 --> 03:00:25,806 DEVICE, LIKE ABPM, IF WE ARE 5409 03:00:25,806 --> 03:00:26,740 LUCKY ENOUGH TO GET TO THAT 5410 03:00:26,740 --> 03:00:29,076 POINT. 5411 03:00:29,076 --> 03:00:31,378 TO SUMMARIZE, I THINK OUR MAIN 5412 03:00:31,378 --> 03:00:32,746 FUTURE DIRECTION IS GETTING THE 5413 03:00:32,746 --> 03:00:36,516 RIGHT PEOPLE TOGETHER TO ADDRESS 5414 03:00:36,516 --> 03:00:39,686 THESE THREE KEY QUESTIONS IN THD 5415 03:00:39,686 --> 03:00:41,355 THE NUMEROUS BARRIERS RELATED TO 5416 03:00:41,355 --> 03:00:42,255 EACH. 5417 03:00:42,255 --> 03:00:43,690 TAMMY, DO YOU HAVE ANYTHING TO 5418 03:00:43,690 --> 03:00:44,858 CORRECT OR ADD? 5419 03:00:44,858 --> 03:00:45,926 >> NO, THAT WAS GREAT. 5420 03:00:45,926 --> 03:00:49,096 THAT WAS GREAT. 5421 03:00:49,096 --> 03:00:51,398 >> THANK YOU, TAMMY AND RAMA, 5422 03:00:51,398 --> 03:00:52,232 REALLY APPRECIATE IT. 5423 03:00:52,232 --> 03:00:56,303 THE NEXT BREAKOUT IS GOING TO BE 5424 03:00:56,303 --> 03:00:58,739 LED BY -- AND JOE, ENSURING 5425 03:00:58,739 --> 03:01:02,576 ACCESS AND EQUITY IN BLOOD 5426 03:01:02,576 --> 03:01:03,710 PRESSURE ASSESSMENT AND 5427 03:01:03,710 --> 03:01:04,611 MONITORING. 5428 03:01:04,611 --> 03:01:05,645 >> GREAT, THANK YOU. 5429 03:01:05,645 --> 03:01:07,814 TERRIFIC JOB, BREAKOUT NUMBER 5430 03:01:07,814 --> 03:01:12,719 ONE. 5431 03:01:12,719 --> 03:01:14,921 SO I EMAILED OUR SLIDES TO 5432 03:01:14,921 --> 03:01:16,656 YOU -- OH, THANK YOU, JOSHUA. 5433 03:01:16,656 --> 03:01:17,157 APPRECIATE THAT. 5434 03:01:17,157 --> 03:01:19,593 ALL RIGHT. 5435 03:01:19,593 --> 03:01:25,032 SO I WAS HAPPY TO BE YVONNE'S 5436 03:01:25,032 --> 03:01:27,367 WINGMAN FOR BREAKOUT GROUP 2. 5437 03:01:27,367 --> 03:01:31,638 WE HAD A TERRIFIC GROUP WHERE 5438 03:01:31,638 --> 03:01:33,140 OUR CHARGE WAS TO TALK ABOUT 5439 03:01:33,140 --> 03:01:34,041 ENSURING ACCESS AND EQUITY IN 5440 03:01:34,041 --> 03:01:38,712 BLOOD PRESSURE ASSESSMENT AND 5441 03:01:38,712 --> 03:01:40,747 MONITORING. 5442 03:01:40,747 --> 03:01:45,419 WE CAME UP WITH A NUMBER OF GAPS 5443 03:01:45,419 --> 03:01:47,854 THAT ARE ALL LISTED HERE, BUT 5444 03:01:47,854 --> 03:01:51,391 BASICALLY WE DISTILLED IT INTO 5445 03:01:51,391 --> 03:01:53,293 THESE FOUR KEY RESEARCH 5446 03:01:53,293 --> 03:01:58,665 QUESTIONS, WHICH INCLUDE 5447 03:01:58,665 --> 03:01:59,733 ANALYZING COST-EFFECTIVENESS OF 5448 03:01:59,733 --> 03:02:02,335 SCREENING AND LINKAGE TO CARE 5449 03:02:02,335 --> 03:02:04,371 APPROACHES, REALIZING THAT 5450 03:02:04,371 --> 03:02:07,274 ULTIMATELY WHAT WE NEED TO SCALE 5451 03:02:07,274 --> 03:02:10,277 AND SUSTAIN MANY OF THESE 5452 03:02:10,277 --> 03:02:13,080 PROGRAMS IS BUY-IN AND FUNDING 5453 03:02:13,080 --> 03:02:18,952 FROM PARTNERS SUCH AS PAYORS, AS 5454 03:02:18,952 --> 03:02:20,020 WELL AS GOVERNMENT ENTITIES AND 5455 03:02:20,020 --> 03:02:22,522 SO HAVING AN UNDERSTANDING OF 5456 03:02:22,522 --> 03:02:25,325 COST IS GOING TO BE KEY IN THAT. 5457 03:02:25,325 --> 03:02:27,360 ALSO THINKING ABOUT MESSAGING 5458 03:02:27,360 --> 03:02:29,029 FOR HOW WE CAN MAKE PATIENTS 5459 03:02:29,029 --> 03:02:32,532 MORE LIKELY TO ENGAGE AND STAY 5460 03:02:32,532 --> 03:02:34,201 ENGAGED IN SELF-MONITORING. 5461 03:02:34,201 --> 03:02:37,971 ANOTHER KEY QUESTION WAS AROUND 5462 03:02:37,971 --> 03:02:39,072 IMPLEMENTATION SCIENCE TO 5463 03:02:39,072 --> 03:02:43,009 SUPPORT PROGRAMS TO ENHANCE 5464 03:02:43,009 --> 03:02:45,846 ACCESS, REALLY THINKING ABOUT 5465 03:02:45,846 --> 03:02:47,080 ACCESSIBILITY POPULATIONS WHO WE 5466 03:02:47,080 --> 03:02:50,650 KNOW ARE INCREDIBLY UNDERSTUD 5467 03:02:50,650 --> 03:02:54,554 DIEDSTUDIEDIN THE HYPERTENSION E 5468 03:02:54,554 --> 03:02:55,555 BUT FOR EXAMPLE, AS WE THINK 5469 03:02:55,555 --> 03:02:57,657 ABOUT OUR VALIDATED MONITORS, 5470 03:02:57,657 --> 03:03:01,895 YOU KNOW, ARE THEY USABLE BY 5471 03:03:01,895 --> 03:03:04,831 PEOPLE WHO ARE BLIND AND/OR LOW 5472 03:03:04,831 --> 03:03:06,299 VISION AND WHAT ABOUT FOLKS WHO 5473 03:03:06,299 --> 03:03:10,203 HAVE OTHER TYPES OF NEEDS, 5474 03:03:10,203 --> 03:03:12,973 THAT'S AN AREA WHERE WE CAN 5475 03:03:12,973 --> 03:03:14,174 DEFINITELY STAND SO HAVE MORE 5476 03:03:14,174 --> 03:03:18,478 SCIENCE. 5477 03:03:18,478 --> 03:03:22,983 THEN WE TALKED A LOT ABOUT 5478 03:03:22,983 --> 03:03:27,420 TRANSDISCIPLINARY APPROACHES TO 5479 03:03:27,420 --> 03:03:30,190 INNOVATE AND IMPROVE ACCESS AND 5480 03:03:30,190 --> 03:03:30,790 ADVANCE EQUITY. 5481 03:03:30,790 --> 03:03:32,692 IN OUR ROOM WE TALKED ABOUT THIS 5482 03:03:32,692 --> 03:03:33,393 TRANSDISCIPLINARY APPROACH 5483 03:03:33,393 --> 03:03:34,194 REALLY WHERE WE'RE THINKING 5484 03:03:34,194 --> 03:03:35,962 ABOUT HEALTH W EQUITY FROM THE 5485 03:03:35,962 --> 03:03:38,398 VERY START, INVOLVING KEY 5486 03:03:38,398 --> 03:03:43,003 PARTNERS SUCH AS THE COMMUNITY, 5487 03:03:43,003 --> 03:03:44,104 NOT JUST AT THE POINT OF 5488 03:03:44,104 --> 03:03:46,039 MARKETING A NEW DRUG, BUT REALLY 5489 03:03:46,039 --> 03:03:48,808 FROM THE POINT OF EVEN BEGINNING 5490 03:03:48,808 --> 03:03:53,813 TO UNDERTAKE A RESEARCH QUESTION 5491 03:03:53,813 --> 03:03:54,848 OR AN INVESTIGATION AND MAKING 5492 03:03:54,848 --> 03:03:57,817 SURE THAT WHAT WE'RE DOING IS 5493 03:03:57,817 --> 03:04:00,086 BOTH PRIORITIZED AND RESONATES 5494 03:04:00,086 --> 03:04:02,155 WITH THE END COMMUNITY OR THE 5495 03:04:02,155 --> 03:04:07,427 END USER. 5496 03:04:07,427 --> 03:04:11,865 SO WE IDENTIFIED SEVERAL 5497 03:04:11,865 --> 03:04:15,468 BARRIERS. 5498 03:04:15,468 --> 03:04:17,370 WE IDENTIFIED SEVERAL BARRIERS 5499 03:04:17,370 --> 03:04:23,643 FOR TRYING TO ADDRESS SOME OF 5500 03:04:23,643 --> 03:04:25,512 THOSE KEY QUESTIONS. 5501 03:04:25,512 --> 03:04:32,719 AND THOSE BARRIERS INCLUDE 5502 03:04:32,719 --> 03:04:37,023 MISALIGNMENT OF INCENTIVES TO 5503 03:04:37,023 --> 03:04:38,458 SUPPORT ADHERENCE TO BEST 5504 03:04:38,458 --> 03:04:46,967 PRACTICES AND GUIDELINES, 5505 03:04:46,967 --> 03:04:47,701 VARIABILITY IN -- HERE WE GO, 5506 03:04:47,701 --> 03:04:48,134 THANK YOU. 5507 03:04:48,134 --> 03:04:53,573 SO MISALIGNMENT OF INCENTIVES TO 5508 03:04:53,573 --> 03:04:54,674 SUPPORT ADHERENCE AND 5509 03:04:54,674 --> 03:04:55,542 INCONSISTENT ADHERENCE WITH 5510 03:04:55,542 --> 03:04:57,410 REGARD TO SPECIAL POPULATIONS, 5511 03:04:57,410 --> 03:04:58,645 SPECIFICALLY WE TALKED ABOUT 5512 03:04:58,645 --> 03:05:00,547 PREGNANT PERSONS AND LACK OF 5513 03:05:00,547 --> 03:05:03,717 ROBUST TRIAL DATA, AS WELL AS 5514 03:05:03,717 --> 03:05:09,856 LACK OF VO VALIDATED DEVICES FOR 5515 03:05:09,856 --> 03:05:11,491 SPECIAL POPULATIONS SUCH AS 5516 03:05:11,491 --> 03:05:12,959 PREGNANT PEOPLE, PERSONS WITH 5517 03:05:12,959 --> 03:05:16,329 CKD AND OTHERS. 5518 03:05:16,329 --> 03:05:20,800 OTHER BARRIERS, AGAIN IF WE 5519 03:05:20,800 --> 03:05:21,901 COULD -- FOR SOME REASON MY 5520 03:05:21,901 --> 03:05:23,903 SCREEN IS NOT UPDATING TO THE 5521 03:05:23,903 --> 03:05:28,008 BARRIERS. 5522 03:05:28,008 --> 03:05:29,709 BUT WE ALSO TALKED ABOUT AS 5523 03:05:29,709 --> 03:05:33,947 BARRIERS, LACK OF ACCESS TO 5524 03:05:33,947 --> 03:05:36,583 COACHING ON MEASURING AND 5525 03:05:36,583 --> 03:05:38,852 MANAGING BLOOD PRESSURE, 5526 03:05:38,852 --> 03:05:40,053 INSUFFICIENT COVERAGE OF BLOOD 5527 03:05:40,053 --> 03:05:43,990 PRESSURE DEVICES, AND SPECIAL 5528 03:05:43,990 --> 03:05:47,494 BARRIER-FREE COVERAGE FOR 5529 03:05:47,494 --> 03:05:49,729 SPECIAL POPULATIONS SUCH AS 5530 03:05:49,729 --> 03:05:52,699 POSTPARTUM PERSONS, LACK OF 5531 03:05:52,699 --> 03:05:54,834 PRIORITIZATION OF HYPERTENSION 5532 03:05:54,834 --> 03:05:55,535 AND ACCURATE BLOOD PRESSURE 5533 03:05:55,535 --> 03:05:57,037 MEASUREMENT IN PEDIATRIC 5534 03:05:57,037 --> 03:06:00,340 SETTINGS. 5535 03:06:00,340 --> 03:06:02,108 LACK OF POLICIES TO SUPPORT 5536 03:06:02,108 --> 03:06:05,545 DIVERSE POPULATIONS WHO ARE 5537 03:06:05,545 --> 03:06:07,847 NON-ENGLISH-SPEAKING WHEN IT 5538 03:06:07,847 --> 03:06:12,285 COMES TO BLOOD PRESSURE 5539 03:06:12,285 --> 03:06:14,387 MEASUREMENT. 5540 03:06:14,387 --> 03:06:16,323 AND THEN ALSO THINKING ABOUT 5541 03:06:16,323 --> 03:06:21,695 MARKET FORCES SUCH AS AMAZON, OR 5542 03:06:21,695 --> 03:06:24,497 OTHERS, WHERE THERE'S VERY 5543 03:06:24,497 --> 03:06:26,800 LITTLE REGULATION OF THE BLOOD 5544 03:06:26,800 --> 03:06:30,036 PRESSURE MONITORS THAT ARE SOLD, 5545 03:06:30,036 --> 03:06:31,071 WHICH MAKES IT VERY, VERY 5546 03:06:31,071 --> 03:06:36,710 DIFFICULT FOR US WHO VALUE 5547 03:06:36,710 --> 03:06:38,845 ACCURATE BLOOD PRESSURE 5548 03:06:38,845 --> 03:06:39,979 MEASUREMENT, OUR PATIENTS 5549 03:06:39,979 --> 03:06:41,948 UNFORTUNATELY HAVE MORE ACCESS 5550 03:06:41,948 --> 03:06:43,750 TO UNREGULATED DEVICES THAN THEY 5551 03:06:43,750 --> 03:06:45,752 OFTEN DO TO OUR REGULATED 5552 03:06:45,752 --> 03:06:47,454 DEVICES, AND SO THINKING ABOUT 5553 03:06:47,454 --> 03:06:51,925 HOW WE ADDRESS THOSE. 5554 03:06:51,925 --> 03:06:52,792 POSSIBLY POLICY CHALLENGES IS 5555 03:06:52,792 --> 03:06:54,160 SOMETHING FOR US TO THINK ABOUT 5556 03:06:54,160 --> 03:06:56,062 FOR THE FUTURE. 5557 03:06:56,062 --> 03:06:58,264 AND THEN ALSO THINKING ABOUT 5558 03:06:58,264 --> 03:07:03,803 LACK OF INTEGRATED CARE MODELS 5559 03:07:03,803 --> 03:07:04,971 AND OUR CURRENT FEE FOR SERVICE 5560 03:07:04,971 --> 03:07:05,739 MODEL ALSO MAKES IT VERY 5561 03:07:05,739 --> 03:07:09,776 DIFFICULT FOR US TO MAKE CHANGE 5562 03:07:09,776 --> 03:07:12,312 IN THIS AREA. 5563 03:07:12,312 --> 03:07:15,882 SO MOVING ON TO STRATEGIES AND 5564 03:07:15,882 --> 03:07:19,619 FUTURE DIRECTIONS, SO SOME OF 5565 03:07:19,619 --> 03:07:22,856 THE STRATEGIES THAT WE TALKED 5566 03:07:22,856 --> 03:07:24,157 ABOUT ARE APPLICATION OF 5567 03:07:24,157 --> 03:07:24,891 IMPLEMENTATION SCIENCE TO 5568 03:07:24,891 --> 03:07:26,159 SUPPORT A LIFESPAN APPROACH TO 5569 03:07:26,159 --> 03:07:28,828 SCREENING AND LINKAGE TO CARE. 5570 03:07:28,828 --> 03:07:32,365 AND SO FUNDING OF LONGITUDINAL 5571 03:07:32,365 --> 03:07:34,667 STUDIES WHERE WE CAN ADDRESS 5572 03:07:34,667 --> 03:07:37,103 SOME OF THESE LIFECOURSE 5573 03:07:37,103 --> 03:07:38,972 QUESTIONS OVER A LONGER 5574 03:07:38,972 --> 03:07:40,740 FOLLOW-UP PERIOD, PARTICULARLY 5575 03:07:40,740 --> 03:07:44,210 AS WE THINK ABOUT SPECIAL 5576 03:07:44,210 --> 03:07:46,179 POPULATIONS SUCH AS PREGNANT 5577 03:07:46,179 --> 03:07:48,615 PERSONS AND THEN OF COURSE THE 5578 03:07:48,615 --> 03:07:50,650 SORT OF NEXT STOP ON THE 5579 03:07:50,650 --> 03:07:53,853 SPECTRUM IS THE PEDIATRIC 5580 03:07:53,853 --> 03:07:55,989 POPULATION, BEING ABLE TO STUDY 5581 03:07:55,989 --> 03:07:58,425 THOSE TRANSITIONS WILL MAKE A 5582 03:07:58,425 --> 03:08:00,693 BIG DIFFERENCE, WE THINK, AND SO 5583 03:08:00,693 --> 03:08:03,129 FUNDING OF THOSE TYPES OF 5584 03:08:03,129 --> 03:08:04,230 MULTILEVEL AND LONGITUDINAL 5585 03:08:04,230 --> 03:08:08,101 STUDIES WILL BE IMPORTANT. 5586 03:08:08,101 --> 03:08:14,441 LEVERAGING AI TO DO MANY THINGS 5587 03:08:14,441 --> 03:08:16,342 THAT A.I. CAN DO MUCH MORE 5588 03:08:16,342 --> 03:08:19,746 EASILY THAN WE COULD IN THE PAST 5589 03:08:19,746 --> 03:08:21,915 SUCH AS IDENTIFYING WHO'S AT 5590 03:08:21,915 --> 03:08:24,017 HIGHEST RISK, IDENTIFYING 5591 03:08:24,017 --> 03:08:27,487 THRESHOLD BIAS OR ZERO DIGIT 5592 03:08:27,487 --> 03:08:28,788 PREFERENCE, HARKENING TO THE 5593 03:08:28,788 --> 03:08:33,326 PRESENTATION BY DR. FOTI ON 5594 03:08:33,326 --> 03:08:36,496 MEASUREMENT BIAS, THINKING ABOUT 5595 03:08:36,496 --> 03:08:38,665 CHATBOTS TO SUPPORT PATIENTS AND 5596 03:08:38,665 --> 03:08:40,934 TO FEED INFORMATION TO 5597 03:08:40,934 --> 03:08:42,435 CLINICIANS FROM OUR AUTOMATED OR 5598 03:08:42,435 --> 03:08:44,704 HOME DEVICES. 5599 03:08:44,704 --> 03:08:47,173 ANALYZING AND TRIAGING INCOMING 5600 03:08:47,173 --> 03:08:50,477 DATA FROM OUR OUT OF OFFICE 5601 03:08:50,477 --> 03:08:54,714 DEVICES TO CLINICAL 5602 03:08:54,714 --> 03:08:55,748 DECISION-MAKERS, AND THINKING 5603 03:08:55,748 --> 03:09:00,587 ABOUT WAYS TO DECREASE CLINICAL 5604 03:09:00,587 --> 03:09:01,888 BURDEN. 5605 03:09:01,888 --> 03:09:02,422 INCREASING TIMELINESS OF 5606 03:09:02,422 --> 03:09:03,823 TREATMENT IN ACUTE SITUATIONS IS 5607 03:09:03,823 --> 03:09:04,891 PARTICULARLY IMPORTANT IN THE 5608 03:09:04,891 --> 03:09:08,361 POSTPARTUM SETTING, AND 5609 03:09:08,361 --> 03:09:11,631 INCORPORATING MULTIMODAL DATA 5610 03:09:11,631 --> 03:09:13,800 SOURCES, REUSING ALL OF THE DATA 5611 03:09:13,800 --> 03:09:15,902 THAT WE HAVE AT OUR DISPOSAL, 5612 03:09:15,902 --> 03:09:17,103 INCLUDING ENVIRONMENTAL DATA, 5613 03:09:17,103 --> 03:09:19,405 NOISE, TEMPERATURE, AND OTHER 5614 03:09:19,405 --> 03:09:22,008 THINGS THAT WE DON'T TYPICALLY 5615 03:09:22,008 --> 03:09:23,376 THINK ABOUT IN THE CLINICAL 5616 03:09:23,376 --> 03:09:23,943 SETTING. 5617 03:09:23,943 --> 03:09:26,012 AND THEN THINGS LIKE A FIDELITY 5618 03:09:26,012 --> 03:09:27,280 CHECKLIST TO IMPROVE OUR 5619 03:09:27,280 --> 03:09:28,715 CONFIDENCE IN HOME BLOOD 5620 03:09:28,715 --> 03:09:30,283 PRESSURE MEASUREMENT READINGS, 5621 03:09:30,283 --> 03:09:34,053 GIVEN THAT MANY CLINICIANS DON'T 5622 03:09:34,053 --> 03:09:35,922 BELIEVE THE VALIDITY OR ACCURACY 5623 03:09:35,922 --> 03:09:37,957 OF HOME BLOOD PRESSURE MONITORS, 5624 03:09:37,957 --> 03:09:39,626 SO HOW CAN WE INCREASE SORT OF 5625 03:09:39,626 --> 03:09:42,228 QUALITY CONTROL FOR THAT. 5626 03:09:42,228 --> 03:09:43,229 INCREASING CLINICIAN RECOGNITION 5627 03:09:43,229 --> 03:09:45,965 OF BIASES IN MEASUREMENT, AND 5628 03:09:45,965 --> 03:09:47,834 THEN FINALLY DEVELOPING QUALITY 5629 03:09:47,834 --> 03:09:54,040 MEASURES TO ADDRESS EQUITY IN 5630 03:09:54,040 --> 03:09:58,611 HOME BLOOD PRESSURE MONITORING. 5631 03:09:58,611 --> 03:09:59,779 AND THINKING ABOUT QUALITY 5632 03:09:59,779 --> 03:10:01,147 MEASURES TO ADDRESS EQUITY 5633 03:10:01,147 --> 03:10:03,950 AROUND HYPERTENSION MANAGEMENT 5634 03:10:03,950 --> 03:10:06,052 GENERALLY IS ANOTHER PLACE WHERE 5635 03:10:06,052 --> 03:10:07,620 WE CAN -- WHERE WE HOPEFULLY 5636 03:10:07,620 --> 03:10:10,924 WILL SEE SOME ADVANCEMENTS IN 5637 03:10:10,924 --> 03:10:12,725 THE NEAR FUTURE. 5638 03:10:12,725 --> 03:10:15,695 SO VERY GRATEFUL TO BREAKOUT 5639 03:10:15,695 --> 03:10:16,362 ROOM 2. 5640 03:10:16,362 --> 03:10:17,797 YVONNE, DID I MISS ANYTHING? 5641 03:10:17,797 --> 03:10:20,466 PLEASE FEEL FREE TO CORRECT OR 5642 03:10:20,466 --> 03:10:22,502 ADDEND. 5643 03:10:22,502 --> 03:10:23,503 >> YOU GOT IT. 5644 03:10:23,503 --> 03:10:28,575 THANK YOU SO MUCH. 5645 03:10:28,575 --> 03:10:30,009 , DR. RAVENELL. 5646 03:10:30,009 --> 03:10:32,512 >> THANK YOU BOTH VERY MUCH. 5647 03:10:32,512 --> 03:10:34,514 AND SO I'LL JUST INTRODUCE THE 5648 03:10:34,514 --> 03:10:37,317 LAST TWO MODERATORS, I WAS 5649 03:10:37,317 --> 03:10:39,686 PRIVILEGED TO BE IN THE SESSION 5650 03:10:39,686 --> 03:10:45,858 ON BREAKOUT 3 ABOUT RELIABLE 5651 03:10:45,858 --> 03:10:48,194 BLOOD PRESSURE MEASUREMENTS, 5652 03:10:48,194 --> 03:10:49,963 GUIDING PROVIDERS, RESEARCHERS 5653 03:10:49,963 --> 03:10:53,600 AND PATIENTS AND TRUSTING TRUSTG 5654 03:10:53,600 --> 03:10:55,068 CURRENT AND URGENT BLOOD 5655 03:10:55,068 --> 03:10:55,668 PRESSURE DEVICES. 5656 03:10:55,668 --> 03:10:57,070 SO REALLY EXCITED TO HEAR FROM 5657 03:10:57,070 --> 03:10:58,338 OUR LAST TWO MODERATORS. 5658 03:10:58,338 --> 03:11:00,373 >> GO AHEAD, JORDY. 5659 03:11:00,373 --> 03:11:01,407 THANK YOU. 5660 03:11:01,407 --> 03:11:01,841 >> GREAT, THANK YOU. 5661 03:11:01,841 --> 03:11:03,376 I THINK WE'RE JUST WAITING FOR 5662 03:11:03,376 --> 03:11:04,744 OUR SLIDES AND I'LL GET STARTED. 5663 03:11:04,744 --> 03:11:06,713 I'LL START BY SAYING, SO WE WERE 5664 03:11:06,713 --> 03:11:07,614 TASKED WITH TALKING ABOUT 5665 03:11:07,614 --> 03:11:09,716 GUIDING PROVIDERS, RESEARCHERS 5666 03:11:09,716 --> 03:11:12,986 AND PATIENTS AND TRUSTING 5667 03:11:12,986 --> 03:11:14,320 CURRENT EMERGENT BLOOD PRESSURE 5668 03:11:14,320 --> 03:11:15,488 DEVICES AS STEPHEN MENTIONED. 5669 03:11:15,488 --> 03:11:17,023 WE TOOK A LITTLE DIFFERENT 5670 03:11:17,023 --> 03:11:17,824 APPROACH TO PRESENTING SORT OF 5671 03:11:17,824 --> 03:11:18,725 THE DISCUSSION. 5672 03:11:18,725 --> 03:11:20,560 WE DIVIDED INTO ABOUT FOUR MAIN 5673 03:11:20,560 --> 03:11:21,394 QUESTIONS AND I'LL TALK ABOUT 5674 03:11:21,394 --> 03:11:23,262 THE KEY BARRIERS THAT WERE 5675 03:11:23,262 --> 03:11:26,132 DISCUSSED AS WELL AS SOME OF THE 5676 03:11:26,132 --> 03:11:28,768 FUTURE DIRECTIONS THAT WE 5677 03:11:28,768 --> 03:11:29,402 DISCUSSED. 5678 03:11:29,402 --> 03:11:35,174 ARE MY SLIDE STILL -- THEY'RE 5679 03:11:35,174 --> 03:11:45,485 NOT SHOWING RIGHT. 5680 03:11:50,189 --> 03:11:51,691 I CAN JUST TALK THROUGH IF WE 5681 03:11:51,691 --> 03:11:57,597 DON'T HAVE THEM UP YET. 5682 03:11:57,597 --> 03:11:59,232 SO I'LL JUST START TALKING JUST 5683 03:11:59,232 --> 03:12:00,867 TO -- FOR THE SAKE OF TIME. 5684 03:12:00,867 --> 03:12:02,502 THE FIRST QUESTION THAT WE 5685 03:12:02,502 --> 03:12:04,137 IDENTIFIED AS BEING SORT OF THE 5686 03:12:04,137 --> 03:12:06,372 HIGHEST PRIORITY ONE WAS WHAT 5687 03:12:06,372 --> 03:12:07,106 ADDITIONAL RESEARCH IS NEEDED TO 5688 03:12:07,106 --> 03:12:10,677 IMPROVE THE INTEGRATION OF AND 5689 03:12:10,677 --> 03:12:11,678 STANDARDIZATION OF BLOOD 5690 03:12:11,678 --> 03:12:13,813 PRESSURE FROM EMERGING 5691 03:12:13,813 --> 03:12:14,480 TECHNOLOGIES WITH CURRENT 5692 03:12:14,480 --> 03:12:17,150 CLINICAL PRACTICE. 5693 03:12:17,150 --> 03:12:21,554 AND WE'VE IDENTIFIED A FEW KEY 5694 03:12:21,554 --> 03:12:23,756 BARRIERS TO TRYING TO DO THIS. 5695 03:12:23,756 --> 03:12:25,391 FIRST OF ALL THE NEED TO BE ABLE 5696 03:12:25,391 --> 03:12:26,626 TO TRANSMIT HOME BLOOD PRESSURES 5697 03:12:26,626 --> 03:12:27,660 DIRECTLY INTO THE ELECTRONIC 5698 03:12:27,660 --> 03:12:29,295 HEALTH RECORD BY MULTIPLE MEANS 5699 03:12:29,295 --> 03:12:30,329 IS SOMETHING THAT IS A BIG 5700 03:12:30,329 --> 03:12:32,031 CHALLENGE THAT WAS BROUGHT UP 5701 03:12:32,031 --> 03:12:32,665 MULTIPLE TIMES IN THE 5702 03:12:32,665 --> 03:12:33,399 DISCUSSIONS. 5703 03:12:33,399 --> 03:12:34,934 ALSO SOMETHING THAT'S REALLY 5704 03:12:34,934 --> 03:12:36,969 CHALLENGING THAT WAS IDENTIFIED 5705 03:12:36,969 --> 03:12:38,604 WAS THE IDEA OF STANDARDIZATION 5706 03:12:38,604 --> 03:12:39,806 IS SOMEWHAT LIMITED BY THE FACT 5707 03:12:39,806 --> 03:12:41,574 THAT THERE IS THIS NATURAL 5708 03:12:41,574 --> 03:12:42,308 VARIATION IN BLOOD PRESSURE AND 5709 03:12:42,308 --> 03:12:45,578 WE STILL DON'T FULLY UNDERSTAND 5710 03:12:45,578 --> 03:12:46,479 EXACTLY WHICH PARAMETERS WE 5711 03:12:46,479 --> 03:12:47,580 SHOULD BE USING. 5712 03:12:47,580 --> 03:12:49,115 SHOULD WE BE USING AN AVERAGE? 5713 03:12:49,115 --> 03:12:49,682 PROBABLY NOT. 5714 03:12:49,682 --> 03:12:51,117 PROBABLY SOMETHING MORE LIKE THE 5715 03:12:51,117 --> 03:12:52,852 PROPORTION OF TIME AND TARGET 5716 03:12:52,852 --> 03:12:54,554 RANGE PLUS UNDERSTANDING THE 5717 03:12:54,554 --> 03:12:55,688 PROPORTION OF OUTLIERS IN EACH 5718 03:12:55,688 --> 03:12:56,355 DIRECTION AND HOW MUCH OF A 5719 03:12:56,355 --> 03:12:57,990 BURDEN THOSE ARE AND WHETHER 5720 03:12:57,990 --> 03:12:58,591 THEY'RE SYMPTOMATIC. 5721 03:12:58,591 --> 03:13:01,527 SO THERE'S A LOT MORE TO TO 5722 03:13:01,527 --> 03:13:02,829 UNPACK THAN JUST UNDERSTANDING 5723 03:13:02,829 --> 03:13:04,330 AVERAGING BLOOD PRESSURES IN 5724 03:13:04,330 --> 03:13:05,965 TERMS OF DELIVERING THE 5725 03:13:05,965 --> 03:13:06,833 INFORMATION. 5726 03:13:06,833 --> 03:13:08,434 ALSO WHAT WAS BROUGHT UP AS 5727 03:13:08,434 --> 03:13:09,402 ANOTHER IMPORTANT BARRIER IS 5728 03:13:09,402 --> 03:13:11,504 PRIVACY CONCERNS FROM THIRD 5729 03:13:11,504 --> 03:13:14,273 PARTY APPLICATIONS, AND THAT'S 5730 03:13:14,273 --> 03:13:15,641 SOMETHING THAT'S GOT TO VERY 5731 03:13:15,641 --> 03:13:16,676 IMPORTANTLY BE ADDRESSED AND 5732 03:13:16,676 --> 03:13:18,177 THAT COULD PREVENT SOME OF THESE 5733 03:13:18,177 --> 03:13:19,345 FROM BEING INTEGRATED IN ALL 5734 03:13:19,345 --> 03:13:20,980 HEALTH SYSTEMS, SINCE DIFFERENT 5735 03:13:20,980 --> 03:13:22,949 HEALTH SYSTEMS HAVE DIFFERENT 5736 03:13:22,949 --> 03:13:24,517 LEVELS OF PRIVACY REQUIREMENTS 5737 03:13:24,517 --> 03:13:25,618 THAT EVEN IF SOMETHING IS 5738 03:13:25,618 --> 03:13:27,086 DEVELOPED, IT MAY NOT BE ABLE TO 5739 03:13:27,086 --> 03:13:36,262 BE IMPLEMENTED ON A BROAD SCALE. 5740 03:13:36,262 --> 03:13:37,764 SO FOR FUTURE DIRECTIONS, WE 5741 03:13:37,764 --> 03:13:39,699 TALKED ABOUT HOW WE REALLY NEED 5742 03:13:39,699 --> 03:13:41,334 HIGH QUALITY STUDIES TO ADDRESS 5743 03:13:41,334 --> 03:13:42,802 A FEW OF THESE ISSUES. 5744 03:13:42,802 --> 03:13:44,570 ONE IS A BETTER UNDERSTANDING 5745 03:13:44,570 --> 03:13:46,906 HOW DRUGS IMPACT THE VARIABILITY 5746 03:13:46,906 --> 03:13:48,975 I MENTIONED AND BRINGING BLOOD 5747 03:13:48,975 --> 03:13:50,343 PRESSURES OUTSIDE OF THOSE 5748 03:13:50,343 --> 03:13:52,445 OUTLIER RANGES MORE INTO A 5749 03:13:52,445 --> 03:13:54,180 NARROWER RANGE, WHETHER THERE 5750 03:13:54,180 --> 03:13:54,747 ARE SPECIFIC DRUGS THAT ARE 5751 03:13:54,747 --> 03:13:55,982 BETTER AT DOING THAT OR JUST THE 5752 03:13:55,982 --> 03:13:57,884 ACT OF INITIATING DRUGS CAN HELP 5753 03:13:57,884 --> 03:13:59,352 TO IMPROVE THAT. 5754 03:13:59,352 --> 03:14:01,788 ALSO DEVELOPING A USER INTERFACE 5755 03:14:01,788 --> 03:14:03,289 FOR HYPERTENSION THAT CAN BE 5756 03:14:03,289 --> 03:14:05,725 USED ACROSS THE TEAM FROM 5757 03:14:05,725 --> 03:14:07,527 PROVIDERS TO PHARMACISTS, FROM 5758 03:14:07,527 --> 03:14:08,795 ANYBODY WHO WOULD HAVE ACCESS TO 5759 03:14:08,795 --> 03:14:11,330 IT AND THAT CAN BE IDEALLY 5760 03:14:11,330 --> 03:14:12,632 MODIFIED BY THE INDIVIDUAL TO 5761 03:14:12,632 --> 03:14:14,200 SERVE THEIR NEEDS, TO GIVE THEM 5762 03:14:14,200 --> 03:14:15,201 THAT INFORMATION WE TALKED 5763 03:14:15,201 --> 03:14:16,335 ABOUT, EITHER THE FULL BREADTH 5764 03:14:16,335 --> 03:14:18,104 OF BLOOD PRESSURE OR SUMMARY 5765 03:14:18,104 --> 03:14:19,438 INFORMATION SUCH AS BOTH THE 5766 03:14:19,438 --> 03:14:24,310 TIME AND TARGET RANGE AND THOSE 5767 03:14:24,310 --> 03:14:25,578 OUTLIERS SO PEOPLE WOULDN'T 5768 03:14:25,578 --> 03:14:27,213 NECESSARILY HAVE TO GO ACROSS 5769 03:14:27,213 --> 03:14:28,247 SEVERAL DIFFERENT SYSTEMS TO BE 5770 03:14:28,247 --> 03:14:29,582 ABLE TO ACCESS THIS CRITICAL 5771 03:14:29,582 --> 03:14:30,016 INFORMATION. 5772 03:14:30,016 --> 03:14:31,250 THERE ALSO REALLY NEED TO BE 5773 03:14:31,250 --> 03:14:35,121 BETTER WAYS TO INPUT MULTIPLE 5774 03:14:35,121 --> 03:14:37,557 SOURCES OF BLOOD PRESSURE INTO A 5775 03:14:37,557 --> 03:14:38,658 MORE UNIFORM AREA, NOT JUST 5776 03:14:38,658 --> 03:14:39,192 USING BLUETOOTH. 5777 03:14:39,192 --> 03:14:40,893 SO WE WERE THINKING FUTURE 5778 03:14:40,893 --> 03:14:42,595 DIRECTIONS FOR RESEARCH WOULD BE 5779 03:14:42,595 --> 03:14:43,996 TO EXPLORE WHETHER THERE'S A WAY 5780 03:14:43,996 --> 03:14:45,131 TO INTEGRATE DELIVERY OF BLOOD 5781 03:14:45,131 --> 03:14:46,199 PRESSURES USING VERBAL 5782 03:14:46,199 --> 03:14:47,200 INFORMATION, USING PHOTOGRAPHS 5783 03:14:47,200 --> 03:14:48,568 OF BLOOD PRESSURES, OTHER WAYS 5784 03:14:48,568 --> 03:14:50,536 TO MEET PATIENT WHERE THEY ARE. 5785 03:14:50,536 --> 03:14:51,938 THERE WAS GREAT DISCUSSION ABOUT 5786 03:14:51,938 --> 03:14:53,372 BRINGING PATIENTS INTO CLINIC TO 5787 03:14:53,372 --> 03:14:54,941 HELP THEM USE THE BLUETOOTH 5788 03:14:54,941 --> 03:14:56,342 DEVICES AND TO HELP UPLOAD THEIR 5789 03:14:56,342 --> 03:14:57,276 BLOOD PRESSURES DIRECTLY, BUT 5790 03:14:57,276 --> 03:15:00,279 NOT EVERYBODY HAS ACCESS TO THAT 5791 03:15:00,279 --> 03:15:01,047 SORT OF ENGAGEMENT WITH THE 5792 03:15:01,047 --> 03:15:03,115 HEALTHCARE SYSTEM, AND ALSO TO 5793 03:15:03,115 --> 03:15:04,317 THAT TECHNOLOGY TO BEGIN WITH. 5794 03:15:04,317 --> 03:15:06,819 SO I THINK WE NEED TO BE HONEST 5795 03:15:06,819 --> 03:15:08,321 WITH OURSELVES ABOUT THAT AND 5796 03:15:08,321 --> 03:15:10,990 MAKE IT MORE ACCESSIBLE. 5797 03:15:10,990 --> 03:15:12,358 AND ALSO MAKING SURE THAT BLOOD 5798 03:15:12,358 --> 03:15:15,361 PRESSURE MONITORS CAN SEND 5799 03:15:15,361 --> 03:15:16,829 INFORMATION IN A HARMONIZED WAY. 5800 03:15:16,829 --> 03:15:18,064 RIGHT NOW THERE ARE MANY 5801 03:15:18,064 --> 03:15:18,798 APPLICATIONS ACROSS MANY 5802 03:15:18,798 --> 03:15:20,299 DIFFERENT TYPES OF DEVICES, SOME 5803 03:15:20,299 --> 03:15:22,368 OF WHICH CAN UPLOAD DIRECTLY TO 5804 03:15:22,368 --> 03:15:24,770 THE EHR, SOME OF WHICH CAN'T. 5805 03:15:24,770 --> 03:15:25,304 ELECTRONIC HEALTH RECORD 5806 03:15:25,304 --> 03:15:26,606 COMPANIES HAVE EXPRESSED 5807 03:15:26,606 --> 03:15:27,573 INTEREST IN BEING ABLE TO DO 5808 03:15:27,573 --> 03:15:29,642 THIS BUT AREN'T ABLE TO DO THIS 5809 03:15:29,642 --> 03:15:30,509 ACROSS MANY, MANY, MANY 5810 03:15:30,509 --> 03:15:31,143 DIFFERENT SOURCES. 5811 03:15:31,143 --> 03:15:33,913 THERE NEEDS TO BE AN INTEGRATED 5812 03:15:33,913 --> 03:15:39,585 A SINGLE SOURCE, SUCH AS SPHYGMO 5813 03:15:39,585 --> 03:15:40,119 WAS ONE EXAMPLE. 5814 03:15:40,119 --> 03:15:41,754 I THINK THIS IS GOING TO BE MORE 5815 03:15:41,754 --> 03:15:43,656 OF AN INDUSTRY-WIDE ISSUE BUT 5816 03:15:43,656 --> 03:15:44,557 CLEARLY SOMETHING THAT'S AN 5817 03:15:44,557 --> 03:15:45,691 IMPORTANT BARRIER THAT I THINK 5818 03:15:45,691 --> 03:15:47,460 THE ANSWER IS HARMONIZATION AND 5819 03:15:47,460 --> 03:15:49,028 CONSISTENCY. 5820 03:15:49,028 --> 03:15:50,062 ACROSS DEVICES AND 5821 03:15:50,062 --> 03:15:57,003 HEALTH SYSTEMS. 5822 03:15:57,003 --> 03:15:59,071 SO REALLY -- OH, I THINK BACK 5823 03:15:59,071 --> 03:16:02,808 ONE, PLEASE. 5824 03:16:02,808 --> 03:16:04,343 SORROWLY THE SUMMARY IS THAT WE 5825 03:16:04,343 --> 03:16:08,781 NEED TO REMOVE BARRIERS AND 5826 03:16:08,781 --> 03:16:10,316 BROADEN TOOLS TO BE ABLE TO 5827 03:16:10,316 --> 03:16:12,051 ALLOW PEOPLE WHO ARE LESS 5828 03:16:12,051 --> 03:16:13,819 TECHNOLOGICALLY SAVVY AND ACROSS 5829 03:16:13,819 --> 03:16:14,620 DIFFERENT SYSTEMS ACCESS TO THE 5830 03:16:14,620 --> 03:16:15,121 SAME INFORMATION. 5831 03:16:15,121 --> 03:16:16,055 SOME PEOPLE BROUGHT UP EXAMPLES 5832 03:16:16,055 --> 03:16:18,090 OF HOW THIS HAS BEEN DONE SUCH 5833 03:16:18,090 --> 03:16:20,493 AS WITH HEART MO MONITORING APPS 5834 03:16:20,493 --> 03:16:21,861 AND REALLY THIS IS FEASIBLE AND 5835 03:16:21,861 --> 03:16:23,195 JUST NOT BEING DONE IN BLOOD 5836 03:16:23,195 --> 03:16:24,497 PRESSURE, PERHAPS THERE'S JUST 5837 03:16:24,497 --> 03:16:30,603 TOO MANY PLAYERS IN THE FIELD. 5838 03:16:30,603 --> 03:16:34,106 THE NEXT KEY GAP THAT WE 5839 03:16:34,106 --> 03:16:35,541 IDENTIFIED WAS TRY AND 5840 03:16:35,541 --> 03:16:38,144 UNDERSTAND WHAT FACTORS ARE 5841 03:16:38,144 --> 03:16:39,545 RELATED TO DISCORDANCE BETWEEN 5842 03:16:39,545 --> 03:16:40,579 OFFICE AND OUT OF OFFICE BLOOD 5843 03:16:40,579 --> 03:16:41,681 PRESSURE MEASUREMENT AND WHETHER 5844 03:16:41,681 --> 03:16:45,651 WE NEED TRIALS TO IDENTIFY AN 5845 03:16:45,651 --> 03:16:47,820 OPTIMAL GOAL IN AND OUT OF 5846 03:16:47,820 --> 03:16:48,354 OFFICE BLOOD PRESSURE 5847 03:16:48,354 --> 03:16:49,989 MEASUREMENT AND WHETHER WE CAN 5848 03:16:49,989 --> 03:16:51,290 JUST USE HOME BLOOD PRESSURE 5849 03:16:51,290 --> 03:16:53,392 DATA AS IT IS TO GUIDE TREATMENT 5850 03:16:53,392 --> 03:16:55,461 AND WHETHER THE DISCORDANCE 5851 03:16:55,461 --> 03:16:57,196 MATTERS ENOUGH THAT WE REALLY 5852 03:16:57,196 --> 03:16:58,597 SHOULD BE THINKING ABOUT THEM 5853 03:16:58,597 --> 03:16:59,832 DIFFERENTLY OR THINKING ABOUT 5854 03:16:59,832 --> 03:17:00,967 THEM THE SAME, AND DO WE HAVE 5855 03:17:00,967 --> 03:17:02,301 ANY CONCERNS WITH USING OFFICE 5856 03:17:02,301 --> 03:17:04,437 BLOOD PRESSURE AS OUR GUIDE, IS 5857 03:17:04,437 --> 03:17:05,004 THERE POTENTIALLY HARM THAT 5858 03:17:05,004 --> 03:17:06,539 COULD BE INVOLVED IN TREATING 5859 03:17:06,539 --> 03:17:08,674 BLOOD PRESSURE OR ARE WE CAUSING 5860 03:17:08,674 --> 03:17:10,543 HARM BY EXPECTING THERE TO BE 5861 03:17:10,543 --> 03:17:12,244 HARM AND SHOULD WE JUST BE USING 5862 03:17:12,244 --> 03:17:17,350 ALL THE DATA WE HAVE? 5863 03:17:17,350 --> 03:17:19,151 SO SOME IMPORTANT BARRIERS THAT 5864 03:17:19,151 --> 03:17:22,888 WE TALKED ABOUT IN THIS REGARD 5865 03:17:22,888 --> 03:17:24,590 WERE BASICALLY THAT FIRST OF ALL 5866 03:17:24,590 --> 03:17:27,827 THERE ARE FEWER NO VALIDATED 5867 03:17:27,827 --> 03:17:28,894 HOME BLOOD PRESSURE DEVICES IN 5868 03:17:28,894 --> 03:17:29,762 SEVERAL POPULATIONS WHICH MAKES 5869 03:17:29,762 --> 03:17:31,263 THIS NOT EVEN ACCESSIBLE, FOR 5870 03:17:31,263 --> 03:17:33,199 EXAMPLE TO CHILDREN AND MANY 5871 03:17:33,199 --> 03:17:33,566 PREGNANT WOMEN. 5872 03:17:33,566 --> 03:17:34,734 THERE ARE A LOT OF ISSUES WITH 5873 03:17:34,734 --> 03:17:35,601 THE QUALITY OF BLOOD PRESSURES 5874 03:17:35,601 --> 03:17:37,470 WE GET IN AND OUT OF THE OFFICE 5875 03:17:37,470 --> 03:17:38,904 INCLUDING SEVERAL BIASES WITH 5876 03:17:38,904 --> 03:17:40,039 HOW THEY'RE PERFORMED DUE TO HOW 5877 03:17:40,039 --> 03:17:42,274 PEOPLE ARE TRAINED TO CHECK 5878 03:17:42,274 --> 03:17:43,542 BLOOD PRESSURE AND WE'LL TALK 5879 03:17:43,542 --> 03:17:44,777 MORE ABOUT OTHER ISSUES WITH 5880 03:17:44,777 --> 03:17:46,545 REGARD TO MEASUREMENT LATER, AND 5881 03:17:46,545 --> 03:17:47,680 AS HAS ALREADY BEEN TALKED 5882 03:17:47,680 --> 03:17:49,215 ABOUT, THESE DEVICES ARE 5883 03:17:49,215 --> 03:17:53,386 DIFFICULT TO CALIBRATE, AND 5884 03:17:53,386 --> 03:17:54,487 REALLY ALSO WE THINK THAT IT'S 5885 03:17:54,487 --> 03:17:55,621 REALLY IMPORTANT FOR US TO NOT 5886 03:17:55,621 --> 03:17:57,923 JUST THINK ABOUT EITHER OF THESE 5887 03:17:57,923 --> 03:17:59,291 EXCLUSIVELY, OF COURSE, SIMILAR 5888 03:17:59,291 --> 03:17:59,959 TO OTHER PREVIOUS SLIDES, WE 5889 03:17:59,959 --> 03:18:01,627 THINK THAT HAVING ACCESS TO 5890 03:18:01,627 --> 03:18:08,000 TRENDS, THE RANGE, AVERAGE, 5891 03:18:08,000 --> 03:18:08,667 VARIATION OF BLOOD PRESSURE IS 5892 03:18:08,667 --> 03:18:10,336 REALLY GOING TO BE IMPORTANT, 5893 03:18:10,336 --> 03:18:11,771 HOW WE'RE USING ALL THIS DATA. 5894 03:18:11,771 --> 03:18:12,705 OF COURSE THERE ARE SAFETY 5895 03:18:12,705 --> 03:18:14,040 CONCERNS IN TERMS OF ALLOWING 5896 03:18:14,040 --> 03:18:16,175 BLOOD PRESSURE TO GO TOO LOW AND 5897 03:18:16,175 --> 03:18:19,845 WHETHER THERE IS A TOO LOW, AND 5898 03:18:19,845 --> 03:18:21,547 JUST IN TERMS OF HOW HIGH 5899 03:18:21,547 --> 03:18:23,416 QUALITY DATA IS EVEN FEASIBLE TO 5900 03:18:23,416 --> 03:18:28,320 PERFORM IN THESE SETTINGS. 5901 03:18:28,320 --> 03:18:30,523 AND THE NEED AGAIN AS MENTIONED 5902 03:18:30,523 --> 03:18:32,324 PREVIOUSLY TO INTEGRATE THIS ALL 5903 03:18:32,324 --> 03:18:33,726 WITHIN THE ELECTRONIC HEALTH 5904 03:18:33,726 --> 03:18:35,061 RECORD IN A WAY WHERE WE CAN 5905 03:18:35,061 --> 03:18:36,362 INTEGRATE IT BUT ALSO UNDERSTAND 5906 03:18:36,362 --> 03:18:37,696 WHICH DATA IS FROM WHICH SOURCE 5907 03:18:37,696 --> 03:18:39,865 IF WE'RE THINKING THAT THEY ARE 5908 03:18:39,865 --> 03:18:42,068 DISTINCTIVE. 5909 03:18:42,068 --> 03:18:43,669 SO FOR FUTURE DIRECTS, WE THINK 5910 03:18:43,669 --> 03:18:47,073 THAT IDEALLY THERE SHOULD BE -- 5911 03:18:47,073 --> 03:18:48,174 THERE NEEDS TO BE SOME SORT OF 5912 03:18:48,174 --> 03:18:49,508 LINKAGE, WHETHER IT'S A TRIAL OR 5913 03:18:49,508 --> 03:18:51,277 STUDY LOOKING AT THE 5914 03:18:51,277 --> 03:18:52,111 RELATIONSHIP OF OUT OF OFFICE 5915 03:18:52,111 --> 03:18:53,345 BLOOD PRESSURES WITH MAJOR 5916 03:18:53,345 --> 03:18:54,280 EVENTS, THERE HAS BEEN WORK IN 5917 03:18:54,280 --> 03:18:55,581 THIS REGARD, THERE IS ONGOING 5918 03:18:55,581 --> 03:18:59,151 WORK IN THIS REGARD, BUT WE 5919 03:18:59,151 --> 03:19:01,153 STILL DON'T REALLY UNDERSTAND 5920 03:19:01,153 --> 03:19:02,354 OPTIMAL THRESHOLDS FOR OUT OF 5921 03:19:02,354 --> 03:19:03,255 OFFICE BLOOD PRESSURE AND 5922 03:19:03,255 --> 03:19:04,824 THRESHOLDS ARE BASED OFF 5923 03:19:04,824 --> 03:19:05,858 INADEQUATE SOURCES OF DATA, SO 5924 03:19:05,858 --> 03:19:08,861 THIS IS AN AREA THAT REALLY IS 5925 03:19:08,861 --> 03:19:11,263 RIPE FOR BETTER UNDERSTANDING OF 5926 03:19:11,263 --> 03:19:15,367 WHAT HE WE SHOUL WE SHOULD BE S, 5927 03:19:15,367 --> 03:19:16,068 AND ALSO AGAIN AS MENTIONED 5928 03:19:16,068 --> 03:19:17,169 DEVELOPING WAYS TO BE ABLE TO 5929 03:19:17,169 --> 03:19:18,971 LOOK AT TRENDS AND NOT JUST 5930 03:19:18,971 --> 03:19:20,706 SINGLE VALUES IN A SYSTEMATIC 5931 03:19:20,706 --> 03:19:22,641 WAY THAT CAN BE OPERATIONALIZED 5932 03:19:22,641 --> 03:19:25,311 ACROSS CLINICAL SPACES, NOT JUST 5933 03:19:25,311 --> 03:19:25,911 RESEARCH SPACES. 5934 03:19:25,911 --> 03:19:26,879 WE THINK A LOT OF THIS IS BEST 5935 03:19:26,879 --> 03:19:28,414 DONE USING PRAGMATIC TRIALS AND 5936 03:19:28,414 --> 03:19:30,015 WAYS TO REALLY INTEGRATE PEOPLE 5937 03:19:30,015 --> 03:19:31,484 ON A LARGE SCALE, ESPECIALLY 5938 03:19:31,484 --> 03:19:32,451 BECAUSE IF WE WANT TO DO ANY 5939 03:19:32,451 --> 03:19:39,458 KIND OF OUTCOME STUDIES, IT MAY 5940 03:19:39,458 --> 03:19:41,794 RETIREE NORMS AMOUNTS OF PEOPLE 5941 03:19:41,794 --> 03:19:43,162 AND OBSERVATIONAL DATA MAY BE 5942 03:19:43,162 --> 03:19:43,996 THE BEST WAY TO ATTAIN SOME OF 5943 03:19:43,996 --> 03:19:46,132 THESE ANSWERS BECAUSE OF 5944 03:19:46,132 --> 03:19:48,367 FEASIBILITY AND SCALE OF 5945 03:19:48,367 --> 03:19:52,104 CONCERNS BUT IDEALLY RANDOMIZED 5946 03:19:52,104 --> 03:19:53,072 TRIALS WOULD BE THE BEST. 5947 03:19:53,072 --> 03:19:54,240 I THINK THAT THE DECISION WAS 5948 03:19:54,240 --> 03:19:55,975 THAT THERE WILL NOT BE A 5949 03:19:55,975 --> 03:19:57,176 RANDOMIZED CONTROL TRIAL 5950 03:19:57,176 --> 03:19:58,244 RANDOMIZING PEOPLE TO HOME 5951 03:19:58,244 --> 03:19:59,512 VERSUS OUT OF OFFICE AS THEIR 5952 03:19:59,512 --> 03:20:01,580 WAY OF MANAGING BLOOD PRESSURE. 5953 03:20:01,580 --> 03:20:03,215 REALLY WHAT CAME OF ALL OF THIS 5954 03:20:03,215 --> 03:20:06,752 AND THE SUMMARY OF IT, I THINK 5955 03:20:06,752 --> 03:20:07,386 THE CONCLUSION WAS WE NEED TO 5956 03:20:07,386 --> 03:20:08,654 DEVELOP A HYBRID APPROACH TO 5957 03:20:08,654 --> 03:20:09,955 USING BOTH OFFICE AND OUT OF 5958 03:20:09,955 --> 03:20:11,857 OFFICE BLOOD PRESSURES TO GUIDE 5959 03:20:11,857 --> 03:20:12,892 THERAPY, AND THAT BETTER TRIALS 5960 03:20:12,892 --> 03:20:15,194 REALLY SHOULD BE DONE TO BE ABLE 5961 03:20:15,194 --> 03:20:17,163 TO DO THAT IN A WAY THAT'S 5962 03:20:17,163 --> 03:20:19,798 ADOPTABLE AND NOT JUST IN A 5963 03:20:19,798 --> 03:20:24,470 PERFECT TRIAL SETTING. 5964 03:20:24,470 --> 03:20:25,771 THE NEXT GAP THAT WE TALKED 5965 03:20:25,771 --> 03:20:28,807 ABOUT OF OUR FOUR WAS CLINIC 5966 03:20:28,807 --> 03:20:29,942 BLOOD PRESSURE NEEDS TO BE 5967 03:20:29,942 --> 03:20:30,442 STREAMLINED. 5968 03:20:30,442 --> 03:20:32,378 IT TECHNICALLY CHALLENGING. 5969 03:20:32,378 --> 03:20:33,546 AND WE'RE ASKING IF THERE'S A 5970 03:20:33,546 --> 03:20:36,182 WAY TO STREAMLINE TO PERFORM IT 5971 03:20:36,182 --> 03:20:36,415 BETTER. 5972 03:20:36,415 --> 03:20:37,216 AND A LOT OF THE BARRIERS THAT 5973 03:20:37,216 --> 03:20:39,919 HAVE BEEN IDENTIFIED AS CLINICAL 5974 03:20:39,919 --> 03:20:42,254 WORK FLOWS, ARCHITECTURE, TIME 5975 03:20:42,254 --> 03:20:42,922 CONSTRAINTS AND CLINIC 5976 03:20:42,922 --> 03:20:44,490 RESTRAINTS REALLY HAVE DEVELOPED 5977 03:20:44,490 --> 03:20:45,457 BLOOD PRESSURE MEASUREMENT TO 5978 03:20:45,457 --> 03:20:46,959 OCCUR IN A WAY THAT'S NOT 5979 03:20:46,959 --> 03:20:48,294 OPTIMAL AND THAT REALLY RESULTS 5980 03:20:48,294 --> 03:20:51,263 IN A LOT OF INACCURACIES. 5981 03:20:51,263 --> 03:20:53,332 THE AMA HAS DEVELOPED AMAZING 5982 03:20:53,332 --> 03:20:54,900 TOOLS THAT WERE TO GO INTO 5983 03:20:54,900 --> 03:20:56,035 CLINICS AND IDENTIFY WHERE BLOOD 5984 03:20:56,035 --> 03:20:57,336 PRESSURES ARE IN THEIR OWN 5985 03:20:57,336 --> 03:21:02,575 PLACES, HOW TO HELP PLAQ PRACTIS 5986 03:21:02,575 --> 03:21:04,376 IMPROVE THEIR BLOOD PRESSURE 5987 03:21:04,376 --> 03:21:05,110 MEASUREMENTS. 5988 03:21:05,110 --> 03:21:10,216 A LOT OF THE SENSE -- BEING DONE 5989 03:21:10,216 --> 03:21:11,717 IS QI WORK, THE PROBLEM IS 5990 03:21:11,717 --> 03:21:13,152 GETTING PEOPLE TO UPTAKE THIS 5991 03:21:13,152 --> 03:21:14,320 AND IT HASN'T BEEN REALLY 5992 03:21:14,320 --> 03:21:14,987 ACHIEVING DISSEMINATION. 5993 03:21:14,987 --> 03:21:16,455 SO I'LL TALK MORE ON OUR NEXT 5994 03:21:16,455 --> 03:21:18,691 FEW SLIDES ABOUT EDUCATION 5995 03:21:18,691 --> 03:21:19,458 FACTORS RELATED TO THAT AND 5996 03:21:19,458 --> 03:21:22,828 OTHER BARRIERS, BUT REALLY THE 5997 03:21:22,828 --> 03:21:24,997 KEY TO THIS WAS RADICALLY 5998 03:21:24,997 --> 03:21:26,198 CHANGING THE ROOMING PROCESS, 5999 03:21:26,198 --> 03:21:27,733 BRINGING IN AUTOMATED OFFICE 6000 03:21:27,733 --> 03:21:32,137 BLOOD PRESSURE ON A LARGER 6001 03:21:32,137 --> 03:21:32,905 SCALE, AND REALLY THEN ONCE YOU 6002 03:21:32,905 --> 03:21:35,274 DO THAT, THE BIGGER PROBLEM 6003 03:21:35,274 --> 03:21:36,242 BECOMES INERTIA RATHER THAN JUST 6004 03:21:36,242 --> 03:21:37,876 THE MEASUREMENT ERRORS, BUT THIS 6005 03:21:37,876 --> 03:21:39,378 IS THE REALLY SORT OF FIRST LOW 6006 03:21:39,378 --> 03:21:41,113 HANGING FRUIT THAT'S STILL NOT 6007 03:21:41,113 --> 03:21:51,523 ADEQUATE IN MOST PLACES. 6008 03:21:53,392 --> 03:21:54,360 SO WE DISCUSSED WE THINK THE 6009 03:21:54,360 --> 03:21:55,661 FUTURE DIRECTIONS IN THIS REGARD 6010 03:21:55,661 --> 03:21:59,431 ARE LIKELY AGAIN REALLY 6011 03:21:59,431 --> 03:22:02,468 PRAGMATIC RCTs AND EVEN MAYBE 6012 03:22:02,468 --> 03:22:03,802 IMPLEMENTATION STUDIES AND 6013 03:22:03,802 --> 03:22:04,870 DISSEMINATION WORK INTO HOW TO 6014 03:22:04,870 --> 03:22:10,776 GET PEOPLE TO ADOPT ABPM AND IT 6015 03:22:10,776 --> 03:22:12,711 SEEMS SOMETHING WHERE AMA HAS 6016 03:22:12,711 --> 03:22:14,046 REALLY OPTIMIZED THIS AND 6017 03:22:14,046 --> 03:22:15,881 DEVELOPS MORE AMAZING TOOLS TO 6018 03:22:15,881 --> 03:22:16,882 DO THIS, THEY'RE GOING TO BE 6019 03:22:16,882 --> 03:22:19,485 MAKING THEM MORE PUBLIC AND MANY 6020 03:22:19,485 --> 03:22:21,053 MORE SINL TO WHOEVER NEEDS THEM 6021 03:22:21,053 --> 03:22:25,024 BUT THE ISSUE IS HOW COULD DO WT 6022 03:22:25,024 --> 03:22:26,625 PEOPLE AWARE OF THIS AND HOW DO 6023 03:22:26,625 --> 03:22:27,826 WE GET PEOPLE TO ACTUALLY DO 6024 03:22:27,826 --> 03:22:28,027 THIS? 6025 03:22:28,027 --> 03:22:30,596 AND I THINK THAT IS THE BIGGER 6026 03:22:30,596 --> 03:22:32,097 QEP, THERE'S DEFINITELY A HUGE 6027 03:22:32,097 --> 03:22:38,304 GAP AND A NEED FOR THIS. 6028 03:22:38,304 --> 03:22:39,538 LAST OBVIOUSLY SOME BIG ASPECT 6029 03:22:39,538 --> 03:22:42,207 OF THIS IS LACK OF EDUCATION. 6030 03:22:42,207 --> 03:22:44,476 WE TALK A LOT ABOUT BARRIERS TO 6031 03:22:44,476 --> 03:22:45,644 EDUCATION, BOTH PATIENTS AND 6032 03:22:45,644 --> 03:22:47,246 CLINICIANS WITH REGARD TO 6033 03:22:47,246 --> 03:22:49,648 TRUSTING AND INTERPRETING BLOOD 6034 03:22:49,648 --> 03:22:51,317 PRESSURE MEASUREMENT USING NEWER 6035 03:22:51,317 --> 03:22:52,584 TECHNOLOGY AND WHAT RESOURCES 6036 03:22:52,584 --> 03:22:53,385 COULD USE TECHNOLOGY TO HELP 6037 03:22:53,385 --> 03:22:56,088 WITH THAT AS WELL. 6038 03:22:56,088 --> 03:22:57,623 AND SO A LOT OF THIS IS RELATED 6039 03:22:57,623 --> 03:22:59,058 TO WHAT RESOURCES ARE 6040 03:22:59,058 --> 03:23:00,559 SPECIFICALLY NEEDED AND HOW BEST 6041 03:23:00,559 --> 03:23:02,661 TO ENGAGE PATIENTS AND 6042 03:23:02,661 --> 03:23:04,430 CLINICIANS AND A BIG ISSUE THAT 6043 03:23:04,430 --> 03:23:05,364 WAS BROUGHT UP WAS THAT THERE 6044 03:23:05,364 --> 03:23:08,233 WAS A LOT OF CULTURAL 6045 03:23:08,233 --> 03:23:08,801 DIFFERENCES, PARTICULARLY IN 6046 03:23:08,801 --> 03:23:09,368 PATIENTS AND HOW THEY THINK 6047 03:23:09,368 --> 03:23:10,169 ABOUT BLOOD PRESSURE, WHAT IT 6048 03:23:10,169 --> 03:23:13,672 MEANS TO THEM, WHETHER 6049 03:23:13,672 --> 03:23:14,707 SPECIFICALLY IT'S SOMETHING THEY 6050 03:23:14,707 --> 03:23:15,908 SEE AS JUST BEING A 6051 03:23:15,908 --> 03:23:16,608 REPRESENTATION OF STRESS AND 6052 03:23:16,608 --> 03:23:19,545 THAT ONLY MATTERS WHEN IT'S 6053 03:23:19,545 --> 03:23:20,979 SYMPTOMATIC AND THESE OTHER 6054 03:23:20,979 --> 03:23:22,614 ISSUES ARE SORT OF INDOCTRINATED 6055 03:23:22,614 --> 03:23:24,083 THAT REQUIRE A LOT OF BEHAVIORAL 6056 03:23:24,083 --> 03:23:26,018 TYPE RESEARCH AND A LOT OF 6057 03:23:26,018 --> 03:23:27,319 REALLY UNDERSTANDING CULTURALLY 6058 03:23:27,319 --> 03:23:30,322 SPECIFIC INFORMATION TO GET AT. 6059 03:23:30,322 --> 03:23:31,890 AND ALSO ADDRESSING STIGMA WHILE 6060 03:23:31,890 --> 03:23:32,858 DOING THAT. 6061 03:23:32,858 --> 03:23:33,926 THIS IS REALLY PROBLEMATIC AND 6062 03:23:33,926 --> 03:23:35,461 CHALLENGING AND REQUIRES A 6063 03:23:35,461 --> 03:23:36,562 DIFFERENT TYPE OF RESEARCH THAN 6064 03:23:36,562 --> 03:23:38,163 I THINK MOST PEOPLE IN THIS ROOM 6065 03:23:38,163 --> 03:23:41,767 TEND TO TYPICALLY ENGAGE IN AND 6066 03:23:41,767 --> 03:23:42,968 I THINK REQUIRES PARTNERING WITH 6067 03:23:42,968 --> 03:23:45,337 OTHER AREAS OR OTHER PEOPLE OF 6068 03:23:45,337 --> 03:23:46,305 EXPERTISE THAT WOULD BE ABLE TO 6069 03:23:46,305 --> 03:23:47,206 BETTER GET AT THIS. 6070 03:23:47,206 --> 03:23:48,707 AND TESTING STRATEGIES IN 6071 03:23:48,707 --> 03:23:50,008 DIFFERENT PATIENT POPULATIONS. 6072 03:23:50,008 --> 03:23:50,909 WE HAVE REALLY GOOD EXAMPLES OF 6073 03:23:50,909 --> 03:23:53,946 WHERE THIS HAS WORKED LIKE THE 6074 03:23:53,946 --> 03:23:54,546 BARBERSHOP STUDY AND LIKE THE 6075 03:23:54,546 --> 03:23:56,348 FAITH STUDY THAT HAVE EMBARKED 6076 03:23:56,348 --> 03:23:57,683 ON DOING THIS AND MEETING PEOPLE 6077 03:23:57,683 --> 03:23:58,951 WHERE THEY ARE, BUT I THINK THAT 6078 03:23:58,951 --> 03:24:00,052 THIS BECOMES STILL A BROADER 6079 03:24:00,052 --> 03:24:03,856 ISSUE IN AREAS WHERE IT'S 6080 03:24:03,856 --> 03:24:04,690 DIFFERENT WITHIN EACH CULTURE 6081 03:24:04,690 --> 03:24:08,127 AND THIS NEEDS TO BE BROUGHT IN 6082 03:24:08,127 --> 03:24:09,228 TO OTHER SUBGROUPS OF PEOPLE 6083 03:24:09,228 --> 03:24:10,462 THAT HAVEN'T BEEN REACHED AND 6084 03:24:10,462 --> 03:24:12,331 MADE FEASIBLE IN THE REAL WORLD, 6085 03:24:12,331 --> 03:24:17,669 WHICH IS THE BIGGER CHALLENGE. 6086 03:24:17,669 --> 03:24:19,271 AND SO FOR FUTURE DIRECTIONS FOR 6087 03:24:19,271 --> 03:24:21,240 THIS, WE TALKED ABOUT PERHAPS 6088 03:24:21,240 --> 03:24:24,309 CONSIDERING PROPOSING A.I. 6089 03:24:24,309 --> 03:24:24,810 ASSISTIVE TECHNOLOGIES, 6090 03:24:24,810 --> 03:24:26,979 PARTICULARLY WHERE WE CAN USE 6091 03:24:26,979 --> 03:24:29,047 THEM IN WAYS THAT DON'T 6092 03:24:29,047 --> 03:24:29,882 NECESSARILY ADDRESS THOSE 6093 03:24:29,882 --> 03:24:31,483 CULTURAL ISSUES BUT THAT ADDRESS 6094 03:24:31,483 --> 03:24:32,518 HELPING PEOPLE WALK THROUGH 6095 03:24:32,518 --> 03:24:34,420 TESTING AND COACHING WITH 6096 03:24:34,420 --> 03:24:37,456 MANAGING THEIR BLOOD PRESSURE, 6097 03:24:37,456 --> 03:24:38,791 HELPING PEOPLE IN TERMS OF HOW 6098 03:24:38,791 --> 03:24:39,525 TO PERFORM BLOOD PRESSURE 6099 03:24:39,525 --> 03:24:41,293 CORRECTLY AND THAT YOU CAN USE 6100 03:24:41,293 --> 03:24:42,294 ADDITIONAL TECHNOLOGICAL TOOLS 6101 03:24:42,294 --> 03:24:44,363 TO ASSESS WHERE THEY ARE, TIME 6102 03:24:44,363 --> 03:24:46,665 AND SPACE, ECOLOGICAL ASSESSMENT 6103 03:24:46,665 --> 03:24:47,733 TO HELP UNDERSTAND BLOOD 6104 03:24:47,733 --> 03:24:48,734 PRESSURE VARIABILITY AND TO HELP 6105 03:24:48,734 --> 03:24:49,368 UNDERSTAND THAT THEY ARE 6106 03:24:49,368 --> 03:24:50,736 ACTUALLY CHECKING THEIR BLOOD 6107 03:24:50,736 --> 03:24:53,972 PRESSURES CORRECTLY. 6108 03:24:53,972 --> 03:24:54,907 THAT SEEMS LIKE A FUEL TOUR 6109 03:24:54,907 --> 03:24:59,545 FEAFUTUREFEASIBLE DIRECTION BUTE 6110 03:24:59,545 --> 03:25:00,379 TALKED ABOUT HOW IT WILL BE 6111 03:25:00,379 --> 03:25:01,580 REALLY, REALLY CRITICAL TO 6112 03:25:01,580 --> 03:25:03,115 UNDERSTAND HOW PEOPLE WANT TO 6113 03:25:03,115 --> 03:25:03,816 COMMUNICATE AND HELP PEOPLE SORT 6114 03:25:03,816 --> 03:25:06,251 OF IN THAT PRECONTEMPLATIVE 6115 03:25:06,251 --> 03:25:07,986 STAGE REALLY EVEN UNDERSTAND HOW 6116 03:25:07,986 --> 03:25:11,857 DO WE START TO COMMUNICATE WITH 6117 03:25:11,857 --> 03:25:13,559 PEOPLE AND GET AT BETTER 6118 03:25:13,559 --> 03:25:14,560 MANAGING BLOOD PRESSURE WHO 6119 03:25:14,560 --> 03:25:15,661 STRUGGLED WITH EVEN THINKING 6120 03:25:15,661 --> 03:25:17,129 IT'S SOMETHING WORTH MANAGING. 6121 03:25:17,129 --> 03:25:17,996 SO THAT'S A BIGGER CHALLENGE 6122 03:25:17,996 --> 03:25:19,698 THAT WE THOUGHT WOULD BE A BIT 6123 03:25:19,698 --> 03:25:23,535 MORE CHALLENGING TO ADDRESS IN 6124 03:25:23,535 --> 03:25:26,839 THE FIRST PLACE. 6125 03:25:26,839 --> 03:25:28,474 SO WE WERE THINKING THERE WERE A 6126 03:25:28,474 --> 03:25:30,309 FEW POTENTIAL WAYS, INFLUENCING 6127 03:25:30,309 --> 03:25:32,144 THE INFLUENCERS AS MENTIONED, 6128 03:25:32,144 --> 03:25:33,479 THINGS LIKE BARBERSHOPS AND 6129 03:25:33,479 --> 03:25:36,748 OTHER OU OUTREACH, USING MOBILE 6130 03:25:36,748 --> 03:25:37,783 VANS LIKE WHAT WAS USED IN 6131 03:25:37,783 --> 03:25:39,518 COVID, ADDRESSING THOSE FOR THE 6132 03:25:39,518 --> 03:25:41,954 TYPE OF SITUATION. 6133 03:25:41,954 --> 03:25:43,322 THINKING ABOUT STANDARDIZED 6134 03:25:43,322 --> 03:25:43,922 PROCESS OF COMPETENCIES FOR 6135 03:25:43,922 --> 03:25:45,691 STAFF AND TRAINING, THE AMERICAN 6136 03:25:45,691 --> 03:25:47,226 MEDICAL ASSOCIATION IS COMING 6137 03:25:47,226 --> 03:25:49,828 OUT WITH A FREE TRAINING PROGRAM 6138 03:25:49,828 --> 03:25:51,230 FOR CLINICIANS, THINGS LIKE THIS 6139 03:25:51,230 --> 03:25:53,632 NEED TO BE DISSEMINATED WIDELY, 6140 03:25:53,632 --> 03:25:54,500 THOUGH, FOR PEOPLE TO EVEN BE 6141 03:25:54,500 --> 03:25:55,367 AWARE THIS IS NEEDED. 6142 03:25:55,367 --> 03:25:56,768 I THINK THERE ARE A LOT OF 6143 03:25:56,768 --> 03:25:58,770 BARRIERS TO MAKING HEALTH 6144 03:25:58,770 --> 03:25:59,638 SYSTEMS AWARE OF HOW IMPORTANT 6145 03:25:59,638 --> 03:26:02,474 THIS IS. 6146 03:26:02,474 --> 03:26:05,777 TESTING, AND OF COURSE EXAMINING 6147 03:26:05,777 --> 03:26:06,512 WORKFLOWS AND IDENTIFYING THE 6148 03:26:06,512 --> 03:26:07,446 BEST WAYS TO IMPLEMENT THESE ALL 6149 03:26:07,446 --> 03:26:10,015 WOULD BE USEFUL WITH 6150 03:26:10,015 --> 03:26:11,483 IMPLEMENTATION RESEARCH AND 6151 03:26:11,483 --> 03:26:12,117 PRAGMATIC TRIALS WHICH SEEMS TO 6152 03:26:12,117 --> 03:26:13,218 BE THE FUTURE OF THIS AREA, AND 6153 03:26:13,218 --> 03:26:15,721 THEN AS MENTIONED PROBABLY ALSO 6154 03:26:15,721 --> 03:26:17,022 SOME BEHAVIORAL INTERVENTIONS TO 6155 03:26:17,022 --> 03:26:17,990 TEST SOME OF THE OTHER 6156 03:26:17,990 --> 03:26:19,291 STRATEGIES WE'VE TALKED ABOUT, 6157 03:26:19,291 --> 03:26:20,225 PARTICULARLY WITH BOTH 6158 03:26:20,225 --> 03:26:21,360 CLINICIANS AND PATIENTS OF HOW 6159 03:26:21,360 --> 03:26:22,261 BEST TO GET PEOPLE TO EVEN THINK 6160 03:26:22,261 --> 03:26:23,896 THAT THIS ALL MATTERS. 6161 03:26:23,896 --> 03:26:33,772 SO I THINK THAT WAS EVERYTHING. 6162 03:26:33,772 --> 03:26:37,509 >> FAN FANTASTIC SUMMARY, JORD. 6163 03:26:37,509 --> 03:26:39,311 THANK YOU FOR ALL THE HARD WORK 6164 03:26:39,311 --> 03:26:41,680 AND ACTUALLY TO ALL THE BREAKOUT 6165 03:26:41,680 --> 03:26:43,949 SESSIONS FOR THIS REPORT. 6166 03:26:43,949 --> 03:26:47,419 I THINK WE'RE NOW A OUT OF TIME, 6167 03:26:47,419 --> 03:26:49,655 BUT JUST SOME CLOSING THOUGHTS. 6168 03:26:49,655 --> 03:26:53,458 WE WANTED TO, A, THANK ALL THE 6169 03:26:53,458 --> 03:26:55,427 PARTICIPANTS OBVIOUSLY AND 6170 03:26:55,427 --> 03:26:56,795 SPEAKERS AND MODERATORS TO 6171 03:26:56,795 --> 03:26:57,763 CONTRIBUTED TO THIS REALLY 6172 03:26:57,763 --> 03:26:59,364 IMPORTANT WORKSHOP, AND THANK 6173 03:26:59,364 --> 03:27:01,867 YOU TO -- I SEE DR. PAULA 6174 03:27:01,867 --> 03:27:03,769 EINHORN AND TO ALL THE OTHER 6175 03:27:03,769 --> 03:27:06,371 NIH, NHLBI FOR CONVENING THIS 6176 03:27:06,371 --> 03:27:07,272 WORKSHOP I THINK AT A VERY 6177 03:27:07,272 --> 03:27:08,774 CRITICAL TIME, AND OVER THE PAST 6178 03:27:08,774 --> 03:27:10,876 TWO DAYS, WE'VE EXPLORED THE 6179 03:27:10,876 --> 03:27:12,144 CURRENT STATE OF BLOOD PRESSURE 6180 03:27:12,144 --> 03:27:13,178 ASSESSMENT ACROSS CLINICAL 6181 03:27:13,178 --> 03:27:16,114 PRACTICE AND RESEARCH, WE 6182 03:27:16,114 --> 03:27:17,583 ATTEMPTED TO IDENTIFY CRITICAL 6183 03:27:17,583 --> 03:27:19,551 KNOWLEDGE GAPS AND DISCUSS 6184 03:27:19,551 --> 03:27:20,652 OBVIOUSLY INNOVATIVE SOLUTIONS 6185 03:27:20,652 --> 03:27:24,556 TO ADVANCE THE FIELD. 6186 03:27:24,556 --> 03:27:26,391 I THINK IT WAS AMAZING TO LISTEN 6187 03:27:26,391 --> 03:27:28,293 TO A DIVERSITY OF TOPICS FROM 6188 03:27:28,293 --> 03:27:29,461 PEDIATRICS, PREGNANCY RELATED 6189 03:27:29,461 --> 03:27:30,529 BLOOD PRESSURE MONITORING, 6190 03:27:30,529 --> 03:27:31,863 INTEGRATIONS OF EMERGING 6191 03:27:31,863 --> 03:27:32,864 TECHNOLOGIES AND OBVIOUSLY 6192 03:27:32,864 --> 03:27:33,999 ADDRESSING EQUITY IS OUR RUNNING 6193 03:27:33,999 --> 03:27:35,567 THEME WHICH OBVIOUSLY 6194 03:27:35,567 --> 03:27:36,335 UNDERSCORES THE COMPLEXITY AND 6195 03:27:36,335 --> 03:27:38,704 IMPORTANCE OF IMPROVING BLOOD 6196 03:27:38,704 --> 03:27:39,137 PRESSURE ASSESSMENT. 6197 03:27:39,137 --> 03:27:41,473 SO FOR US, OUR KEY TAKEAWAYS 6198 03:27:41,473 --> 03:27:42,507 HAVE INCLUDED THE NEED TO 6199 03:27:42,507 --> 03:27:45,210 VALIDATE OBVIOUSLY THESE 6200 03:27:45,210 --> 03:27:47,913 EMERGING CONTINUOUS AND CUFFLESS 6201 03:27:47,913 --> 03:27:49,314 BLOOD PRESSURE MONITORING 6202 03:27:49,314 --> 03:27:50,115 TECHNIQUES FOR DIVERSE 6203 03:27:50,115 --> 03:27:53,552 POPULATIONS ACROSS THE LIFESPAN, 6204 03:27:53,552 --> 03:27:55,220 ADDRESSING ANY CHALLENGES IN 6205 03:27:55,220 --> 03:27:56,321 SPECIFIC POPULATIONS AND 6206 03:27:56,321 --> 03:27:58,357 CLINICAL CONDITIONS, OBVIOUSLY A 6207 03:27:58,357 --> 03:28:00,492 CALL TO ACTION TO ENSURE 6208 03:28:00,492 --> 03:28:02,928 EQUITABLE ACCESS THROUGH A 6209 03:28:02,928 --> 03:28:05,564 RELIABLE BLOOD PRESSURE 6210 03:28:05,564 --> 03:28:07,799 ASSESSMENT TOOLS AND MITIGATE 6211 03:28:07,799 --> 03:28:09,301 POTENTIAL BIAS AND EMERGING 6212 03:28:09,301 --> 03:28:11,770 TECHNOLOGIES, AND NECESSITY OF 6213 03:28:11,770 --> 03:28:13,572 INTEGRATING PATIENT GENERATED 6214 03:28:13,572 --> 03:28:15,474 DATA INTO WORKFLOWS WHILE 6215 03:28:15,474 --> 03:28:17,075 LERCHGING LARGE DATASETS FOR 6216 03:28:17,075 --> 03:28:18,010 MEANINGFUL CLINICAL 6217 03:28:18,010 --> 03:28:18,810 DECISION-MAKING SO OUR NEXT 6218 03:28:18,810 --> 03:28:20,379 STEPS WILL BE TO CONVENE A 6219 03:28:20,379 --> 03:28:22,147 WRITING GROUP TO TRANSLATE THE 6220 03:28:22,147 --> 03:28:23,448 FINDINGS FROM THIS WORKSHOP INTO 6221 03:28:23,448 --> 03:28:25,283 A MEANING FULL ROAD MAP FOR A 6222 03:28:25,283 --> 03:28:27,653 BROAD RANGE OF KNOWLEDGE HOLDERS 6223 03:28:27,653 --> 03:28:29,287 INCLUDING CLINICIANS PATIENTS, 6224 03:28:29,287 --> 03:28:30,622 RESEARCHERS AND FUNDERS BUT I 6225 03:28:30,622 --> 03:28:32,090 THINK ALSO POLICYMAKERS IN ORDER 6226 03:28:32,090 --> 03:28:33,759 TO INSPIRE SYSTEM CHANGE 6227 03:28:33,759 --> 03:28:34,926 ULTIMATELY FOCUSING ON HOW WE 6228 03:28:34,926 --> 03:28:36,695 CAN IMPACT CLINICAL GUIDELINES, 6229 03:28:36,695 --> 03:28:38,797 HEALTHCARE DELIVERY AND PUBLIC 6230 03:28:38,797 --> 03:28:41,500 HEALTH POLICY TO IMPROVE BLOOD 6231 03:28:41,500 --> 03:28:42,901 PRESSURE CONTROL EQUITABLY. 6232 03:28:42,901 --> 03:28:44,369 I'LL HAND IT OVER TO STEPHEN FOR 6233 03:28:44,369 --> 03:28:44,670 NEXT STEPS. 6234 03:28:44,670 --> 03:28:47,072 >> THANK YOU TO YOU, MARWAH, FOR 6235 03:28:47,072 --> 03:28:49,941 ALL YOUR LEADERSHIP AND 6236 03:28:49,941 --> 03:28:50,842 SHOULDERING OF BULK OF ALL THE 6237 03:28:50,842 --> 03:28:52,344 LOAD, BUT IT BEEN SUCH A 6238 03:28:52,344 --> 03:28:54,813 PLEASURE, AND I AGAIN JUST WANT 6239 03:28:54,813 --> 03:28:56,114 TO ECHO MY THANKS TO NHLBI AND 6240 03:28:56,114 --> 03:28:58,550 ALL OF YOU FOR CONTRIBUTING SO 6241 03:28:58,550 --> 03:29:00,986 MUCH TO THIS CRITICAL DISCUSSION 6242 03:29:00,986 --> 03:29:03,789 AROUND SUCH AN IMPORTANT RISK 6243 03:29:03,789 --> 03:29:04,923 FACTOR FOR CARDIOVASCULAR 6244 03:29:04,923 --> 03:29:05,924 DISEASE. 6245 03:29:05,924 --> 03:29:08,727 SO AS MARWAH WAS SAYING, OUR 6246 03:29:08,727 --> 03:29:10,462 HOPE IS TO CONVENE THE WORKING 6247 03:29:10,462 --> 03:29:12,531 GROUP AND TO WORK EFFICIENTLY, 6248 03:29:12,531 --> 03:29:16,068 WHILE IDEAS ARE FRESH. 6249 03:29:16,068 --> 03:29:17,035 OUR UNDERSTANDING IS THERE WILL 6250 03:29:17,035 --> 03:29:19,571 BE AN EXECUTIVE SYNOPSIS FOR 6251 03:29:19,571 --> 03:29:22,374 POSTING BY NHLBI, WHICH WILL BE 6252 03:29:22,374 --> 03:29:23,909 REALLY IMPORTANT FOR 6253 03:29:23,909 --> 03:29:27,579 HIGHLIGHTING THE KEY OVERARCHING 6254 03:29:27,579 --> 03:29:30,348 CONCLUSIONS FROM THE DISCUSSION. 6255 03:29:30,348 --> 03:29:33,752 BUT IN ADDITION, IN THE KIND OF 6256 03:29:33,752 --> 03:29:35,787 TRADITION OF THE LAST WORKSHOP, 6257 03:29:35,787 --> 03:29:37,055 I THINK A MAJOR OBJECTIVE WOULD 6258 03:29:37,055 --> 03:29:39,691 BE TO HAVE A SIMILAR WHITE PAPER 6259 03:29:39,691 --> 03:29:42,527 THAT WAS PUBLISHED BY THE FORMER 6260 03:29:42,527 --> 03:29:44,062 WORKING GROUP, I BELIEVE THAT 6261 03:29:44,062 --> 03:29:49,634 ONE WENT TO JACK IN 2019, AND I 6262 03:29:49,634 --> 03:29:51,436 THINK IT WAS A REALLY HELPFUL 6263 03:29:51,436 --> 03:29:52,104 DOCUMENT FOR FOLLOWING UP ON 6264 03:29:52,104 --> 03:29:53,705 SOME OF THE RESEARCH 6265 03:29:53,705 --> 03:29:55,340 RECOMMENDATIONS OR NEXT STEPS 6266 03:29:55,340 --> 03:29:56,575 FUTURE DIRECTIONS THAT WERE 6267 03:29:56,575 --> 03:29:58,343 IDENTIFIED BY THAT WORKING 6268 03:29:58,343 --> 03:30:00,312 GROUP, AND THAT CERTAINLY IS 6269 03:30:00,312 --> 03:30:01,713 SOMETHING THAT WE BELIEVE COULD 6270 03:30:01,713 --> 03:30:04,950 BE REALLY VALUABLE WAY TO 6271 03:30:04,950 --> 03:30:05,984 SUMMARIZE WHAT WAS DISCUSSED 6272 03:30:05,984 --> 03:30:07,853 TODAY AND CAPTURE IT FOR OTHERS 6273 03:30:07,853 --> 03:30:10,388 TOO, TO KIND OF CARRY OUT AND 6274 03:30:10,388 --> 03:30:13,759 WORK ON A NUMBER OF THE ITEMS. 6275 03:30:13,759 --> 03:30:16,161 AND SO OUR HOPE IS TO CONVENE 6276 03:30:16,161 --> 03:30:20,532 THE WORKING GROUP TO VERY 6277 03:30:20,532 --> 03:30:23,468 QUICKLY PUT TOGETHER A DRAFT, AN 6278 03:30:23,468 --> 03:30:24,269 OUTLINE WITH SOME ASSIGNMENTS 6279 03:30:24,269 --> 03:30:27,038 THAT WE CAN CIRCULATE TO THE 6280 03:30:27,038 --> 03:30:31,643 GROUP AND THEN ESTABLISH A 6281 03:30:31,643 --> 03:30:34,012 TIMELINE FOR ACCOMPLISHING THIS 6282 03:30:34,012 --> 03:30:36,848 WHITE PAPER DRAFT, AND OBVIOUSLY 6283 03:30:36,848 --> 03:30:39,484 IN COORDINATION WITH NHLBI, OUR 6284 03:30:39,484 --> 03:30:42,154 THINKING MIGHT BE THAT IT WOULD 6285 03:30:42,154 --> 03:30:46,158 BE GREAT IF THIS COULD GET 6286 03:30:46,158 --> 03:30:47,692 PUBLISHED IN THREE TO SIX MONTHS 6287 03:30:47,692 --> 03:30:48,460 POTENTIALLY. 6288 03:30:48,460 --> 03:30:50,028 THAT'S OVERLY AMBITIOUS, BUT 6289 03:30:50,028 --> 03:30:52,731 THERE WILL BE ADDITIONAL 6290 03:30:52,731 --> 03:30:53,698 CORRESPONDENCE AROUND JUST HOW 6291 03:30:53,698 --> 03:30:54,866 TO IMPLEMENT THE NEXT STEPS. 6292 03:30:54,866 --> 03:30:57,269 SO STAY TUNED, WE'RE REALLY 6293 03:30:57,269 --> 03:30:58,403 EXCITED TO BE WORKING WITH SUCH 6294 03:30:58,403 --> 03:31:00,071 A GROUP, AND IT WILL BE A BIG 6295 03:31:00,071 --> 03:31:02,407 TASK TO CAPTURE ALL THE IDEAS 6296 03:31:02,407 --> 03:31:03,708 AND THOUGHTS BUT CERTAINLY, I 6297 03:31:03,708 --> 03:31:05,710 THINK, THAT BACK AND FORTH IN 6298 03:31:05,710 --> 03:31:07,646 DISCUSSION WILL REALLY MAKE IT A 6299 03:31:07,646 --> 03:31:08,180 REALLY USEFUL DOCUMENT FOR 6300 03:31:08,180 --> 03:31:10,982 OTHERS. 6301 03:31:10,982 --> 03:31:20,982 SO THANK YOU SO MUCH.