GOOD AFTERNOON, GOOD EVENING,
FRIENDS AND COLLEAGUES, WE ARE
DELIGHTED TO HOST THIS WEBINAR.
MY NAME IS KARA LOUIS, I'M THE
DEPUTY DIRECTOR FOR THE CENTER
FOR IMPLEMENTATION SCIENCE
FONDLY REFERRED TO AS CTRIS. WE
ARE SO GRATEFUL FOR THE TIME
THAT YOU'RE TAKING TO JOIN US
TODAY FOR THIS REALLY IMPORTANT
TOPIC. WE KNOW YOU'RE ALL VERY
BUSY AND WE'VE TUCKED THIS IN
BETWEEN TWO HOLIDAYS SO GRATEFUL
THAT YOU DECIDED TO JOIN US.
SLIDE, PLEASE. BEFORE WE GET
STARTED, LET ME JUST SHARE A
COUPLE OF HOUSEKEEPING ITEMS.
SO ATTENDEES ARE MUTED UPON
ENTRY. DOESN'T MEAN WE DON'T
WANT TO HEAR FROM YOU, IN FACT,
IT'S QUITE THE OPPOSITE WE
REALLY HOPE THAT YOU'LL BE
PUTTING YOUR QUESTIONS AND YOUR
COMMENTS IN THE CHAT THROUGHOUT
THE PRESENTATIONS TODAY. AND
SHOULD YOU BE INTERESTED AT THE
VERY END OF ALL OF OUR SPEAKERS'
PRESENTATIONS WE CAN INVITE YOU
TO JOIN THE CONVERSATION MORE
FULLY. WE WANT TOWENOWLEDGE
THE WEBINAR IS BEING RECORDED AS
HAVE ALL OF THE OTHER HERO
LECTURES SO THAT OTHER FOLKS WHO
ARE UNABLE TO JOIN US IN
REALTIME CAN LOOK BACK AT THE
CONVERSATION THAT WE'RE HAVING.
SHOULD YOU EXPERIENCE ANY
TECHNICAL ISSUES YOU'VE GOT A
CONTACT E-MAIL ON YOUR SCREEN.
SLIDE, PLEASE. SO AS I ELUDED
TO THIS LECTURE IART OF A
LARGER SERIES THAT THE HERO
SERIES WHICH STARTED IN JANUARY
2022. AND IT'S INTENDED TO
HIGHLIGHT THE WORK AND VOICES OF
THOSE INVOLVED IN GLOBAL AND
DOMESTIC HEALTH EQUITY RESEARCH
THROUGH DISCUSSION AND
ENGAGEMENT THIS SERIES AIMS TO
ADDRESS PRESSING CHALLENGES AND
OPPORTUNITIES IN THIS AREA OF
SCIENTIFIC RESEARCH. AS I
MENTIONED CTRI IS IS HOSTING
THIS RE LOOKING AT THE FOUR
PILLARS AT THE STRATEGIC FOCAL
POINT FOR GLOBAL HEALTH
RESEARCH, HEALTH INEQUITIES
RESEARCH, IMPLEMENTATION SCIENCE
AND COMMUNITY RESEARCH HERE AT
THE NATIONAL HEART, LUNG AND
BLOOD INSTITUTE. CTRIS IS
CELEBRATING ITS TENTH YEAR AS A
CENTER.
AND TO CELEBRATE THE TENTH
ANNIVERSARY WE'VE BEEN
DEDICATING THE HERO LECTURE
SERIES TO EACH OF THE FOUR
PILLARS THROUGHOUT THE YEAR SO
TO DATE WE'VE HOSTED RESOLVE SO
SAVE LIVES, CARDIOVASCULAR
HEALTH PROMOTION IN LOW AND
MIDDLE INCOME COUNTRIES ON APRIL
29TH AND ADVANCING HEALTH
INEQUITY ON AUGUST 27TH AND YOU
CAN LOOK ON OUR WEBSITE FOR
ARCHIVED RECORDINGS OF THESE
CONVERSATIONS FOR YOUR VIEWING
PLEASURE. TODAY WILL FEATURE
THE INTERSECTION OF
IMPLEMENTATION SCIENCE AND
HEALTH EQUITY. BEFORE WE JUMP
INTO OUR AGENDA FOR TODAY THOUGH
SLIDE, PLEASE. I DID WANT TO
INVITE YOU ALL TO JOIN US IN THE
ONGOING CELEBRATORY ACTIVITIES.
THERE'S A SPECIAL EVENT THAT'S
BEING SORT OF TAGGED ONTO THE
ACADEMY HEALTH DNI CONFERENCE
THAT'S TAKING PLACE THIS
DECEMBER. AND THE INFORMATION
ON YOUR SCREEN WILL HELP YOU
DECIDE IF YOU CAN JOIN US
VIRTUALLY OR IN-PERSON ON
DECEMBER 11TH. IN THE AFTERNOON
AND HOPEFULLY THAT QR CODE WORKS
FOR YOU TO TAKE YOUR WAY INTO
THE ATTENDEE LIST. WE'VE GOT A
REALLY PACKED AGENDA OF
GRANTEES, SPEAKING, A HOSTER
SESSION, AS WELL AS LEADERS FROM
NIH TO HELP US CELEBRATE, SLIDE,
PLEASE. SO AS YOU CAN SEE, THIS
IS OUR INTENDED AGENDA FOR THE
SHORT TIME WE ARE TOGETHER
TODAY. WE WILL HEAR FROM THREE
PANELISTS AND THEN HAVE, GOSH,
ABOUT THIRTY MINUTES OR SO FOR
CONVERSATIONS, SO, SLIDE,
PLEASE. LET ME INTRODUCE YOU TO
OUR FIRST PANELIST. I'LL
INTRODUCE THEM ALL NOW. THEY'LL
SPEAK IN TURN AND THEN WE'LL
MAXIMIZE TIME FOR DIALOGUE. SO
FIRST UP WILL BE DR. RI THATTED
WHO IS THE CHAIR AND AT THE
NORTHWESTERN UNIVERSITY. SHE IS
A VERY LARGE BIO LONLINE IF YOU
DON'T KNOW HER ALREADY.
AND NEXT SLIDE, PLEASE. SECOND
WE'LL HEAR FROM THE FOUNDING
DIRECTOR FOR HEALTH AND
DR. ADOLF AND MARGARET PROFESSOR
AT THE GROSSMANN SCHOOL OF
MEDICINE ALSO VERY GOOGLEABLE
AND PROLIFIC AS A RESEARCHER IN
THE INTERSTITIAL SPACES THAT
YOU'LL HEAR ABOUT LATER THIS
MORNING AND THEN FINALLY, LAST
BUT NOT LEAST WE'LL HEAR FROM
DR. LITTLE YA, ATTENDED
PROFESSOR AND THE DIRECTOR OF
IMMIGRANT RESEARCH AT THE
UNIVERSITY OF COLORADO SCHOOL OF
MEDICINE. AND REALLY EXCITED TO
HAVE THIS SORT OF GROUNDING
VIEWPOINT FROM THE DOCTOR TO
KICK US OFF AND SOME FOCUSED
EXAMPLES OF HEALTH EQUITY
RESEARCH AND COMMUNITY ENGAGED
RESEARCH AND BRINGING IN HEALTH
JUSTICE FROM OUR OTHER TWO
SPEAKERS. SO WITHOUT FURTHER
ADO, I WILL PUT MYSELF ON MUTE,
TURN IT OTHER TO THE DOCTOR AND
LOOKING FORWARD TO OUR
CONVERSATION.
>> THANK YOU SO MUCH FOR HAVING
ME I HOPE TO SEE ALL OF YOU ALL
AT THE CELEBRATION IN D.C. OR
VIRTUALLY. I AM GOING TO GO
AHEAD AND SHARE MY SCREEN. AND
GO TO SLIDESHOW. CAN SOMEBODY
GIVE ME A VISUAL THAT YOU'RE
SEEING THE RIGHT SLIDES AND YOU
CAN HEAR ME OKAY? FANTASTIC.
WONDERFUL. IT IS A HUGE HONOR
TO BE HERE AT THE HERO SEMINAR
SERIES AND WITH MY ESTEEMED
PANELISTS. I'M REALLY LOOKING
FORWARD TO CHATTING WITH YOU ALL
A BIT TODAY. I WOULD LIKE TO
START WITH A POSITIONALITY
STATEMENT. AS MY IDENTITY, AND
LIVED EXPERIENCES DEEPLY SHAPE
MY PERSPECTIVE. I AM A MIDDLE
EASTERN IMMIGRANT MOTHER
COMMUNITY MEMBER AND
PSYCHOLOGIST, MY EARLIEST
MEMORIES INCLUDE BEDTIME
DISCUSSIONS WITH MY FATHER WHO
IS A FOREIGN TRAINED MEDICAL
GRADUATE INFECTIOUS DISEASE DRO
WHO WAS ON THE FRONTLINE OF THE
HIV EPIDEMIC WORKING IN A SAFETY
NET HOSPITAL AND AT BED AS HE
TOLD ME STORIES ABOUT HIS
PATIENTS, I JUST COULDN'T WRAP
MY HEAD AROUND THE FACT THAT NOT
EVERYONE WAS AFFORDED THE
FUNDAMENTAL HUMAN RIGHT OF
HEALTH AND IT IGNITED A PASSION
TO DO SOMETHING ABOUT THAT. I
CURRENTLY SERVE AS CHAIR OF THE
DEPARTMENT OF MEDICAL SOCIAL
SCIENCES AT NORTHWESTERN
FEINBERG SCHOOL OF MEDICINE AND
WE HARNESS BEHAVIOR SCIENCES TO
ADVANCE EQUITY AND INNOVATION
AND IMPACT OF HEALTH WHICH IS
CONSISTENT WITH MY OVERALL
MISSION AS A SCIENTIST AND THE
REASON I GET UP IN THE MORNING
AND AM EXCITED ABOUT
IMPLEMENTATION SCIENCE IS
BECAUSE I REALLY DO SEE IT AS A
TOOL. AND A METHOD THAT ALLOWS
US TO ADVOCATE FOR THE NEEDS OF
OUR COMMUNITIES IN PURSUIT OF
POPULATION HEALTH AND SOCIAL
JUSTICE AT SCALE. GIVEN THE
FOCUS OF TODAY'S TALK IS ON
HEALTH EQUITY I DO WANT TO BE
EXPLICIT ABOUT THIS MESSAGE
WHICH IS THAT I AM TRAINED AS AN
IMPLEMENTATION SCIENTIST AND I
REALLY SEE THE WORLD THROUGH
THAT LENS, HAVING DONE THIS WORK
NOW FOR THE PAST TWO DECADES.
MY EARLY WORK WHICH I'LL BRIEFLY
TALK ABOUT HAD AN IMPLICIT FOCUS
ON HEALTH EQUITY BECAUSE IT WAS
REALLY FOCUSED ON CENTERING
IMPLEMENTATION OF EVIDENCE-BASED
PRACTICES SERVING POPULATION
SERVED BY MEDICAID THAT WORK WAS
BUILT UPON A FOUNDATION OF DEEP
COMMUNITY PARTNERSHIP AND
FOCUSED ON BRINGING HIGH QUALITY
CARE TO POPULATIONS WHO HAD NOT
HAD ACCESS MORE RECENTLY IS THE
FIELD OF IMPLEMENTATION SCIENCE
HAS GROWN. I HAVE BEGUN TO
EXPLICITLY BRING THIS INTO MY
WORK WITH SUPPORT FROM COLLEAGUE
WHO IS ARE EXPERTS AND I HOPE
WHAT I PRESENT CAN SERVE AS
EXAMS FOR OTHERS WHO MAY WANT TO
CENTER EQUITABLE IMPLEMENTATION
WHICH I ARGUE EVERYONE SHOULD BE
DOING.
AND I ESPECIALLY WANT TO CALL
OUT DR. RACHEL SHELTON WHO IS AN
INTERNATIONAL EXPERT AT THE
INTERSECTION OF SCIENCE AND
EQUITY BECAUSE SHE'S BEEN A
CRITICAL PARTNER IN THESE
EFFORTS AND YOU'LL SEE HER
FINGERPRINT ON ALL THE WORK I'M
PRESENTING SO WHAT I WOULD LIKE
TO SHARE IS AS FOLLOWS, FIRST I
DON'T BELIEVE THAT WE CAN
ACHIEVE POPULATION HEALTH
WITHOUT HEALTH FOR ALL PEOPLE.
I BELIEVE IT IS OUR
RESPONSIBILITY TO PROSPECTIVELY
FOCUS IMPLEMENTATION SCIENCE THE
REASON FOR HA IS WE HAVE TO MAKE
SURE THAT WE DO NOT CREATE NEW
INEQUITY FOR EXAMPLE IF WE ONLY
IMPLEMENT IN HIGH RESOURCE
PLACES THUS CREATING NEW GAPS OR
WORSEN EXISTING INEQUITIES.
SECOND I WOULD LIKE TO SHARE A
DEFINITION OF IMPLEMENTATION
SCIENCE. BEFORE I DO THAT, I
JUST WANT TO ALSO SAY, HOW I
THINK ABOUT IMPLEMENTATION
SCIENCE MORE BROADLY. FOR ME,
IMPLEMENTATION SCIENCE IS REALLY
ABOUT MOVING THE NEEDLE IN
HEALTH FOR ALL OR HELPING PEOPLE
IN PLACES DO THE THING FOR ALL
PEOPLE. SO EQUITY FOCUSED
IMPLEMENTATION SCIENCE IS WHEN
STRONG EQUITY COMPONENTS, BEING
EXPLICIT ABOUT ATTENTION TO
CULTURE, HISTORY, VALUES, ASSETS
AND NEEDS OF THE COMMUNITY ARE
INTEGRATED INTO THE PRINCIPLE
STRATEGIES FRAMEWORKS AND TOOLS
OF IMPLEMENTATION SCIENCE. AND
THERE'S BEEN GREAT PROGRESS MADE
IN THE PAST FEW YEARS BUT
THERE'S A LOT OF WAYS TO GO IN
ACHIEVING A VISION OF EQUITY
FOCUSED IMPLEMENTATION SCIENCE.
THESE ARTICLES HAVE DEEPLY
SHAPED MY THINKING OVER THE PAST
FEW YEARS. AND I DID WANT TO
SHARE THEM WITH YOU ALL AND HAVE
THEM BE A RESOURCE. AT THE
INTERSECTION OF HEALTH EQUITY
AND IMPLEMENTATION SCIENCE AND I
PARTICULARLY WANT TO CALL OUT
THE IMPLEMENTATION SCIENCE
CENTERS IN CANCER CONTROL
TOOLKIT. FOR GETTING STARTED
WITH HEALTH EQUITY FOCUSED
IMPLEMENTATION RESEARCH AS IT'S
A GREAT PLACE TO KIND OF START.
SO I'VE ORGANIZED MY COMMENTS
TODAY AROUND A NEW VIEWPOINT AS
JUST PUBLISHED AS PART OF A NEW
ISSUE IN PREVENTION SCIENCE.
AND IN THAT VIEWPOINT, THEY
OFFER SEVEN CALLS TO ACTION. I
HAVE TAKEN THE LIBERTY OF
ORGANIZING THOSE SEVEN CALL TO
ACTION WITHIN THREE THEMATIC
BUCKETS. THE FIRST BEING AROUND
BUILDING TRUST AND A MODEL OF
CO-CREATION WITH OUR
COMMUNITIES. THE SECOND BEING A
FOCUS ON OUTER SETTING FACTORS
AND POLICY DEVELOPMENT AND THE
THIRD BEING AROUND REFOCUSING
OUR INTERVENTION AND
IMPLEMENTATION SCIENCE WORK.
TODAY I'M GOING TO HIGHLIGHT
SOME OF OUR TEAM'S WORK IN
BUCKETS ONE TO THREE.
PARTNERSHIP BEING AN EFFECTIVE
TOOL FOR AMPLIFYING THE NEEDS OF
OUR COMMUNITIES AND I WILL TALK
ABOUT HOW WE TRIED TO REFOCUS
OUR IMPLEMENTATION IN SCIENCE IN
THE FOLLOWING WAYS AND WE'LL
GIVE YOU SOME EXAMPLES OF THAT.
THAT INCLUDES ADAPTING
INTERVENTIONS AND STRATEGIES IN
PARTNERSHIP WITH OUR COMMUNITIES
TO MAKE SURE THAT THEY'RE
APPROPRIATE AND FIT THE CONTEXT
AND THE NEEDS. INCORPORATING
DETERMINANTS OF HEALTH EQUITY
INTO OUR IMPLEMENTATION SCIENCE
FRAMEWORKS AND THINKING ABOUT
HOW WE MEASURE EQUITABLE
OUTCOMES. CENTERING THE VOICES
OF CONSTITUENTS AND THEIR
EXPERIENCE OF THE IMPLEMENTATION
PROCESS. AND PERSPECTIVELY
DEFINING WHICH POPULATIONS MAY
EXPERIENCE INEQUITIES AND
MEASURING DIFFERENTIAL
IMPLEMENTATION STRATEGY
EFFECTIVENESS SO, IN THE COMING
MINUTES I'M GOING TO BE GIVING
YOU SOME EXAMPLES FROM OUR WORK
OF THESE -- THIS KIND OF WORK IN
THE HOPE THAT IT CAN SERVE AS AN
EXAMPLE FROM YOU AND I LOOK
FORWARD TO HEARING FROM OUR
ESTEEMED PANELISTS AS WELL AS
THEY WILL BE SHARING THEIR WORK
IN THIS SPACE. I WILL START
WITH THIS IDEA OF BUILDING TRUST
IN A MODEL OF CO-CREATION WITH
COMMUNITIES AS BEING
FOUNDATIONAL TO THIS IDEA OF
EQUITY FOCUSED IMPLEMENTATION
SCIENCE. AND REALLY THIS STARTS
WITH THE FUNDAMENTAL VALUE THAT
WE'RE FILLED WITH WISDOM AND
THAT WE MUST HAVE OUR NEEDS AND
POWERS IN PLACE AND BE HUMBLE
AND EXPLICITLY OR TICK LATE --
ARTICULATE OUR VALUES.
BEFORE WE RELEASED THIS THAT I
THINK IS HELPFUL BECAUSE I THINK
IT HELPS US MOVE TOWARDS A
BETTER UNDERSTANDING OF HOW TO
ENGAME IN THESE KINDS OF
RELATIONSHIPS AND HAVE RESULTS
IN EQUITABLE IMPLEMENTATION. I
WILL GIVE YOU AN EXAMPLE OR TWO
BUT ENCOURAGE YOU TO TAKE A LOOK
AT THESE THE FIRST BEING THAT
PROJECTS SHOULD INCLUDE
PARTNERS, ORGANIZATIONS,
RESEARCHERS AND TEAM MEMBERS WHO
REFLECT THE DIVERSITY OF THE
PATIENTS AND COMMUNITIES
AFFECTED BY THE RESEARCH TOPIC.
ANOTHER ONE THAT I THINK IS
INCREDIBLY SPORE IMPORTANT IS
THE NEED TO DEDICATE FUNDS IN A
TIMELY MANNER.
THESE VALUES MUST BE PRIORITIZED
ACROSS THE PHASES OF
IMPLEMENTATION RESEARCH AND IN
OUR IMPLEMENTATION STUDIES AND
PRACTICE TO ENSURE THAT WE CAN
HAVE RESULTING EQUITABLE
IMPLEMENTATION. TO GIVE YOU A
FLAVOR OF HOW WE'VE PUT THIS
INTO ACTION IN OUR TEAMS, I'D
LIKE TO SHARE A LITTLE BIT ABOUT
THE PARTNERSHIP THAT I HAVE THE
GREAT PRIVILEGE OF BEING A PART
OF IN THE CITY OF PHILADELPHIA
FROM 2011-2022. AND FOR ME THIS
IS AN EXAMPLE OF SOME OF THE
EARLY WORK THAT OUR GROUP DID
THAT CENTERED EQUITABLE
IMPLEMENTATION BY BRINGING
EVIDENCE-BASED PRACTICES TO A
SETTING SERVING OUR COMMUNITIES
THROUGH THE PUBIC -- PUBLIC
BEHAVIORAL SYSTEM.
ALTHOUGH THE SLIDE CAN'T SHOW
ALL THE PEOPLE SEMINAL TO THIS
WORK.
AND THE PARTNERSHIP WAS A 30
YEAR PARTNERSHIP BETWEEN THE
CITY OF PHILADELPHIA AND THE PEN
CENTER FOR DEVELOPMENTAL HEALTH
AND THEY OVERSEE ALL THE
SERVICES PROVIDE FOR IN THE
BEHAVIORAL HEALTH AS A SINGLE
PAIR. USING FEDERAL, STATE AND
LOCAL DOLLARS INCLUDING MEDICAID
AND IN PHILLY OF THE 1.5 MILLION
PEOPLE THAT ARE IN THE CITY,
ABOUT HALF ARE ELIGIBLE FOR
MEDICAID. AND DBHIDS SERVES
ABOUT 170,000 PEOPLE ANNUALLY SO
REALLY LARGE-SCALE. AND WHAT
YOU CAN SEE HERE ARE OUR LAST
THREE COMMISSIONERS OF DVHIDS
WHO ARE ALL DEEPLY COMMITTED TO
ENSURING THAT OUR COMMUNITIES
SERVEDED BY THE BEHAVIORAL
HEALTH SYSTEM HAS ACCESS TO THE
VERY BEST BEHAVIORAL HEALTH CARE
AND I SPENT A DECADE OBSERVING,
MEASURING AND PARTNERING WITH
CONSTITUENTS, AS PART OF A
NATURALISTIC OBSERVATIONAL STUDY
THAT GREW OUT OF THIS
LONG-STANDING PARTNERSHIP THAT
PREDATED ME AND I WENT INTO THE
WORK REALLY PLANNING TO LEARN
ABOUT HOW A SYSTEM CAN SUPPORT
EVIDENCE-BASED PRACTICE. I WAS
VERY FOCUSED ON THINKING ABOUT
HOW CLINICIAN FACTORS AND
ORGANIZATIONAL FACTORS MADE IT
HARD OR EASY TO DO
EVIDENCE-BASED PRACTICE. AND
WHAT I LEARNED WAS THAT THE MOST
MEANINGFUL QUESTIONS THAT WE
PURSUED CAME DIRECTLY FROM OUR
CONSTITUENTS AND REALLY RELATED
TO STRUCTURAL FACTORS. THAT
MADE IT DIFFICULT TO DELIVER
HIGH QUALITY CARE. UPSTREAM
SYSTEM LEVEL FACTORS. AND JUST
TO BRING THAT TO LIFE FOR YOU IN
OUR MIXED METHODS WORK LED BY
OUR COLLEAGUES PICTURED HIRE WE
HEARD FROM ADMINISTRATORS AND
CLINICIANS THE BALANCE OF
HEALTH. WE HEARD THINGS LIKE WE
HOLD OUR BREATH AND PAY WHEN WE
PAY PEOPLE. THE ORGANIZATIONS
WERE FACING FINANCIAL STRESSORS
BUT IT'S ALSO WHAT WE HEARD FROM
OUR KRI CLINICIANS AND WE FOUND
THAT CLINICIANS FACING FINANCIAL
STRAIN WERE LIKELY TO LEAVE
COMMISSIONS. AND THEY OWE MORE
THAN ONE HUNDRED THOUSAND
DOLLARS IN DEBT WITH A THIRD
FOREGOING THEIR OWN HEALTH CARE.
AND THIS LED US TO UNDERSTAND,
YOU KNOW, THE CONTEXT FOR
IMPLEMENTATION. EQUITABLE
IMPLEMENTATION OF EVIDENCE-BASED
PRACTICES IN A PUBLIC BEHAVIORAL
HEALTH SYSTEM IT MIGHT BE EASY
TO ASSUME THAT THE REASON IS
BECAUSE THEY DONE WANT TO OR
BECAUSE THEY'RE RESISTANT BUT
YOU CAN SEE HOW THIS AMPLIFIED
THE VOICE OF OUR PARTNERS AND
HELPED SHED A LIGHT ON WHAT IT'S
LIKE TO DELIVER CARE AND WE
STARTED THINKING ABOUT MASLOW'S
HIERARCHY OF NEEDS OF CLINICIANS
IN THE PROCESS OF DELIVERING
EVIDENCE-BASED CARE AND THIS
KIND OF ROBUST COMMUNITY
ACADEMIC PARTNERSHIP ALLOWED US
TO ENGAGE IN AN ITERATIVE
APPROACH TO EQUITABLE
IMPLEMENTATION CHARACTERIZED BY
RAPID LEARNING. WE WERE ABLE TO
DEMONSTRATE THAT WE COULD
IMPROVE OUTCOMES FOR PEOPLE
SERVED BY THE PHILADELPHIA
PUBLIC BEHAVIORAL HEALTH SYSTEM
AS WELL AS SEE ACTUAL CHANGE IN
POLICIES AND PAYMENT STRUCTURES
TO SHINE A SPOTLIGHT AND AMPLIFY
THE NEEDS OF OUR CONSTITUENTS
EMPOWERING THEM TO LEAD CHANGE
AND TO PRODUCE GENERALIZABLE
KNOWLEDGE. AND THIS PARTNERSHIP
CONTINUES TO LIVE ON AND GROW
AND I THINK REALLY NICELY
DEMONSTRATES WHAT EQUITABLE
IMPLEMENTATION BUILT UPON A DEEP
COMMUNITY PARTNERSHIP CAN LOOK
LIKE. NOW I'M SGIGOING TO SHAR
THE IMPLEMENTATION SCIENCE
ACROSS SETTINGS AND DISEASE
AREAS AND I THINK WHAT'S REALLY
IMPORTANT TO CALL OUT HERE IS
THAT THESE STUDIES ARE ALL
INTENTIONALLY PROSPECTIVELY
CENTERING AND THINKING ABOUT
EQUITABLE IMPLEMENTATION. NOW
THEY'RE NOT SEEKING TO CLOSE
INEQUITIES BUT THERE ARE STUDIES
SEEKING TO ENSURE THAT WE
UNDERSTAND WHAT INEQUITIES MIGHT
EXIST AND MONITOR THROUGH THE
PROCESS OF EQUITABLE
IMPLEMENTATION. HERE I'D LIKE
TO GIVE THE EXAMPLE OF THE
IMPLEMENTATION SCIENCE CENTERS
IN CANCER CONTROL THIS IS A
RESEARCH NETWORK THAT WAS FUNDED
BY THE NATIONAL CANCER INSTITUTE
AND OUR CENTERS WERE DESIGNED TO
BE RESPONSIVE TO EMERGING
PRIORITIES OF OUR COMMUNITY
PARTNERS AND TO ADDRESS THE
DYNAMIC MULTILEVEL CONTEXT IN
RAPID APPROACHES THAT LEVERAGED
PARTNER EXPERTISE AND THE
CENTERS WERE REALLY EMPHASIZES
PRAGMATIC DESIGN AND RAPID
DISSEMINATION OF RESULTS OF
PARTNER TO HELP TRANSLATE
FINDINGS INTO ACTION. OUR
EQUITY FOCUSED WORK WAS LED BY
DR. RACHEL SHELTON, DR. KATE,
AND WE HAD FIVE PILOT PROJECTS,
TWO OF WHICH HAVE BEEN PUBLISHED
AND PICTURED HERE ALREADY SO YOU
MIGHT THINK IN THE TRADITIONAL
IMPLEMENTATION TRIAL APPROACH
YOU HAVE A SET OF IMPLEMENTATION
STRATEGIES THAT YOU'RE TESTING
ACROSS THE POPULATION AND THEN
YOU LOOK AT THE OUTCOMES. BUT I
BRING YOUR ATTENTION TO THIS
FRAMEWORK WITH THE PURPLE BLUE
ORANGE AND GREEN COLORS. AND
YOU CAN SEE HERE HOW BEFORE WE
STARTED THESE STUDIES WE USED
THIS FRAMEWORK IN WAY OF
THINKING TO CENTER SOCIAL
DETERMINANTS INTO OUR GUIDING
FRAMEWORK AND STUDY APPROACH.
AND SO WE WERE INTERESTED IN
RACE. INCOME, SETTING WHERE
CARE WAS DELIVERED AND WE WERE
TESTING TWO DIFFERENT TYPES OF
IMPLEMENTATION STRATEGIES.
PATIENT FACING IMPLEMENTATION
STRATEGIES, NUDGES, AND THEN
PROVIDER FACING IMPLEMENTATION
STRATEGIES WHICH WERE NUDGES
TARGETING THE PROVIDERS AND WHAT
WE CENTERED IN OUR MIXED METHODS
EVALUATION WAS BOTH
UNDERSTANDING DIFFERENCES IN
PATIENT PERCEPTIONS, BASED ON
THOSE SOCIAL DETERMINANTS AS
WELL AS DIFFERENCE IN THEIR
CONTEXTUAL FACTORS AND HOW THAT
IMPACTED OUTCOMES, AND CENTERING
EQUITABLE OUTCOMES. HERE'S
ANOTHER EXAMPLE FROM NHLVI
FUNDED WORK SEEKING TO INCREASE
SCREENING IN PEOPLE WITH HIGH
CHOLESTEROL. SO THIS IS A
PRACTICE WHERE THERE'S A NO DUE
GAP FOR ALL POPULATIONS. FOR
LOW FAMILY CASCADE SCREENING BUT
THE PARTICULAR POPULATION WHERE
IS THE GAP IS GREATER. SO
PLANNING FOR THIS WORK WE START
BY IDENTIFYING THE POPULATION
THAT EXPERIENCE INEQUITIES IN
THE IMPLEMENTATION OF THE THING
WHICH IS CASCADE SCREENING WHICH
INCLUDE BLACK OR AFRICAN
AMERICAN PEOPLE, ASIAN OR
ASIAN-AMERICAN PEOPLE, AND WOMEN
ACROSS RACIAL GROUPS. AND SO IN
THIS STUDY WE WILL LOOK AT WHAT
QUESTION JUST MENTIONED AND THIS
IS GUIDED BY THE CONSOLIDATED
WORK AND ENRICH WITH CONSTRUCTS
FROM THE EQUITY IMPLEMENTATION
WORK. WE INCLUDE THE STRUCTURAL
FACTORS THAT CONTRIBUTE TO
HEALTH INEQUITIES SUCH AS LACK
OF HEALTH CARE ACCESS AND
LANGUAGE BARRIERS WE HAVE A
DOCTORAL STUDENT, CHINA MILLS
WHO IS PARTICULARLY INTERESTED
IN THE EXPERIENCE OF BLACK OR
AFRICAN AMERICAN FAMILIES AND IS
LEADING A SUPPLEMENT WITH
ADDITIONAL FACTORS THAT MAY BE
HIGHLY SALIENT TO REACH A
CASCADE SCREENING OF BLACK
FAMILY MEMBERS. THE CONSTRUCTS
SHE'S INTERESTED IN IS
CENTRALITY OF RACIAL IDENTITY,
SELF-EFFICACY, FAMILY DYNAMICS
AND SOCIAL DETERMINANTS OF
HEALTH. ANOTHER EXAMPLE AND
THIS WAS WORK LED BY DR. KATIE
HOES KINS SDOE DEMONSTRATES
PERSPECTIVE PLANNING AS PART OF
A LARGE TRIAL INTEND TO REACH
ACROSS POPULATIONS FOR A NO DUE
GAP THAT IS PRESENT FOR ALL.
IMPLEMENTATION OF SECURE FIREARM
STORAGE IN PEDIATRIC PRIMARY
CARE THIS IS AN EXAMPLE OF A
CASE WHERE WE WANT TO ENSURE
THAT IN THIS LARGE-SCALE TRIAL
THE PROGRAM REACH LED ALL AND
YOU CAN SEE HOW THE
RECOMMENDATIONS FROM SOME OF THE
SEMINAL PAPERS THAT I PRESENTED
AT THE BEGINNING OF THE TALK.
TO ENGAGE IN A FIVE STEP PROCESS
THAT ALLOWED US TO ENGAGE IN
INEQUITY. STARTING WITH
ENGAGING WITH CONSTITUENTS AND
CRITICALLY REVIEWING THE
LITERATURE, FINDING THAT
PROVIDERS WERE CONCERNED THAT IT
WOULD BE DIFFICULT TO IMPLEMENT
THIS PROGRAM FOR YOUNG PEOPLE
WITH MEDICAL COMPLEXITY AS WELL
AS LOOKING AT THE LITERATURE AND
SEEING INCREASES OF SUICIDE AND
FIREARM INJURY IN BLACK AND
AFRICAN AMERICAN YOUTH. AS WELL
AS SELECTING A CONCEPTUAL
FRAMEWORK TO INFORM OUR
UNDERSTANDING. WE USE THE
HEALTH EQUITY IMPLEMENTATION
FRAMEWORK AND USING THAT PILOT
THAT WE DID BEFORE THE
IMPLEMENTATION TRIAL TO REALLY
HELP US STUDY SIGNALS OF
INEQUITIES THAT WE CAN TRACK AND
MONITOR IN THE IMPLEMENTATION
STRATEGIES IN FUTURE WORK. OUR
TEAM IS EXCITED TO DO MORE WORK
IN THIS SPACE. AS PART OF A P
50 ALACK RAHTY CENTER FROM THE
NATIONAL INSTITUTE OF MENTAL
HEALTH WE ARE LOOKING TO
INTEGRATE APPROACHES WE USED IN
PREVIOUS STUDIES CALLED A
PREMORTEM WHICH ALLOWS YOU TO
THINK ABOUT FAILURE POINTS AND
TO CENTER ON IMPLEMENTATION AS
FAILURE POINTS. THIS IS WORK
I'M CO-LEADING WITH TWO DOCTORS.
AND THEN USING THAT INFORMATION
AS WE DO THESE PREMORTEM
CENTERING EQUITY WITH EACH OF
THE PROJECT TEAMS TO ENSURE THAT
UP IT INFORMS IMPLEMENTATION
STRATEGY ACROSS THE ENTIRE
CENTER AS WELL AS THE NEW R 01
FUNDED BY THE NATIONAL INSTITUTE
OF RESEARCH WHERE WE TAKE THE
RESEARCH THAT WE'RE DOING AND
SEEKING TO IMPLEMENT THAT SECURE
FIREARM STORAGE PROGRAM AND
SAFETY NET SETTINGS SO WE'RE
GOING TO BE ADAPTING OUR
INTERVENTION AND IMPLEMENTATION
APPROACH TO ENSURE IT CENTERS
THE CENTERS AS WELL AS IN OUR
EVALUATION CENTERING CONSTITUENT
VOICES AND INVESTIGATING
EFFECTIVENESS BY SOCIAL
DETERMINANTS OF HEALTH SUCH AS
HOUSING INSECURITY. IN CLOSING
I WOULD LIKE TO REITERATE THE
MAIN MESSAGE THAT I WOULD LIKE
TO SHARE WITH YOU TODAY WHICH IS
THAT WE MUST IN INEQUITY FOCUSED
SCIENCE AND I WOULD LIKE TO
LEAVE YOU WITH SOME INSPIRING
INVESTIGATORS TO MEET THE NEEDS
IN EQUITY FOCUSED SAYS IT'S NOT
EXHAUSTIVE BUT THE FUTURE IS
BRIGHT AND THERE'S FANTASTIC
WORK GOING ON IN THIS SPACE.
THANK YOU.
>> THANK YOU SO MUCH. FOLKS,
DON'T HESITATE TO PUT COMMENTS
AND QUESTIONS IN THE CHAT AS WE
CONTINUE TO MOVE ONTO OUR NEXT
SPEAKER, OVER TO YOU O.
>> THANK YOU VERY MUCH. I
APOLOGIZE FOR MY VOICE. I HAVE
A BIT OF A COLD. SO WHAT I ARE
TALK ABOUT TODAY IS HOW TO
ADDRESS THE FIELD OF
HYPERTENSION THROUGH A HEALTH
EQUITY LENS. MOST OF MY WORK IN
THE PAST TWO AND A HALF DECADES
HAVE BEEN FOCUSED ON REALLY
NARROWING THE RACIAL GAP. WITH
A PARTICULAR FOCUS ON
HYPERTENSION IN BLACK
POPULATIONS. THAT IS IN THE
AFRICAN CONTENT. I WILL START
WITH THIS HERE. WHAT IS THE
PROBLEM THAT WE'RE TALKING ABOUT
HERE? THIS CARTOON I HAVE USED
FOR A WHILE NOW. WE REALLY HAVE
THE PROPER NEEDS. HERE IS A GUY
IN A BALLOON SAYING WHERE AM I?
THERE'S A GUY IN THE LAKE WHO IS
FISHING SAYING YOU ARE 30 METERS
ABOVE THE GROUND IN A BALLOON.
HE MUST BE A RESEARCHER SAID THE
GUY IN THE BALLOON. YES, I
DIDN'T KNOW THAT. BECAUSE WHAT
YOU TOLD ME IS ABSOLUTELY
CORRECT OR COMPLETELY USELESS.
THE GUY IN THE LAKE SAYING YOU
MUST BE A POLICYMAKER. YES, HOW
DID YOU KNOW THAT? WELL,
BECAUSE YOU DON'T KNOW WHERE YOU
ARE, YOU DON'T KNOW WHERE YOU'RE
GOING AND NOW YOU'RE BLAMING ME.
SO IN ESSENCE, THIS SLIDE SHOWS
AND THE CARTOON DEPICTS THE HUGE
GULF BETWEEN WHAT EVIDENCE WE
HAVE AND WHAT EVIDENCE WE'RE
IMPLEMENTING IN PRACTICE.
ALL COMMUNITY SETTINGS FOR THAT
MATTER SO POLICYMAKERS ARE
RESEARCHERS WHO DON'T OFTEN
THINK ABOUT THESE THINGS BECAUSE
IN SCIENTISTS BOTH ARE DIFFERENT
AND THIS MAY EXPLAIN THESE.
THAT WE TAKE THESE TO PRACTICE.
SO IF YOU LOOK AT THE SCIENCE OF
PRACTICE CONTINUES. AS I
SOME SHOW
HERE MOST OF MY WORK FOCUSED ON
EFFECTIVE STUDIES AND TODAY MY
FOCUS IS ON REALLY TAKING THAT
EVIDENCE AND LOOKING AT WAYS TO
PRACTICE THE COMMUNITY CENTERS.
SO THE WORK ON HYPERTENSION I
WOULD LIKE TO SPEAK TO YOU ABOUT
THE MODALITY IN BLACK
POPULATIONS. WE THINK THIS
CONTRIBUTES THE MOST TO THAT
RACIAL DISPARITY. AND IF YOU
SEE DOCTOR, I TRY TO UNDERSTAND
WHAT IS THAT CONTROL YOU CAN
START BY SAYING WHAT ARE THE
DIFFERENT LEVELS DOES THE
PATIENT LEVEL BARRIER, DOES THE
SYSTEMS LEVEL BARRIER AND OF
COURSE THERE ARE COMMUNITY LEVEL
BARRIERS. SO THIS IS -- THIS
SLIDE CANNOT DEFINE WHAT THAT
MEANS. THEY PROBABLY GO TO SEE
DOC. THE DOC ADVISES THEM TO
ENGAGE IN LIFESTYLE MODIFICATION
AND THE PATIENTS WILL TAKE THE
MEDICINES. IF THEY HAVE IT
UNDER CONTROL THEY WILL SAY THEY
HAVE ACCESS TO CARE SO MOST OF
MY WORK IS FOCUSED OWN REALLY
HOW DO WE USE THIS TO LOOK AT
THE ADHERENCE IN BLACK PATIENT
WE THINK IF WE DO THAT WE CAN
ACHIEVE ADEQUATE CONTROL. WHAT
WE FOUND IN THIS STUDY WHERE
PATIENTS WERE GETTING
MOTIVATIONAL EVERY THREE MONTHS
THAT'S WE USE MI FOR PATIENTS
WITH CHRONIC DISEASE. WHAT YOU
SEE HERE IS THAT THE BLUE LINE
SHOWS YOU THE ADHERENCE RATE
USING THIS. AT 14 POINTS AND IT
DOES IT WITH EVERYTHING.
PATIENTS WHO ARE ADHERENT AND
THOSE IN THE CONTROL GROUP YOU
SEE A HUGE DIFFERENCE BUT AT THE
END OF THE STUDY THOUGH WE DID
NOT FIND ANY DIFFERENCE IN THE
BLOOD PRESSURE CONTROL OF THE
PATIENTS. THIS IS WHERE I BEGAN
TO SCRATCH MY HEAD IS THERE A
MEDICATION ADHERENCE. IS IT THE
PATIENT'S PROBLEM OR IS IT THAT
THEY DO NOT ACTUALLY ADHERE TO
THE GUIDELINES WHICH WE KNOW AND
ALSO CONTRIBUTE TO THOSE. AND
WE THINK IT'S THE PATIENTS THAT
ARE THE PROBLEM NOT WHAT THEY
ARE PRESCRIBED. SO WE DID A
STUDY LIKE THAT WHERE WE RAN
RANDOMIZED ABOUT 30 CENTERS, ALL
QUALIFIED TO, EXCUSE ME, TO A
KITCHEN SINK OF INTERVENTIONS
WHERE WE TRAINED THE PROVIDERS
ON THE EVIDENCE BASED
GUIDELINES. WE HAD THAT IN
EVERY MONTH. IN THE
INTERVENTION CLINICS. WE
TRAINED ON LIFESTYLE COUNSELING
AND WE GAVE THE PATIENTS HOME BP
MONITORS. AS YOU CAN SEE HERE
ON THIS SLIDE, THE BLUE LINE
DEPICTS THE ACTUALLY THE CONTROL
GROUP OR THE CONTROL OF
INTERVENTION SIDE. AND THE RED
BARS AT THE INTERVENTION SIDE.
BLOOD PRESSURE DROPPED
PREDICTIVELY BUT THERE WAS NO
DIFFERENCE IN BP CONTROL RATES
AT THE END OF ONE YEAR BETWEEN
THE INTERVENTION GROUP AND THE
CONTROL GROUP. AND THIS IS
WHERE I BEGAN TO HAVE A BETTER
SAY, A BETTER SENSE OF WHAT ARE
THE THINGS THAT PATIENTS REALLY
FACE? WHEN THEY ARE DOING THIS
WORK. A SIGNIFICANT NUMBER OF
POPULATION, WITH LOW INCOME
PATIENTS, WITH VERY HIGH RATES
OF COMORBIDITY EITHER THEIR
ABILITIES OR HEART FAILURE. WE
FOUND A LOT OF PATIENTS WERE
ACTUALLY DROPPING OUT OF THE
STUDY, OF COURSE IT IS
INTENTIONAL TO TREAT ANALYSIS SO
WE HAD TO TRACK THEM DOWN. MOST
HAVE SIGNIFICANT SOCIAL
DETERMINANTS AND ONE CALLED
COMMUNITY BARRIERS AT A TIME AND
THAT IMMEDIATE -- MADE ME BEGIN
TO THINK WHAT IF WE TAKE
LIFESTYLE INTERVENTIONS.
AT THIS TIME THAT SHOULD BE
RELEASED FOR THE POTENTIAL,
PREMIERE STUDY, ALSO WHAT IS
PUBLISHED ALREADY WITH THE LOOK
OF THE EFFECTIVENESS WE THEN
SAID WHAT IF WE DO THIS IN THE
COMMUNITY? WELL, WE WORK WITH
THE DEPARTMENT OF HEALTH, OFFICE
OF HEALTH IN NEW YORK CITY TO
ACTUALLY RANDOMIZE 32 BLACK
CHURCHES AND ONE GROUP GOT JUST
HEALTH EDUCATION AND THE OTHER
GROUP GOT LIFESTYLE COUNSELING.
CODEVELOPED ACTUALLY WITH THE
PASTORS AND THE CHURCHES AND
WHAT WE FOUND WAS IN THAT
REGARD, WITH THE BLUE BAR HERE
IS THE INTERVENTION CHURCHES AND
THE RED BAR IS THE CONTROL
CHURCHES. AND THE INTERVENTION
WAS ACTUALLY DELIVERED BY HEALTH
ADVISORS. THESE ARE FOLKS WHO
ARE ALREADY MEMBERS OF THE
CHURCH AND THEY FOUND THE HEALTH
MINISTRY. OVER TIME YOU SEE A
SIGNIFICANT DROP IN SYSTOLIC
BLOOD PRESSURE, THE INTERVENTION
GROUP ARE SIX MONTHS AFTER ABOUT
5.6 MAKE A DIFFERENCE BUT WHEN
YOU EXTEND THAT TO NINE MONTHS
IT DROPPED BY THREE. IN TERMS
OF THE DIFFERENCE. IT'S STILL
SIGNIFICANT BUT A LOT OF THESE
ARE AT THE HEART OF DIAGNOSIS OF
HYPERTENSION SO WHILE IT WAS
TRUE CARING FOR THEM IN THE
CHURCHES WHAT WASN'T HAPPENING
WAS REFERRING THOSE PATIENTS
BACK SO WE DIDN'T CLOSE THE LOOP
AND THIS WAS A TIME WHEN A LOT
OF DATA WAS BEGINNING TO EMERGE
ESPECIALLY WITH THE POWERFUL
THINGS WE HAVE TO CONSIDER IN
INTERVENTIONS THAT WE DO. WELL,
WHEN YOU LOOK AT THE HEALTH
CASES THEN, WHAT YOU BEGIN TO
SEE, THIS IS ALL CRITICAL ERA IS
IS FOCUS ON THE PATIENT, DOCTOR
PATIENT COMMUNICATION, CLINICAL
INERTIA FOR THE CLINICAL SYSTEMS
AND REALLY THE IDEA OF QUALITY
IMPROVEMENT PROJECTS. THAT
ALLOWS THE HEALTH CARE SYSTEM TO
BE MORE AGILE IN HOW THEY
ADDRESS CARE. SO WHILE ALL THAT
IS HAPPENING, THE ENVIRONMENT
THOUGH, THE SOCIAL SUPPORT, THE
FOOD, THE COMMUNITY RESOURCES,
WEREN'T DOING A GOOD JOB ON THAT
SO IT BECAME CLEAR AS RECEIVED
FROM THIS SLIDE IT WASN'T DOING
A GOOD JOB IN THE HEALTH SETTING
THERE'S STILL A HUGE GULF IN HOW
WE BEGIN TO ADDRESS THE
COMMISSION.
WHICH ACCORDING TO THAT YOU CAN
SEE HERE THAT 20% OF A PERSON'S
HEALTH AND WELL-BEING IS RELATED
TO THE ACCESS TO CARE. AND
QUALITY OF SERVICES. SO THEY
ARE JUGGLING IN THAT SPACE AND
IF THEY HAVE ACCESS TO CARE IN A
HOEPT SYSTEM THEY HAVE THOSE
METRICS.
SO THE QUESTION THEN BECOMES,
WHAT DO WE DO? HOW DO WE
REIMAGINE WHAT WE'RE SUPPOSED TO
DO? AND AND WHEN WE LOOK AT
DATA FROM THE LITERATURE IT DOES
SHOW ALSO THAT A LOT OF THESE
THINGS ARE ACTUALLY RELATED TO
WHAT HYPERTENSION OUTCOMES. I
THINK THAT COME FROM HOP KIDNAPS
ACTUALLY LOOK AT THE DATA AND
BEGIN TO SEE 1 SOCIAL
DETERMINANTS. SO WE RESPONDED
LOOKING AT WAY TO REALLY
ELIMINATE THIS THROUGH OTHER
COORDINATED INTERVENTION. TO
PREVENT OUR CONTROL AND OUR LUNG
DISEASE. SO AS PART OF THIS
PROPOSED STUDIES THIS IS OUR
COLLEAGUES HERE. WHO WOULD
ACTUALLY -- WE WENT IN TOGETHER,
WE PUT IN THIS PROPOSAL.
ACTIONS TO DECREASE DISPARITIES
IN RISK AND ENGAGING SHARED
SUPPORT FOR CONTROL IN BLACK
PATIENTS SO JUST SO LEVEL SET,
WHAT WE TALKED ABOUT IN THIS
STUDY WAS, HEY, LISTEN, WE
DIDN'T REALLY FOCUS ON
ADDRESSING THOSE SOCIAL LEVEL
BARRIERS, THE SOCIAL
DETERMINANTS OF HEALTH, HOW DO
WE MAKE SURE THAT AFTER GIVING A
PATIENT EVIDENCE-BASED
INTERVENTION WE ALSO ADDRESSING
THE COMMUNITY SETTING IN WHICH
THEY LIVE AND THE FACT WAS THE
TIME IN THEIR HEALTH OUTCOME SO
WE USE THE PRACTICE
IMPLEMENTATION TO IMPLEMENT THE
MEMBER. REMEMBER IN OUR
EARLIEST DAYS THIS WAS THE PIECE
WE WERE MISSING. I ONLY SHARED
A FEW WITH YOU BUT WE HAVE
STUDIES IN SENIOR CENTERS ALL
ACROSS NEW YORK CITY. FABULOUS
STUDIES ALL EFFECTIVE. PROBLEM
WAS LINKING PEOPLE BACK TO CARE
AND MAKING SURE THAT YOU HAVE
THAT COMMUNITY MODEL SO WE HAVE
THREE INTERVENTIONS THAT HAVE
BEEN SHOWN TO FABULOUSLY DROP
SIGNIFICANTLY BLOOD PRESSURE
CONTROL AND SO IT'S THE BP
MONITOR, AND THE USE OF
COMMUNITY HEALTH WORKERS AS A
WAY TO BRIDGE THE GAP BETWEEN
THE HEALTH CARE SYSTEM AND THE
PATIENT LEVEL. AND HERE WE HAVE
THE UGUH MECHANISM WHERE WE
DEVELOPED A CONTEXT SPECIFIC
PRACTICE STRATEGY TO IMPLEMENT
THOSE THREE INTERVENTIONS TO
CALL THEM BASE. USING COMMUNITY
BASED RESEARCH AND THIS
FRAMEWORK. ACTUALLY TAKE TIME
TO JUST EXPLAIN A FEW THINGS
HERE. WHEN YOU ARE WORKING WITH
THE HEALTH CARE SYSTEM, WHOSE
REVENUE IS BASED ON REALLY HOW
WELL QUALITY OF CARE THEY GIVE
TO THEIR PATIENTS THEY ARE LEFT
TO UNDERSTAND WHAT IS IMPORTANT
TO INTEGRATE WHATEVER MODEL YOU
WANT TO USE INTO THAT HEALTH
SETTING. IT TOOK US THREE YEARS
BUT WHAT I'M PROPOSING IS TO
EMBED WITH SAME EACH FACULTY
PRACTICE. THE COMMUNITY HEALTH
WORKER. WHAT WE'RE FINDING
QUICKLY WAS THAT IT WAS VERY
DIFFICULT TO ADDRESS THOSE
BECAUSE A LOT OF THE FACTORS
THAT DRIVE OUTCOMES IN THOSE
SETTINGS ARE VERY WELL-DEFINED
AND INTRODUCE THAT WORKER WITH
THAT ISSUE SO WE ARE TO REVISIT
THAT STRATEGY AND WORKING WITH
LEADERS IN INSTITUTIONAL GROUPS
READAPT OUR SETTINGS WE LOOK AT
THE CW CHARACTERISTICS AND IT
BECAME CLEAR THAT CENTRALIZED
CARE COORDINATION IS THE WAY TO
GO AND THAT'S WHAT WE PROPOSED.
SO RIGHT NOW IN YEAR THREE, YEAR
FOUR OF THIS STORY, AND THE IDEA
WAS TO USE ZEPHYR TO UNDERSTAND
THE PLANNING PHASE AND WE JUST
FINISHED SEVERAL MONTHS AGO AND
WITH THE CLINICAL TRIAL WE'RE
IMPLEMENTING THE FRAMEWORK TO
EVALUATE OUR OUTCOMES OF
ADOPTION OF IMPLEMENTATION AND
COST-EFFECTIVENESS. THE PRIMARY
QUESTION IS TO HAVE THESE STUDY
THAT DOES A TAILOR PRACTICE THAT
INTEGRATES IN THE VIEW TO RESULT
IN A HIGHER LEVEL OF ADOPTION.
REMOTE BLOOD PRESSURE MONITORING
AND SUPPORT AND OF COURSE OUR
CLINICAL EFFECTIVENESS AIMS WERE
STILL BLOOD PRESSURE CONTROLS.
CLUSTER TRIAL OF 20 SITES AND
IT'S STILL ONGOING. WE JUST
BEGAN ACTUALLY WHAT YOU MIGHT
CALL IT, THE IMPLEMENTED PART OF
THE STUDY SO WE ARE REMOTE BP
MONITORING, PATIENT TAKES THEIR
BLOOD PRESSURE READING. AND
THEN THEY CAN HELP YOU PROVIDE
US TO EITHER ADJUST THE
MEDICATIONS AND IF THAT DOESN'T
WORK, AND THE PATIENT HAS THE
HOME MONITORING, THEN WE BEGIN
TO DO THE COUNSELLING AND IF
THAT'S STILL NOT WORKING IN 3-6
MONTHS THIS IS WHEN WE TRIGGER
THE USE OF -- OR RATHER THE
HEALTH WORKER INCLUDING THE
HEALTH SYSTEM. AND SO WE'VE
ACTUALLY IDENTIFIED THE 25
PRACTICE SITES. WE TRAINED THE
STAFF ALREADY. WE DEVELOPED THE
PROCESS TO SUPPORT THE PATIENTS.
WE COMPLETE THE ONE-ON-ONE
INTERVIEW TO REALLY HELP US
UNDERSTAND THE ENVIRONMENTAL
SCANS THAT PATIENTS ARE GOING
THROUGH. AND SO PATIENT STUDY
IS BEGINNING TO RUN FOR SENSE OF
PATIENTS. BUT IN DOING THIS
STUDY IT BECAME CLEAR ALSO THAT
THIS IS STILL ONGOING, WE HAVE
FOUR MORE YEARS TO GO THAT IF
WE'RE REALLY GOING TO ADVANCE
THE FIELD IN THE HEALTH EQUITY
ISSUE WE HAVE TO DO FOUR THINGS.
THE PROGRAM IS DESIGNED TO BUILD
EQUITY. TO MITIGATE THE ADVERSE
EFFECTS THAT ARE PERVASIVE IN
BLACK COMMUNITIES. THE SECOND
THING IS THAT WE NEED TO PARTNER
WITH BLACK COMMUNITIES TO
DEVELOP EFFECTIVE STRATEGIES
THAT GOES ACROSS A BUNCH OF THE
HEALTH CARE SYSTEM. THAT
INTEGRATE HOW WE USE COMMUNITY
BASED RESOURCES AND THE THIRD
THING THAT IS -- THAT ACTUALLY
PARTNER AND INCENTIVIZE THESE
MODELS BECAUSE AT THE END OF THE
DAY THEY WON'T BE SUSTAINABLE IF
IT'S NOT PAID FOR AND POPULATION
HEALTH ACTUALLY DEMANDS 245 WE
HAVE HEALTH CARE AND WE MUST
MAKE SURE THE THAT THE
PARTNERSHIP WITH THE COMMUNITY
IS INCENTIVIZED AND WE NEED TO
GENERATE DATA SO THAT
POLICYMAKERS ARE ASSURE ED AND
HAVE ROBUST INFORMATION IN
REALTIME TO HELP SEE THE DATA TO
DRIVE ACTION FOR THIS FORCE.
SO TO THAT AIM, WE ARE
RESPONDING REALLY TO THE AH
THREE YEARS AGO THAT CAME OUT
WITH A CALL TO ADDRESS THE
INEQUITIES REALLY IN BLACK
COMMUNITIES. SO TO PROPOSE THE
RESEARCH NETWORK. WAS PLAN WE
SEE HOW WE CAN ACTUALLY HELP TO
REDUCE INEQUITIES AND SEE THE
HOW MANY BETTER IF IT IS
EVIDENCE BASED AND HAVE
PREVENTIONS IN THIS CASE
LIFESTYLE INTERVENTIONS INTO
COMMUNITY SETTINGS. BY EIGHT
INSTITUTIONS, A LOT OF PEOPLE,
AND THAT'S FOR THOSE, AND THAT'S
RESTORED THE NETWORK NOW. IN
BLACK COMMUNITIES TO MITIGATE
THE IMPACT OF SOCIAL
DETERMINANTS FELT ON BLOOD
PRESSURE DEVELOP ON CALL
STRATEGIES TO IMPLEMENT THIS
LIFESTYLE INTERVENTIONS AND BY
THEN TO BRING THE BP DOWN BUT
MOST IMPORTANTLY, WE PLAN TO
DISSEMINATE THE FINDINGS OF
THESE STUDIES TO POLICYMAKERS
AND STAKEHOLDERS SO WE CAN
ACTUALLY ENSURE SUSTAINABILITY
OF HIGH BLOOD PRESSURE
PREVENTION AND OF COURSE WE USE
THE PLATFORM TO TRAIN EARLY
INVESTIGATORS. WHEN I LOOK AT
THE DATA HERE THE MODEL THAT WE
USE WAS ACTUALLY OVER D WE
OVERLAID THE MODEL.
ON THE NIMHD, AND I JUST WALK
YOU THROUGH THESE QUICKLY. IT
HAS TO BE MULTILEVEL. SO WE
HAVE THE HEALTH CONSISTENT. WE
HAVE THE BARBERSHOPS, WE HAVE
CHURCHES AND WE HAVE THESE
MOBILE. AND WE LOOK AT ALSO USE
PRACTICE NAVIGATORS TO WORK INTO
CARE AND WORK WITH THE
ASSISTANCE AND THE KEY AS THE
DOMAINS OR ADDRESSES ARE SHOWN
HERE AND THE HOPE IS THAT THIS
WORKS WELL, TO ACTUALLY REDUCE
BLOOD PRESSURE AND PREVENT THE
POTENTIAL IN THIS COMMUNITIES.
EACH PROJECT, THERE ARE FIVE OF
THEM, WILL TEST THE STRATEGY
INFORM BID COMMUNITY
STAKEHOLDERS AS YOU CAN SEE
HERE.
WE HAVE MANY CAUSE THAT ACTUALLY
HAPPENED THAT IS -- WE HAVE THE
COMMUNITY ENGAGEMENT CODAS LED
BY HOPKINS AND WE HAVE THE LAST
INTERVENTION CODAS LED BY US AND
WE ALSO HAVE THE USE OF
TECHNOLOGY, OF COURSE WE'RE
LOOKING AT THE MONITORING. AND
WE'RE COLLECTING DATA ON CROSS
EFFECTIVENESS. THE FIVE WE HAVE
HOWEVER. O-- HERE.
WE HAVE THE ONE IN NEW YORK
CITY. THE SECOND ONE IS WORKING
WITH CHURCHES TO ADDRESS VARIOUS
NUTRITION OR PHYSICAL ACTIVITY
AND THE THIRD IS REALLY USING
THE MOBILE VANS TO GO TO
NEIGHBORHOODS TO ENGAGE IN
POPULATIONS AND NAVIGATE THEM TO
CARE AND THE FOURTH IS USING
HOME BP AND LINK THEM AND THE
ONE IN HARBOR IS LOOKING AT THE
EFFECTS OF THE THOSE WITH HIGH
BLOOD PRESSURE SO THE HOPE IS
THAT IF WE DO THIS RIGHT WE CAN
ADVANCE THE IMPACT BY
TRANSLATING IMPLEMENTED --
EVIDENCE-
EVIDENCE-BASED ISSUES. FOR
THESE WHO ARE INTERESTED IN THE
COMPENDIUM OF PAPERS IT IS SHOWN
ON THIS SLIDE HERE. AND WE WILL
HAVE OTHER PROTOCOLS PUBLISHED
AND TUNE IN NEXT TIME THIS YEAR
WE SHOULD HAVE ARTICLES
PUBLISHED FOR YOU. THANK YOU.
>> THANK YOU SO MUCH, THAT WAS A
FANTASTIC RAPID OVERVIEW OF
INSIGHTS THROUGHOUT. WE WILL
TURN IT TO OUR THIRD AND FINAL
SPEAKER AND OPEN IT UP FOR
DISCUSSION. DON'T HESITATE TO
PUT YOUR COMMENTS OR QUESTIONS
IN THE CHAT AT ANY POINT. OVER
TO YOU DR. SIR VAN TES.
>> THANK YOU, AND CAN YOU HEAR
ME OKAY? REALLY EXCITED TO BE
HERE. I AM GOING TO BEGIN BY
ALSO DESCRIBING MY IDENTITY
FIRST BECAUSE IT HAS TRULY
SHAPED MY CAREER AND PASSION FOR
THE WORK THAT I DO.
MY PARENTS WERE MEXICAN
IMMIGRANTS. I GREW UP IN DENVER
LEARNING ENGLISH AS MY SECOND
LANGUAGE AND ONE OF THE THINGS I
ENJOYED MOST GROWING UP WAS
DANCING WHICH I DID THROUGHOUT
THE STATE OF COLORADO. AND THEN
IN MIDDLE SCHOOL AND HIGH
SCHOOL, I LIVED IN MEXICO AND
THEN EVENTUALLY MOVED BACK TO
COLORADO TO COMPLETE ALL OF MY
TRAINING. BUT MY WORK HAS
PREDOMINANTLY FOCUSED ON
CONDUCTING ADVOCACY FOCUSED
RESEARCH THAT IS RESEARCH WITH
THE ULTIMATE GOAL O
CHANGING
PRACTICE. BY CHANGING POLICY.
AND SO I COMPLETED RESIDENCY AND
INTERNAL MEDICINE IN 2008 AND I
BEGAN MY CLINICAL CAREER AS A
HOSPITAL MEDICINE PHYSICIAN AT
DENVER HEALTH WHICH IS A SAFETY
NET HOSPITAL AND AS A HOSPITAL
MEDICINE PHYSICIAN WE DON'T
TYPICALLY EXPERIENCE CONTINUE
NEWTY OF CARE.
MEANING WE ADMIT A PATIENT, TAKE
CARE OF THEM AND DISCHARGE THEM
AND IDEALLY THEY DON'T COME BACK
BECAUSE THEY'RE HEALTHY
AFTERWARDS BUT I CAME ACROSS A
GROUP OF PATIENTS THAT I GOT TO
KNOW REALLY WELL BECAUSE THEY
WERE ESSENTIALLY STUCK AT THAT
RESOLVING DOOR IN THE EMERGENCY
DEPARTMENT. MANY PEOPLE IN OUR
COUNTRY DON'T HAVE HEALTH
INSURANCE. AND FOR THE MOST
PART, THEY RECEIVE PRIMARY CARE
THROUGH FEDERALLY QUALIFIRO
HEALTH CENTERS BUT BEYOND
PRIMARY CARE, MANY REQUIRE
SUBSPECIALTY CARE AND SERVICES.
AND THIS IS ESSENTIALLY HOW I
CAME TO KNOW THE UNDOCUMENTED
IMMIGRANT COMMUNITY WITH KIDNEY
FAILURE. SOME OF YOU KNOW, MOST
PEOPLE HAVE TWO KIDNEYS. THE
KIDNEYS FILTER THE BLOOD AND
REMOVE EXCESS FLUID AND WASTE
WHICH IS EXCRETED AS URINE.
WHEN BOTH KIDNEYS STOP WORKING
PEOPLE REQUIRE KIDNEY
REPLACEMENT THERAPY OR
TREATMENT. THAT CAN BE
TRANSPLANT, HOME DIALYSIS OR IN
CENTER DIALYSIS WHICH IS THE
MOST COMMON FORM OF TREATMENT IN
THE U.S. AND THIS ESSENTIALLY
REQUIRES THAT PEOPLE COME TO A
CENTER AND A MACHINE CLEANS
THEIR BLOOD FOR FOUR HOURS THREE
TIMES A WEEK. ALL THESE
TREATMENTS ARE AVAILABLE TO U.S.
CITIZENS BECAUSE OF A MEDICARE
ENTITLEMENT PROGRAM BUT FOR
UNDOCUMENTED UP IMMIGRANTS CARE
VARIES THROUGHOUT THE COUNTRY.
INSTEAD OF THREE TIMES PER WEEK
DIALYSIS, UNDOCUMENTED IMMIGRANT
CONSIST ONLY RECEIVE IT ONCE A
WEEK.
SO THAT'S ONCE EVERY SEVEN DAYS
THIS MEANS THE FLUID AND THE
TOXINS ACCUMULATE IN NARY BLOOD.
THEIR LUNGS FILL UP WITH FLUID.
THE TOXINS GROW. THE POTASSIUM
BUILDS UP AND CAN CAUSE ABNORMAL
HEART RHYTHMS AND IT'S HONESTLY
A TERRIBLE WAY TO TREAT PEOPLE
BECAUSE IT'S IMPRACTICAL, IT'S
EXTREMELY COSTLY BECAUSE IT'S
ALL THROUGH THE EMERGENCY
DEPARTMENT AND IT'S
DEHUMANIZING. I MET HILDA
AROUND 2010. SHE HAD KIDNEY
FAILURE AND COULD ONLY RECEIVE
DIALYSIS ONCE A WEEK AND I
BECAME CLOSE FRIENDS WITH HILDA
BECAUSE OUR LIVES WERE PARALLEL.
MY PARENTS WERE MEXICAN AMERICAN
IMMIGRANTS I WATCHED HER HEALTH
DETERIORATE. SHE HAD THREE NEAR
FATAL CARDIAC ARRESTS AND HILDA
SAW HER PEERS CODE AND DIE WHILE
WAITING IN THE EMERGENCY
DEPARTMENT IN THE DIALYSIS
CENTER AND IT MADE HER WORRY FOR
HER BOYS BECAUSE THEY WOULDN'T
LEAVE HER SIDE. THEY WEREN'T
GOING TO SCHOOL. THEY WERE
WORRIED IF NO ONE WAS AROUND
THEIR MOM WOULD HAVE A CARDIAC
ARREST. AND SO AFTER SEVERAL
MONTHS HILDA DECIDED TO IDENTIFY
ADOPTIVE PARENTS AND INTERVIEWED
SEVERAL UNTIL SHE MET CHRIS AND
HELEN. SHE HAD TWO REMAINING
WISHES BEFORE STOPPING EMERGENCY
DIALYSIS. WHICH WAS TO SPEND A
WEEK IN THE MOUNTAINS AND TO
HAVE ONE LAST CHRISTMAS
GATHERING AND SHE DIED ON
MOTHER'S DAY IN 2014. BEFORE
HILDA DIED, I ENGAGED IN
ADVOCACY AT THE STATE-LEVEL AND
I SHARED HILDA'S STORY WITH
ANYONE WHO WOULD LISTEN AND I
TRIED TO FIND A SOLUTION BEFORE
SHE DIED BUT I DIDN'T. AFTER
SHE DIED I FELT COMPELLED TO
CHANGE THIS AND OTHER PATIENTS
AND CLINICIANS ALSO FELT
COMPELLED TO CHANGE THIS AT THIS
POINT I WAS ABOUT SIX YEARS OUT
FROM RESIDENCY AND HAD NO FORMAL
RESEARCH TRAINING. BUT I
DECIDED IN PARTNERSHIP WITH
PATIENTS AND CAREGIVERS AND
OTHER CLINICIANS THAT WE NEEDED
TO WORK ON RESEARCH. FOR THE
SOLE PURPOSE OF CHANGING
PRACTICE AND POLICY. AND SO
EVERYTHING I'M ABOUT TO DESCRIBE
WAS INSPIRED BY HILDA. AND IN
PARTNERSHIP WITH HER FRIENDS,
THE CLINICIANS THAT KNEW HER AND
OTHER PEOPLE THAT FORMED PART OF
OUR COALITION. SO THIS FIRST
STUDY IS ONE OF MY FAVORITES
BECAUSE IT'S THE FIRST ONE WE
PUBLISHED ON THIS ISSUE WE
DECIDED TO CENTER PATIENTS AND
INTERVIEWED 20 UNDOCUMENTED
PEOPLE AND ASKED THEM ABOUT
THEIR EXPERIENCES RECEIVING
EMERGENCY DIALYSIS. AND IN OUR
THEMATIC ANALYSIS, WE LEARNED
THAT PATIENTS WERE FACING A
DISTRESSING SYMPTOM BURDEN
BECAUSE AS I MENTIONED THEY HAD
TO WAIT SEVEN WHOLE DAYS. THEY
WERE HAVING THEIR SYMPTOMS
ACCUMULATE AND OFTENTIMES IN OUR
EMERGENCY DEPARTMENT BECAUSE WE
HAD SO MANY PATIENTS AND A
LIMITED NUMBER OF DIALYSIS
CHAIRS WE HAD TO BASE ADMISSION
ON THE POTASSIUM LEVEL THIS
MEANS THAT WE HAD TO TURN VERY
VISIBLY ILL PATIENTS AWAY UNLESS
THEIR POTASSIUM REACHED A
CERTAIN LEVEL AND SO PATIENTS
DESCRIBED HOW THEY SOMETIMES
CONSUMED FOODS THAT WERE HIGH IN
POTASSIUM JUST OUTSIDE OUR
HOSPITAL DOORS BECAUSE THEY
RATHER RISK DEATH AND DIE FROM A
CARDIAC ARREST DUE TO THE HIGH
POTASSIUM THAN TO BE DISCHARGED
FROM THE ED WITHOUT DIALYSIS.
YOU CAN'T EXPLAIN YOUR ILLNESS,
YOU ARRIVE IN YOUR BAD SHAPE YOU
HAVE TO HAVE A HIGH POTASSIUM OR
YOU GO HOME. SOMETIMES YOU
CRAWL OUT. YOU EAT A BANANA
BECAUSE IT'S HIGH IN POTASSIUM
AND YOU GO BACK AND HOPE THEY
WILL DO DIALYSIS. AS WE
CONNECTED WITH PATIENTS AND
AGAIN, THIS WAS 20 PATIENTS THAT
WE INTERVIEWED AND THIS WAS
AFTER HILDA PASSED AWAY. WE
LEARNED FROM PATIENTS THAT THEY
WANTED TO BUILD COMMUNITY. THEY
WANTED TO BE MORE CONNECTED TO
EACH OTHER, TO SUPPORT EACH
OTHER. AND SO THEY TOOK THE
INITIATIVE OF MEETING AT A LOCAL
CHURCH THAT WAS JUST A BLOCK
AWAY FROM THE HOSPITAL. AND WE
DECIDED AS A TEAM THAT IN
ADDITION TO THAT, WE WOULD BUILD
A PEER SUPPORT GROUP
INTERVENTION BECAUSE ON ANY
GIVEN DAY THERE WERE 12 H12-15
PATIENTS THAT WERE HOSPITALIZED
WAITING FOR THEIR DIALYSIS. WE
FELT THIS WAS AN OPPORTUNITY TO
START BUILDING A COMMUNITY. IN
THE EVENING WE WOULD HAVE DIN IR
TOGETHER. WE WOULD DISCUSS A
TOPIC THEY WERE INTERESTED IN.
AND SOMETIMES DO ARTS AND CRAFTS
AND A LOT OF SHARING. AND THIS
WAS, I KNOW I SAID THE LAST ONE
WAS MY FAVORITE STUDY BUT THIS
ONE IS ALSO ONE OF MY FAVORITES
BECAUSE THIS ONE ORGANICALLY LED
TO COALITION BUILDING. AND
ESSENTIALLY THIS GROUP BECAME
OUR FUTURE COMMUNITY STEERING
COMMITTEE. WE HAD 23
PARTICIPANTS IN TOTAL. ALSO
AUDIO RECORDED ALL OF OUR
MEETINGS AND THEMATICALLY AND
ANALYZED THEM AND LEARNED FROM
THESE MEETINGS THAT PATIENTS
SHARED A LOT ABOUT HOW TO
SELF-ADVOCATE INCLUDING
DOWNLOADING APPS SO THAT THEY
COULD INTERPRET FOR THEMSELVES
IF A CLINICIAN DIDN'T BRING A
LANGUAGE INTERPRETER. THEY
TALKED ABOUT SELF-MOTIVATION AND
PATIENTS TALKED ABOUT HOW PEER
SUPPORT IS VITAL ESPECIALLY
THOSE WITH NEWLY DIAGNOSED
KIDNEY FAILURE AND THE MOST
IMPORTANT PIECE WAS IT BUILT
COMRADERY AND CULTIVATED
SOLIDARITY TO SURVIVE AND CHANGE
POLICY AND FROM THIS AS THESE
MEETINGS FROM THE FIRST SIX
MONTHS WERE COMING TO AN END THE
PATIENTS DECIDED TO ORGANIZE
THEMSELVES AND THEY STARTED
COMMUNICATING AROUND HOW WE
COULD COLLECTIVELY CHANGE
POLICY. CAREGIVERS ALSO WANTED
TO BE INTERVIEW AND MOST OF
THESE CAREGIVERS WERE ADULT
CHILDREN OR PARENTS. AND THEY
DESCRIBED SIMILAR EXPERIENCES TO
HILDA MEANING THAT THEIR KIDS
WERE DROPPING OUT OF SCHOOL TO
WORK OR TO ACCOMPANY THEM TO THE
HOSPITAL TO PROVIDE LANGUAGE
INTERPRETATION. WE ALSO
INTERVIEWED CLINICIANS, 50 OF
THEM, 25 IN COLORADO AND 25 IN
HOUSTON, TEXAS. AND LIKE
MYSELF, CLINICIANS DESCRIBED
SEVERAL DRIVERS OF BURNOUT
INCLUDING EMOTIONAL EXHAUSTION.
THEY FELT THEY WERE JEOPARDIZING
THEIR PATIENT'S TRUST BECAUSE
THEY HAD TO TURN PATIENTS AWAY
WITHOUT OFFERING DIALYSIS. AND
THEY ALSO DESCRIBING NUMBING
THEMSELVES FROM FEELING TOO MUCH
EMPATHY FOR THESE PATIENTS. AND
SO THEY DETACHED. ONE CLINICIAN
SAID TURNING PATIENTS AWAY FROM
DIALYSIS IS A HUGE ASPECT OF
PHYSICIAN BURNOUT. RES DID I
WANT -- RESIDENTS HAVE TO
DISASSOCIATE.
WE ALSO CONDUCTED SEVERAL
QUANTITATIVE STUDIES I'M NOT
GOING TO GO THROUGH THESE BUT WE
FOUND THAT MORTALITY WAS 14 FOLD
GREATER FIVE YEARS AFTER
PATIENTS INITIATED DIALYSIS
COMPARED TO THOSE WHO RECEIVED
THREE TIMES PER WEEK DIALYSIS
AND LOOKING AT PATIENTS WHO DIED
PRESENTING AT THE HOSPITAL WE
FOUND THEY HAD A HIGH LEVEL OF
MEAN POTASSIUM AND OVER HALF
DIED OF CARDIAC ARREST. AND SO,
IN ADDITION TO PARTNERING WITH
PATIENTS AND CLINICIANS AND AS
WE PUBLISHED THIS WORK, WE
PARTNERED WITH COMMUNITY BASED
ORGANIZATIONS ANDNNI
MAKERS AND PEOPLE IN HEALTH
POLICY. AND TOGETHER WE ENGAGED
IN POLICY BUT WHEN I DESCRIBE
THIS WORK I REALIZE THAT
SOMETIMES -- WHEN I DESCRIBE IT,
IT LOOKS VERY LINEAR BUT IN
REALITY THERE WERE MANY TWISTS
AND TURNS AND AS I REFLECTED ON
HOW WE WERE ABLE TO ACCOMPLISH
THIS INCREDIBLE WORK, WE HAVE
IDENTIFIED AS A TEAM FOUR SKILLS
THAT WE FELT WERE REALLY
IMPORTANT FROM TRANSLATING
RESEARCH TO POLICY CHANGE. AND
THIS FRAMEWORK ON THE RIGHT IS
ONE WE HAVE PUBLISHED AND TEACH
ACROSS THE COUNTRY TO
RESEARCHERS. BUT TO CHANGE
POLICY, WE NEEDED TO CONDUCT A
POLICY ANALYSIS. AND THERE WERE
TWO GROUPS THAT CONDUCTED POLICY
ANALYSES FOR OUR TEAM. ONE WAS
THE SAFETY NET HOSPITAL AND
ANOTHER ONE WAS A COMMUNITY
BASED ORGANIZATION. THEY HELPED
US UNDERSTOOD ALL THE POLICIES
THAT STOOD IN THE WAY AS WELL AS
HOW WE COULD CHANGE THOSE
POLICIES TO IMPROVE ACCESS FOR
CARE WHO ARE UNDOCUMENTED. WE
LEARNED ABOUT THE ACTIVE LABOR
ACT. THIS IS LAW ENACTED IN
1986 AND REQUIRES HOSPITALS
SCREEN PATIENT WHO IS HAVE AN
EMERGENCY AND IT IS BECAUSE OF
THIS THAT PATIENTS CAN NOT BE
TURNED AWAY BASED ON IMMIGRATION
STATUS AND AS A RESULT OF THIS
LAW, STATES BASICALLY DEVELOPED
THEIR OWN EMERGENCY MEDICAID
PROGRAMS.
AND MOST EMERGENCY MEDICAID
PROGRAMS ABIDE BY THE EXACT
LANGUAGE IN THIS LAW. BUT WHAT
IS CRITICALLY IMPORTANT THAT WE
LEARNED IN THIS POLICY ANALYSIS
IS THAT STATES HAVE MODIFIED
THESE SERVICES AND CONDITIONS
THAT QUALIFY AS EMERGENCIES.
AND WE ALSO LEARNED THAT CMS
PROVIDES NO GUIDANCE FOR
DEFINING THOSE EMERGENCIES THEY
ACTUALLY DEFER TO STATES. AND
SO WE LOOKED AT THE STATES THAT
PROVIDED ACCESS TO CARE TO
UNDOCUMENTED IMMIGRANTS AND THE
THIS IS, IN THIS SLIDE YOU SEE
AN EXAMPLE OF WASHINGTON STATE
THEY MODIFIED THEIR SERVICES TO
INCLUDE DIALYSISES AND SO WHAT
IS IMPORTANT ABOUT ALL THIS IS
WE IDENTIFIED THOSE POLICIES.
AND FOUND A POLICY PATHWAY. WE
ALSO MEANINGFULLY AND VERY
EFFECTIVELY ENGAGED IN BUILDING
RELATIONSHIPS AS A TEAM.
SOMETIMES THE POWER AND
INFLUENCE OF THE RELATIONSHIPS
THAT WE BUILD CAN DETERMINE THAT
POTENTIAL FOR CHANGE. AND ONE
REALLY IMPORTANT AND EFFECTIVE
WAY WE HAVE FOUND TO DOING THIS
IS THROUGH POWER MAPPING. AND
IN THIS SLIDE IT'S SORT OF, YOU
CAN SEE SORT OF A VISUAL
STRATEGY THAT HELPS US
UNDERSTAND THE SOCIAL AND
POLITICAL ENVIRONMENT. YOU CAN
BEGIN BUT I THINKING ABOUT WHO
THOSE DECISION MAKERS ARE.
RIGHT? AND SO THAT IS INFORMED
BY THE POLICIES THAT YOU NEED TO
CHANGE. AND ON THE AXES YOU MAP
BASED ON WHAT THEY HAVE. RATHER
THAN THE ISSUE. WE
STRATEGICALLY CONNECT WITH
PEOPLE THAT HAD POWER OVER
CHANGING EMERGENCY MEDICAID
WHICH INCLUDED THE STATE
MEDICAID OFFICE, THE GOVERNOR'S
OFFICE AND MANY, MANY OTHERS.
AND WHAT I WANT TO JUST PAUSE
AND SAY IS THAT SINCE THIS
INITIAL POLICY CHANGE BECAUSE OF
THE RELATIONSHIPS THAT WE HAVE
CULTIVATED WITH THIS INITIAL
WORK, WE HAVE BEEN ABLE TO
CONDUCT ADDITIONAL QUALITATIVE
MIXED METHODS AND QUANTITATIVE
STUDIES BUT BECAUSE WE HAVE
CULTIVATED THESE RELATIONSHIPS E
HAS BEEN THAT MUCH FASTER I
MENTIONED THAT PATIENTS ENGAGED
IN THIS WORK. IT WAS INSPIRED
BY HILDA AND IT IS BECAUSE OF
THIS PARTNERSHIP THAT THE
PATIENTS HAVE BEEN ABLE TO
MEANINGFULLY ABLE TO CHANGE
POLICY. THEY DEVELOPED A SENSE
OF ADVOCACY SKILLS, POLICY
AWARP, A SENSE OF RIGHTS AND
LEADERSHIP.
AND AND THEY FORMED THEIR OWN
RELATIONSHIPS AND NOW THEY CAN
CONTINUE TO DO POLICY WORK
WITHOUT ME.
WE ALSO BUILT RELATIONSHIPS WITH
OUR EXECUTIVE HOSPITAL STAFFS,
COMMUNITY BASED ORGANIZATIONS,
AND PROFESSIONAL SOCIETIES. THE
THIRD ADVOCACY SCALE JUST VERY
QUICKLY WAS CONDUCTING RESEARCH.
A QUICK WORD ON QUALITATIVE
RESEARCH. I THINK IT'S SUCH A
MEANINGFUL RESEARCH METHOD
BECAUSE IT PROVIDES OUR
COMMUNITIES THE PEOPLE THAT ARE
FACING ADVOCACY CHALLENGES A
VOICE. IN ACADEMIC PUBLICATIONS
AND MAINSTREAM MEDIA, IN FACT WE
ALWAYS BEGIN POLICY BRIEFS AT
THE TOP AND IT'S A MORE STORY
BASED NARRATIVE THAT DRAWS IN
MEDIA BECAUSE THEY CAN CONNECT
WITH IT AND THEY CAN SHARE IT IN
A WAY THAT'S MEANINGFUL. WE
ALSO CONDUCTED SEVERAL
QUANTITATIVE STUDIES AND WHAT I
WANT TO SAY HERE IS THAT MANY OF
OUR QUANTITATIVE STUDIES WERE
ACTUALLY INFORMED BY CONNECTING
WITH PEOPLE THAT HAD DIFFERING
OPINIONS OR OPPONENTS BUT PEOPLE
WITH DIFFERING OPINIONS AND IT
WAS IMPORTANT TO LEAN IN TO
CONNECTING WITH PEOPLE THAT HAD
DIFFERENT OPINIONS BECAUSE THEY
SHARED THEIR VALUES AND THEIR
THOUGHTS ON THE ISSUE AND WE
WERE ABLE TO SORT OF INFORM
ADDITIONAL RESEARCH QUESTIONS
AND BUILD EFFECTIVE MESSAGING.
WE DISSEMINATED THIS INFORMATION
THROUGH A MIX OF SOCIAL MEDIA
REACHING OUT TO REPORTERS AND
THEN WITH THE COMMUNITY ONCE WE
IMPLEMENTED THE POLICY CHANGE,
WE REACHED OUT THROUGH CHURCH
NEWSLETTERS, SPANISH, TV AND
RADIO. ALL RIGHT, I THINK I'M
OUT OF TIME. I AM GOING TO GO
THROUGH THESE ONES CAREFULLY.
IN 2019, A FEW YEARS AFTER HILDA
DIED OUR COMMUNITY WORK LED TO
POLICY CHANGE. THIS SHOWS ALL
THE STATES THAT HAD PROVIDED
ACCESS TO IMMIGRANTS IN 2019 AND
BECAUSE OF ADDITIONAL CARE, IN
ADDITION TO A COST ANALYSIS,
THAT SHOWED THAT WE REDUCED CARE
FROM 20,000 PER PERSON PER MONTH
TO 5,500 PER PERSON PER MONTH.
WE WERE ABLE TO FURTHER
DISSEMINATE THIS INFORMATION.
THE PARTNERSHIPS WITH OUR
POLICYMAKERS LED TO ADDITIONAL
PUBLICATIONS IN FACT, WE HAD
PUBLISHED A POLICY ANALYSIS THAT
DESCRIBES A STEP BY STEP POLICY
PATHWAY WITH OUR STATE MEDICAID
DIRECTOR AND THIS IS THE RESULT
OF THE DISSEMINATION OF THIS
WORK AND SO TO END, I WANT TO
JUST SHARE THAT THIS PICTURE.
OUR COMMUNITY STEERING COMMITTEE
SO THIS IS THE GROUP THAT FWAN
THIS WORK WITH US. WITH HILDA.
THIS IS NOW TEN YEARS LATER.
AND WE ARE STILL WORKING
TOGETHER ON OTHER RESEARCH. WE
HAVE A WHOLE BODY OF WORK
FOCUSED ON COMMUNITY HEALTH
WORKER INTERVENTIONS TO IMPROVE
CARE FOR LATINOS WITH KIDNEY
DISEASE, WE'VE CONDUCTED A
SINGLE ARM STUDY, A RANDOMIZED
CONTROL TRIAL AND NOW WE'RE
TESTING AN ADAPTED VERSION OF A
NAVIGATE KIDNEY INTERVENTION IN
A LARGE-SCALE RCT WE'RE ALSO
ENGAGED IN TRANSPLANT ADVOCACY
RESEARCH AND POLICY WORK AND
CANCER RESEARCH AND POLICY WORK
AND SO THIS IS A GROUP THAT HAS
MEANINGFULLY BEEN PART OF THE
WORK FOR OVER TEN YEARS AND WITH
EVERY PROJECT THAT WE TAKE ON WE
TAKE IT ON INTENTIONALLY WITH
THE PURPOSE OF CHANGING POLICY
IN THE FUTURE. OR INFORMING
POLICY CHANGE. AND SO THANK YOU
AND THANK YOU TO EVERYONE THAT
HAS BEEN PART OF THIS WORK
BECAUSE THIS IS CERTAINLY A
JOURNEY I HAVE NOT DONE ON MY
OWN. IT HAS BEEN WITH PATIENTS
AND MANY OTHER PARTNERS. THANK
YOU.
>> THANK YOU SO MUCH TO EACH OF
OUR PANELISTS. REALLY
INSPIRING, GROUNDING TALKS AND I
WOULD LIKE TO OPEN IT UP TO THE
AUDIENCE TO RAISE ANY QUESTIONS
MENTS FOR THE PANELISTS.
WE'VE GOT 20 MINUTES I BELIEVE
TO HAVE A DISCUSSION TOGETHERA
I'LL JUST REFLECT AS WE WAIT
THESE TO COME IN WE HEARD ABOUT
A RANGE CONDITIONS AND
CHALLENGES MANY DIVERSE
SETTINGS. WHERE HEALTH EQUITY
HAS BEEN CENTERED AND
IMPLEMENTATION SCIENCE
ESSENTIALLY AS A TOOL. AND
THERE HAVE BEEN SOME THEMES
THROUGHOUT EACH OF THE
PRESENTATIONS THAT MIGHT BE
WORTH DURING THE COURSE OF THE
TRIALLING DOWN INTO A LITTLE BIT
MORE. AND I WOULD LOVE TO HEAR
FROM EACH OF YOU ABOUT
OPPORTUNITIES AND CHALLENGES
PARTICULARLY LET'S MAYBE START
WITH PARTNERSHIPS AND
RELATIONSHIPS. YOU'VE GOT
SUCCESS STORIES BUT I'M SURE
WITHOUT CHALLENGES. IF YOU CAN
TALK ABOUT IN THE RESEARCH
STRUCTURE WHAT ARE SOME
CHALLENGES TO RELATIONSHIP
FORMING AND SUSTAINING THAT WE
MIGHT WANT TO ADDRESS?
>> I CAN DIVE IN. OF COURSE I
WANT TO SAY THANK YOU. THIS
SHOWS THE ART OF THIS WORK IS
NOT SHORT-TERM. IT'S ACTUALLY
LONG-TERM. SO THE CHALLENGES
THAT WE FACE AND THE WORK THAT
WE DO. THROUGH THE FIRST TRIAL
THAT I SHOWED YOU, I RUN A
CLINIC. I DIDN'T TALK ABOUT MY
OWN PERSONAL STORY ABOUT THAT.
MY UNCLE DIED ACTUALLY FROM
KIDNEY DIALYSIS, 1994, HE DIED
IN NIGERIA. IN NIGERIA THEY
DIDN'T HAVE THE SUSTAINABILITY.
BUT THE STORY I WAS GOING TO
TELL IS THE FACT THAT WHEN WE
SAW PATIENTS, A PERCENT OF THE
PATIENTS HAVE COMPLICATIONS.
AND I BEGAN TO ASK MYSELF, WHAT
IS IT WITH THE TRIAL AT THAT
TIME, WE'RE RUNNING THE SECOND
ONE AND IT BECAME VERY CLEAR
THAT WE DON'T HAVE DATA TO SHOW
HOW WELL THE COMMUNITY LED
INTERVENTIONS WITH THIS
POTENTIAL. THIS IS WAY BACK
2008 AND I WENT TO THE
DEPARTMENT OF HEALTH. ALSO
MINORITY HEALTH AND SAID WE NEED
TO START LOOKING AT CHURCHES
WHERE WE CAN HAVE REAL DATA.
AND THEY SAID NOT SO FAST. YOU
NEED TO MEET WITH THE CLERGY.
SO WE'RE HAVING MEETINGS WITH
THE CLERGY EVERY MONTH, I AM
INTERESTED IN OUR POTENTIAL.
THAT IS THE LEAST OF THEIR
PROBLEM. THEY WERE JOINING FIRE
SAFETY AT THE TIME OF NEW YORK
CITY BECAUSE OF THE VIOLATIONS.
AND THERE WERE VICTIMS OF THIS.
BUT I WAS SLAMMED DOWN ALL THE
WAY TO THE NORTH IN COLUMBIA AND
IT TOOK THREE HOURS EVERY MONTH.
TO WORK WITH THEM AND THE
FACULTY IS NOT WHAT I DO. AND I
WAS TOLD, LOOK, THIS DOESN'T
LEAD TO THIS. TODAY, IT IS
BEAUTIFUL TO SEE THAT FOLKS ARE
INSPIRED AND TO SPEAK THAT
LANGUAGE. IT TOOK A LOT OF
WORK. TO ME, IT TAKES
PARTNERSHIP. AND IT TAKES
HAVING A LONG VIEW THAT IT MAY
NOT HAPPEN ON YOUR TENURE BUT AT
THE VERY LEAST ONCE YOU BUILD
THAT INFRASTRUCTURE IT IS EASIER
TO DO A WHOLE HOST MORE. SO
WITH THAT EXPERIENCE, WASN'T A
STRETCH FOR US TO PUT TOGETHER
THE HEALTH AND MATERIAL SEARCH
NETWORK THAT I SHARE WITH YOU
ALL. IN THREE WEEKS OR SIX
WEEKS AS A PROPOSAL. BUILD A
SOLUTION AND MAKE IT SO MUCH
EASIER BUT IT'S TOUGH WORK.
IT'S NOT SOMETHING THAT IS
INCENTIVIZED. IT TAKES A
SPECIAL PERSON TO MAKE IT
HAPPE
HAPPEN.
>> I COULDN'T AGREE MORE AND IT
WAS SO WONNED AND FEEL --
WONDERFUL AND INSPIRING TO HEAR
YOUR TALK.
SO SOME DEGREE THE FUNDING
MODELS MAKE IT CHALLENGING FOR
THIS LONG-TERM EMBEDDED
PARTNERSHIPS.
AND, YOU KNOW, THERE'S BEEN
GREAT MOVEMENT IN RECENT TIMES
INCLUDING THE NEW COMPASS MODEL
THAT NIH HAS SUPPORTED BUT IF
YOU THINK ABOUT IT THE WAY WE
FUND PROJECTS IS WE GIVE
INVESTIGATORS AND INSTITUTIONS
AWARDS THAT THEN DO AWARDS TO
OUR ORGANIZATIONS AND THAT
CHANGES THE POWER DYNAMICS. I
LOVE COMPASS BECAUSE IT FLIPS
THE MODEL ON ITS HEAD AND I LOOK
FORWARD TO SEEING WHAT COMES OUT
OF THAT BUT REALLY TO DO THIS
WORK WELL AND TO ENGAGE IN IT IN
LONG SUSTAINED MANNER IT
REQUIRES EMBEDDING WITH OUR
CONTEXTS THAT ARE NOT TYPICALLY
OUR ACADEMIC INSTITUTIONS AND
THAT CAN BE CHALLENGING FOR
EARLY CAREER PEOPLE AND I AM
SEEING MOVEMENT IN ACADEMIC
INSTITUTIONS AROUND, YOU KNOW,
PROMOTION AND TENURE, AROUND
UNDERSTANDING WHAT IT TAKES TO
DO THIS REALLY THOUGHTFUL,
DEEPLY EMBEDDED WORK. BUT WE'RE
NOT WHERE WE NEED TO BE TO MAKE
THIS SUSTAINABLE AND YOU NEED TO
HAVE LEADERS IN THE SETTINGS
THAT YOU'RE HOPING TO WORK WITH
THAT ARE BOUGHT IN THAT AS A
SCIENTIST YOU HAVE SOMETHING
THAT CAN BE HELPFUL. BECAUSE WE
HAVE A LITTLE BIT OF AN UPHILL
BATTLE TO COME UP AGAINST
BECAUSE WE HAVEN'T ALWAYS KIND
OF PUT OTHER PEOPLE'S PRIORITIES
FIRST. AND THEN FINALLY I JUST
SAY, YOU KNOW, SHIFTING
LANDSCAPES. NEW PARTNERS COME
INTO THE CONTEXT SO THE CONSTANT
CULTIVATION AND, YOU KNOW, YOU
HAVE TO ALWAYS BE DOING THE
WORK. AND THAT CAN BE
CHALLENGING AS WELL GIVEN THE
INCENTIVES AND THE ACADEMIC
STRUCTURES.
>> THANK YOU. I WILL JUST ECHO
WHAT EVERYONE HAS SAID AND ADD
THAT FOR US, YOU KNOW, HAVING
OUR COMMUNITY STEERING COMMITTEE
FOR TEN YEARS HAS BEEN, YOU
KNOW, A WORK OF HARD LABOR
BECAUSE IT MEANS WE'VE HAD TO
HAVE FUNDING FOR TEN YEARS TO
MAKE SURE THAT WE CONTINUE TO
COMPENSATE OUR COMMUNITY
MEMBERS. AND MOST OF THESE
AWARDS ARE ONLY FIVE YEARS LONG
AND THE OTHER THING I WOULD ADD
CONSIDERING OTHER TYPES OF
PARTNERS LIKE FOLKS IN POLICY IS
REALLY MEANINGFUL AND IMPORTANT
BECAUSE WHEN WE THINK ABOUT
PRACTICE CHANGE, THOSE ARE THE
INDIVIDUALS THAT WE REALLY WANT
TO DRAW IN, THAT WE WANT TO
CONNECT WITH, TO INFORM SOME OF
THESE RESEARCH QUESTIONS THAT
WE'RE ASKING AND SO REALLY
THINKING THOUGHTFULLY ABOUT WHAT
DOES PARTNERSHIP MEAN AND
ENSURING THAT WE INCLUDE
MULTILEVEL, MULTIPERSPECTIVES IN
THE WORK THAT WE DO. AND
THINKING ABOUT IMPLEMENTATION AT
THE ONSET.
ABOUT, YOU KNOW, HOW IS THIS
RESEARCH GOING TO MEANINGFULLY
INFORM POLICY CHANGE AND HOW IS
IT GOING TO CHANGE BEHAVIOR?
AND SO -- THAT'S WHAT I THINK
ABOUT WITH RESPECT TO
SUSTAINABILITY AND IMPACT.
>> THANKS FOR THOSE RESPONSE. I
SEE A QUESTION IN THE CHAT THAT
IS DIRECTED SPECIFICALLY TO
DR. SIR VAN AT THE SCENE IF YOU
WANT TO COME OFF MUTE.
>> THANK YOU. I ACTUALLY HAD A
QUESTION FOR DR. SIR VAN AT THE
SCENE BUT I FEEL OUR OTHER TWO
PANELISTS MIGHT WANT TO WEIGH IN
AS WELL AND I PUT IT IN THE CHAT
SO YOU CAN LOOK AT IT. BUT
GIVEN THE AMAZING WORK THAT
YOU'VE DONE AROUND THIS
COMMUNITY ADVOCACY PROJECT HAVE
YOU ACTIVELY TRIED TO COLLECT
INPUT FROM COMMUNITY PARTNERS
AND PATIENTS ON WHAT IT MEANS TO
THEM TO BE PART OF THESE
COMMUNITY ENGAGED ADVOCACY
PROJECTS AND WHAT ARE SOME OF
THE BEST PRACTICES THAT THEY
SEEM TO IDENTIFY THAT
RESEARCHERS AND OTHERS CAN
CONSIDER? AND ALSO YOU DID
MENTION BUILDING COMMUNITY EARLY
AND I AM WONDERING IF THERE'S
BEEN MORE OF A PUSH TOWARDS OUR
EARLY STAGE INVEST DWA TORTOISE
BUILD THESE RELATIONSHIPS WITH
COMMUNITY MEMBERS BEFORE THEY
EVEN DESIGN THEIR RESEARCH
PROJECT AND APPLY FOR FUNDING SO
THAT THEY INCORPORATE THE
COMMUNITY'S PERSPECTIVE, NEEDS
AND PRIORITIES BEFORE THEY COME
IN FOR FUNDING. THANK YOU SO
MUC
MUCH.
>> THANK YOU FOR THAT QUESTION.
LY I WILL TRY TO REMEMBER
EVERYTHING.
I HAVE NOT COLLECTED STRUCTURED
FEEDBACK ALTHOUGH THAT'S A
FUTURE RESEARCH QUESTION I LOOK
INTO. BUT IT'S INTERESTING
BECAUSE I WOULD SAY, SO WE HAVE
OUR COMMUNITY STEERING COMMITTEE
MEETINGS EVERY TWO TO FOUR WEEKS
BUT THIS COMMUNITY ACTUALLY GETS
TOGETHER PROBABLY ONE OR TWO
EXTRA TIMES PER MONTH BECAUSE
THEY HAVE BUILT SUCH STRONG
COMRADERY LIKE THEY CELEBRATE
THEIR BIRTHDAYS, THEY CELEBRATE
QUINCEAÑERA, THEY ARE TOGETHER
ALL THE TIME. I WOULD SAY THE
MOST VALUABLE PART OF THIS IS
THEY HAVE TRULY CULTIVATED
COMMUNITY IN THE TRUEST SENSE.
AND WHEN WE NEED AGAIN EVERY TWO
TO FOUR WEEKS WHAT WE END UP
DOING CHANGES EACH TIME AND SO
SOMETIMES WE WILL WORK ON
FEEDBACK, ON PATIENT FACING
MATERIALS FOR OUR CURRENT
STUDIES, BUT I LOVE THAT YOU
MENTIONED JUNIOR INVESTIGATORS
BECAUSE WE INVITE JUNIOR
INVESTIGATORS TO PRESENT THEIR
RESEARCH FINDINGS AND IT IS SO
FUN FOR THEM TO RECEIVE FEEDBACK
FROM COMMUNITY MEMBERS AND SO
THAT HAS BEEN A REAL VALUE ADDED
TO SORT OF BRING IN OUR JUNIOR
FACULTY INTO THESE MEETINGS AND
WE DO THIS ACROSS THE NATION
TOO. SO OUR COMMUNITY MEETS AT
A NONPROFIT COMMUNITY BASED
ORGANIZATION BECAUSE IT'S THE
PLACE THAT FEELS SAFE FOR THEM
AND WHEN RESEARCHERS PRESENT WE
BRING THEM IN VIRTUALLY AND HAVE
AN IN-PERSON LANGUAGE
INTERPRETER. AND SO THAT'S HOW
WE'RE ABLE TO SORT OF
MEANINGFULLY IMPACT RESEARCH NOT
JUST IN COLORADO BUT ACROSS THE
COUNTRY AND AS FAR AS SKILLS, I
THINK ONE OF THE -- WELL THE
FOUR I DESCRIBED ARE PROBABLY
KEY BUT I WOULD SAY THE
RELATIONSHIP BUILDING HAS BEEN
KEY BECAUSE I THINK MANY OF THEM
NEVER IMAGINED BEING ABLE TO
CONNECT WITH, YOU KNOW, AN
EXECUTIVE HOSPITAL STAFF MEMBER
FOR EXAMPLE. OR TO HAVE DINNER
WITH A GROUP OF CLINICIANS. I
THINK IN BUILDING THESE
RELATIONSHIPS IT HAS BEEN VERY
MEANINGFUL FOR THEM BECAUSE
THEY'RE ABLE TO SORT OF, UTILIZE
THOSE RELATIONSHIPS TO CONTINUE
TO DO ADVOCACY WORK, MANY OF
THEM YOU CAN SEE HAVE BECOME
NATURAL LEADERS AS WELL WHICH
HAS BEEN REALLY FUN AND SO I
THINK FOR THEM, SORT OF TAKING
ON THESE ADVOCACY SKILLS HAS
BEEN VERY IMPORTANT BECAUSE
THEY, YOU KNOW, SELF-EFFICACY IN
THE HOSPITAL BUT JUST TAKING ON
ADDITIONAL ADVOCACY ISSUES ON
THEIR OWN WITHOUT ME AND WITHOUT
OTHERS HAS BEEN VERY MEANINGFUL.
SORRY, I DON'T KNOW FEW -- IF I
ANSWERED ALL YOUR QUESTIONS BUT
I WILL LET THE OTHERS RESPOND.
>> I THINK YOU ANSWERED IT
BEAUTIFULLY BUT YES, I WOULD
LIKE TO HEAR FROM THE OTHER
PANELISTS.
>> I CAN WEIGH IN. WHAT I TELL
MY FACULTY IS THIS, WHEN I WAS A
JUNIOR FACULTY AND I DESIGNED MY
FIRST TRIAL, THE ORIGINAL PERSON
HAD TO SIGN OFF. AND HE CALLED
ME AND SAID WHY ARE YOU DOING
THIS WORK? THIS IS 2008, AND I
SAID, WELL, DOES EVERYONE COUNT
AS THE GRANT AND HE SAID YEAH.
AND I SAID LET'S TUNE IN AND SEE
WHAT HAPPENS. WHEN I SEE HIM,
NOW AND THEN, HE SAYS MANY YEARS
AGO, WHY DID YOU LEVERAGE SO
MANY GRANTS. WHAT I SAY TO
JUNIOR FACULTY IS LOOK, TIME IS
SHORT. I'M IN THE MEDICAL
SCHOOL. MOST MEDICAL SCHOOLS
REMOVE YOU FROM TENURE AND SO
THE QUESTION THEN BECOMES KNEW
WHAT DO YOU DO WITH THE TIME
THAT YOU HAVE? DON'T DO IT
ALONE. IT TAKES TIME TO BUILD
TRUST. IN WHAT IS PRESENTED,
WHAT SHE'S NOT SAYING IS WHAT
I'M GOING TO SAY NOW, AND THAT
IS -- IT IS THAT PEOPLE DON'T
CARE WHAT YOU KNOW UNTIL THEY
KNOW THAT YOU CARE. I THINK SHE
SHOWED SHE CARED FOR HER
COMMUNITY. AND I SAY TO PEOPLE
DON'T TRY TO REINVENT THE WHEEL.
TRY TO WORK WITH EXISTING
COMMUNITY BASED BODIES. AT
LEAST IN EVERY INSTITUTION.
MAJOR ONES. YOU HAVE THE CTS OR
AT LEAST TRY TO LOOK UP FROM THE
WEBSITE IN YOUR SCHOOL THE WORK
AND YOU LINK UP WITH THEM THAT
WAY YOU RIDE ON THEIR COATTAILS
TO MAKE IT EASIER TO HAVE ACCESS
TO THE COMMUNITY. SO DON'T STOP
THE WORK. IT TAKES A LOT OF
GUTS AND THESE DAYS, IN OUR
INSTITUTION WE ADDED THAT ON THE
INSTITUTE TO FIGHT FOR HOW WE
CAN PUT THAT COMMUNITY BASED
WORK AND RECOGNIZE AS PART OF
YOUR TENURE SO IT'S NOT JUST
SERVICE. IT'S IMPORTANT
ACADEMIC SERVICE I THINK IT'S
IMPORTANT TO FIND NETWORKS.
>> I THINK, YOU KNOW, JUST TO
AMPLIFY THE POINTS THAT HAVE
BEEN MADE, I MEAN I THINK
APPROACHING ALL OF THIS WITH
HUMILITY WHEN I TALK TO OUR
COMMUNITY PARTNERS THE THINGS
THAT MEAN THE MOST TO THEM IS
THAT WE'RE COMING AND SAYING
WHAT KEEPS YOU UP AT NIGHT? HOW
CAN I BE HELPFUL TO YOU NOT THAT
I HAVE THIS THING THAT I WANT
YOU TO DO AND WHY AREN'T YOU
DOING IT. IT'S SO OBVIOUS AND
ALSO THAT IS NOT ALWAYS WHAT
PEOPLE DO. AND SO I THINK
LEADING WITH THE NEEDS OF THE
COMMUNITY IS REALLY IMPORTANT
AND THEN THE OTHER THING AND
THIS GOES TO WHAT I WAS SAYING
IN MY TALK IS LIKE, WE REALLY
ARE ABLE TO EMPOWER OUR
COMMUNITY MEMBERS TO BE THE
EXPERTS AS DR. CERVANTES
PRESENTED SO WELL SO WE DID THIS
THING WITH, INSTEAD OF ASSUMING
THAT WE KNEW THE BEST
IMPLEMENTATION STRATEGIES TO
DEPLOY EVIDENCE-BASED PRACTICES
WE DID AN INNOVATION TOURNAMENT
WHICH IS LIKE AMERICAN IDOL BUT
FOR IDEAS AND HAVE OUR COMMUNITY
TELL US WHAT IS NEEDED AND WE
HAD THIS BIG PARTY WHERE THE
COMMISSIONER WAS THERE AND ALL
THE CLINICIANS WHO WERE THE
WINNING FOLKS BROUGHT THEIR
PARTNERS, THEIR BOSSES, THIS WAS
MEANINGFUL, SOMEONE CARED TO
LISTEN TO THEM AND AMPLIFIED
THEIR EXPERIENCE. I THINK
EMPOWERING FOLKS TO BET TTEX T
EXPERTS RATHER THAN US.
BECAUSE WE'RE NOT.
THE ONLY OTHER THING I WANT TO
SAY ABOUT EARLY CAREER
INVESTIGATORS, WHEN I WAS AT
PENN WHERE THERE'S A T32 WHERE
WE EM GO AHEAD POSTDOCS IN THE
COMMUNITY ORGANIZATION.
AND THE PROJECT WAS BASED ON A
NEED FOR THAT COMMUNITY BASED
ORGANIZATION. USING THE
TRAINING THEY WERE GETTING
THROUGH THE T32. PEOPLE ARE
HUNGRY FOR THIS. EARLY STAGE
INVESTIGATORS WANT TO DO THIS
WORK SO THE MORE WE CAN DO TO
EMBED THEM THE BETTER.
>> APPRECIATE YOU ALL. I DID
WANT TO PUT OUT ONE OTHER
QUESTION. ANOTHER THEME THAT
RAN THROUGH ALL YOUR TALKS IS
SOCIAL DETERMINANTS OF HEALTH OR
SOCIAL RISK AND I'M SURE YOU'RE
FAMILIAR WITH IT WASN'T STATED
EXPLICITLY THE NATIONAL
ACADEMY'S FIVE AS. THE
AWARENESS, AWARENESS OF SOCIAL
RISKS, ASSISTANCE, SO DIRECTLY
SORT OF TARGETING, ADJUSTMENT OR
CARE IS MODIFIED, YOU KNOW, WITH
THE SOCIAL RISKS IN MIND,
ALIGNMENT, WHERE THE SOCIAL CARE
ASSETS OF THE COMMUNITY ARE
UNDERSTOOD AND TAKEN INTO
ACCOUNT AND ADVOCACY WHICH IS
PRETTY SELF DESCRIPTIVE AND I
WONDER IF YOU CAN REFLECT ON AS
YOU THINK OF IMPLEMENTATION
SCIENCE ITS ROLE AS A TOOL.
WHAT ARE THE OBVIOUS
OPPORTUNITIES IF YOU HAVE THAT
FRAME WO
FRAMEWORK IN MIND AND WHAT ARE
THE MOST CHALLENGING?
>> I CAN TRY. I GAVE A TALK ON
ACADEMIC HEALTH IN 2022 ON
TALKING ABOUT THE CELL SCIENCE
MODULES. IT'S VERY CHALLENGING
TO SHOEHORN EARLY MODELS INTO
REAL LIFE EXPERIENCE SO WHAT I
SAY IN THE FIELD IS THAT IT WILL
HAVE TO UNDERSTAND WHAT IS THE
USE OF THE CONCEPTUAL MODEL?
IT'S NOT HOLY GRAIL. YOU JUST
WANT TO UNDERSTAND HOW YOU
ACTUALLY DECIPHER INFORMATION,
HOW YOU USE THAT TO INFORM THE
INTERVENTION THAT YOU HAVE. OUR
SCIENTISTS ENJOY THE MODEL.
WHAT I FIND THE MODELS, ONE IS
GREAT. IT'S NOT LIKE IT WAS TEN
YEARS AGO. AND WE HAD ONE WITH
A MODULE THAT EVERYBODY ALSO
HAVE A WAY TO LOOK AT THAT LOGIC
MODEL. IT TALKS ABOUT THE
EVIDENCE, I THINK TALKS ABOUT
YOUR CHANGING. I THINK PEOPLE
GET LOST. SO IT'S HIGHLY
CHALLENGING. AND THEN -- THE
OTHER CHALLENGE IS THAT I DON'T
BELIEVE THAT IF THE ADDITIONAL
SCIENCE YOU HAVE UNDERMINES
TRIALS. THAT'S FOR THE
SCIENTIFIC WORLD WANTS. WHAT IT
DOESN'T WANT. LET ME TELL YOU
WHY. YOU LOOK AT THE
BOUNDARIES. YOU LOOK AT THE
CHALLENGE. THERE'S THE PATIENTS
AROUND. WHEN YOU DO THAT THE
HEALTH CARE SYSTEM CHANGES. IT
DOESN'T WAIT. THINGS ARE
HAPPENING EVERYDAY. COMMUNITIES
CHANGE TOO BY THE WAY. QUICKLY.
WE HAVE TO REIMAGINE WHAT THE
CLINICAL TRIAL CAN HELP US TO DO
HERE. THE REASON IS NOT HOLY
GRAIL. CONTEXT IS DIFFERENT IN
EVERY PLACE. IF YOU IMPLEMENT
IT IN CHICAGO. IT DOESN'T NEED
TO WORK IN ARIZONA, OR PHOENIX,
OR WORK IN NEW YORK CITY. SO WE
HAVE TO UNDERSTAND THAT AND THE
CONTEXT CHANGES OVER TIME AS
WELL SO AROUND THAT TIME, GUESS
WHAT, YOUR PREMISE HAS ALREADY
CHANGED WHICH MEANS YOUR
INTERVENTIONS SO TO ME IT IS
THE -- WITHIN SYSTEM CHANGE THAT
IT IS VERY IMPORTANT. IF YOU
THINK ABOUT TIME SAVING ANALYSIS
TO HELP US MAKE THIS HAPPEN AND
YOU CAN ADD THAT. SO THAT'S MY
OWN FOR THE CHALLENGES HOLD FOR
US IS LOOKING FOR THAT
INNOVATIVE METHOD THAT YOU CAN
USE IN THE INTONATION.
>> I THINK THAT IS RIGHT. I
THINK AS A FIELD WE HAVE
CENTERED EQUITY AND THINKING
ABOUT HOW SUH EFFECT OUR ABILITY
TO IMPLEMENT OUR THINGS LIKE I
THINK WE HAVE THAT AWARENESS
PIECE COVERED AT THIS POINT
WE'VE STARTED TO INTEGRATE THESE
CONCEPTS INTO OUR CONCEPTUAL
FRAMEWORKS ALTHOUGH I AGREE
THERE ARE TOO MANY. I THINK
PROBABLY THE AREA FOR FUTURE
STUDY IS REALLY THINKING ABOUT
MORE EQUITY FOCUSED
IMPLEMENTATION STRATEGIES. WE
TEND TO FOCUS ON CLINICIANS
MAYBE ORGANIZATIONS WHEN WE ARE
DOING OUR STUDIES AND I THINK
REALLY WHAT OUR PRESENTERS DID
SUCH A BEAUTIFUL JOB OF TODAY IS
SHOWING HOW THIS MULTILEVEL
APPROACH IS SO MUCH MORE
POWERFUL. AND SO I THINK THAT
FOR ME, I THINK, AND I'M NOT
SURE WHICH A THAT FALLS INTO.
BUT I THINK THAT'S THE AREA FOR
FUTURE WORK.
>> YEAH, AND MICHELE, HAS PUT A
DIFFERENT SPIN ON MY QUESTION.
I WOULD LOVE TO HEAR YOU ADDRESS
DR. CERVANTES AS WE WRAP UP I
CAN SEE THAT IN THE CHAT. SO IN
TERMS OF THE ADVOCACY AND THE
POLICY CHANGE THAT YOUR GROUP
UNDERTOOK. CAN YOU SPEAK MORE
TO THE COMMUNITY EXPECTATIONS?
>> YEAH WITH RESPECT TO ADVOCACY
AND SOME OF THE FRAMEWORKS. I
THINK, YOU KNOW, ONCE BEGIN
THINK IT'S CRITICALLY IMPORTANT
TO THINK ABOUT THE CHANGE THAT
WE WANT TO SEE. YOU KNOW, THE
OUTCOME THAT WE WANT TO SEE AND
WHAT ARE THE STUDIES THAT WILL
HELP US GET TO THAT PRACTICE
CHANGE OUTCOME. AND FROM THE
COMMUNITY PERSPECTIVE, WHEN WE
STARTED THIS WORK I'M NOT SURE
THAT THEY EXPECTED THE CHANGE TO
HAPPEN SO QUICKLY. YOU KNOW, IT
HAPPENED JUST FOUR YEARS AFTER
HILDA PASSED AWAY. BUT THEY
WERE DETERMINED. AND SO THEIR
EXPECTATION WAS WE ARE GOING TO
CHANGE THIS REGARDLESS OF HOW
MANY YEARS IT TAKES TO CHANGE
THIS. AND I THINK MOVING
FORWARD, THE CHALLENGES IN
CONSIDERING THE SOCIAL
DETERMINANTS OF HEALTH IS THAT,
FROM MY PERSPECTIVE, SOME OF
THEM ARE MODIFIABLE AND SOME OF
THEM ARE A LITTLE MORE
CHALLENGING TO MODIFY.
ESPECIALLY GIVING SORT OF
CHANGING STRUCTURES AND
ADMINISTRATIONS AND SO YOU KNOW
THERE ARE CERTAIN GROUPS THAT
WILL BE EXCLUDED MOVING FORWARD
AND SO I THINK YOU KNOW, FOR MY
WORK AT LEAST, IT'S INCREASINGLY
IMPORTANT TO REALLY THINK ABOUT
THE STRUCTURES THAT REDUCE THE
QUALITY OF HEALTH BECAUSE
CERTAIN GROUPS ARE EXCLUDED AND
HOW WE SORT OF MOVE FORWARD WITH
POLICY CHANGE AND RESEARCH.
>> GRATEFUL TO EACH OF YOU FOR
YOUR INSIGHTS, YOUR PERSPECTIVE,
YOUR TIME, THIS IS ABSOLUTELY TO
ECHO THIS THE CHAT A FABULOUS
SESSION. THANK YOU SO MUCH AND
WE'LL LET YOU KNOW WHEN THE LINK
IS AVAILABLE.
>> THANK YOU. THANK YOU VERY
MUCH.
>> TAKE CARE.
>> THANK YOU.
GUESS WE'LL SEE YOU GUYS. .