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GOOD AFTERNOON, GOOD EVENING,

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FRIENDS AND COLLEAGUES, WE ARE 

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DELIGHTED TO HOST THIS WEBINAR. 

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MY NAME IS KARA LOUIS, I'M THE 

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DEPUTY DIRECTOR FOR THE CENTER 

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FOR IMPLEMENTATION SCIENCE 

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FONDLY REFERRED TO AS CTRIS.  WE

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ARE SO GRATEFUL FOR THE TIME 

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THAT YOU'RE TAKING TO JOIN US 

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TODAY FOR THIS REALLY IMPORTANT 

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TOPIC.  WE KNOW YOU'RE ALL VERY 

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BUSY AND WE'VE TUCKED THIS IN 

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BETWEEN TWO HOLIDAYS SO GRATEFUL

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THAT YOU DECIDED TO JOIN US.  

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SLIDE, PLEASE.  BEFORE WE GET 

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STARTED, LET ME JUST SHARE A 

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COUPLE OF HOUSEKEEPING ITEMS.  

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SO ATTENDEES ARE MUTED UPON 

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ENTRY.  DOESN'T MEAN WE DON'T 

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WANT TO HEAR FROM YOU, IN FACT, 

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IT'S QUITE THE OPPOSITE WE 

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REALLY HOPE THAT YOU'LL BE 

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PUTTING YOUR QUESTIONS AND YOUR 

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COMMENTS IN THE CHAT THROUGHOUT 

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THE PRESENTATIONS TODAY.  AND 

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SHOULD YOU BE INTERESTED AT THE 

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VERY END OF ALL OF OUR SPEAKERS'

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PRESENTATIONS WE CAN INVITE YOU 

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TO JOIN THE CONVERSATION MORE 

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FULLY.  WE WANT TOWENOWLEDGE

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THE WEBINAR IS BEING RECORDED AS

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HAVE ALL OF THE OTHER HERO 

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LECTURES SO THAT OTHER FOLKS WHO

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ARE UNABLE TO JOIN US IN 

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REALTIME CAN LOOK BACK AT THE 

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CONVERSATION THAT WE'RE HAVING. 

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SHOULD YOU EXPERIENCE ANY 

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TECHNICAL ISSUES YOU'VE GOT A 

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CONTACT E-MAIL ON YOUR SCREEN.  

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SLIDE, PLEASE.  SO AS I ELUDED 

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TO THIS LECTURE IART OF A 

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LARGER SERIES THAT THE HERO 

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SERIES WHICH STARTED IN JANUARY 

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2022.  AND IT'S INTENDED TO 

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HIGHLIGHT THE WORK AND VOICES OF

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THOSE INVOLVED IN GLOBAL AND 

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DOMESTIC HEALTH EQUITY RESEARCH 

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THROUGH DISCUSSION AND 

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ENGAGEMENT THIS SERIES AIMS TO 

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ADDRESS PRESSING CHALLENGES AND 

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OPPORTUNITIES IN THIS AREA OF 

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SCIENTIFIC RESEARCH.  AS I 

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MENTIONED CTRI IS IS HOSTING 

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THIS  RE LOOKING AT THE FOUR 

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PILLARS AT THE STRATEGIC FOCAL 

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POINT FOR GLOBAL HEALTH 

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RESEARCH, HEALTH INEQUITIES 

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RESEARCH, IMPLEMENTATION SCIENCE

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AND COMMUNITY RESEARCH HERE AT 

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THE NATIONAL HEART, LUNG AND 

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BLOOD INSTITUTE.  CTRIS IS 

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CELEBRATING ITS TENTH YEAR AS A 

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CENTER.  

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AND TO CELEBRATE THE TENTH 

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ANNIVERSARY WE'VE BEEN 

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DEDICATING THE HERO LECTURE 

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SERIES TO EACH OF THE FOUR 

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PILLARS THROUGHOUT THE YEAR SO 

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TO DATE WE'VE HOSTED RESOLVE SO 

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SAVE LIVES, CARDIOVASCULAR 

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HEALTH PROMOTION IN LOW AND 

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MIDDLE INCOME COUNTRIES ON APRIL

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29TH AND ADVANCING HEALTH 

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INEQUITY ON AUGUST 27TH AND YOU 

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CAN LOOK ON OUR WEBSITE FOR 

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ARCHIVED RECORDINGS OF THESE 

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CONVERSATIONS FOR YOUR VIEWING 

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PLEASURE.  TODAY WILL FEATURE 

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THE INTERSECTION OF 

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IMPLEMENTATION SCIENCE AND 

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HEALTH EQUITY.  BEFORE WE JUMP 

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INTO OUR AGENDA FOR TODAY THOUGH

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SLIDE, PLEASE.  I DID WANT TO 

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INVITE YOU ALL TO JOIN US IN THE

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ONGOING CELEBRATORY ACTIVITIES. 

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THERE'S A SPECIAL EVENT THAT'S 

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BEING SORT OF TAGGED ONTO THE 

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ACADEMY HEALTH DNI CONFERENCE 

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THAT'S TAKING PLACE THIS 

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DECEMBER.  AND THE INFORMATION 

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ON YOUR SCREEN WILL HELP YOU 

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DECIDE IF YOU CAN JOIN US 

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VIRTUALLY OR IN-PERSON ON 

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DECEMBER 11TH.  IN THE AFTERNOON

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AND HOPEFULLY THAT QR CODE WORKS

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FOR YOU TO TAKE YOUR WAY INTO 

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THE ATTENDEE LIST.  WE'VE GOT A 

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REALLY PACKED AGENDA OF 

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GRANTEES, SPEAKING, A HOSTER 

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SESSION, AS WELL AS LEADERS FROM

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NIH TO HELP US CELEBRATE, SLIDE,

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PLEASE.  SO AS YOU CAN SEE, THIS

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IS OUR INTENDED AGENDA FOR THE 

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SHORT TIME WE ARE TOGETHER 

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TODAY.  WE WILL HEAR FROM THREE 

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PANELISTS AND THEN HAVE, GOSH, 

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ABOUT THIRTY MINUTES OR SO FOR 

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CONVERSATIONS, SO, SLIDE, 

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PLEASE.  LET ME INTRODUCE YOU TO

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OUR FIRST PANELIST.  I'LL 

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INTRODUCE THEM ALL NOW.  THEY'LL

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SPEAK IN TURN AND THEN WE'LL 

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MAXIMIZE TIME FOR DIALOGUE.  SO 

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FIRST UP WILL BE DR. RI THATTED 

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WHO IS THE CHAIR AND AT THE 

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NORTHWESTERN UNIVERSITY.  SHE IS

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A VERY LARGE BIO LONLINE IF YOU 

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DON'T KNOW HER ALREADY. 

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AND NEXT SLIDE, PLEASE.  SECOND 

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WE'LL HEAR FROM THE FOUNDING 

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DIRECTOR FOR HEALTH AND 

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DR. ADOLF AND MARGARET PROFESSOR

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AT THE GROSSMANN SCHOOL OF 

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MEDICINE ALSO VERY GOOGLEABLE 

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AND PROLIFIC AS A RESEARCHER IN 

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THE INTERSTITIAL SPACES THAT 

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YOU'LL HEAR ABOUT LATER THIS 

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MORNING AND THEN FINALLY, LAST 

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BUT NOT LEAST WE'LL HEAR FROM 

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DR. LITTLE YA, ATTENDED 

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PROFESSOR AND THE DIRECTOR OF 

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IMMIGRANT RESEARCH AT THE 

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UNIVERSITY OF COLORADO SCHOOL OF

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MEDICINE.  AND REALLY EXCITED TO

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HAVE THIS SORT OF GROUNDING 

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VIEWPOINT FROM THE DOCTOR TO 

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KICK US OFF AND SOME FOCUSED 

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EXAMPLES OF HEALTH EQUITY 

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RESEARCH AND COMMUNITY ENGAGED 

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RESEARCH AND BRINGING IN HEALTH 

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JUSTICE FROM OUR OTHER TWO 

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SPEAKERS.  SO WITHOUT FURTHER 

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ADO, I WILL PUT MYSELF ON MUTE, 

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TURN IT OTHER TO THE DOCTOR AND 

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LOOKING FORWARD TO OUR 

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CONVERSATION.

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>> THANK YOU SO MUCH FOR
HAVING 

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ME I HOPE TO SEE ALL OF YOU ALL 

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AT THE CELEBRATION IN D.C. OR 

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VIRTUALLY.  I AM GOING TO GO 

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AHEAD AND SHARE MY SCREEN.  AND 

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GO TO SLIDESHOW.  CAN SOMEBODY 

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GIVE ME A VISUAL THAT YOU'RE 

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SEEING THE RIGHT SLIDES AND YOU 

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CAN HEAR ME OKAY?  FANTASTIC.  

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WONDERFUL.  IT IS A HUGE HONOR 

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TO BE HERE AT THE HERO SEMINAR 

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SERIES AND WITH MY ESTEEMED 

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PANELISTS.  I'M REALLY LOOKING 

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FORWARD TO CHATTING WITH YOU ALL

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A BIT TODAY.  I WOULD LIKE TO 

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START WITH A POSITIONALITY 

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STATEMENT.  AS MY IDENTITY, AND 

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LIVED EXPERIENCES DEEPLY SHAPE 

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MY PERSPECTIVE.  I AM A MIDDLE 

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EASTERN IMMIGRANT MOTHER 

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COMMUNITY MEMBER AND 

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PSYCHOLOGIST, MY EARLIEST 

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MEMORIES INCLUDE BEDTIME 

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DISCUSSIONS WITH MY FATHER WHO 

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IS A FOREIGN TRAINED MEDICAL 

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GRADUATE INFECTIOUS DISEASE DRO 

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WHO WAS ON THE FRONTLINE OF THE 

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HIV EPIDEMIC WORKING IN A SAFETY

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NET HOSPITAL AND AT BED AS HE 

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TOLD ME STORIES ABOUT HIS 

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PATIENTS, I JUST COULDN'T WRAP 

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MY HEAD AROUND THE FACT THAT NOT

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EVERYONE WAS AFFORDED THE 

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FUNDAMENTAL HUMAN RIGHT OF 

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HEALTH AND IT IGNITED A PASSION 

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TO DO SOMETHING ABOUT THAT.  I 

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CURRENTLY SERVE AS CHAIR OF THE 

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DEPARTMENT OF MEDICAL SOCIAL 

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SCIENCES AT NORTHWESTERN 

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FEINBERG SCHOOL OF MEDICINE AND 

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WE HARNESS BEHAVIOR SCIENCES TO 

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ADVANCE EQUITY AND INNOVATION 

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AND IMPACT OF HEALTH WHICH IS 

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CONSISTENT WITH MY OVERALL 

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MISSION AS A SCIENTIST AND THE 

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REASON I GET UP IN THE MORNING 

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AND AM EXCITED ABOUT 

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IMPLEMENTATION SCIENCE IS 

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BECAUSE I REALLY DO SEE IT AS A 

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TOOL.  AND A METHOD THAT ALLOWS 

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US TO ADVOCATE FOR THE NEEDS OF 

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OUR COMMUNITIES IN PURSUIT OF 

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POPULATION HEALTH AND SOCIAL 

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JUSTICE AT SCALE.  GIVEN THE 

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FOCUS OF TODAY'S TALK IS ON 

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HEALTH EQUITY I DO WANT TO BE 

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EXPLICIT ABOUT THIS MESSAGE 

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WHICH IS THAT I AM TRAINED AS AN

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IMPLEMENTATION SCIENTIST AND I 

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REALLY SEE THE WORLD THROUGH 

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THAT LENS, HAVING DONE THIS WORK

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NOW FOR THE PAST TWO DECADES.  

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MY EARLY WORK WHICH I'LL BRIEFLY

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TALK ABOUT HAD AN IMPLICIT FOCUS

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ON HEALTH EQUITY BECAUSE IT WAS 

212
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REALLY FOCUSED ON CENTERING 

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IMPLEMENTATION OF EVIDENCE-BASED

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PRACTICES SERVING POPULATION 

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SERVED BY MEDICAID THAT WORK WAS

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BUILT UPON A FOUNDATION OF DEEP 

217
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COMMUNITY PARTNERSHIP AND 

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FOCUSED ON BRINGING HIGH QUALITY

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CARE TO POPULATIONS WHO HAD NOT 

220
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HAD ACCESS MORE RECENTLY IS THE 

221
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FIELD OF IMPLEMENTATION SCIENCE 

222
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HAS GROWN.  I HAVE BEGUN TO 

223
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EXPLICITLY BRING THIS INTO MY 

224
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WORK WITH SUPPORT FROM COLLEAGUE

225
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WHO IS ARE EXPERTS AND I HOPE 

226
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WHAT I PRESENT CAN SERVE AS 

227
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EXAMS FOR OTHERS WHO MAY WANT TO

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CENTER EQUITABLE IMPLEMENTATION 

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WHICH I ARGUE EVERYONE SHOULD BE

230
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DOING. 

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AND I ESPECIALLY WANT TO CALL 

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OUT DR. RACHEL SHELTON WHO IS AN

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INTERNATIONAL EXPERT AT THE 

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INTERSECTION OF SCIENCE AND 

235
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EQUITY BECAUSE SHE'S BEEN A 

236
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CRITICAL PARTNER IN THESE 

237
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EFFORTS AND YOU'LL SEE HER 

238
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FINGERPRINT ON ALL THE WORK I'M 

239
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PRESENTING SO WHAT I WOULD LIKE 

240
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TO SHARE IS AS FOLLOWS, FIRST I 

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DON'T BELIEVE THAT WE CAN 

242
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ACHIEVE POPULATION HEALTH 

243
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WITHOUT HEALTH FOR ALL PEOPLE.  

244
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I BELIEVE IT IS OUR 

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RESPONSIBILITY TO PROSPECTIVELY 

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FOCUS IMPLEMENTATION SCIENCE THE

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REASON FOR HA IS WE HAVE TO MAKE

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SURE THAT WE DO NOT CREATE NEW 

249
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INEQUITY FOR EXAMPLE IF WE ONLY 

250
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IMPLEMENT IN HIGH RESOURCE 

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PLACES THUS CREATING NEW GAPS OR

252
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WORSEN EXISTING INEQUITIES.  

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SECOND I WOULD LIKE TO SHARE A 

254
00:09:44,257 --> 00:09:45,926
DEFINITION OF IMPLEMENTATION 

255
00:09:45,926 --> 00:09:47,928
SCIENCE.  BEFORE I DO THAT, I 

256
00:09:47,928 --> 00:09:49,196
JUST WANT TO ALSO SAY, HOW I 

257
00:09:49,196 --> 00:09:53,066
THINK ABOUT IMPLEMENTATION 

258
00:09:53,066 --> 00:09:55,769
SCIENCE MORE BROADLY.  FOR ME, 

259
00:09:55,769 --> 00:09:56,603
IMPLEMENTATION SCIENCE IS REALLY

260
00:09:56,603 --> 00:09:59,106
ABOUT MOVING THE NEEDLE IN 

261
00:09:59,106 --> 00:10:01,174
HEALTH FOR ALL OR HELPING PEOPLE

262
00:10:01,174 --> 00:10:04,377
IN PLACES DO THE THING FOR ALL 

263
00:10:04,377 --> 00:10:06,513
PEOPLE.  SO EQUITY FOCUSED 

264
00:10:06,513 --> 00:10:07,247
IMPLEMENTATION SCIENCE IS WHEN 

265
00:10:07,247 --> 00:10:10,417
STRONG EQUITY COMPONENTS, BEING 

266
00:10:10,417 --> 00:10:11,952
EXPLICIT ABOUT ATTENTION TO 

267
00:10:11,952 --> 00:10:14,287
CULTURE, HISTORY, VALUES, ASSETS

268
00:10:14,287 --> 00:10:16,656
AND NEEDS OF THE COMMUNITY ARE 

269
00:10:16,656 --> 00:10:18,492
INTEGRATED INTO THE PRINCIPLE 

270
00:10:18,492 --> 00:10:20,794
STRATEGIES FRAMEWORKS AND TOOLS 

271
00:10:20,794 --> 00:10:22,429
OF IMPLEMENTATION SCIENCE.  AND 

272
00:10:22,429 --> 00:10:23,396
THERE'S BEEN GREAT PROGRESS MADE

273
00:10:23,396 --> 00:10:26,199
IN THE PAST FEW YEARS BUT 

274
00:10:26,199 --> 00:10:28,435
THERE'S A LOT OF WAYS TO GO IN 

275
00:10:28,435 --> 00:10:31,204
ACHIEVING A VISION OF EQUITY 

276
00:10:31,204 --> 00:10:34,307
FOCUSED IMPLEMENTATION SCIENCE. 

277
00:10:34,307 --> 00:10:35,408
THESE ARTICLES HAVE DEEPLY 

278
00:10:35,408 --> 00:10:37,177
SHAPED MY THINKING OVER THE PAST

279
00:10:37,177 --> 00:10:39,379
FEW YEARS.  AND I DID WANT TO 

280
00:10:39,379 --> 00:10:42,115
SHARE THEM WITH YOU ALL AND HAVE

281
00:10:42,115 --> 00:10:43,850
THEM BE A RESOURCE.  AT THE 

282
00:10:43,850 --> 00:10:45,585
INTERSECTION OF HEALTH EQUITY 

283
00:10:45,585 --> 00:10:47,420
AND IMPLEMENTATION SCIENCE AND I

284
00:10:47,420 --> 00:10:48,555
PARTICULARLY WANT TO CALL OUT 

285
00:10:48,555 --> 00:10:51,291
THE IMPLEMENTATION SCIENCE 

286
00:10:51,291 --> 00:10:52,159
CENTERS IN CANCER CONTROL 

287
00:10:52,159 --> 00:10:54,861
TOOLKIT.  FOR GETTING STARTED 

288
00:10:54,861 --> 00:10:56,730
WITH HEALTH EQUITY FOCUSED 

289
00:10:56,730 --> 00:10:57,497
IMPLEMENTATION RESEARCH AS IT'S 

290
00:10:57,497 --> 00:11:03,403
A GREAT PLACE TO KIND OF START. 

291
00:11:03,403 --> 00:11:07,974
SO I'VE ORGANIZED MY COMMENTS 

292
00:11:07,974 --> 00:11:11,378
TODAY AROUND A NEW VIEWPOINT AS 

293
00:11:11,378 --> 00:11:12,913
JUST PUBLISHED AS PART OF A NEW 

294
00:11:12,913 --> 00:11:14,714
ISSUE IN PREVENTION SCIENCE.  

295
00:11:14,714 --> 00:11:17,417
AND IN THAT VIEWPOINT, THEY 

296
00:11:17,417 --> 00:11:20,187
OFFER SEVEN CALLS TO ACTION.  I 

297
00:11:20,187 --> 00:11:23,423
HAVE TAKEN THE LIBERTY OF 

298
00:11:23,423 --> 00:11:25,125
ORGANIZING THOSE SEVEN CALL TO 

299
00:11:25,125 --> 00:11:27,561
ACTION WITHIN THREE THEMATIC 

300
00:11:27,561 --> 00:11:28,828
BUCKETS.  THE FIRST BEING AROUND

301
00:11:28,828 --> 00:11:30,397
BUILDING TRUST AND A MODEL OF 

302
00:11:30,397 --> 00:11:32,432
CO-CREATION WITH OUR 

303
00:11:32,432 --> 00:11:33,700
COMMUNITIES.  THE SECOND BEING A

304
00:11:33,700 --> 00:11:37,370
FOCUS ON OUTER SETTING FACTORS 

305
00:11:37,370 --> 00:11:39,139
AND POLICY DEVELOPMENT AND THE 

306
00:11:39,139 --> 00:11:41,174
THIRD BEING AROUND REFOCUSING 

307
00:11:41,174 --> 00:11:41,775
OUR INTERVENTION AND 

308
00:11:41,775 --> 00:11:49,149
IMPLEMENTATION SCIENCE WORK.  

309
00:11:49,149 --> 00:11:50,483
TODAY I'M GOING TO HIGHLIGHT 

310
00:11:50,483 --> 00:11:52,852
SOME OF OUR TEAM'S WORK IN 

311
00:11:52,852 --> 00:11:55,121
BUCKETS ONE TO THREE.  

312
00:11:55,121 --> 00:11:56,489
PARTNERSHIP BEING AN EFFECTIVE 

313
00:11:56,489 --> 00:11:58,458
TOOL FOR AMPLIFYING THE NEEDS OF

314
00:11:58,458 --> 00:11:59,359
OUR COMMUNITIES AND I WILL TALK 

315
00:11:59,359 --> 00:12:03,363
ABOUT HOW WE TRIED TO REFOCUS 

316
00:12:03,363 --> 00:12:05,031
OUR IMPLEMENTATION IN SCIENCE IN

317
00:12:05,031 --> 00:12:06,366
THE FOLLOWING WAYS AND WE'LL 

318
00:12:06,366 --> 00:12:08,602
GIVE YOU SOME EXAMPLES OF THAT. 

319
00:12:08,602 --> 00:12:10,170
THAT INCLUDES ADAPTING 

320
00:12:10,170 --> 00:12:10,971
INTERVENTIONS AND STRATEGIES IN 

321
00:12:10,971 --> 00:12:11,972
PARTNERSHIP WITH OUR COMMUNITIES

322
00:12:11,972 --> 00:12:13,773
TO MAKE SURE THAT THEY'RE 

323
00:12:13,773 --> 00:12:15,375
APPROPRIATE AND FIT THE CONTEXT 

324
00:12:15,375 --> 00:12:17,877
AND THE NEEDS.  INCORPORATING 

325
00:12:17,877 --> 00:12:19,145
DETERMINANTS OF HEALTH EQUITY 

326
00:12:19,145 --> 00:12:20,780
INTO OUR IMPLEMENTATION SCIENCE 

327
00:12:20,780 --> 00:12:22,015
FRAMEWORKS AND THINKING ABOUT 

328
00:12:22,015 --> 00:12:24,851
HOW WE MEASURE EQUITABLE 

329
00:12:24,851 --> 00:12:26,920
OUTCOMES.  CENTERING THE VOICES 

330
00:12:26,920 --> 00:12:27,487
OF CONSTITUENTS AND THEIR 

331
00:12:27,487 --> 00:12:30,890
EXPERIENCE OF THE IMPLEMENTATION

332
00:12:30,890 --> 00:12:32,359
PROCESS.  AND PERSPECTIVELY 

333
00:12:32,359 --> 00:12:34,027
DEFINING WHICH POPULATIONS MAY 

334
00:12:34,027 --> 00:12:37,063
EXPERIENCE INEQUITIES AND 

335
00:12:37,063 --> 00:12:38,398
MEASURING DIFFERENTIAL 

336
00:12:38,398 --> 00:12:39,332
IMPLEMENTATION STRATEGY 

337
00:12:39,332 --> 00:12:40,667
EFFECTIVENESS SO, IN THE COMING 

338
00:12:40,667 --> 00:12:42,302
MINUTES I'M GOING TO BE GIVING 

339
00:12:42,302 --> 00:12:44,671
YOU SOME EXAMPLES FROM OUR WORK 

340
00:12:44,671 --> 00:12:47,140
OF THESE -- THIS KIND OF WORK IN

341
00:12:47,140 --> 00:12:49,042
THE HOPE THAT IT CAN SERVE AS AN

342
00:12:49,042 --> 00:12:50,176
EXAMPLE FROM YOU AND I LOOK 

343
00:12:50,176 --> 00:12:52,112
FORWARD TO HEARING FROM OUR 

344
00:12:52,112 --> 00:12:53,680
ESTEEMED PANELISTS AS WELL AS 

345
00:12:53,680 --> 00:12:54,948
THEY WILL BE SHARING THEIR WORK 

346
00:12:54,948 --> 00:12:57,150
IN THIS SPACE.  I WILL START 

347
00:12:57,150 --> 00:12:58,785
WITH THIS IDEA OF BUILDING TRUST

348
00:12:58,785 --> 00:13:01,755
IN A MODEL OF CO-CREATION WITH 

349
00:13:01,755 --> 00:13:02,756
COMMUNITIES AS BEING 

350
00:13:02,756 --> 00:13:04,424
FOUNDATIONAL TO THIS IDEA OF 

351
00:13:04,424 --> 00:13:07,527
EQUITY FOCUSED IMPLEMENTATION 

352
00:13:07,527 --> 00:13:12,666
SCIENCE.  AND REALLY THIS STARTS

353
00:13:12,666 --> 00:13:15,368
WITH THE FUNDAMENTAL VALUE THAT 

354
00:13:15,368 --> 00:13:18,538
WE'RE FILLED WITH WISDOM AND 

355
00:13:18,538 --> 00:13:21,141
THAT WE MUST HAVE OUR NEEDS AND 

356
00:13:21,141 --> 00:13:23,109
POWERS IN PLACE AND BE HUMBLE 

357
00:13:23,109 --> 00:13:28,715
AND EXPLICITLY OR TICK LATE  -- 

358
00:13:28,715 --> 00:13:29,749
ARTICULATE OUR VALUES. 

359
00:13:29,749 --> 00:13:31,384
BEFORE WE RELEASED THIS THAT I 

360
00:13:31,384 --> 00:13:34,387
THINK IS HELPFUL BECAUSE I THINK

361
00:13:34,387 --> 00:13:35,388
IT HELPS US MOVE TOWARDS A 

362
00:13:35,388 --> 00:13:38,358
BETTER UNDERSTANDING OF HOW TO 

363
00:13:38,358 --> 00:13:39,359
ENGAME IN THESE KINDS OF 

364
00:13:39,359 --> 00:13:40,960
RELATIONSHIPS AND HAVE RESULTS 

365
00:13:40,960 --> 00:13:42,228
IN EQUITABLE IMPLEMENTATION.  I 

366
00:13:42,228 --> 00:13:44,164
WILL GIVE YOU AN EXAMPLE OR TWO 

367
00:13:44,164 --> 00:13:46,900
BUT ENCOURAGE YOU TO TAKE A LOOK

368
00:13:46,900 --> 00:13:49,002
AT THESE THE FIRST BEING THAT 

369
00:13:49,002 --> 00:13:50,770
PROJECTS SHOULD INCLUDE 

370
00:13:50,770 --> 00:13:51,638
PARTNERS, ORGANIZATIONS, 

371
00:13:51,638 --> 00:13:53,606
RESEARCHERS AND TEAM MEMBERS WHO

372
00:13:53,606 --> 00:13:55,141
REFLECT THE DIVERSITY OF THE 

373
00:13:55,141 --> 00:13:55,875
PATIENTS AND COMMUNITIES 

374
00:13:55,875 --> 00:13:57,110
AFFECTED BY THE RESEARCH TOPIC. 

375
00:13:57,110 --> 00:14:00,080
ANOTHER ONE THAT I THINK IS 

376
00:14:00,080 --> 00:14:02,982
INCREDIBLY SPORE  IMPORTANT IS 

377
00:14:02,982 --> 00:14:09,122
THE NEED TO  DEDICATE FUNDS IN A

378
00:14:09,122 --> 00:14:10,690
TIMELY MANNER.  

379
00:14:10,690 --> 00:14:12,492
THESE VALUES MUST BE PRIORITIZED

380
00:14:12,492 --> 00:14:13,893
ACROSS THE PHASES OF 

381
00:14:13,893 --> 00:14:15,028
IMPLEMENTATION RESEARCH AND IN 

382
00:14:15,028 --> 00:14:17,397
OUR IMPLEMENTATION STUDIES AND 

383
00:14:17,397 --> 00:14:19,366
PRACTICE TO ENSURE THAT WE CAN 

384
00:14:19,366 --> 00:14:22,135
HAVE RESULTING EQUITABLE 

385
00:14:22,135 --> 00:14:23,470
IMPLEMENTATION.  TO GIVE YOU A 

386
00:14:23,470 --> 00:14:25,171
FLAVOR OF HOW WE'VE PUT THIS 

387
00:14:25,171 --> 00:14:27,107
INTO ACTION IN OUR TEAMS, I'D 

388
00:14:27,107 --> 00:14:29,709
LIKE TO SHARE A LITTLE BIT ABOUT

389
00:14:29,709 --> 00:14:30,377
THE PARTNERSHIP THAT I HAVE THE 

390
00:14:30,377 --> 00:14:31,911
GREAT PRIVILEGE OF BEING A PART 

391
00:14:31,911 --> 00:14:33,113
OF IN THE CITY OF PHILADELPHIA 

392
00:14:33,113 --> 00:14:37,150
FROM 2011-2022.  AND FOR ME THIS

393
00:14:37,150 --> 00:14:39,753
IS AN EXAMPLE OF SOME OF THE 

394
00:14:39,753 --> 00:14:41,421
EARLY WORK THAT OUR GROUP DID 

395
00:14:41,421 --> 00:14:43,123
THAT CENTERED EQUITABLE 

396
00:14:43,123 --> 00:14:44,424
IMPLEMENTATION BY BRINGING 

397
00:14:44,424 --> 00:14:45,692
EVIDENCE-BASED PRACTICES TO A 

398
00:14:45,692 --> 00:14:47,327
SETTING SERVING OUR COMMUNITIES 

399
00:14:47,327 --> 00:14:55,902
THROUGH THE PUBIC -- PUBLIC 

400
00:14:55,902 --> 00:14:56,770
BEHAVIORAL SYSTEM.  

401
00:14:56,770 --> 00:14:58,471
ALTHOUGH THE SLIDE CAN'T SHOW 

402
00:14:58,471 --> 00:15:01,107
ALL THE PEOPLE SEMINAL TO THIS 

403
00:15:01,107 --> 00:15:01,307
WORK. 

404
00:15:01,307 --> 00:15:05,745
AND THE PARTNERSHIP WAS A 30 

405
00:15:05,745 --> 00:15:06,913
YEAR PARTNERSHIP BETWEEN THE 

406
00:15:06,913 --> 00:15:08,481
CITY OF PHILADELPHIA AND THE PEN

407
00:15:08,481 --> 00:15:10,183
CENTER FOR DEVELOPMENTAL HEALTH 

408
00:15:10,183 --> 00:15:12,786
AND THEY OVERSEE ALL THE 

409
00:15:12,786 --> 00:15:14,154
SERVICES PROVIDE FOR IN THE 

410
00:15:14,154 --> 00:15:15,755
BEHAVIORAL HEALTH AS A SINGLE 

411
00:15:15,755 --> 00:15:17,490
PAIR.  USING FEDERAL, STATE AND 

412
00:15:17,490 --> 00:15:18,892
LOCAL DOLLARS INCLUDING MEDICAID

413
00:15:18,892 --> 00:15:21,761
AND IN PHILLY OF THE 1.5 MILLION

414
00:15:21,761 --> 00:15:23,396
PEOPLE THAT ARE IN THE CITY, 

415
00:15:23,396 --> 00:15:25,398
ABOUT HALF ARE ELIGIBLE FOR 

416
00:15:25,398 --> 00:15:28,735
MEDICAID.  AND DBHIDS SERVES 

417
00:15:28,735 --> 00:15:31,171
ABOUT 170,000 PEOPLE ANNUALLY SO

418
00:15:31,171 --> 00:15:32,972
REALLY LARGE-SCALE.  AND WHAT 

419
00:15:32,972 --> 00:15:34,541
YOU CAN SEE HERE ARE OUR LAST 

420
00:15:34,541 --> 00:15:38,378
THREE COMMISSIONERS OF DVHIDS 

421
00:15:38,378 --> 00:15:40,980
WHO ARE ALL DEEPLY COMMITTED TO 

422
00:15:40,980 --> 00:15:43,116
ENSURING THAT OUR COMMUNITIES 

423
00:15:43,116 --> 00:15:44,617
SERVEDED BY THE BEHAVIORAL 

424
00:15:44,617 --> 00:15:47,320
HEALTH SYSTEM HAS ACCESS TO THE 

425
00:15:47,320 --> 00:15:49,956
VERY BEST BEHAVIORAL HEALTH CARE

426
00:15:49,956 --> 00:15:52,325
AND I SPENT A DECADE OBSERVING, 

427
00:15:52,325 --> 00:15:54,894
MEASURING AND PARTNERING WITH 

428
00:15:54,894 --> 00:15:57,430
CONSTITUENTS, AS PART OF A 

429
00:15:57,430 --> 00:15:58,465
NATURALISTIC OBSERVATIONAL STUDY

430
00:15:58,465 --> 00:15:59,766
THAT GREW OUT OF THIS 

431
00:15:59,766 --> 00:16:01,868
LONG-STANDING PARTNERSHIP THAT 

432
00:16:01,868 --> 00:16:03,369
PREDATED ME AND I WENT INTO THE 

433
00:16:03,369 --> 00:16:04,504
WORK REALLY PLANNING TO LEARN 

434
00:16:04,504 --> 00:16:06,840
ABOUT HOW A SYSTEM CAN SUPPORT 

435
00:16:06,840 --> 00:16:08,107
EVIDENCE-BASED PRACTICE.  I WAS 

436
00:16:08,107 --> 00:16:09,776
VERY FOCUSED ON THINKING ABOUT 

437
00:16:09,776 --> 00:16:11,377
HOW CLINICIAN FACTORS AND 

438
00:16:11,377 --> 00:16:13,179
ORGANIZATIONAL FACTORS MADE IT 

439
00:16:13,179 --> 00:16:15,381
HARD OR EASY TO DO 

440
00:16:15,381 --> 00:16:16,249
EVIDENCE-BASED PRACTICE.  AND 

441
00:16:16,249 --> 00:16:18,284
WHAT I LEARNED WAS THAT THE MOST

442
00:16:18,284 --> 00:16:19,953
MEANINGFUL QUESTIONS THAT WE 

443
00:16:19,953 --> 00:16:21,988
PURSUED CAME DIRECTLY FROM OUR 

444
00:16:21,988 --> 00:16:22,989
CONSTITUENTS AND REALLY RELATED 

445
00:16:22,989 --> 00:16:25,158
TO STRUCTURAL FACTORS.  THAT 

446
00:16:25,158 --> 00:16:26,993
MADE IT DIFFICULT TO DELIVER 

447
00:16:26,993 --> 00:16:28,161
HIGH QUALITY CARE.  UPSTREAM 

448
00:16:28,161 --> 00:16:36,336
SYSTEM LEVEL FACTORS.  AND JUST 

449
00:16:36,336 --> 00:16:39,305
TO BRING THAT TO LIFE FOR YOU IN

450
00:16:39,305 --> 00:16:40,773
OUR MIXED METHODS WORK LED BY 

451
00:16:40,773 --> 00:16:43,142
OUR COLLEAGUES PICTURED HIRE WE 

452
00:16:43,142 --> 00:16:46,779
HEARD FROM ADMINISTRATORS AND 

453
00:16:46,779 --> 00:16:48,681
CLINICIANS THE BALANCE OF 

454
00:16:48,681 --> 00:16:51,084
HEALTH.  WE HEARD THINGS LIKE WE

455
00:16:51,084 --> 00:16:53,019
HOLD OUR BREATH AND PAY WHEN WE 

456
00:16:53,019 --> 00:16:54,687
PAY PEOPLE.  THE ORGANIZATIONS 

457
00:16:54,687 --> 00:16:56,189
WERE FACING FINANCIAL STRESSORS 

458
00:16:56,189 --> 00:16:58,091
BUT IT'S ALSO WHAT WE HEARD FROM

459
00:16:58,091 --> 00:17:03,363
OUR KRI CLINICIANS AND WE FOUND 

460
00:17:03,363 --> 00:17:04,697
THAT CLINICIANS FACING FINANCIAL

461
00:17:04,697 --> 00:17:07,867
STRAIN WERE LIKELY TO LEAVE 

462
00:17:07,867 --> 00:17:09,536
COMMISSIONS.  AND THEY OWE MORE 

463
00:17:09,536 --> 00:17:10,870
THAN ONE HUNDRED THOUSAND 

464
00:17:10,870 --> 00:17:12,372
DOLLARS IN DEBT WITH A THIRD 

465
00:17:12,372 --> 00:17:15,041
FOREGOING THEIR OWN HEALTH CARE.

466
00:17:15,041 --> 00:17:16,876
AND THIS LED US TO UNDERSTAND, 

467
00:17:16,876 --> 00:17:19,145
YOU KNOW, THE CONTEXT FOR 

468
00:17:19,145 --> 00:17:21,848
IMPLEMENTATION.  EQUITABLE 

469
00:17:21,848 --> 00:17:23,082
IMPLEMENTATION OF EVIDENCE-BASED

470
00:17:23,082 --> 00:17:25,218
PRACTICES IN A PUBLIC BEHAVIORAL

471
00:17:25,218 --> 00:17:27,353
HEALTH SYSTEM IT MIGHT BE EASY 

472
00:17:27,353 --> 00:17:31,157
TO ASSUME THAT THE REASON IS 

473
00:17:31,157 --> 00:17:33,426
BECAUSE THEY DONE WANT TO OR 

474
00:17:33,426 --> 00:17:35,161
BECAUSE THEY'RE RESISTANT BUT 

475
00:17:35,161 --> 00:17:37,163
YOU CAN SEE HOW THIS AMPLIFIED 

476
00:17:37,163 --> 00:17:39,899
THE VOICE OF OUR PARTNERS AND 

477
00:17:39,899 --> 00:17:41,601
HELPED SHED A LIGHT ON WHAT IT'S

478
00:17:41,601 --> 00:17:44,737
LIKE TO DELIVER CARE AND WE 

479
00:17:44,737 --> 00:17:48,041
STARTED THINKING ABOUT MASLOW'S 

480
00:17:48,041 --> 00:17:49,943
HIERARCHY OF NEEDS OF CLINICIANS

481
00:17:49,943 --> 00:17:51,844
IN THE PROCESS OF DELIVERING 

482
00:17:51,844 --> 00:17:52,912
EVIDENCE-BASED CARE AND THIS 

483
00:17:52,912 --> 00:17:54,414
KIND OF ROBUST COMMUNITY 

484
00:17:54,414 --> 00:17:55,448
ACADEMIC PARTNERSHIP ALLOWED US 

485
00:17:55,448 --> 00:17:58,251
TO ENGAGE IN AN ITERATIVE 

486
00:17:58,251 --> 00:17:58,885
APPROACH TO EQUITABLE 

487
00:17:58,885 --> 00:18:01,154
IMPLEMENTATION CHARACTERIZED BY 

488
00:18:01,154 --> 00:18:03,856
RAPID LEARNING.  WE WERE ABLE TO

489
00:18:03,856 --> 00:18:04,524
DEMONSTRATE THAT WE COULD 

490
00:18:04,524 --> 00:18:05,858
IMPROVE OUTCOMES FOR PEOPLE 

491
00:18:05,858 --> 00:18:07,093
SERVED BY THE PHILADELPHIA 

492
00:18:07,093 --> 00:18:09,395
PUBLIC BEHAVIORAL HEALTH SYSTEM 

493
00:18:09,395 --> 00:18:11,364
AS WELL AS SEE ACTUAL CHANGE IN 

494
00:18:11,364 --> 00:18:13,700
POLICIES AND PAYMENT STRUCTURES 

495
00:18:13,700 --> 00:18:15,368
TO SHINE A SPOTLIGHT AND AMPLIFY

496
00:18:15,368 --> 00:18:18,538
THE NEEDS OF OUR CONSTITUENTS 

497
00:18:18,538 --> 00:18:20,039
EMPOWERING THEM TO LEAD CHANGE 

498
00:18:20,039 --> 00:18:22,075
AND TO PRODUCE GENERALIZABLE 

499
00:18:22,075 --> 00:18:23,376
KNOWLEDGE.  AND THIS PARTNERSHIP

500
00:18:23,376 --> 00:18:25,144
CONTINUES TO LIVE ON AND GROW 

501
00:18:25,144 --> 00:18:27,380
AND I THINK REALLY NICELY 

502
00:18:27,380 --> 00:18:29,782
DEMONSTRATES WHAT EQUITABLE 

503
00:18:29,782 --> 00:18:31,150
IMPLEMENTATION BUILT UPON A DEEP

504
00:18:31,150 --> 00:18:35,355
COMMUNITY PARTNERSHIP CAN LOOK 

505
00:18:35,355 --> 00:18:45,798
LIKE.  NOW I'M SGIGOING TO SHAR 

506
00:18:45,798 --> 00:18:47,367
THE IMPLEMENTATION SCIENCE 

507
00:18:47,367 --> 00:18:48,935
ACROSS SETTINGS AND DISEASE 

508
00:18:48,935 --> 00:18:49,969
AREAS AND I THINK WHAT'S REALLY 

509
00:18:49,969 --> 00:18:51,371
IMPORTANT TO CALL OUT HERE IS 

510
00:18:51,371 --> 00:18:55,174
THAT THESE STUDIES ARE ALL 

511
00:18:55,174 --> 00:18:55,775
INTENTIONALLY PROSPECTIVELY 

512
00:18:55,775 --> 00:18:58,544
CENTERING AND THINKING ABOUT 

513
00:18:58,544 --> 00:19:00,113
EQUITABLE IMPLEMENTATION.  NOW 

514
00:19:00,113 --> 00:19:03,282
THEY'RE NOT SEEKING TO CLOSE 

515
00:19:03,282 --> 00:19:04,517
INEQUITIES BUT THERE ARE STUDIES

516
00:19:04,517 --> 00:19:05,918
SEEKING TO ENSURE THAT WE 

517
00:19:05,918 --> 00:19:08,721
UNDERSTAND WHAT INEQUITIES MIGHT

518
00:19:08,721 --> 00:19:10,189
EXIST AND MONITOR THROUGH THE 

519
00:19:10,189 --> 00:19:13,192
PROCESS OF EQUITABLE 

520
00:19:13,192 --> 00:19:14,060
IMPLEMENTATION.  HERE I'D LIKE 

521
00:19:14,060 --> 00:19:17,630
TO GIVE THE EXAMPLE OF THE 

522
00:19:17,630 --> 00:19:18,331
IMPLEMENTATION SCIENCE CENTERS 

523
00:19:18,331 --> 00:19:19,399
IN CANCER CONTROL THIS IS A 

524
00:19:19,399 --> 00:19:21,034
RESEARCH NETWORK THAT WAS FUNDED

525
00:19:21,034 --> 00:19:23,403
BY THE NATIONAL CANCER INSTITUTE

526
00:19:23,403 --> 00:19:25,204
AND OUR CENTERS WERE DESIGNED TO

527
00:19:25,204 --> 00:19:27,106
BE RESPONSIVE TO EMERGING 

528
00:19:27,106 --> 00:19:29,142
PRIORITIES OF OUR COMMUNITY 

529
00:19:29,142 --> 00:19:31,377
PARTNERS AND TO ADDRESS THE 

530
00:19:31,377 --> 00:19:33,479
DYNAMIC MULTILEVEL CONTEXT IN 

531
00:19:33,479 --> 00:19:34,914
RAPID APPROACHES THAT LEVERAGED 

532
00:19:34,914 --> 00:19:36,115
PARTNER EXPERTISE AND THE 

533
00:19:36,115 --> 00:19:39,085
CENTERS WERE REALLY EMPHASIZES 

534
00:19:39,085 --> 00:19:40,453
PRAGMATIC DESIGN AND RAPID 

535
00:19:40,453 --> 00:19:42,055
DISSEMINATION OF RESULTS OF 

536
00:19:42,055 --> 00:19:43,389
PARTNER TO HELP TRANSLATE 

537
00:19:43,389 --> 00:19:45,425
FINDINGS INTO ACTION.  OUR 

538
00:19:45,425 --> 00:19:46,959
EQUITY FOCUSED WORK WAS LED BY 

539
00:19:46,959 --> 00:19:51,664
DR. RACHEL SHELTON, DR. KATE, 

540
00:19:51,664 --> 00:19:54,233
AND WE HAD FIVE PILOT PROJECTS, 

541
00:19:54,233 --> 00:19:56,002
TWO OF WHICH HAVE BEEN PUBLISHED

542
00:19:56,002 --> 00:19:57,170
AND PICTURED HERE ALREADY SO YOU

543
00:19:57,170 --> 00:19:58,905
MIGHT THINK IN THE TRADITIONAL 

544
00:19:58,905 --> 00:19:59,639
IMPLEMENTATION TRIAL APPROACH 

545
00:19:59,639 --> 00:20:02,075
YOU HAVE A SET OF IMPLEMENTATION

546
00:20:02,075 --> 00:20:04,210
STRATEGIES THAT YOU'RE TESTING 

547
00:20:04,210 --> 00:20:05,278
ACROSS THE POPULATION AND THEN 

548
00:20:05,278 --> 00:20:07,380
YOU LOOK AT THE OUTCOMES.  BUT I

549
00:20:07,380 --> 00:20:09,415
BRING YOUR ATTENTION TO THIS 

550
00:20:09,415 --> 00:20:11,350
FRAMEWORK WITH THE PURPLE BLUE 

551
00:20:11,350 --> 00:20:12,752
ORANGE AND GREEN COLORS.  AND 

552
00:20:12,752 --> 00:20:14,153
YOU CAN SEE HERE HOW BEFORE WE 

553
00:20:14,153 --> 00:20:16,255
STARTED THESE STUDIES WE USED 

554
00:20:16,255 --> 00:20:17,957
THIS FRAMEWORK IN WAY OF 

555
00:20:17,957 --> 00:20:19,392
THINKING TO CENTER SOCIAL 

556
00:20:19,392 --> 00:20:20,526
DETERMINANTS INTO OUR GUIDING 

557
00:20:20,526 --> 00:20:22,795
FRAMEWORK AND STUDY APPROACH.  

558
00:20:22,795 --> 00:20:27,166
AND SO WE WERE INTERESTED IN 

559
00:20:27,166 --> 00:20:29,736
RACE.  INCOME, SETTING WHERE 

560
00:20:29,736 --> 00:20:30,703
CARE WAS DELIVERED AND WE WERE 

561
00:20:30,703 --> 00:20:33,339
TESTING TWO DIFFERENT TYPES OF 

562
00:20:33,339 --> 00:20:34,540
IMPLEMENTATION STRATEGIES.  

563
00:20:34,540 --> 00:20:37,110
PATIENT FACING IMPLEMENTATION 

564
00:20:37,110 --> 00:20:39,378
STRATEGIES, NUDGES, AND THEN 

565
00:20:39,378 --> 00:20:41,614
PROVIDER FACING IMPLEMENTATION 

566
00:20:41,614 --> 00:20:42,849
STRATEGIES WHICH WERE NUDGES 

567
00:20:42,849 --> 00:20:44,350
TARGETING THE PROVIDERS AND WHAT

568
00:20:44,350 --> 00:20:47,920
WE CENTERED IN OUR MIXED METHODS

569
00:20:47,920 --> 00:20:49,188
EVALUATION WAS BOTH 

570
00:20:49,188 --> 00:20:51,424
UNDERSTANDING DIFFERENCES IN 

571
00:20:51,424 --> 00:20:54,160
PATIENT PERCEPTIONS, BASED ON 

572
00:20:54,160 --> 00:20:55,194
THOSE SOCIAL DETERMINANTS AS 

573
00:20:55,194 --> 00:20:57,163
WELL AS DIFFERENCE IN THEIR 

574
00:20:57,163 --> 00:20:58,498
CONTEXTUAL FACTORS AND HOW THAT 

575
00:20:58,498 --> 00:21:03,703
IMPACTED OUTCOMES, AND CENTERING

576
00:21:03,703 --> 00:21:06,672
EQUITABLE OUTCOMES.  HERE'S 

577
00:21:06,672 --> 00:21:09,842
ANOTHER EXAMPLE FROM NHLVI 

578
00:21:09,842 --> 00:21:11,911
FUNDED WORK SEEKING TO INCREASE 

579
00:21:11,911 --> 00:21:13,179
SCREENING IN PEOPLE WITH HIGH 

580
00:21:13,179 --> 00:21:15,381
CHOLESTEROL.  SO THIS IS A 

581
00:21:15,381 --> 00:21:17,116
PRACTICE WHERE THERE'S A NO DUE 

582
00:21:17,116 --> 00:21:20,319
GAP FOR ALL POPULATIONS.  FOR 

583
00:21:20,319 --> 00:21:22,889
LOW FAMILY CASCADE SCREENING BUT

584
00:21:22,889 --> 00:21:23,556
THE PARTICULAR POPULATION WHERE 

585
00:21:23,556 --> 00:21:25,191
IS THE GAP IS GREATER.  SO 

586
00:21:25,191 --> 00:21:27,360
PLANNING FOR THIS WORK WE START 

587
00:21:27,360 --> 00:21:28,861
BY IDENTIFYING THE POPULATION 

588
00:21:28,861 --> 00:21:30,997
THAT EXPERIENCE INEQUITIES IN 

589
00:21:30,997 --> 00:21:32,131
THE IMPLEMENTATION OF THE THING 

590
00:21:32,131 --> 00:21:34,534
WHICH IS CASCADE SCREENING WHICH

591
00:21:34,534 --> 00:21:35,835
INCLUDE BLACK OR AFRICAN 

592
00:21:35,835 --> 00:21:37,737
AMERICAN PEOPLE, ASIAN OR 

593
00:21:37,737 --> 00:21:39,372
ASIAN-AMERICAN PEOPLE, AND WOMEN

594
00:21:39,372 --> 00:21:49,916
ACROSS RACIAL GROUPS.  AND SO IN

595
00:21:51,250 --> 00:21:53,119
THIS STUDY WE WILL LOOK AT WHAT 

596
00:21:53,119 --> 00:21:55,188
QUESTION JUST MENTIONED AND THIS

597
00:21:55,188 --> 00:21:57,423
IS GUIDED BY THE CONSOLIDATED 

598
00:21:57,423 --> 00:21:59,692
WORK AND ENRICH WITH CONSTRUCTS 

599
00:21:59,692 --> 00:22:03,196
FROM THE EQUITY IMPLEMENTATION 

600
00:22:03,196 --> 00:22:06,299
WORK.  WE INCLUDE THE STRUCTURAL

601
00:22:06,299 --> 00:22:07,200
FACTORS THAT CONTRIBUTE TO 

602
00:22:07,200 --> 00:22:09,769
HEALTH INEQUITIES SUCH AS LACK 

603
00:22:09,769 --> 00:22:11,370
OF HEALTH CARE ACCESS AND 

604
00:22:11,370 --> 00:22:13,206
LANGUAGE BARRIERS WE HAVE A 

605
00:22:13,206 --> 00:22:14,774
DOCTORAL STUDENT, CHINA MILLS 

606
00:22:14,774 --> 00:22:17,710
WHO IS PARTICULARLY INTERESTED 

607
00:22:17,710 --> 00:22:20,479
IN THE EXPERIENCE OF BLACK OR 

608
00:22:20,479 --> 00:22:22,148
AFRICAN AMERICAN FAMILIES AND IS

609
00:22:22,148 --> 00:22:23,382
LEADING A SUPPLEMENT WITH 

610
00:22:23,382 --> 00:22:25,184
ADDITIONAL FACTORS THAT MAY BE 

611
00:22:25,184 --> 00:22:28,788
HIGHLY SALIENT TO REACH A 

612
00:22:28,788 --> 00:22:29,922
CASCADE SCREENING OF BLACK 

613
00:22:29,922 --> 00:22:31,958
FAMILY MEMBERS.  THE CONSTRUCTS 

614
00:22:31,958 --> 00:22:33,926
SHE'S INTERESTED IN IS 

615
00:22:33,926 --> 00:22:36,062
CENTRALITY OF RACIAL IDENTITY, 

616
00:22:36,062 --> 00:22:37,296
SELF-EFFICACY, FAMILY DYNAMICS 

617
00:22:37,296 --> 00:22:40,566
AND SOCIAL DETERMINANTS OF 

618
00:22:40,566 --> 00:22:46,639
HEALTH.  ANOTHER EXAMPLE AND 

619
00:22:46,639 --> 00:22:48,808
THIS WAS WORK LED BY DR. KATIE 

620
00:22:48,808 --> 00:22:53,813
HOES KINS SDOE DEMONSTRATES 

621
00:22:53,813 --> 00:22:55,114
PERSPECTIVE PLANNING AS PART OF 

622
00:22:55,114 --> 00:22:56,415
A LARGE TRIAL INTEND TO REACH 

623
00:22:56,415 --> 00:22:58,751
ACROSS POPULATIONS FOR A NO DUE 

624
00:22:58,751 --> 00:23:01,621
GAP THAT IS PRESENT FOR ALL. 

625
00:23:01,621 --> 00:23:03,923
IMPLEMENTATION OF SECURE FIREARM

626
00:23:03,923 --> 00:23:05,791
STORAGE IN PEDIATRIC PRIMARY 

627
00:23:05,791 --> 00:23:07,560
CARE THIS IS AN EXAMPLE OF A 

628
00:23:07,560 --> 00:23:09,929
CASE WHERE WE WANT TO ENSURE 

629
00:23:09,929 --> 00:23:13,065
THAT IN THIS LARGE-SCALE TRIAL 

630
00:23:13,065 --> 00:23:16,602
THE PROGRAM REACH LED ALL AND 

631
00:23:16,602 --> 00:23:18,404
YOU CAN SEE HOW THE 

632
00:23:18,404 --> 00:23:20,339
RECOMMENDATIONS FROM SOME OF THE

633
00:23:20,339 --> 00:23:22,208
SEMINAL PAPERS THAT I PRESENTED 

634
00:23:22,208 --> 00:23:23,376
AT THE BEGINNING OF THE TALK. 

635
00:23:23,376 --> 00:23:26,145
TO ENGAGE IN A FIVE STEP PROCESS

636
00:23:26,145 --> 00:23:29,248
THAT ALLOWED US TO ENGAGE IN 

637
00:23:29,248 --> 00:23:30,349
INEQUITY.  STARTING WITH 

638
00:23:30,349 --> 00:23:33,486
ENGAGING WITH CONSTITUENTS AND 

639
00:23:33,486 --> 00:23:34,553
CRITICALLY REVIEWING THE 

640
00:23:34,553 --> 00:23:36,055
LITERATURE, FINDING THAT 

641
00:23:36,055 --> 00:23:37,223
PROVIDERS WERE CONCERNED THAT IT

642
00:23:37,223 --> 00:23:38,357
WOULD BE DIFFICULT TO IMPLEMENT 

643
00:23:38,357 --> 00:23:40,793
THIS PROGRAM FOR YOUNG PEOPLE 

644
00:23:40,793 --> 00:23:41,827
WITH MEDICAL COMPLEXITY AS WELL 

645
00:23:41,827 --> 00:23:44,430
AS LOOKING AT THE LITERATURE AND

646
00:23:44,430 --> 00:23:46,966
SEEING INCREASES OF SUICIDE AND 

647
00:23:46,966 --> 00:23:49,235
FIREARM INJURY IN BLACK AND 

648
00:23:49,235 --> 00:23:51,003
AFRICAN AMERICAN YOUTH.  AS WELL

649
00:23:51,003 --> 00:23:53,306
AS SELECTING A CONCEPTUAL 

650
00:23:53,306 --> 00:23:55,107
FRAMEWORK TO INFORM OUR 

651
00:23:55,107 --> 00:23:56,409
UNDERSTANDING.  WE USE THE 

652
00:23:56,409 --> 00:23:59,378
HEALTH EQUITY IMPLEMENTATION 

653
00:23:59,378 --> 00:24:00,613
FRAMEWORK AND USING THAT PILOT 

654
00:24:00,613 --> 00:24:02,548
THAT WE DID BEFORE THE 

655
00:24:02,548 --> 00:24:05,885
IMPLEMENTATION TRIAL TO REALLY 

656
00:24:05,885 --> 00:24:08,654
HELP US STUDY SIGNALS OF 

657
00:24:08,654 --> 00:24:10,022
INEQUITIES THAT WE CAN TRACK AND

658
00:24:10,022 --> 00:24:13,626
MONITOR IN THE IMPLEMENTATION 

659
00:24:13,626 --> 00:24:15,394
STRATEGIES IN FUTURE WORK.  OUR 

660
00:24:15,394 --> 00:24:16,862
TEAM IS EXCITED TO DO MORE WORK 

661
00:24:16,862 --> 00:24:20,032
IN THIS SPACE.  AS PART OF A P 

662
00:24:20,032 --> 00:24:23,102
50 ALACK RAHTY CENTER FROM THE 

663
00:24:23,102 --> 00:24:23,703
NATIONAL INSTITUTE OF MENTAL 

664
00:24:23,703 --> 00:24:27,373
HEALTH WE ARE LOOKING TO 

665
00:24:27,373 --> 00:24:29,976
INTEGRATE APPROACHES WE USED IN 

666
00:24:29,976 --> 00:24:32,445
PREVIOUS STUDIES CALLED A 

667
00:24:32,445 --> 00:24:35,381
PREMORTEM WHICH ALLOWS YOU TO 

668
00:24:35,381 --> 00:24:36,916
THINK ABOUT FAILURE POINTS AND 

669
00:24:36,916 --> 00:24:39,251
TO CENTER ON IMPLEMENTATION AS 

670
00:24:39,251 --> 00:24:40,820
FAILURE POINTS.  THIS IS WORK 

671
00:24:40,820 --> 00:24:43,589
I'M CO-LEADING WITH TWO DOCTORS.

672
00:24:43,589 --> 00:24:45,658
AND THEN USING THAT INFORMATION 

673
00:24:45,658 --> 00:24:47,360
AS WE DO THESE PREMORTEM 

674
00:24:47,360 --> 00:24:49,095
CENTERING EQUITY WITH EACH OF 

675
00:24:49,095 --> 00:24:51,130
THE PROJECT TEAMS TO ENSURE THAT

676
00:24:51,130 --> 00:24:54,433
UP IT INFORMS IMPLEMENTATION 

677
00:24:54,433 --> 00:24:55,901
STRATEGY ACROSS THE ENTIRE 

678
00:24:55,901 --> 00:24:57,536
CENTER AS WELL AS THE NEW R 01 

679
00:24:57,536 --> 00:25:00,706
FUNDED BY THE NATIONAL INSTITUTE

680
00:25:00,706 --> 00:25:03,376
OF RESEARCH WHERE WE TAKE THE 

681
00:25:03,376 --> 00:25:06,145
RESEARCH THAT WE'RE DOING AND 

682
00:25:06,145 --> 00:25:09,448
SEEKING TO IMPLEMENT THAT SECURE

683
00:25:09,448 --> 00:25:11,117
FIREARM STORAGE PROGRAM AND 

684
00:25:11,117 --> 00:25:13,219
SAFETY NET SETTINGS SO WE'RE 

685
00:25:13,219 --> 00:25:14,587
GOING TO BE ADAPTING OUR 

686
00:25:14,587 --> 00:25:16,022
INTERVENTION AND IMPLEMENTATION 

687
00:25:16,022 --> 00:25:19,091
APPROACH TO ENSURE IT CENTERS 

688
00:25:19,091 --> 00:25:23,195
THE CENTERS AS WELL AS IN OUR 

689
00:25:23,195 --> 00:25:25,231
EVALUATION CENTERING CONSTITUENT

690
00:25:25,231 --> 00:25:27,199
VOICES AND INVESTIGATING 

691
00:25:27,199 --> 00:25:28,868
EFFECTIVENESS BY SOCIAL 

692
00:25:28,868 --> 00:25:31,404
DETERMINANTS OF HEALTH SUCH AS 

693
00:25:31,404 --> 00:25:33,706
HOUSING INSECURITY.  IN CLOSING 

694
00:25:33,706 --> 00:25:35,374
I WOULD LIKE TO REITERATE THE 

695
00:25:35,374 --> 00:25:36,575
MAIN MESSAGE THAT I WOULD LIKE 

696
00:25:36,575 --> 00:25:38,411
TO SHARE WITH YOU TODAY WHICH IS

697
00:25:38,411 --> 00:25:44,183
THAT WE MUST IN INEQUITY FOCUSED

698
00:25:44,183 --> 00:25:45,217
SCIENCE AND I WOULD LIKE TO 

699
00:25:45,217 --> 00:25:49,221
LEAVE YOU WITH SOME INSPIRING 

700
00:25:49,221 --> 00:25:51,357
INVESTIGATORS TO MEET THE NEEDS 

701
00:25:51,357 --> 00:25:54,760
IN EQUITY FOCUSED SAYS IT'S NOT 

702
00:25:54,760 --> 00:25:57,930
EXHAUSTIVE BUT THE FUTURE IS 

703
00:25:57,930 --> 00:25:59,065
BRIGHT AND THERE'S FANTASTIC 

704
00:25:59,065 --> 00:26:03,369
WORK GOING ON IN THIS SPACE.  

705
00:26:03,369 --> 00:26:04,637
THANK YOU.

706
00:26:04,637 --> 00:26:07,006
>> THANK YOU SO MUCH. 
FOLKS, 

707
00:26:07,006 --> 00:26:08,307
DON'T HESITATE TO PUT COMMENTS 

708
00:26:08,307 --> 00:26:10,409
AND QUESTIONS IN THE CHAT AS WE 

709
00:26:10,409 --> 00:26:15,381
CONTINUE TO MOVE ONTO OUR NEXT 

710
00:26:15,381 --> 00:26:22,955
SPEAKER, OVER TO YOU O.

711
00:26:22,955 --> 00:26:25,224
>> THANK YOU VERY MUCH.  I

712
00:26:25,224 --> 00:26:27,560
APOLOGIZE FOR MY VOICE.  I HAVE 

713
00:26:27,560 --> 00:26:33,866
A BIT OF A COLD.  SO WHAT I ARE 

714
00:26:33,866 --> 00:26:37,470
TALK ABOUT TODAY IS HOW TO 

715
00:26:37,470 --> 00:26:39,338
ADDRESS THE FIELD OF 

716
00:26:39,338 --> 00:26:40,172
HYPERTENSION THROUGH A HEALTH 

717
00:26:40,172 --> 00:26:44,877
EQUITY LENS.  MOST OF MY WORK IN

718
00:26:44,877 --> 00:26:46,078
THE PAST TWO AND A HALF DECADES 

719
00:26:46,078 --> 00:26:50,983
HAVE BEEN FOCUSED ON REALLY 

720
00:26:50,983 --> 00:26:51,984
NARROWING THE RACIAL GAP.  WITH 

721
00:26:51,984 --> 00:26:53,752
A PARTICULAR FOCUS ON 

722
00:26:53,752 --> 00:26:57,256
HYPERTENSION IN BLACK 

723
00:26:57,256 --> 00:26:59,191
POPULATIONS.  THAT IS IN THE 

724
00:26:59,191 --> 00:27:02,828
AFRICAN CONTENT.  I WILL START 

725
00:27:02,828 --> 00:27:08,567
WITH THIS HERE.  WHAT IS THE 

726
00:27:08,567 --> 00:27:10,703
PROBLEM THAT WE'RE TALKING ABOUT

727
00:27:10,703 --> 00:27:13,205
HERE?  THIS CARTOON I HAVE USED 

728
00:27:13,205 --> 00:27:16,976
FOR A WHILE NOW.  WE REALLY HAVE

729
00:27:16,976 --> 00:27:19,211
THE PROPER NEEDS.  HERE IS A GUY

730
00:27:19,211 --> 00:27:21,380
IN A BALLOON SAYING WHERE AM I? 

731
00:27:21,380 --> 00:27:25,217
THERE'S A GUY IN THE LAKE WHO IS

732
00:27:25,217 --> 00:27:27,820
FISHING SAYING YOU ARE 30 METERS

733
00:27:27,820 --> 00:27:29,155
ABOVE THE GROUND IN A BALLOON.  

734
00:27:29,155 --> 00:27:31,323
HE MUST BE A RESEARCHER SAID THE

735
00:27:31,323 --> 00:27:35,361
GUY IN THE BALLOON.  YES, I 

736
00:27:35,361 --> 00:27:38,164
DIDN'T KNOW THAT.  BECAUSE WHAT 

737
00:27:38,164 --> 00:27:39,265
YOU TOLD ME IS ABSOLUTELY 

738
00:27:39,265 --> 00:27:41,233
CORRECT OR COMPLETELY USELESS.  

739
00:27:41,233 --> 00:27:43,502
THE GUY IN THE LAKE SAYING YOU 

740
00:27:43,502 --> 00:27:46,539
MUST BE A POLICYMAKER.  YES, HOW

741
00:27:46,539 --> 00:27:48,040
DID YOU KNOW THAT?  WELL, 

742
00:27:48,040 --> 00:27:49,975
BECAUSE YOU DON'T KNOW WHERE YOU

743
00:27:49,975 --> 00:27:51,710
ARE, YOU DON'T KNOW WHERE YOU'RE

744
00:27:51,710 --> 00:27:55,214
GOING AND NOW YOU'RE BLAMING ME.

745
00:27:55,214 --> 00:28:01,086
SO IN ESSENCE, THIS SLIDE SHOWS 

746
00:28:01,086 --> 00:28:04,857
AND THE CARTOON DEPICTS THE HUGE

747
00:28:04,857 --> 00:28:06,492
GULF BETWEEN WHAT EVIDENCE WE 

748
00:28:06,492 --> 00:28:08,027
HAVE AND WHAT EVIDENCE WE'RE 

749
00:28:08,027 --> 00:28:09,695
IMPLEMENTING IN PRACTICE.  

750
00:28:09,695 --> 00:28:10,829
ALL COMMUNITY SETTINGS FOR THAT 

751
00:28:10,829 --> 00:28:13,599
MATTER SO POLICYMAKERS ARE 

752
00:28:13,599 --> 00:28:14,400
RESEARCHERS WHO DON'T OFTEN 

753
00:28:14,400 --> 00:28:17,803
THINK ABOUT THESE THINGS BECAUSE

754
00:28:17,803 --> 00:28:18,637
IN SCIENTISTS BOTH ARE DIFFERENT

755
00:28:18,637 --> 00:28:27,313
AND THIS MAY EXPLAIN THESE.  

756
00:28:27,313 --> 00:28:29,081
THAT WE TAKE THESE TO PRACTICE. 

757
00:28:29,081 --> 00:28:31,217
SO IF YOU LOOK AT THE SCIENCE OF

758
00:28:31,217 --> 00:28:38,023
PRACTICE CONTINUES.  AS I 

759
00:28:38,023 --> 00:28:38,657
SOME SHOW 

760
00:28:38,657 --> 00:28:41,160
HERE MOST OF MY WORK FOCUSED ON 

761
00:28:41,160 --> 00:28:43,329
EFFECTIVE STUDIES AND TODAY MY 

762
00:28:43,329 --> 00:28:47,299
FOCUS IS ON REALLY TAKING THAT 

763
00:28:47,299 --> 00:28:48,667
EVIDENCE AND LOOKING AT WAYS TO 

764
00:28:48,667 --> 00:28:55,207
PRACTICE THE COMMUNITY CENTERS. 

765
00:28:55,207 --> 00:28:57,543
SO THE WORK ON HYPERTENSION I 

766
00:28:57,543 --> 00:28:59,812
WOULD LIKE TO SPEAK TO YOU ABOUT

767
00:28:59,812 --> 00:29:02,081
THE MODALITY IN BLACK 

768
00:29:02,081 --> 00:29:03,282
POPULATIONS.  WE THINK THIS 

769
00:29:03,282 --> 00:29:06,252
CONTRIBUTES THE MOST TO THAT 

770
00:29:06,252 --> 00:29:08,287
RACIAL DISPARITY.  AND IF YOU 

771
00:29:08,287 --> 00:29:12,057
SEE DOCTOR, I TRY TO UNDERSTAND 

772
00:29:12,057 --> 00:29:12,891
WHAT IS THAT CONTROL YOU CAN 

773
00:29:12,891 --> 00:29:15,294
START BY SAYING WHAT ARE THE 

774
00:29:15,294 --> 00:29:16,028
DIFFERENT LEVELS DOES THE 

775
00:29:16,028 --> 00:29:18,631
PATIENT LEVEL BARRIER, DOES THE 

776
00:29:18,631 --> 00:29:20,199
SYSTEMS LEVEL BARRIER AND OF 

777
00:29:20,199 --> 00:29:23,202
COURSE THERE ARE COMMUNITY LEVEL

778
00:29:23,202 --> 00:29:26,171
BARRIERS.  SO THIS IS -- THIS 

779
00:29:26,171 --> 00:29:29,441
SLIDE CANNOT DEFINE WHAT THAT 

780
00:29:29,441 --> 00:29:34,313
MEANS.  THEY PROBABLY GO TO SEE 

781
00:29:34,313 --> 00:29:37,216
DOC.  THE DOC ADVISES THEM TO 

782
00:29:37,216 --> 00:29:38,550
ENGAGE IN LIFESTYLE MODIFICATION

783
00:29:38,550 --> 00:29:42,121
AND THE PATIENTS WILL TAKE THE 

784
00:29:42,121 --> 00:29:45,691
MEDICINES.  IF THEY HAVE IT 

785
00:29:45,691 --> 00:29:47,293
UNDER CONTROL THEY WILL SAY THEY

786
00:29:47,293 --> 00:29:49,194
HAVE ACCESS TO CARE SO MOST OF 

787
00:29:49,194 --> 00:29:52,798
MY WORK IS FOCUSED OWN REALLY 

788
00:29:52,798 --> 00:29:58,437
HOW DO WE USE THIS TO LOOK AT 

789
00:29:58,437 --> 00:30:04,043
THE ADHERENCE IN BLACK PATIENT 

790
00:30:04,043 --> 00:30:07,112
WE THINK IF WE DO THAT WE CAN 

791
00:30:07,112 --> 00:30:07,980
ACHIEVE ADEQUATE CONTROL.  WHAT 

792
00:30:07,980 --> 00:30:10,582
WE FOUND IN THIS STUDY WHERE 

793
00:30:10,582 --> 00:30:15,287
PATIENTS WERE GETTING 

794
00:30:15,287 --> 00:30:19,124
MOTIVATIONAL EVERY THREE MONTHS 

795
00:30:19,124 --> 00:30:23,295
THAT'S WE USE MI FOR PATIENTS 

796
00:30:23,295 --> 00:30:26,098
WITH CHRONIC DISEASE.  WHAT YOU 

797
00:30:26,098 --> 00:30:28,133
SEE HERE IS THAT THE BLUE LINE 

798
00:30:28,133 --> 00:30:32,204
SHOWS YOU THE ADHERENCE RATE 

799
00:30:32,204 --> 00:30:34,506
USING THIS.  AT 14 POINTS AND IT

800
00:30:34,506 --> 00:30:36,675
DOES IT WITH EVERYTHING.  

801
00:30:36,675 --> 00:30:38,243
PATIENTS WHO ARE ADHERENT AND 

802
00:30:38,243 --> 00:30:39,378
THOSE IN THE CONTROL GROUP YOU 

803
00:30:39,378 --> 00:30:41,180
SEE A HUGE DIFFERENCE BUT AT THE

804
00:30:41,180 --> 00:30:43,215
END OF THE STUDY THOUGH WE DID 

805
00:30:43,215 --> 00:30:45,017
NOT FIND ANY DIFFERENCE IN THE 

806
00:30:45,017 --> 00:30:46,618
BLOOD PRESSURE CONTROL OF THE 

807
00:30:46,618 --> 00:30:48,187
PATIENTS.  THIS IS WHERE I BEGAN

808
00:30:48,187 --> 00:30:51,323
TO SCRATCH MY HEAD IS THERE A 

809
00:30:51,323 --> 00:30:54,860
MEDICATION ADHERENCE.  IS IT THE

810
00:30:54,860 --> 00:30:57,062
PATIENT'S PROBLEM OR IS IT THAT 

811
00:30:57,062 --> 00:30:59,131
THEY DO NOT ACTUALLY ADHERE TO 

812
00:30:59,131 --> 00:31:02,201
THE GUIDELINES WHICH WE KNOW AND

813
00:31:02,201 --> 00:31:07,106
ALSO CONTRIBUTE TO THOSE.  AND 

814
00:31:07,106 --> 00:31:09,241
WE THINK IT'S THE PATIENTS THAT 

815
00:31:09,241 --> 00:31:10,676
ARE THE PROBLEM NOT WHAT THEY 

816
00:31:10,676 --> 00:31:12,478
ARE PRESCRIBED.  SO WE DID A 

817
00:31:12,478 --> 00:31:15,247
STUDY LIKE THAT WHERE WE RAN

818
00:31:15,247 --> 00:31:20,486
RANDOMIZED ABOUT 30 CENTERS, ALL

819
00:31:20,486 --> 00:31:22,321
QUALIFIED TO, EXCUSE ME, TO A 

820
00:31:22,321 --> 00:31:23,789
KITCHEN SINK OF INTERVENTIONS 

821
00:31:23,789 --> 00:31:26,291
WHERE WE TRAINED THE PROVIDERS 

822
00:31:26,291 --> 00:31:28,227
ON THE EVIDENCE BASED 

823
00:31:28,227 --> 00:31:29,695
GUIDELINES.  WE HAD THAT IN 

824
00:31:29,695 --> 00:31:31,230
EVERY MONTH.  IN THE 

825
00:31:31,230 --> 00:31:33,599
INTERVENTION CLINICS.  WE 

826
00:31:33,599 --> 00:31:34,633
TRAINED ON LIFESTYLE COUNSELING 

827
00:31:34,633 --> 00:31:37,770
AND WE GAVE THE PATIENTS HOME BP

828
00:31:37,770 --> 00:31:39,304
MONITORS.  AS YOU CAN SEE HERE 

829
00:31:39,304 --> 00:31:44,176
ON THIS SLIDE, THE BLUE LINE 

830
00:31:44,176 --> 00:31:45,844
DEPICTS THE ACTUALLY THE CONTROL

831
00:31:45,844 --> 00:31:47,679
GROUP OR THE CONTROL OF 

832
00:31:47,679 --> 00:31:50,048
INTERVENTION SIDE.  AND THE RED 

833
00:31:50,048 --> 00:31:54,153
BARS AT THE INTERVENTION SIDE.  

834
00:31:54,153 --> 00:31:54,920
BLOOD PRESSURE DROPPED 

835
00:31:54,920 --> 00:31:57,556
PREDICTIVELY BUT THERE WAS NO 

836
00:31:57,556 --> 00:31:59,057
DIFFERENCE IN BP CONTROL RATES 

837
00:31:59,057 --> 00:32:00,526
AT THE END OF ONE YEAR BETWEEN 

838
00:32:00,526 --> 00:32:02,327
THE INTERVENTION GROUP AND THE 

839
00:32:02,327 --> 00:32:03,695
CONTROL GROUP.  AND THIS IS 

840
00:32:03,695 --> 00:32:06,031
WHERE I BEGAN TO HAVE A BETTER 

841
00:32:06,031 --> 00:32:07,299
SAY, A BETTER SENSE OF WHAT ARE 

842
00:32:07,299 --> 00:32:11,303
THE THINGS THAT PATIENTS REALLY 

843
00:32:11,303 --> 00:32:15,541
FACE?  WHEN THEY ARE DOING THIS 

844
00:32:15,541 --> 00:32:16,642
WORK.  A SIGNIFICANT NUMBER OF 

845
00:32:16,642 --> 00:32:19,211
POPULATION, WITH LOW INCOME 

846
00:32:19,211 --> 00:32:22,881
PATIENTS, WITH VERY HIGH RATES 

847
00:32:22,881 --> 00:32:26,318
OF COMORBIDITY EITHER THEIR 

848
00:32:26,318 --> 00:32:28,654
ABILITIES OR HEART FAILURE.  WE 

849
00:32:28,654 --> 00:32:30,722
FOUND A LOT OF PATIENTS WERE 

850
00:32:30,722 --> 00:32:32,591
ACTUALLY DROPPING OUT OF THE 

851
00:32:32,591 --> 00:32:33,492
STUDY, OF COURSE IT IS 

852
00:32:33,492 --> 00:32:35,227
INTENTIONAL TO TREAT ANALYSIS SO

853
00:32:35,227 --> 00:32:38,630
WE HAD TO TRACK THEM DOWN.  MOST

854
00:32:38,630 --> 00:32:39,498
HAVE SIGNIFICANT SOCIAL 

855
00:32:39,498 --> 00:32:41,133
DETERMINANTS AND ONE CALLED 

856
00:32:41,133 --> 00:32:43,202
COMMUNITY BARRIERS AT A TIME AND

857
00:32:43,202 --> 00:32:47,773
THAT IMMEDIATE -- MADE ME BEGIN 

858
00:32:47,773 --> 00:32:49,475
TO THINK WHAT IF WE TAKE 

859
00:32:49,475 --> 00:32:51,243
LIFESTYLE INTERVENTIONS. 

860
00:32:51,243 --> 00:32:54,079
AT THIS TIME THAT SHOULD BE 

861
00:32:54,079 --> 00:32:55,180
RELEASED FOR THE POTENTIAL, 

862
00:32:55,180 --> 00:32:57,850
PREMIERE STUDY, ALSO WHAT IS 

863
00:32:57,850 --> 00:32:59,151
PUBLISHED ALREADY WITH THE LOOK 

864
00:32:59,151 --> 00:33:02,688
OF THE EFFECTIVENESS WE THEN 

865
00:33:02,688 --> 00:33:05,357
SAID WHAT IF WE DO THIS IN THE 

866
00:33:05,357 --> 00:33:07,226
COMMUNITY?  WELL, WE WORK WITH 

867
00:33:07,226 --> 00:33:09,962
THE DEPARTMENT OF HEALTH, OFFICE

868
00:33:09,962 --> 00:33:13,198
OF HEALTH IN NEW YORK CITY TO 

869
00:33:13,198 --> 00:33:15,634
ACTUALLY RANDOMIZE 32 BLACK 

870
00:33:15,634 --> 00:33:18,003
CHURCHES AND ONE GROUP GOT JUST 

871
00:33:18,003 --> 00:33:19,705
HEALTH EDUCATION AND THE OTHER 

872
00:33:19,705 --> 00:33:22,608
GROUP GOT LIFESTYLE COUNSELING. 

873
00:33:22,608 --> 00:33:23,308
CODEVELOPED ACTUALLY WITH THE 

874
00:33:23,308 --> 00:33:25,177
PASTORS AND THE CHURCHES AND 

875
00:33:25,177 --> 00:33:26,879
WHAT WE FOUND WAS IN THAT 

876
00:33:26,879 --> 00:33:28,981
REGARD, WITH THE BLUE BAR HERE 

877
00:33:28,981 --> 00:33:31,216
IS THE INTERVENTION CHURCHES AND

878
00:33:31,216 --> 00:33:34,853
THE RED BAR IS THE CONTROL 

879
00:33:34,853 --> 00:33:37,222
CHURCHES.  AND THE INTERVENTION 

880
00:33:37,222 --> 00:33:39,892
WAS ACTUALLY DELIVERED BY HEALTH

881
00:33:39,892 --> 00:33:41,193
ADVISORS.  THESE ARE FOLKS WHO 

882
00:33:41,193 --> 00:33:43,061
ARE ALREADY MEMBERS OF THE 

883
00:33:43,061 --> 00:33:45,564
CHURCH AND THEY FOUND THE HEALTH

884
00:33:45,564 --> 00:33:49,201
MINISTRY.  OVER TIME YOU SEE A 

885
00:33:49,201 --> 00:33:50,569
SIGNIFICANT DROP IN SYSTOLIC 

886
00:33:50,569 --> 00:33:51,670
BLOOD PRESSURE, THE INTERVENTION

887
00:33:51,670 --> 00:33:54,840
GROUP ARE SIX MONTHS AFTER ABOUT

888
00:33:54,840 --> 00:33:56,375
5.6 MAKE A DIFFERENCE BUT WHEN 

889
00:33:56,375 --> 00:33:59,311
YOU EXTEND THAT TO NINE MONTHS 

890
00:33:59,311 --> 00:34:00,312
IT DROPPED BY THREE.  IN TERMS 

891
00:34:00,312 --> 00:34:05,784
OF THE DIFFERENCE.  IT'S STILL 

892
00:34:05,784 --> 00:34:07,252
SIGNIFICANT BUT A LOT OF THESE 

893
00:34:07,252 --> 00:34:13,225
ARE AT THE HEART OF DIAGNOSIS OF

894
00:34:13,225 --> 00:34:14,960
HYPERTENSION SO WHILE IT WAS 

895
00:34:14,960 --> 00:34:16,762
TRUE CARING FOR THEM IN THE 

896
00:34:16,762 --> 00:34:19,197
CHURCHES WHAT WASN'T HAPPENING 

897
00:34:19,197 --> 00:34:22,000
WAS REFERRING THOSE PATIENTS 

898
00:34:22,000 --> 00:34:23,402
BACK SO WE DIDN'T CLOSE THE LOOP

899
00:34:23,402 --> 00:34:25,904
AND THIS WAS A TIME WHEN A LOT 

900
00:34:25,904 --> 00:34:28,874
OF DATA WAS BEGINNING TO EMERGE 

901
00:34:28,874 --> 00:34:30,475
ESPECIALLY WITH THE POWERFUL 

902
00:34:30,475 --> 00:34:31,443
THINGS WE HAVE TO CONSIDER IN 

903
00:34:31,443 --> 00:34:32,811
INTERVENTIONS THAT WE DO.  WELL,

904
00:34:32,811 --> 00:34:34,846
WHEN YOU LOOK AT THE HEALTH 

905
00:34:34,846 --> 00:34:37,783
CASES THEN, WHAT YOU BEGIN TO 

906
00:34:37,783 --> 00:34:40,218
SEE, THIS IS ALL CRITICAL ERA IS

907
00:34:40,218 --> 00:34:43,055
IS FOCUS ON THE PATIENT, DOCTOR 

908
00:34:43,055 --> 00:34:45,090
PATIENT COMMUNICATION, CLINICAL 

909
00:34:45,090 --> 00:34:46,024
INERTIA FOR THE CLINICAL SYSTEMS

910
00:34:46,024 --> 00:34:48,126
AND REALLY THE IDEA OF QUALITY 

911
00:34:48,126 --> 00:34:50,862
IMPROVEMENT PROJECTS.  THAT 

912
00:34:50,862 --> 00:34:52,397
ALLOWS THE HEALTH CARE SYSTEM TO

913
00:34:52,397 --> 00:34:54,232
BE MORE AGILE IN HOW THEY 

914
00:34:54,232 --> 00:34:56,702
ADDRESS CARE.  SO WHILE ALL THAT

915
00:34:56,702 --> 00:34:58,637
IS HAPPENING, THE ENVIRONMENT 

916
00:34:58,637 --> 00:35:01,206
THOUGH, THE SOCIAL SUPPORT, THE 

917
00:35:01,206 --> 00:35:03,141
FOOD, THE COMMUNITY RESOURCES, 

918
00:35:03,141 --> 00:35:05,811
WEREN'T DOING A GOOD JOB ON THAT

919
00:35:05,811 --> 00:35:10,482
SO IT BECAME CLEAR AS  RECEIVED 

920
00:35:10,482 --> 00:35:11,617
FROM THIS SLIDE IT WASN'T DOING 

921
00:35:11,617 --> 00:35:14,720
A GOOD JOB IN THE HEALTH SETTING

922
00:35:14,720 --> 00:35:16,154
THERE'S STILL A HUGE GULF IN HOW

923
00:35:16,154 --> 00:35:19,691
WE BEGIN TO ADDRESS THE 

924
00:35:19,691 --> 00:35:20,025
COMMISSION. 

925
00:35:20,025 --> 00:35:22,094
WHICH ACCORDING TO THAT YOU CAN 

926
00:35:22,094 --> 00:35:23,929
SEE HERE THAT 20% OF A PERSON'S 

927
00:35:23,929 --> 00:35:25,263
HEALTH AND WELL-BEING IS RELATED

928
00:35:25,263 --> 00:35:27,032
TO THE ACCESS TO CARE.  AND 

929
00:35:27,032 --> 00:35:33,238
QUALITY OF SERVICES.  SO THEY 

930
00:35:33,238 --> 00:35:38,276
ARE JUGGLING IN THAT SPACE AND 

931
00:35:38,276 --> 00:35:47,185
IF THEY HAVE ACCESS TO CARE IN A

932
00:35:47,185 --> 00:35:47,786
HOEPT SYSTEM THEY HAVE THOSE 

933
00:35:47,786 --> 00:35:48,420
METRICS.  

934
00:35:48,420 --> 00:35:50,222
SO THE QUESTION THEN BECOMES, 

935
00:35:50,222 --> 00:35:52,991
WHAT DO WE DO?  HOW DO WE 

936
00:35:52,991 --> 00:35:54,526
REIMAGINE WHAT WE'RE SUPPOSED TO

937
00:35:54,526 --> 00:35:55,761
DO?  AND AND WHEN WE LOOK AT 

938
00:35:55,761 --> 00:35:57,229
DATA FROM THE LITERATURE IT DOES

939
00:35:57,229 --> 00:35:59,297
SHOW ALSO THAT A LOT OF THESE 

940
00:35:59,297 --> 00:36:01,233
THINGS ARE ACTUALLY RELATED TO 

941
00:36:01,233 --> 00:36:04,302
WHAT HYPERTENSION OUTCOMES.  I 

942
00:36:04,302 --> 00:36:06,071
THINK THAT COME FROM HOP KIDNAPS

943
00:36:06,071 --> 00:36:10,108
ACTUALLY LOOK AT THE DATA AND 

944
00:36:10,108 --> 00:36:20,485
BEGIN TO SEE 1 SOCIAL 

945
00:36:22,187 --> 00:36:25,223
DETERMINANTS.  SO WE RESPONDED 

946
00:36:25,223 --> 00:36:27,759
LOOKING AT WAY TO REALLY 

947
00:36:27,759 --> 00:36:30,095
ELIMINATE THIS THROUGH OTHER 

948
00:36:30,095 --> 00:36:31,863
COORDINATED INTERVENTION.  TO 

949
00:36:31,863 --> 00:36:33,432
PREVENT OUR CONTROL AND OUR LUNG

950
00:36:33,432 --> 00:36:35,300
DISEASE.  SO AS PART OF THIS 

951
00:36:35,300 --> 00:36:39,337
PROPOSED STUDIES THIS IS OUR 

952
00:36:39,337 --> 00:36:42,407
COLLEAGUES HERE.  WHO WOULD 

953
00:36:42,407 --> 00:36:43,942
ACTUALLY -- WE WENT IN TOGETHER,

954
00:36:43,942 --> 00:36:47,879
WE PUT IN THIS PROPOSAL.  

955
00:36:47,879 --> 00:36:49,648
ACTIONS TO DECREASE DISPARITIES 

956
00:36:49,648 --> 00:36:52,050
IN RISK AND ENGAGING SHARED 

957
00:36:52,050 --> 00:36:53,518
SUPPORT FOR CONTROL IN BLACK 

958
00:36:53,518 --> 00:36:55,387
PATIENTS SO JUST SO LEVEL SET, 

959
00:36:55,387 --> 00:36:57,022
WHAT WE TALKED ABOUT IN THIS 

960
00:36:57,022 --> 00:36:58,590
STUDY WAS, HEY, LISTEN, WE 

961
00:36:58,590 --> 00:37:00,892
DIDN'T REALLY FOCUS ON 

962
00:37:00,892 --> 00:37:02,194
ADDRESSING THOSE SOCIAL LEVEL 

963
00:37:02,194 --> 00:37:03,295
BARRIERS, THE SOCIAL 

964
00:37:03,295 --> 00:37:05,330
DETERMINANTS OF HEALTH, HOW DO 

965
00:37:05,330 --> 00:37:08,533
WE MAKE SURE THAT AFTER GIVING A

966
00:37:08,533 --> 00:37:09,034
PATIENT EVIDENCE-BASED 

967
00:37:09,034 --> 00:37:10,702
INTERVENTION WE ALSO ADDRESSING 

968
00:37:10,702 --> 00:37:12,070
THE COMMUNITY SETTING IN WHICH 

969
00:37:12,070 --> 00:37:15,507
THEY LIVE AND THE FACT WAS THE 

970
00:37:15,507 --> 00:37:17,175
TIME IN THEIR HEALTH OUTCOME SO 

971
00:37:17,175 --> 00:37:21,046
WE USE THE PRACTICE 

972
00:37:21,046 --> 00:37:23,281
IMPLEMENTATION TO IMPLEMENT THE 

973
00:37:23,281 --> 00:37:25,250
MEMBER.  REMEMBER IN OUR 

974
00:37:25,250 --> 00:37:27,018
EARLIEST DAYS THIS WAS THE PIECE

975
00:37:27,018 --> 00:37:28,420
WE WERE MISSING.  I ONLY SHARED 

976
00:37:28,420 --> 00:37:31,089
A FEW WITH YOU BUT WE HAVE 

977
00:37:31,089 --> 00:37:33,191
STUDIES IN SENIOR CENTERS ALL 

978
00:37:33,191 --> 00:37:35,293
ACROSS NEW YORK CITY.  FABULOUS 

979
00:37:35,293 --> 00:37:36,795
STUDIES ALL EFFECTIVE.  PROBLEM 

980
00:37:36,795 --> 00:37:39,998
WAS LINKING PEOPLE BACK TO CARE 

981
00:37:39,998 --> 00:37:44,102
AND MAKING SURE THAT YOU HAVE 

982
00:37:44,102 --> 00:37:46,738
THAT COMMUNITY MODEL SO WE HAVE 

983
00:37:46,738 --> 00:37:47,339
THREE INTERVENTIONS THAT HAVE 

984
00:37:47,339 --> 00:37:51,176
BEEN SHOWN TO FABULOUSLY DROP 

985
00:37:51,176 --> 00:37:53,211
SIGNIFICANTLY BLOOD PRESSURE 

986
00:37:53,211 --> 00:37:56,114
CONTROL AND SO IT'S THE BP 

987
00:37:56,114 --> 00:37:58,250
MONITOR, AND THE USE OF 

988
00:37:58,250 --> 00:38:00,185
COMMUNITY HEALTH WORKERS AS A 

989
00:38:00,185 --> 00:38:01,987
WAY TO BRIDGE THE GAP BETWEEN 

990
00:38:01,987 --> 00:38:04,256
THE HEALTH CARE SYSTEM AND THE 

991
00:38:04,256 --> 00:38:07,659
PATIENT LEVEL.  AND HERE WE HAVE

992
00:38:07,659 --> 00:38:11,630
THE UGUH MECHANISM WHERE WE 

993
00:38:11,630 --> 00:38:14,833
DEVELOPED A CONTEXT SPECIFIC 

994
00:38:14,833 --> 00:38:15,967
PRACTICE STRATEGY TO IMPLEMENT 

995
00:38:15,967 --> 00:38:19,237
THOSE THREE INTERVENTIONS TO 

996
00:38:19,237 --> 00:38:22,107
CALL THEM BASE.  USING COMMUNITY

997
00:38:22,107 --> 00:38:24,042
BASED RESEARCH AND THIS 

998
00:38:24,042 --> 00:38:24,976
FRAMEWORK.  ACTUALLY TAKE TIME 

999
00:38:24,976 --> 00:38:27,212
TO JUST EXPLAIN A FEW THINGS 

1000
00:38:27,212 --> 00:38:30,649
HERE.  WHEN YOU ARE WORKING WITH

1001
00:38:30,649 --> 00:38:33,852
THE HEALTH CARE SYSTEM, WHOSE 

1002
00:38:33,852 --> 00:38:37,088
REVENUE IS BASED ON REALLY HOW 

1003
00:38:37,088 --> 00:38:38,156
WELL QUALITY OF CARE THEY GIVE 

1004
00:38:38,156 --> 00:38:40,091
TO THEIR PATIENTS THEY ARE LEFT 

1005
00:38:40,091 --> 00:38:43,228
TO UNDERSTAND WHAT IS IMPORTANT 

1006
00:38:43,228 --> 00:38:46,865
TO INTEGRATE WHATEVER MODEL YOU 

1007
00:38:46,865 --> 00:38:48,567
WANT TO USE INTO THAT HEALTH 

1008
00:38:48,567 --> 00:38:50,702
SETTING.  IT TOOK US THREE YEARS

1009
00:38:50,702 --> 00:38:53,672
BUT WHAT I'M PROPOSING IS TO 

1010
00:38:53,672 --> 00:38:55,240
EMBED WITH SAME EACH FACULTY 

1011
00:38:55,240 --> 00:38:57,509
PRACTICE.  THE COMMUNITY HEALTH 

1012
00:38:57,509 --> 00:38:58,810
WORKER.  WHAT WE'RE FINDING 

1013
00:38:58,810 --> 00:39:00,579
QUICKLY WAS THAT IT WAS VERY 

1014
00:39:00,579 --> 00:39:02,681
DIFFICULT TO ADDRESS THOSE 

1015
00:39:02,681 --> 00:39:04,282
BECAUSE A LOT OF THE FACTORS 

1016
00:39:04,282 --> 00:39:06,585
THAT DRIVE OUTCOMES IN THOSE 

1017
00:39:06,585 --> 00:39:09,955
SETTINGS ARE VERY WELL-DEFINED 

1018
00:39:09,955 --> 00:39:12,724
AND INTRODUCE THAT WORKER WITH 

1019
00:39:12,724 --> 00:39:15,560
THAT ISSUE SO WE ARE TO REVISIT 

1020
00:39:15,560 --> 00:39:19,865
THAT STRATEGY AND WORKING WITH 

1021
00:39:19,865 --> 00:39:21,433
LEADERS IN INSTITUTIONAL GROUPS 

1022
00:39:21,433 --> 00:39:24,669
READAPT OUR SETTINGS WE LOOK AT 

1023
00:39:24,669 --> 00:39:28,707
THE CW CHARACTERISTICS AND IT 

1024
00:39:28,707 --> 00:39:30,475
BECAME CLEAR THAT CENTRALIZED 

1025
00:39:30,475 --> 00:39:31,643
CARE COORDINATION IS THE WAY TO 

1026
00:39:31,643 --> 00:39:34,412
GO AND THAT'S WHAT WE PROPOSED. 

1027
00:39:34,412 --> 00:39:35,714
SO RIGHT NOW IN YEAR THREE, YEAR

1028
00:39:35,714 --> 00:39:39,284
FOUR OF THIS STORY, AND THE IDEA

1029
00:39:39,284 --> 00:39:42,654
WAS TO USE ZEPHYR TO UNDERSTAND 

1030
00:39:42,654 --> 00:39:44,756
THE PLANNING PHASE AND WE JUST 

1031
00:39:44,756 --> 00:39:47,292
FINISHED SEVERAL MONTHS AGO AND 

1032
00:39:47,292 --> 00:39:49,527
WITH THE CLINICAL TRIAL WE'RE 

1033
00:39:49,527 --> 00:39:51,196
IMPLEMENTING THE FRAMEWORK TO 

1034
00:39:51,196 --> 00:39:53,231
EVALUATE OUR OUTCOMES OF 

1035
00:39:53,231 --> 00:39:57,302
ADOPTION OF IMPLEMENTATION AND 

1036
00:39:57,302 --> 00:39:58,603
COST-EFFECTIVENESS.  THE PRIMARY

1037
00:39:58,603 --> 00:40:02,641
QUESTION IS TO HAVE THESE STUDY 

1038
00:40:02,641 --> 00:40:06,578
THAT DOES A TAILOR PRACTICE THAT

1039
00:40:06,578 --> 00:40:08,713
INTEGRATES IN THE VIEW TO RESULT

1040
00:40:08,713 --> 00:40:13,218
IN A HIGHER LEVEL OF ADOPTION.  

1041
00:40:13,218 --> 00:40:15,287
REMOTE BLOOD PRESSURE MONITORING

1042
00:40:15,287 --> 00:40:16,755
AND SUPPORT AND OF COURSE OUR 

1043
00:40:16,755 --> 00:40:20,191
CLINICAL EFFECTIVENESS AIMS WERE

1044
00:40:20,191 --> 00:40:23,228
STILL BLOOD PRESSURE CONTROLS.  

1045
00:40:23,228 --> 00:40:25,230
CLUSTER TRIAL OF 20 SITES AND 

1046
00:40:25,230 --> 00:40:27,299
IT'S STILL ONGOING.  WE JUST 

1047
00:40:27,299 --> 00:40:28,533
BEGAN ACTUALLY WHAT YOU MIGHT 

1048
00:40:28,533 --> 00:40:31,236
CALL IT, THE IMPLEMENTED PART OF

1049
00:40:31,236 --> 00:40:36,308
THE STUDY SO WE ARE REMOTE BP 

1050
00:40:36,308 --> 00:40:38,076
MONITORING, PATIENT TAKES THEIR 

1051
00:40:38,076 --> 00:40:40,211
BLOOD PRESSURE READING.  AND 

1052
00:40:40,211 --> 00:40:42,280
THEN THEY CAN HELP YOU PROVIDE 

1053
00:40:42,280 --> 00:40:44,349
US TO EITHER ADJUST THE 

1054
00:40:44,349 --> 00:40:45,750
MEDICATIONS AND IF THAT DOESN'T 

1055
00:40:45,750 --> 00:40:47,285
WORK, AND THE PATIENT HAS THE 

1056
00:40:47,285 --> 00:40:49,521
HOME MONITORING, THEN WE BEGIN 

1057
00:40:49,521 --> 00:40:51,589
TO DO THE COUNSELLING AND IF 

1058
00:40:51,589 --> 00:40:53,825
THAT'S STILL NOT WORKING IN 3-6 

1059
00:40:53,825 --> 00:40:57,996
MONTHS THIS IS WHEN WE TRIGGER 

1060
00:40:57,996 --> 00:40:59,297
THE USE OF -- OR RATHER THE 

1061
00:40:59,297 --> 00:41:02,567
HEALTH WORKER INCLUDING THE 

1062
00:41:02,567 --> 00:41:05,370
HEALTH SYSTEM.  AND SO WE'VE 

1063
00:41:05,370 --> 00:41:07,238
ACTUALLY IDENTIFIED THE 25 

1064
00:41:07,238 --> 00:41:09,207
PRACTICE SITES.  WE TRAINED THE 

1065
00:41:09,207 --> 00:41:11,109
STAFF ALREADY.  WE DEVELOPED THE

1066
00:41:11,109 --> 00:41:13,244
PROCESS TO SUPPORT THE PATIENTS.

1067
00:41:13,244 --> 00:41:15,113
WE COMPLETE THE ONE-ON-ONE 

1068
00:41:15,113 --> 00:41:16,548
INTERVIEW TO REALLY HELP US 

1069
00:41:16,548 --> 00:41:18,149
UNDERSTAND THE ENVIRONMENTAL 

1070
00:41:18,149 --> 00:41:20,585
SCANS THAT PATIENTS ARE GOING 

1071
00:41:20,585 --> 00:41:23,254
THROUGH.  AND SO PATIENT STUDY 

1072
00:41:23,254 --> 00:41:26,391
IS BEGINNING TO RUN FOR SENSE OF

1073
00:41:26,391 --> 00:41:28,393
PATIENTS.  BUT IN DOING THIS 

1074
00:41:28,393 --> 00:41:29,427
STUDY IT BECAME CLEAR ALSO THAT 

1075
00:41:29,427 --> 00:41:32,364
THIS IS STILL ONGOING, WE HAVE 

1076
00:41:32,364 --> 00:41:33,598
FOUR MORE YEARS TO GO THAT IF 

1077
00:41:33,598 --> 00:41:36,835
WE'RE REALLY GOING TO ADVANCE 

1078
00:41:36,835 --> 00:41:38,503
THE FIELD IN THE HEALTH EQUITY 

1079
00:41:38,503 --> 00:41:40,472
ISSUE WE HAVE TO DO FOUR THINGS.

1080
00:41:40,472 --> 00:41:44,009
THE PROGRAM IS DESIGNED TO BUILD

1081
00:41:44,009 --> 00:41:48,747
EQUITY.  TO MITIGATE THE ADVERSE

1082
00:41:48,747 --> 00:41:49,347
EFFECTS THAT ARE PERVASIVE IN 

1083
00:41:49,347 --> 00:41:50,582
BLACK COMMUNITIES.  THE SECOND 

1084
00:41:50,582 --> 00:41:52,650
THING IS THAT WE NEED TO PARTNER

1085
00:41:52,650 --> 00:41:56,554
WITH BLACK COMMUNITIES TO 

1086
00:41:56,554 --> 00:41:57,956
DEVELOP EFFECTIVE STRATEGIES 

1087
00:41:57,956 --> 00:42:00,825
THAT GOES ACROSS A BUNCH OF THE 

1088
00:42:00,825 --> 00:42:02,527
HEALTH CARE SYSTEM.  THAT 

1089
00:42:02,527 --> 00:42:05,030
INTEGRATE HOW WE USE COMMUNITY 

1090
00:42:05,030 --> 00:42:06,398
BASED RESOURCES AND THE THIRD 

1091
00:42:06,398 --> 00:42:10,902
THING THAT IS  -- THAT ACTUALLY 

1092
00:42:10,902 --> 00:42:12,771
PARTNER AND INCENTIVIZE THESE 

1093
00:42:12,771 --> 00:42:14,172
MODELS BECAUSE AT THE END OF THE

1094
00:42:14,172 --> 00:42:15,774
DAY THEY WON'T BE SUSTAINABLE IF

1095
00:42:15,774 --> 00:42:18,576
IT'S NOT PAID FOR AND POPULATION

1096
00:42:18,576 --> 00:42:23,281
HEALTH ACTUALLY DEMANDS 245 WE 

1097
00:42:23,281 --> 00:42:27,752
HAVE HEALTH CARE AND WE MUST 

1098
00:42:27,752 --> 00:42:28,420
MAKE SURE THE THAT THE 

1099
00:42:28,420 --> 00:42:29,320
PARTNERSHIP WITH THE COMMUNITY 

1100
00:42:29,320 --> 00:42:32,290
IS INCENTIVIZED AND WE NEED TO 

1101
00:42:32,290 --> 00:42:33,792
GENERATE DATA SO THAT 

1102
00:42:33,792 --> 00:42:38,496
POLICYMAKERS ARE ASSURE ED AND 

1103
00:42:38,496 --> 00:42:40,999
HAVE ROBUST INFORMATION IN 

1104
00:42:40,999 --> 00:42:43,068
REALTIME TO HELP SEE THE DATA TO

1105
00:42:43,068 --> 00:42:44,936
DRIVE ACTION FOR THIS FORCE.  

1106
00:42:44,936 --> 00:42:47,806
SO TO THAT AIM, WE ARE 

1107
00:42:47,806 --> 00:42:50,642
RESPONDING REALLY TO THE AH 

1108
00:42:50,642 --> 00:42:51,676
THREE YEARS AGO THAT CAME OUT 

1109
00:42:51,676 --> 00:42:54,579
WITH A CALL TO ADDRESS THE 

1110
00:42:54,579 --> 00:42:57,015
INEQUITIES REALLY IN BLACK 

1111
00:42:57,015 --> 00:43:00,885
COMMUNITIES.  SO TO PROPOSE THE 

1112
00:43:00,885 --> 00:43:02,053
RESEARCH NETWORK.  WAS PLAN WE 

1113
00:43:02,053 --> 00:43:05,356
SEE HOW WE CAN ACTUALLY HELP TO 

1114
00:43:05,356 --> 00:43:07,358
REDUCE INEQUITIES AND SEE THE 

1115
00:43:07,358 --> 00:43:10,829
HOW MANY BETTER IF IT IS 

1116
00:43:10,829 --> 00:43:12,197
EVIDENCE BASED AND HAVE 

1117
00:43:12,197 --> 00:43:13,264
PREVENTIONS IN THIS CASE 

1118
00:43:13,264 --> 00:43:14,866
LIFESTYLE INTERVENTIONS INTO 

1119
00:43:14,866 --> 00:43:15,867
COMMUNITY SETTINGS.  BY EIGHT 

1120
00:43:15,867 --> 00:43:18,336
INSTITUTIONS, A LOT OF PEOPLE, 

1121
00:43:18,336 --> 00:43:21,773
AND THAT'S FOR THOSE, AND THAT'S

1122
00:43:21,773 --> 00:43:23,274
RESTORED THE NETWORK NOW.  IN 

1123
00:43:23,274 --> 00:43:25,577
BLACK COMMUNITIES TO MITIGATE 

1124
00:43:25,577 --> 00:43:29,581
THE IMPACT OF SOCIAL 

1125
00:43:29,581 --> 00:43:30,148
DETERMINANTS FELT ON BLOOD 

1126
00:43:30,148 --> 00:43:32,383
PRESSURE DEVELOP ON CALL 

1127
00:43:32,383 --> 00:43:34,619
STRATEGIES TO IMPLEMENT THIS 

1128
00:43:34,619 --> 00:43:35,286
LIFESTYLE INTERVENTIONS AND BY 

1129
00:43:35,286 --> 00:43:38,056
THEN TO BRING THE BP DOWN BUT 

1130
00:43:38,056 --> 00:43:40,158
MOST IMPORTANTLY, WE PLAN TO 

1131
00:43:40,158 --> 00:43:41,459
DISSEMINATE THE FINDINGS OF 

1132
00:43:41,459 --> 00:43:43,294
THESE STUDIES TO POLICYMAKERS 

1133
00:43:43,294 --> 00:43:45,130
AND STAKEHOLDERS SO WE CAN 

1134
00:43:45,130 --> 00:43:49,000
ACTUALLY ENSURE SUSTAINABILITY 

1135
00:43:49,000 --> 00:43:50,435
OF HIGH BLOOD PRESSURE 

1136
00:43:50,435 --> 00:43:52,570
PREVENTION AND OF COURSE WE USE 

1137
00:43:52,570 --> 00:43:54,806
THE PLATFORM TO TRAIN EARLY 

1138
00:43:54,806 --> 00:43:56,207
INVESTIGATORS.  WHEN I LOOK AT 

1139
00:43:56,207 --> 00:43:58,209
THE DATA HERE THE MODEL THAT WE 

1140
00:43:58,209 --> 00:44:03,214
USE WAS ACTUALLY OVER D WE 

1141
00:44:03,214 --> 00:44:06,417
OVERLAID THE MODEL. 

1142
00:44:06,417 --> 00:44:12,724
ON THE NIMHD, AND I JUST WALK 

1143
00:44:12,724 --> 00:44:13,992
YOU THROUGH THESE QUICKLY.  IT 

1144
00:44:13,992 --> 00:44:15,293
HAS TO BE MULTILEVEL.  SO WE 

1145
00:44:15,293 --> 00:44:16,728
HAVE THE HEALTH CONSISTENT.  WE 

1146
00:44:16,728 --> 00:44:22,800
HAVE THE BARBERSHOPS, WE HAVE 

1147
00:44:22,800 --> 00:44:24,202
CHURCHES AND WE HAVE THESE 

1148
00:44:24,202 --> 00:44:32,644
MOBILE.  AND WE LOOK AT ALSO USE

1149
00:44:32,644 --> 00:44:34,345
PRACTICE NAVIGATORS TO WORK INTO

1150
00:44:34,345 --> 00:44:36,114
CARE AND WORK WITH THE 

1151
00:44:36,114 --> 00:44:38,116
ASSISTANCE AND THE KEY AS THE 

1152
00:44:38,116 --> 00:44:39,217
DOMAINS OR ADDRESSES ARE SHOWN 

1153
00:44:39,217 --> 00:44:41,052
HERE AND THE HOPE IS THAT THIS 

1154
00:44:41,052 --> 00:44:43,221
WORKS WELL, TO ACTUALLY REDUCE 

1155
00:44:43,221 --> 00:44:43,955
BLOOD PRESSURE AND PREVENT THE 

1156
00:44:43,955 --> 00:44:47,125
POTENTIAL IN THIS COMMUNITIES.  

1157
00:44:47,125 --> 00:44:49,227
EACH PROJECT, THERE ARE FIVE OF 

1158
00:44:49,227 --> 00:44:50,962
THEM, WILL TEST THE STRATEGY 

1159
00:44:50,962 --> 00:44:52,163
INFORM BID COMMUNITY 

1160
00:44:52,163 --> 00:44:54,899
STAKEHOLDERS AS YOU CAN SEE 

1161
00:44:54,899 --> 00:44:55,233
HERE. 

1162
00:44:55,233 --> 00:44:57,335
WE HAVE MANY CAUSE THAT ACTUALLY

1163
00:44:57,335 --> 00:44:59,270
HAPPENED THAT IS -- WE HAVE THE 

1164
00:44:59,270 --> 00:45:02,040
COMMUNITY ENGAGEMENT CODAS LED 

1165
00:45:02,040 --> 00:45:03,474
BY HOPKINS AND WE HAVE THE LAST 

1166
00:45:03,474 --> 00:45:05,710
INTERVENTION CODAS LED BY US AND

1167
00:45:05,710 --> 00:45:08,279
WE ALSO HAVE THE USE OF 

1168
00:45:08,279 --> 00:45:08,880
TECHNOLOGY, OF COURSE WE'RE 

1169
00:45:08,880 --> 00:45:11,282
LOOKING AT THE MONITORING.  AND 

1170
00:45:11,282 --> 00:45:13,685
WE'RE COLLECTING DATA ON CROSS 

1171
00:45:13,685 --> 00:45:14,686
EFFECTIVENESS.  THE FIVE WE HAVE

1172
00:45:14,686 --> 00:45:19,958
HOWEVER.  O-- HERE. 

1173
00:45:19,958 --> 00:45:20,992
WE HAVE THE ONE IN NEW YORK 

1174
00:45:20,992 --> 00:45:22,560
CITY.  THE SECOND ONE IS WORKING

1175
00:45:22,560 --> 00:45:25,230
WITH CHURCHES TO ADDRESS VARIOUS

1176
00:45:25,230 --> 00:45:28,166
NUTRITION OR PHYSICAL ACTIVITY 

1177
00:45:28,166 --> 00:45:30,268
AND THE THIRD IS REALLY USING 

1178
00:45:30,268 --> 00:45:33,538
THE MOBILE VANS TO GO TO 

1179
00:45:33,538 --> 00:45:34,472
NEIGHBORHOODS TO ENGAGE IN 

1180
00:45:34,472 --> 00:45:36,241
POPULATIONS AND NAVIGATE THEM TO

1181
00:45:36,241 --> 00:45:39,277
CARE AND THE FOURTH IS USING 

1182
00:45:39,277 --> 00:45:44,983
HOME BP AND LINK THEM AND THE 

1183
00:45:44,983 --> 00:45:49,220
ONE IN HARBOR IS LOOKING AT THE 

1184
00:45:49,220 --> 00:45:53,157
EFFECTS OF THE THOSE WITH HIGH 

1185
00:45:53,157 --> 00:45:54,626
BLOOD PRESSURE SO THE HOPE IS 

1186
00:45:54,626 --> 00:45:57,061
THAT IF WE DO THIS RIGHT WE CAN 

1187
00:45:57,061 --> 00:46:00,331
ADVANCE THE IMPACT BY 

1188
00:46:00,331 --> 00:46:06,070
TRANSLATING IMPLEMENTED -- 

1189
00:46:06,070 --> 00:46:07,238
EVIDENCE-

1190
00:46:07,238 --> 00:46:08,373
EVIDENCE-BASED ISSUES.  FOR 

1191
00:46:08,373 --> 00:46:10,341
THESE WHO ARE INTERESTED IN THE 

1192
00:46:10,341 --> 00:46:12,010
COMPENDIUM OF PAPERS IT IS SHOWN

1193
00:46:12,010 --> 00:46:14,112
ON THIS SLIDE HERE.  AND WE WILL

1194
00:46:14,112 --> 00:46:17,048
HAVE OTHER PROTOCOLS PUBLISHED 

1195
00:46:17,048 --> 00:46:20,785
AND TUNE IN NEXT TIME THIS YEAR 

1196
00:46:20,785 --> 00:46:23,288
WE SHOULD HAVE ARTICLES 

1197
00:46:23,288 --> 00:46:28,559
PUBLISHED FOR YOU.  THANK YOU.

1198
00:46:28,559 --> 00:46:31,229
>> THANK YOU SO MUCH, THAT
WAS A

1199
00:46:31,229 --> 00:46:36,501
FANTASTIC RAPID OVERVIEW OF 

1200
00:46:36,501 --> 00:46:38,136
INSIGHTS THROUGHOUT.  WE WILL 

1201
00:46:38,136 --> 00:46:39,003
TURN IT TO OUR THIRD AND FINAL 

1202
00:46:39,003 --> 00:46:41,472
SPEAKER AND OPEN IT UP FOR 

1203
00:46:41,472 --> 00:46:42,940
DISCUSSION.  DON'T HESITATE TO 

1204
00:46:42,940 --> 00:46:44,142
PUT YOUR COMMENTS OR QUESTIONS 

1205
00:46:44,142 --> 00:46:46,678
IN THE CHAT AT ANY POINT.  OVER 

1206
00:46:46,678 --> 00:46:53,084
TO YOU DR. SIR VAN TES.

1207
00:46:53,084 --> 00:46:54,952
>> THANK YOU, AND CAN YOU
HEAR 

1208
00:46:54,952 --> 00:46:57,455
ME OKAY?  REALLY EXCITED TO BE 

1209
00:46:57,455 --> 00:46:59,290
HERE.  I AM GOING TO BEGIN BY 

1210
00:46:59,290 --> 00:47:01,259
ALSO DESCRIBING MY IDENTITY 

1211
00:47:01,259 --> 00:47:02,894
FIRST BECAUSE IT HAS TRULY 

1212
00:47:02,894 --> 00:47:04,095
SHAPED MY CAREER AND PASSION FOR

1213
00:47:04,095 --> 00:47:07,265
THE WORK THAT I DO.  

1214
00:47:07,265 --> 00:47:09,133
MY PARENTS WERE MEXICAN 

1215
00:47:09,133 --> 00:47:11,269
IMMIGRANTS.  I GREW UP IN DENVER

1216
00:47:11,269 --> 00:47:12,337
LEARNING ENGLISH AS MY SECOND 

1217
00:47:12,337 --> 00:47:14,305
LANGUAGE AND ONE OF THE THINGS I

1218
00:47:14,305 --> 00:47:17,175
ENJOYED MOST GROWING UP WAS 

1219
00:47:17,175 --> 00:47:18,543
DANCING WHICH I DID THROUGHOUT 

1220
00:47:18,543 --> 00:47:20,411
THE STATE OF COLORADO.  AND THEN

1221
00:47:20,411 --> 00:47:22,780
IN MIDDLE SCHOOL AND HIGH 

1222
00:47:22,780 --> 00:47:25,249
SCHOOL, I LIVED IN MEXICO AND 

1223
00:47:25,249 --> 00:47:27,285
THEN EVENTUALLY MOVED BACK TO 

1224
00:47:27,285 --> 00:47:29,620
COLORADO TO COMPLETE ALL OF MY 

1225
00:47:29,620 --> 00:47:31,255
TRAINING.  BUT MY WORK HAS 

1226
00:47:31,255 --> 00:47:35,159
PREDOMINANTLY FOCUSED ON 

1227
00:47:35,159 --> 00:47:36,260
CONDUCTING ADVOCACY FOCUSED 

1228
00:47:36,260 --> 00:47:37,495
RESEARCH THAT IS RESEARCH WITH 

1229
00:47:37,495 --> 00:47:37,962
THE ULTIMATE GOAL O

1230
00:47:37,962 --> 00:47:39,430
 CHANGING 

1231
00:47:39,430 --> 00:47:43,134
PRACTICE.  BY CHANGING POLICY.  

1232
00:47:43,134 --> 00:47:46,037
AND SO I COMPLETED RESIDENCY AND

1233
00:47:46,037 --> 00:47:49,140
INTERNAL MEDICINE IN 2008 AND I 

1234
00:47:49,140 --> 00:47:51,576
BEGAN MY CLINICAL CAREER AS A 

1235
00:47:51,576 --> 00:47:53,144
HOSPITAL MEDICINE PHYSICIAN AT 

1236
00:47:53,144 --> 00:47:55,146
DENVER HEALTH WHICH IS A SAFETY 

1237
00:47:55,146 --> 00:47:57,982
NET HOSPITAL AND AS A HOSPITAL 

1238
00:47:57,982 --> 00:48:00,318
MEDICINE PHYSICIAN WE DON'T 

1239
00:48:00,318 --> 00:48:01,619
TYPICALLY EXPERIENCE CONTINUE 

1240
00:48:01,619 --> 00:48:02,587
NEWTY OF CARE. 

1241
00:48:02,587 --> 00:48:06,391
MEANING WE ADMIT A PATIENT, TAKE

1242
00:48:06,391 --> 00:48:08,526
CARE OF THEM AND DISCHARGE THEM 

1243
00:48:08,526 --> 00:48:09,660
AND IDEALLY THEY DON'T COME BACK

1244
00:48:09,660 --> 00:48:10,995
BECAUSE THEY'RE HEALTHY 

1245
00:48:10,995 --> 00:48:12,196
AFTERWARDS BUT I CAME ACROSS A 

1246
00:48:12,196 --> 00:48:15,967
GROUP OF PATIENTS THAT I GOT TO 

1247
00:48:15,967 --> 00:48:16,801
KNOW REALLY WELL BECAUSE THEY 

1248
00:48:16,801 --> 00:48:19,137
WERE ESSENTIALLY STUCK AT THAT 

1249
00:48:19,137 --> 00:48:20,571
RESOLVING DOOR IN THE EMERGENCY 

1250
00:48:20,571 --> 00:48:22,340
DEPARTMENT.  MANY PEOPLE IN OUR 

1251
00:48:22,340 --> 00:48:23,674
COUNTRY DON'T HAVE HEALTH 

1252
00:48:23,674 --> 00:48:25,376
INSURANCE.  AND FOR THE MOST 

1253
00:48:25,376 --> 00:48:28,212
PART, THEY RECEIVE PRIMARY CARE 

1254
00:48:28,212 --> 00:48:28,813
THROUGH FEDERALLY QUALIFIRO

1255
00:48:28,813 --> 00:48:31,115
HEALTH CENTERS BUT BEYOND 

1256
00:48:31,115 --> 00:48:33,584
PRIMARY CARE, MANY REQUIRE 

1257
00:48:33,584 --> 00:48:35,019
SUBSPECIALTY CARE AND SERVICES. 

1258
00:48:35,019 --> 00:48:36,821
AND THIS IS ESSENTIALLY HOW I 

1259
00:48:36,821 --> 00:48:38,556
CAME TO KNOW THE UNDOCUMENTED 

1260
00:48:38,556 --> 00:48:41,125
IMMIGRANT COMMUNITY WITH KIDNEY 

1261
00:48:41,125 --> 00:48:42,560
FAILURE.  SOME OF YOU KNOW, MOST

1262
00:48:42,560 --> 00:48:44,595
PEOPLE HAVE TWO KIDNEYS.  THE 

1263
00:48:44,595 --> 00:48:46,464
KIDNEYS FILTER THE BLOOD AND 

1264
00:48:46,464 --> 00:48:47,665
REMOVE EXCESS FLUID AND WASTE 

1265
00:48:47,665 --> 00:48:50,468
WHICH IS EXCRETED AS URINE.  

1266
00:48:50,468 --> 00:48:51,969
WHEN BOTH KIDNEYS STOP WORKING 

1267
00:48:51,969 --> 00:48:53,805
PEOPLE REQUIRE KIDNEY 

1268
00:48:53,805 --> 00:48:55,106
REPLACEMENT THERAPY OR 

1269
00:48:55,106 --> 00:48:57,508
TREATMENT.  THAT CAN BE 

1270
00:48:57,508 --> 00:49:00,378
TRANSPLANT, HOME DIALYSIS OR IN 

1271
00:49:00,378 --> 00:49:01,913
CENTER DIALYSIS WHICH IS THE 

1272
00:49:01,913 --> 00:49:02,814
MOST COMMON FORM OF TREATMENT IN

1273
00:49:02,814 --> 00:49:05,249
THE U.S. AND THIS ESSENTIALLY 

1274
00:49:05,249 --> 00:49:07,118
REQUIRES THAT PEOPLE COME TO A 

1275
00:49:07,118 --> 00:49:09,454
CENTER AND A MACHINE CLEANS 

1276
00:49:09,454 --> 00:49:11,055
THEIR BLOOD FOR FOUR HOURS THREE

1277
00:49:11,055 --> 00:49:13,791
TIMES A WEEK.  ALL THESE 

1278
00:49:13,791 --> 00:49:15,059
TREATMENTS ARE AVAILABLE TO U.S.

1279
00:49:15,059 --> 00:49:17,161
CITIZENS BECAUSE OF A MEDICARE 

1280
00:49:17,161 --> 00:49:19,530
ENTITLEMENT PROGRAM BUT FOR 

1281
00:49:19,530 --> 00:49:21,432
UNDOCUMENTED UP IMMIGRANTS CARE 

1282
00:49:21,432 --> 00:49:22,867
VARIES THROUGHOUT THE COUNTRY. 

1283
00:49:22,867 --> 00:49:26,971
INSTEAD OF THREE TIMES PER WEEK 

1284
00:49:26,971 --> 00:49:27,805
DIALYSIS, UNDOCUMENTED IMMIGRANT

1285
00:49:27,805 --> 00:49:29,240
CONSIST ONLY RECEIVE IT ONCE A 

1286
00:49:29,240 --> 00:49:29,974
WEEK. 

1287
00:49:29,974 --> 00:49:32,443
SO THAT'S ONCE EVERY SEVEN DAYS 

1288
00:49:32,443 --> 00:49:34,445
THIS MEANS THE FLUID AND THE 

1289
00:49:34,445 --> 00:49:37,114
TOXINS ACCUMULATE IN NARY BLOOD.

1290
00:49:37,114 --> 00:49:43,087
THEIR LUNGS FILL UP WITH FLUID. 

1291
00:49:43,087 --> 00:49:46,757
THE TOXINS GROW.  THE POTASSIUM 

1292
00:49:46,757 --> 00:49:49,160
BUILDS UP AND CAN CAUSE ABNORMAL

1293
00:49:49,160 --> 00:49:51,195
HEART RHYTHMS AND IT'S HONESTLY 

1294
00:49:51,195 --> 00:49:52,930
A TERRIBLE WAY TO TREAT PEOPLE 

1295
00:49:52,930 --> 00:49:55,132
BECAUSE IT'S IMPRACTICAL, IT'S 

1296
00:49:55,132 --> 00:49:56,767
EXTREMELY COSTLY BECAUSE IT'S 

1297
00:49:56,767 --> 00:49:59,036
ALL THROUGH THE EMERGENCY 

1298
00:49:59,036 --> 00:50:04,909
DEPARTMENT AND IT'S 

1299
00:50:04,909 --> 00:50:06,043
DEHUMANIZING.  I MET HILDA 

1300
00:50:06,043 --> 00:50:12,817
AROUND 2010.  SHE HAD KIDNEY 

1301
00:50:12,817 --> 00:50:14,018
FAILURE AND COULD ONLY RECEIVE 

1302
00:50:14,018 --> 00:50:16,153
DIALYSIS ONCE A WEEK AND I 

1303
00:50:16,153 --> 00:50:18,623
BECAME CLOSE FRIENDS WITH HILDA 

1304
00:50:18,623 --> 00:50:20,958
BECAUSE OUR LIVES WERE PARALLEL.

1305
00:50:20,958 --> 00:50:22,793
MY PARENTS WERE MEXICAN AMERICAN

1306
00:50:22,793 --> 00:50:25,129
IMMIGRANTS I WATCHED HER HEALTH 

1307
00:50:25,129 --> 00:50:26,664
DETERIORATE.  SHE HAD THREE NEAR

1308
00:50:26,664 --> 00:50:31,102
FATAL CARDIAC ARRESTS AND HILDA 

1309
00:50:31,102 --> 00:50:35,439
SAW HER PEERS CODE AND DIE WHILE

1310
00:50:35,439 --> 00:50:36,240
WAITING IN THE EMERGENCY 

1311
00:50:36,240 --> 00:50:37,975
DEPARTMENT IN THE DIALYSIS 

1312
00:50:37,975 --> 00:50:40,077
CENTER AND IT MADE HER WORRY FOR

1313
00:50:40,077 --> 00:50:41,612
HER BOYS BECAUSE THEY WOULDN'T 

1314
00:50:41,612 --> 00:50:42,713
LEAVE HER SIDE.  THEY WEREN'T 

1315
00:50:42,713 --> 00:50:44,982
GOING TO SCHOOL.  THEY WERE 

1316
00:50:44,982 --> 00:50:47,285
WORRIED IF NO ONE WAS AROUND 

1317
00:50:47,285 --> 00:50:51,188
THEIR MOM WOULD HAVE A CARDIAC 

1318
00:50:51,188 --> 00:50:53,391
ARREST.  AND SO AFTER SEVERAL 

1319
00:50:53,391 --> 00:50:56,494
MONTHS HILDA DECIDED TO IDENTIFY

1320
00:50:56,494 --> 00:51:00,665
ADOPTIVE PARENTS AND INTERVIEWED

1321
00:51:00,665 --> 00:51:07,838
SEVERAL UNTIL SHE MET CHRIS AND 

1322
00:51:07,838 --> 00:51:10,408
HELEN.  SHE HAD TWO REMAINING 

1323
00:51:10,408 --> 00:51:12,577
WISHES BEFORE STOPPING EMERGENCY

1324
00:51:12,577 --> 00:51:14,345
DIALYSIS.  WHICH WAS TO SPEND A 

1325
00:51:14,345 --> 00:51:16,814
WEEK IN THE MOUNTAINS AND TO 

1326
00:51:16,814 --> 00:51:18,249
HAVE ONE LAST CHRISTMAS 

1327
00:51:18,249 --> 00:51:19,116
GATHERING AND SHE DIED ON 

1328
00:51:19,116 --> 00:51:23,020
MOTHER'S DAY IN 2014.  BEFORE 

1329
00:51:23,020 --> 00:51:25,823
HILDA DIED, I ENGAGED IN 

1330
00:51:25,823 --> 00:51:27,091
ADVOCACY AT THE STATE-LEVEL AND 

1331
00:51:27,091 --> 00:51:29,894
I SHARED HILDA'S STORY WITH 

1332
00:51:29,894 --> 00:51:31,128
ANYONE WHO WOULD LISTEN AND I 

1333
00:51:31,128 --> 00:51:32,496
TRIED TO FIND A SOLUTION BEFORE 

1334
00:51:32,496 --> 00:51:36,100
SHE DIED BUT I DIDN'T.  AFTER 

1335
00:51:36,100 --> 00:51:39,136
SHE DIED I FELT COMPELLED TO 

1336
00:51:39,136 --> 00:51:41,339
CHANGE THIS AND OTHER PATIENTS 

1337
00:51:41,339 --> 00:51:43,107
AND CLINICIANS ALSO FELT 

1338
00:51:43,107 --> 00:51:44,875
COMPELLED TO CHANGE THIS AT THIS

1339
00:51:44,875 --> 00:51:46,210
POINT I WAS ABOUT SIX YEARS OUT 

1340
00:51:46,210 --> 00:51:49,113
FROM RESIDENCY AND HAD NO FORMAL

1341
00:51:49,113 --> 00:51:51,182
RESEARCH TRAINING.  BUT I 

1342
00:51:51,182 --> 00:51:52,750
DECIDED IN PARTNERSHIP WITH 

1343
00:51:52,750 --> 00:51:54,518
PATIENTS AND CAREGIVERS AND 

1344
00:51:54,518 --> 00:51:55,920
OTHER CLINICIANS THAT WE NEEDED 

1345
00:51:55,920 --> 00:51:58,522
TO WORK ON RESEARCH.  FOR THE 

1346
00:51:58,522 --> 00:52:01,125
SOLE PURPOSE OF CHANGING 

1347
00:52:01,125 --> 00:52:02,960
PRACTICE AND POLICY.  AND SO 

1348
00:52:02,960 --> 00:52:04,061
EVERYTHING I'M ABOUT TO DESCRIBE

1349
00:52:04,061 --> 00:52:07,131
WAS INSPIRED BY HILDA.  AND IN 

1350
00:52:07,131 --> 00:52:08,799
PARTNERSHIP WITH HER FRIENDS, 

1351
00:52:08,799 --> 00:52:10,368
THE CLINICIANS THAT KNEW HER AND

1352
00:52:10,368 --> 00:52:12,770
OTHER PEOPLE THAT FORMED PART OF

1353
00:52:12,770 --> 00:52:16,040
OUR COALITION.  SO THIS FIRST 

1354
00:52:16,040 --> 00:52:17,608
STUDY IS ONE OF MY FAVORITES 

1355
00:52:17,608 --> 00:52:19,110
BECAUSE IT'S THE FIRST ONE WE 

1356
00:52:19,110 --> 00:52:20,544
PUBLISHED ON THIS ISSUE WE 

1357
00:52:20,544 --> 00:52:23,147
DECIDED TO CENTER PATIENTS AND 

1358
00:52:23,147 --> 00:52:23,748
INTERVIEWED 20 UNDOCUMENTED 

1359
00:52:23,748 --> 00:52:26,117
PEOPLE AND ASKED THEM ABOUT 

1360
00:52:26,117 --> 00:52:27,151
THEIR EXPERIENCES RECEIVING 

1361
00:52:27,151 --> 00:52:30,588
EMERGENCY DIALYSIS.  AND IN OUR 

1362
00:52:30,588 --> 00:52:34,091
THEMATIC ANALYSIS, WE LEARNED 

1363
00:52:34,091 --> 00:52:36,394
THAT PATIENTS WERE FACING A 

1364
00:52:36,394 --> 00:52:37,561
DISTRESSING SYMPTOM BURDEN 

1365
00:52:37,561 --> 00:52:41,298
BECAUSE AS I MENTIONED THEY HAD 

1366
00:52:41,298 --> 00:52:44,068
TO WAIT SEVEN WHOLE DAYS.  THEY 

1367
00:52:44,068 --> 00:52:45,536
WERE HAVING THEIR SYMPTOMS 

1368
00:52:45,536 --> 00:52:47,638
ACCUMULATE AND OFTENTIMES IN OUR

1369
00:52:47,638 --> 00:52:48,606
EMERGENCY DEPARTMENT BECAUSE WE 

1370
00:52:48,606 --> 00:52:51,175
HAD SO MANY PATIENTS AND A 

1371
00:52:51,175 --> 00:52:53,377
LIMITED NUMBER OF DIALYSIS 

1372
00:52:53,377 --> 00:52:55,946
CHAIRS WE HAD TO BASE ADMISSION 

1373
00:52:55,946 --> 00:52:56,814
ON THE POTASSIUM LEVEL THIS 

1374
00:52:56,814 --> 00:52:59,617
MEANS THAT WE HAD TO TURN VERY 

1375
00:52:59,617 --> 00:53:01,919
VISIBLY ILL PATIENTS AWAY UNLESS

1376
00:53:01,919 --> 00:53:02,820
THEIR POTASSIUM REACHED A 

1377
00:53:02,820 --> 00:53:05,589
CERTAIN LEVEL AND SO PATIENTS 

1378
00:53:05,589 --> 00:53:06,891
DESCRIBED HOW THEY SOMETIMES 

1379
00:53:06,891 --> 00:53:09,060
CONSUMED FOODS THAT WERE HIGH IN

1380
00:53:09,060 --> 00:53:10,594
POTASSIUM JUST OUTSIDE OUR 

1381
00:53:10,594 --> 00:53:12,530
HOSPITAL DOORS BECAUSE THEY 

1382
00:53:12,530 --> 00:53:15,366
RATHER RISK DEATH AND DIE FROM A

1383
00:53:15,366 --> 00:53:19,003
CARDIAC ARREST DUE TO THE HIGH 

1384
00:53:19,003 --> 00:53:20,738
POTASSIUM THAN TO BE DISCHARGED 

1385
00:53:20,738 --> 00:53:22,373
FROM THE ED WITHOUT DIALYSIS.  

1386
00:53:22,373 --> 00:53:24,175
YOU CAN'T EXPLAIN YOUR ILLNESS, 

1387
00:53:24,175 --> 00:53:26,777
YOU ARRIVE IN YOUR BAD SHAPE YOU

1388
00:53:26,777 --> 00:53:29,380
HAVE TO HAVE A HIGH POTASSIUM OR

1389
00:53:29,380 --> 00:53:30,915
YOU GO HOME.  SOMETIMES YOU 

1390
00:53:30,915 --> 00:53:33,684
CRAWL OUT.  YOU EAT A BANANA 

1391
00:53:33,684 --> 00:53:34,418
BECAUSE IT'S HIGH IN POTASSIUM 

1392
00:53:34,418 --> 00:53:36,520
AND YOU GO BACK AND HOPE THEY 

1393
00:53:36,520 --> 00:53:40,257
WILL DO DIALYSIS.  AS WE 

1394
00:53:40,257 --> 00:53:40,891
CONNECTED WITH PATIENTS AND 

1395
00:53:40,891 --> 00:53:41,659
AGAIN, THIS WAS 20 PATIENTS THAT

1396
00:53:41,659 --> 00:53:43,461
WE INTERVIEWED AND THIS WAS 

1397
00:53:43,461 --> 00:53:45,830
AFTER HILDA PASSED AWAY.  WE 

1398
00:53:45,830 --> 00:53:46,964
LEARNED FROM PATIENTS THAT THEY 

1399
00:53:46,964 --> 00:53:49,433
WANTED TO BUILD COMMUNITY.  THEY

1400
00:53:49,433 --> 00:53:50,935
WANTED TO BE MORE CONNECTED TO 

1401
00:53:50,935 --> 00:53:51,836
EACH OTHER, TO SUPPORT EACH 

1402
00:53:51,836 --> 00:53:54,238
OTHER.  AND SO THEY TOOK THE 

1403
00:53:54,238 --> 00:53:55,906
INITIATIVE OF MEETING AT A LOCAL

1404
00:53:55,906 --> 00:53:57,975
CHURCH THAT WAS JUST A BLOCK 

1405
00:53:57,975 --> 00:54:00,144
AWAY FROM THE HOSPITAL.  AND WE 

1406
00:54:00,144 --> 00:54:01,045
DECIDED AS A TEAM THAT IN 

1407
00:54:01,045 --> 00:54:03,380
ADDITION TO THAT, WE WOULD BUILD

1408
00:54:03,380 --> 00:54:05,449
A PEER SUPPORT GROUP 

1409
00:54:05,449 --> 00:54:07,451
INTERVENTION BECAUSE ON ANY 

1410
00:54:07,451 --> 00:54:11,922
GIVEN DAY THERE WERE 12 H12-15 

1411
00:54:11,922 --> 00:54:13,858
PATIENTS THAT WERE HOSPITALIZED 

1412
00:54:13,858 --> 00:54:20,598
WAITING FOR THEIR DIALYSIS.  WE 

1413
00:54:20,598 --> 00:54:25,035
FELT THIS WAS AN OPPORTUNITY TO 

1414
00:54:25,035 --> 00:54:27,938
START BUILDING A COMMUNITY.  IN 

1415
00:54:27,938 --> 00:54:29,840
THE EVENING WE WOULD HAVE DIN IR

1416
00:54:29,840 --> 00:54:31,041
TOGETHER.  WE WOULD DISCUSS A 

1417
00:54:31,041 --> 00:54:32,610
TOPIC THEY WERE INTERESTED IN. 

1418
00:54:32,610 --> 00:54:34,445
AND SOMETIMES DO ARTS AND CRAFTS

1419
00:54:34,445 --> 00:54:36,213
AND A LOT OF SHARING.  AND THIS 

1420
00:54:36,213 --> 00:54:38,449
WAS, I KNOW I SAID THE LAST ONE 

1421
00:54:38,449 --> 00:54:39,717
WAS MY FAVORITE STUDY BUT THIS 

1422
00:54:39,717 --> 00:54:42,119
ONE IS ALSO ONE OF MY FAVORITES 

1423
00:54:42,119 --> 00:54:45,122
BECAUSE THIS ONE ORGANICALLY LED

1424
00:54:45,122 --> 00:54:47,091
TO COALITION BUILDING.  AND 

1425
00:54:47,091 --> 00:54:48,592
ESSENTIALLY THIS GROUP BECAME 

1426
00:54:48,592 --> 00:54:51,896
OUR FUTURE COMMUNITY STEERING 

1427
00:54:51,896 --> 00:54:53,063
COMMITTEE.  WE HAD 23 

1428
00:54:53,063 --> 00:54:55,032
PARTICIPANTS IN TOTAL.  ALSO 

1429
00:54:55,032 --> 00:54:58,202
AUDIO RECORDED ALL OF OUR 

1430
00:54:58,202 --> 00:55:00,538
MEETINGS AND THEMATICALLY AND 

1431
00:55:00,538 --> 00:55:01,872
ANALYZED THEM AND LEARNED FROM 

1432
00:55:01,872 --> 00:55:03,841
THESE MEETINGS THAT PATIENTS 

1433
00:55:03,841 --> 00:55:07,044
SHARED A LOT ABOUT HOW TO 

1434
00:55:07,044 --> 00:55:09,747
SELF-ADVOCATE INCLUDING 

1435
00:55:09,747 --> 00:55:10,447
DOWNLOADING APPS SO THAT THEY 

1436
00:55:10,447 --> 00:55:12,183
COULD INTERPRET FOR THEMSELVES 

1437
00:55:12,183 --> 00:55:13,584
IF A CLINICIAN DIDN'T BRING A 

1438
00:55:13,584 --> 00:55:16,220
LANGUAGE INTERPRETER.  THEY 

1439
00:55:16,220 --> 00:55:18,722
TALKED ABOUT SELF-MOTIVATION AND

1440
00:55:18,722 --> 00:55:20,324
PATIENTS TALKED ABOUT HOW PEER 

1441
00:55:20,324 --> 00:55:21,192
SUPPORT IS VITAL ESPECIALLY 

1442
00:55:21,192 --> 00:55:23,093
THOSE WITH NEWLY DIAGNOSED 

1443
00:55:23,093 --> 00:55:25,029
KIDNEY FAILURE AND THE MOST 

1444
00:55:25,029 --> 00:55:27,064
IMPORTANT PIECE WAS IT BUILT 

1445
00:55:27,064 --> 00:55:30,634
COMRADERY AND CULTIVATED 

1446
00:55:30,634 --> 00:55:31,735
SOLIDARITY TO SURVIVE AND CHANGE

1447
00:55:31,735 --> 00:55:33,704
POLICY AND FROM THIS AS THESE 

1448
00:55:33,704 --> 00:55:34,705
MEETINGS FROM THE FIRST SIX 

1449
00:55:34,705 --> 00:55:37,408
MONTHS WERE COMING TO AN END THE

1450
00:55:37,408 --> 00:55:43,347
PATIENTS DECIDED TO ORGANIZE 

1451
00:55:43,347 --> 00:55:45,249
THEMSELVES AND THEY STARTED 

1452
00:55:45,249 --> 00:55:47,084
COMMUNICATING AROUND HOW WE 

1453
00:55:47,084 --> 00:55:55,059
COULD COLLECTIVELY CHANGE 

1454
00:55:55,059 --> 00:55:57,027
POLICY.  CAREGIVERS ALSO WANTED 

1455
00:55:57,027 --> 00:55:58,829
TO BE INTERVIEW AND MOST OF 

1456
00:55:58,829 --> 00:56:00,364
THESE CAREGIVERS WERE ADULT 

1457
00:56:00,364 --> 00:56:04,335
CHILDREN OR PARENTS.  AND THEY 

1458
00:56:04,335 --> 00:56:05,469
DESCRIBED SIMILAR EXPERIENCES TO

1459
00:56:05,469 --> 00:56:07,037
HILDA MEANING THAT THEIR KIDS 

1460
00:56:07,037 --> 00:56:08,873
WERE DROPPING OUT OF SCHOOL TO 

1461
00:56:08,873 --> 00:56:10,774
WORK OR TO ACCOMPANY THEM TO THE

1462
00:56:10,774 --> 00:56:13,043
HOSPITAL TO PROVIDE LANGUAGE 

1463
00:56:13,043 --> 00:56:14,845
INTERPRETATION.  WE ALSO 

1464
00:56:14,845 --> 00:56:16,213
INTERVIEWED CLINICIANS, 50 OF 

1465
00:56:16,213 --> 00:56:19,416
THEM, 25 IN COLORADO AND 25 IN 

1466
00:56:19,416 --> 00:56:22,419
HOUSTON, TEXAS.  AND LIKE 

1467
00:56:22,419 --> 00:56:23,454
MYSELF, CLINICIANS DESCRIBED 

1468
00:56:23,454 --> 00:56:27,958
SEVERAL DRIVERS OF BURNOUT 

1469
00:56:27,958 --> 00:56:30,060
INCLUDING EMOTIONAL EXHAUSTION. 

1470
00:56:30,060 --> 00:56:32,396
THEY FELT THEY WERE JEOPARDIZING

1471
00:56:32,396 --> 00:56:33,998
THEIR PATIENT'S TRUST BECAUSE 

1472
00:56:33,998 --> 00:56:37,034
THEY HAD TO TURN PATIENTS AWAY 

1473
00:56:37,034 --> 00:56:39,470
WITHOUT OFFERING DIALYSIS.  AND 

1474
00:56:39,470 --> 00:56:41,138
THEY ALSO DESCRIBING NUMBING 

1475
00:56:41,138 --> 00:56:42,506
THEMSELVES FROM FEELING TOO MUCH

1476
00:56:42,506 --> 00:56:44,375
EMPATHY FOR THESE PATIENTS.  AND

1477
00:56:44,375 --> 00:56:46,477
SO THEY DETACHED.  ONE CLINICIAN

1478
00:56:46,477 --> 00:56:48,279
SAID TURNING PATIENTS AWAY FROM 

1479
00:56:48,279 --> 00:56:50,915
DIALYSIS IS A HUGE ASPECT OF 

1480
00:56:50,915 --> 00:56:54,551
PHYSICIAN BURNOUT.  RES DID I 

1481
00:56:54,551 --> 00:56:59,490
WANT -- RESIDENTS HAVE TO 

1482
00:56:59,490 --> 00:56:59,890
DISASSOCIATE. 

1483
00:56:59,890 --> 00:57:01,825
WE ALSO CONDUCTED SEVERAL 

1484
00:57:01,825 --> 00:57:02,593
QUANTITATIVE STUDIES I'M NOT 

1485
00:57:02,593 --> 00:57:04,194
GOING TO GO THROUGH THESE BUT WE

1486
00:57:04,194 --> 00:57:06,497
FOUND THAT MORTALITY WAS 14 FOLD

1487
00:57:06,497 --> 00:57:10,367
GREATER FIVE YEARS AFTER 

1488
00:57:10,367 --> 00:57:12,436
PATIENTS INITIATED DIALYSIS 

1489
00:57:12,436 --> 00:57:14,805
COMPARED TO THOSE WHO RECEIVED 

1490
00:57:14,805 --> 00:57:15,639
THREE TIMES PER WEEK DIALYSIS 

1491
00:57:15,639 --> 00:57:18,676
AND LOOKING AT PATIENTS WHO DIED

1492
00:57:18,676 --> 00:57:21,245
PRESENTING AT THE HOSPITAL WE 

1493
00:57:21,245 --> 00:57:23,080
FOUND THEY HAD A HIGH LEVEL OF 

1494
00:57:23,080 --> 00:57:24,381
MEAN POTASSIUM AND OVER HALF 

1495
00:57:24,381 --> 00:57:28,118
DIED OF CARDIAC ARREST.  AND SO,

1496
00:57:28,118 --> 00:57:29,386
IN ADDITION TO PARTNERING WITH 

1497
00:57:29,386 --> 00:57:31,588
PATIENTS AND CLINICIANS AND AS 

1498
00:57:31,588 --> 00:57:33,624
WE PUBLISHED THIS WORK, WE 

1499
00:57:33,624 --> 00:57:36,226
PARTNERED WITH COMMUNITY BASED 

1500
00:57:36,226 --> 00:57:37,094
ORGANIZATIONS ANDNNI 

1501
00:57:37,094 --> 00:57:38,996
MAKERS AND PEOPLE IN HEALTH 

1502
00:57:38,996 --> 00:57:41,899
POLICY.  AND TOGETHER WE ENGAGED

1503
00:57:41,899 --> 00:57:43,600
IN POLICY BUT WHEN I DESCRIBE 

1504
00:57:43,600 --> 00:57:45,202
THIS WORK I REALIZE THAT 

1505
00:57:45,202 --> 00:57:47,004
SOMETIMES -- WHEN I DESCRIBE IT,

1506
00:57:47,004 --> 00:57:48,973
IT LOOKS VERY LINEAR BUT IN 

1507
00:57:48,973 --> 00:57:49,974
REALITY THERE WERE MANY TWISTS 

1508
00:57:49,974 --> 00:57:53,143
AND TURNS AND AS I REFLECTED ON 

1509
00:57:53,143 --> 00:57:53,844
HOW WE WERE ABLE TO ACCOMPLISH 

1510
00:57:53,844 --> 00:57:56,513
THIS INCREDIBLE WORK, WE HAVE 

1511
00:57:56,513 --> 00:57:57,448
IDENTIFIED AS A TEAM FOUR SKILLS

1512
00:57:57,448 --> 00:57:59,483
THAT WE FELT WERE REALLY 

1513
00:57:59,483 --> 00:58:00,985
IMPORTANT FROM TRANSLATING 

1514
00:58:00,985 --> 00:58:04,989
RESEARCH TO POLICY CHANGE.  AND 

1515
00:58:04,989 --> 00:58:06,590
THIS FRAMEWORK ON THE RIGHT IS 

1516
00:58:06,590 --> 00:58:08,692
ONE WE HAVE PUBLISHED AND TEACH 

1517
00:58:08,692 --> 00:58:10,260
ACROSS THE COUNTRY TO 

1518
00:58:10,260 --> 00:58:11,328
RESEARCHERS.  BUT TO CHANGE 

1519
00:58:11,328 --> 00:58:13,697
POLICY, WE NEEDED TO CONDUCT A 

1520
00:58:13,697 --> 00:58:14,598
POLICY ANALYSIS.  AND THERE WERE

1521
00:58:14,598 --> 00:58:16,834
TWO GROUPS THAT CONDUCTED POLICY

1522
00:58:16,834 --> 00:58:18,502
ANALYSES FOR OUR TEAM.  ONE WAS 

1523
00:58:18,502 --> 00:58:19,636
THE SAFETY NET HOSPITAL AND 

1524
00:58:19,636 --> 00:58:21,372
ANOTHER ONE WAS A COMMUNITY 

1525
00:58:21,372 --> 00:58:23,774
BASED ORGANIZATION.  THEY HELPED

1526
00:58:23,774 --> 00:58:24,975
US UNDERSTOOD ALL THE POLICIES 

1527
00:58:24,975 --> 00:58:26,844
THAT STOOD IN THE WAY AS WELL AS

1528
00:58:26,844 --> 00:58:29,146
HOW WE COULD CHANGE THOSE 

1529
00:58:29,146 --> 00:58:31,515
POLICIES TO IMPROVE ACCESS FOR 

1530
00:58:31,515 --> 00:58:34,151
CARE WHO ARE UNDOCUMENTED.  WE 

1531
00:58:34,151 --> 00:58:35,886
LEARNED ABOUT THE ACTIVE LABOR 

1532
00:58:35,886 --> 00:58:42,059
ACT.  THIS IS LAW ENACTED IN 

1533
00:58:42,059 --> 00:58:44,228
1986 AND REQUIRES HOSPITALS 

1534
00:58:44,228 --> 00:58:45,195
SCREEN PATIENT WHO IS HAVE AN 

1535
00:58:45,195 --> 00:58:46,864
EMERGENCY AND IT IS BECAUSE OF 

1536
00:58:46,864 --> 00:58:48,866
THIS THAT PATIENTS CAN NOT BE 

1537
00:58:48,866 --> 00:58:51,602
TURNED AWAY BASED ON IMMIGRATION

1538
00:58:51,602 --> 00:58:53,670
STATUS AND AS A RESULT OF THIS 

1539
00:58:53,670 --> 00:58:54,972
LAW, STATES BASICALLY DEVELOPED 

1540
00:58:54,972 --> 00:58:57,041
THEIR OWN EMERGENCY MEDICAID 

1541
00:58:57,041 --> 00:58:57,608
PROGRAMS.  

1542
00:58:57,608 --> 00:58:59,009
AND MOST EMERGENCY MEDICAID 

1543
00:58:59,009 --> 00:59:00,778
PROGRAMS ABIDE BY THE EXACT 

1544
00:59:00,778 --> 00:59:02,513
LANGUAGE IN THIS LAW.  BUT WHAT 

1545
00:59:02,513 --> 00:59:04,415
IS CRITICALLY IMPORTANT THAT WE 

1546
00:59:04,415 --> 00:59:06,083
LEARNED IN THIS POLICY ANALYSIS 

1547
00:59:06,083 --> 00:59:09,186
IS THAT STATES HAVE MODIFIED 

1548
00:59:09,186 --> 00:59:10,988
THESE SERVICES AND CONDITIONS 

1549
00:59:10,988 --> 00:59:12,489
THAT QUALIFY AS EMERGENCIES.  

1550
00:59:12,489 --> 00:59:15,559
AND WE ALSO LEARNED THAT CMS 

1551
00:59:15,559 --> 00:59:17,027
PROVIDES NO GUIDANCE FOR 

1552
00:59:17,027 --> 00:59:17,761
DEFINING THOSE EMERGENCIES THEY 

1553
00:59:17,761 --> 00:59:20,264
ACTUALLY DEFER TO STATES.  AND 

1554
00:59:20,264 --> 00:59:23,000
SO WE LOOKED AT THE STATES THAT 

1555
00:59:23,000 --> 00:59:24,968
PROVIDED ACCESS TO CARE TO 

1556
00:59:24,968 --> 00:59:26,136
UNDOCUMENTED IMMIGRANTS AND THE 

1557
00:59:26,136 --> 00:59:28,405
THIS IS, IN THIS SLIDE YOU SEE 

1558
00:59:28,405 --> 00:59:29,540
AN EXAMPLE OF WASHINGTON STATE 

1559
00:59:29,540 --> 00:59:31,041
THEY MODIFIED THEIR SERVICES TO 

1560
00:59:31,041 --> 00:59:34,411
INCLUDE DIALYSISES AND SO WHAT 

1561
00:59:34,411 --> 00:59:35,079
IS IMPORTANT ABOUT ALL THIS IS 

1562
00:59:35,079 --> 00:59:36,380
WE IDENTIFIED THOSE POLICIES. 

1563
00:59:36,380 --> 00:59:41,218
AND FOUND A POLICY PATHWAY.  WE 

1564
00:59:41,218 --> 00:59:42,686
ALSO MEANINGFULLY AND VERY 

1565
00:59:42,686 --> 00:59:47,024
EFFECTIVELY ENGAGED IN BUILDING 

1566
00:59:47,024 --> 00:59:48,425
RELATIONSHIPS AS A TEAM.  

1567
00:59:48,425 --> 00:59:49,259
SOMETIMES THE POWER AND 

1568
00:59:49,259 --> 00:59:50,861
INFLUENCE OF THE RELATIONSHIPS 

1569
00:59:50,861 --> 00:59:53,130
THAT WE BUILD CAN DETERMINE THAT

1570
00:59:53,130 --> 00:59:54,932
POTENTIAL FOR CHANGE.  AND ONE 

1571
00:59:54,932 --> 00:59:56,533
REALLY IMPORTANT AND EFFECTIVE 

1572
00:59:56,533 --> 00:59:58,735
WAY WE HAVE FOUND TO DOING THIS 

1573
00:59:58,735 --> 01:00:00,971
IS THROUGH POWER MAPPING.  AND 

1574
01:00:00,971 --> 01:00:02,706
IN THIS SLIDE IT'S SORT OF, YOU 

1575
01:00:02,706 --> 01:00:04,074
CAN SEE SORT OF A VISUAL 

1576
01:00:04,074 --> 01:00:05,542
STRATEGY THAT HELPS US 

1577
01:00:05,542 --> 01:00:07,578
UNDERSTAND THE SOCIAL AND 

1578
01:00:07,578 --> 01:00:08,846
POLITICAL ENVIRONMENT.  YOU CAN 

1579
01:00:08,846 --> 01:00:09,746
BEGIN BUT I THINKING ABOUT WHO 

1580
01:00:09,746 --> 01:00:11,849
THOSE DECISION MAKERS ARE.  

1581
01:00:11,849 --> 01:00:13,283
RIGHT?  AND SO THAT IS INFORMED 

1582
01:00:13,283 --> 01:00:15,652
BY THE POLICIES THAT YOU NEED TO

1583
01:00:15,652 --> 01:00:22,993
CHANGE.  AND ON THE AXES YOU MAP

1584
01:00:22,993 --> 01:00:29,733
BASED ON WHAT THEY HAVE.  RATHER

1585
01:00:29,733 --> 01:00:30,968
THAN THE ISSUE.  WE 

1586
01:00:30,968 --> 01:00:32,469
STRATEGICALLY CONNECT WITH 

1587
01:00:32,469 --> 01:00:34,538
PEOPLE THAT HAD POWER OVER 

1588
01:00:34,538 --> 01:00:36,974
CHANGING EMERGENCY MEDICAID 

1589
01:00:36,974 --> 01:00:39,042
WHICH INCLUDED THE STATE 

1590
01:00:39,042 --> 01:00:41,011
MEDICAID OFFICE, THE GOVERNOR'S 

1591
01:00:41,011 --> 01:00:43,747
OFFICE AND MANY, MANY OTHERS.  

1592
01:00:43,747 --> 01:00:45,249
AND WHAT I WANT TO JUST PAUSE 

1593
01:00:45,249 --> 01:00:47,017
AND SAY IS THAT SINCE THIS 

1594
01:00:47,017 --> 01:00:48,552
INITIAL POLICY CHANGE BECAUSE OF

1595
01:00:48,552 --> 01:00:50,354
THE RELATIONSHIPS THAT WE HAVE 

1596
01:00:50,354 --> 01:00:51,989
CULTIVATED WITH THIS INITIAL 

1597
01:00:51,989 --> 01:00:53,423
WORK, WE HAVE BEEN ABLE TO 

1598
01:00:53,423 --> 01:00:55,726
CONDUCT ADDITIONAL QUALITATIVE 

1599
01:00:55,726 --> 01:00:57,828
MIXED METHODS AND QUANTITATIVE 

1600
01:00:57,828 --> 01:00:59,496
STUDIES BUT BECAUSE WE HAVE 

1601
01:00:59,496 --> 01:01:05,169
CULTIVATED THESE RELATIONSHIPS E

1602
01:01:05,169 --> 01:01:08,205
HAS BEEN THAT MUCH FASTER I 

1603
01:01:08,205 --> 01:01:09,406
MENTIONED THAT PATIENTS ENGAGED 

1604
01:01:09,406 --> 01:01:12,943
IN THIS WORK.  IT WAS INSPIRED 

1605
01:01:12,943 --> 01:01:15,612
BY HILDA AND IT IS BECAUSE OF 

1606
01:01:15,612 --> 01:01:18,949
THIS PARTNERSHIP THAT THE 

1607
01:01:18,949 --> 01:01:20,517
PATIENTS HAVE BEEN ABLE TO 

1608
01:01:20,517 --> 01:01:21,752
MEANINGFULLY ABLE TO CHANGE 

1609
01:01:21,752 --> 01:01:23,487
POLICY.  THEY DEVELOPED A SENSE 

1610
01:01:23,487 --> 01:01:25,789
OF ADVOCACY SKILLS, POLICY 

1611
01:01:25,789 --> 01:01:27,824
AWARP, A SENSE OF RIGHTS AND 

1612
01:01:27,824 --> 01:01:28,125
LEADERSHIP. 

1613
01:01:28,125 --> 01:01:30,327
AND AND THEY FORMED THEIR OWN 

1614
01:01:30,327 --> 01:01:30,994
RELATIONSHIPS AND NOW THEY CAN 

1615
01:01:30,994 --> 01:01:33,597
CONTINUE TO DO POLICY WORK 

1616
01:01:33,597 --> 01:01:35,199
WITHOUT ME.  

1617
01:01:35,199 --> 01:01:36,600
WE ALSO BUILT RELATIONSHIPS WITH

1618
01:01:36,600 --> 01:01:38,969
OUR EXECUTIVE HOSPITAL STAFFS, 

1619
01:01:38,969 --> 01:01:41,605
COMMUNITY BASED ORGANIZATIONS, 

1620
01:01:41,605 --> 01:01:43,340
AND PROFESSIONAL SOCIETIES.  THE

1621
01:01:43,340 --> 01:01:46,009
THIRD ADVOCACY SCALE JUST VERY 

1622
01:01:46,009 --> 01:01:48,011
QUICKLY WAS CONDUCTING RESEARCH.

1623
01:01:48,011 --> 01:01:49,680
A QUICK WORD ON QUALITATIVE 

1624
01:01:49,680 --> 01:01:53,016
RESEARCH.  I THINK IT'S SUCH A 

1625
01:01:53,016 --> 01:01:54,151
MEANINGFUL RESEARCH METHOD 

1626
01:01:54,151 --> 01:01:55,752
BECAUSE IT PROVIDES OUR 

1627
01:01:55,752 --> 01:01:56,987
COMMUNITIES THE PEOPLE THAT ARE 

1628
01:01:56,987 --> 01:01:59,189
FACING ADVOCACY CHALLENGES A 

1629
01:01:59,189 --> 01:02:02,960
VOICE.  IN ACADEMIC PUBLICATIONS

1630
01:02:02,960 --> 01:02:05,529
AND MAINSTREAM MEDIA, IN FACT WE

1631
01:02:05,529 --> 01:02:09,600
ALWAYS BEGIN POLICY BRIEFS AT 

1632
01:02:09,600 --> 01:02:11,068
THE TOP AND IT'S A MORE STORY 

1633
01:02:11,068 --> 01:02:13,136
BASED NARRATIVE THAT DRAWS IN 

1634
01:02:13,136 --> 01:02:15,572
MEDIA BECAUSE THEY CAN CONNECT 

1635
01:02:15,572 --> 01:02:17,507
WITH IT AND THEY CAN SHARE IT IN

1636
01:02:17,507 --> 01:02:19,676
A WAY THAT'S MEANINGFUL.  WE 

1637
01:02:19,676 --> 01:02:21,278
ALSO CONDUCTED SEVERAL 

1638
01:02:21,278 --> 01:02:21,912
QUANTITATIVE STUDIES AND WHAT I 

1639
01:02:21,912 --> 01:02:24,314
WANT TO SAY HERE IS THAT MANY OF

1640
01:02:24,314 --> 01:02:25,382
OUR QUANTITATIVE STUDIES WERE 

1641
01:02:25,382 --> 01:02:28,819
ACTUALLY INFORMED BY CONNECTING 

1642
01:02:28,819 --> 01:02:30,621
WITH PEOPLE THAT HAD DIFFERING 

1643
01:02:30,621 --> 01:02:32,856
OPINIONS OR OPPONENTS BUT PEOPLE

1644
01:02:32,856 --> 01:02:34,024
WITH DIFFERING OPINIONS AND IT 

1645
01:02:34,024 --> 01:02:35,626
WAS IMPORTANT TO LEAN IN TO 

1646
01:02:35,626 --> 01:02:37,094
CONNECTING WITH PEOPLE THAT HAD 

1647
01:02:37,094 --> 01:02:39,329
DIFFERENT OPINIONS BECAUSE THEY 

1648
01:02:39,329 --> 01:02:41,198
SHARED THEIR VALUES AND THEIR 

1649
01:02:41,198 --> 01:02:41,999
THOUGHTS ON THE ISSUE AND WE 

1650
01:02:41,999 --> 01:02:44,968
WERE ABLE TO SORT OF INFORM 

1651
01:02:44,968 --> 01:02:46,036
ADDITIONAL RESEARCH QUESTIONS 

1652
01:02:46,036 --> 01:02:50,073
AND BUILD EFFECTIVE MESSAGING.  

1653
01:02:50,073 --> 01:02:50,907
WE DISSEMINATED THIS INFORMATION

1654
01:02:50,907 --> 01:02:53,277
THROUGH A MIX OF SOCIAL MEDIA 

1655
01:02:53,277 --> 01:02:54,111
REACHING OUT TO REPORTERS AND 

1656
01:02:54,111 --> 01:02:57,114
THEN WITH THE COMMUNITY ONCE WE 

1657
01:02:57,114 --> 01:02:58,815
IMPLEMENTED THE POLICY CHANGE, 

1658
01:02:58,815 --> 01:03:01,652
WE REACHED OUT THROUGH CHURCH 

1659
01:03:01,652 --> 01:03:03,420
NEWSLETTERS, SPANISH, TV AND 

1660
01:03:03,420 --> 01:03:05,022
RADIO.  ALL RIGHT, I THINK I'M 

1661
01:03:05,022 --> 01:03:08,392
OUT OF TIME.  I AM GOING TO GO 

1662
01:03:08,392 --> 01:03:09,626
THROUGH THESE ONES CAREFULLY.  

1663
01:03:09,626 --> 01:03:12,963
IN 2019, A FEW YEARS AFTER HILDA

1664
01:03:12,963 --> 01:03:16,033
DIED OUR COMMUNITY WORK LED TO 

1665
01:03:16,033 --> 01:03:18,935
POLICY CHANGE.  THIS SHOWS ALL 

1666
01:03:18,935 --> 01:03:21,571
THE STATES THAT HAD PROVIDED 

1667
01:03:21,571 --> 01:03:29,346
ACCESS TO IMMIGRANTS IN 2019 AND

1668
01:03:29,346 --> 01:03:30,113
BECAUSE OF ADDITIONAL CARE, IN 

1669
01:03:30,113 --> 01:03:31,682
ADDITION TO A COST ANALYSIS, 

1670
01:03:31,682 --> 01:03:34,351
THAT SHOWED THAT WE REDUCED CARE

1671
01:03:34,351 --> 01:03:36,887
FROM 20,000 PER PERSON PER MONTH

1672
01:03:36,887 --> 01:03:40,624
TO 5,500 PER PERSON PER MONTH.  

1673
01:03:40,624 --> 01:03:42,993
WE WERE ABLE TO FURTHER 

1674
01:03:42,993 --> 01:03:44,161
DISSEMINATE THIS INFORMATION.  

1675
01:03:44,161 --> 01:03:46,396
THE PARTNERSHIPS WITH OUR 

1676
01:03:46,396 --> 01:03:48,965
POLICYMAKERS LED TO ADDITIONAL 

1677
01:03:48,965 --> 01:03:51,034
PUBLICATIONS IN FACT, WE HAD 

1678
01:03:51,034 --> 01:03:52,969
PUBLISHED A POLICY ANALYSIS THAT

1679
01:03:52,969 --> 01:03:54,971
DESCRIBES A STEP BY STEP POLICY 

1680
01:03:54,971 --> 01:03:56,606
PATHWAY WITH OUR STATE MEDICAID 

1681
01:03:56,606 --> 01:03:58,875
DIRECTOR AND THIS IS THE RESULT 

1682
01:03:58,875 --> 01:04:02,512
OF THE DISSEMINATION OF THIS 

1683
01:04:02,512 --> 01:04:06,450
WORK AND SO TO END, I WANT TO 

1684
01:04:06,450 --> 01:04:08,285
JUST SHARE THAT THIS PICTURE.  

1685
01:04:08,285 --> 01:04:09,553
OUR COMMUNITY STEERING COMMITTEE

1686
01:04:09,553 --> 01:04:11,288
SO THIS IS THE GROUP THAT FWAN 

1687
01:04:11,288 --> 01:04:13,757
THIS WORK WITH US.  WITH HILDA. 

1688
01:04:13,757 --> 01:04:15,892
THIS IS NOW TEN YEARS LATER.  

1689
01:04:15,892 --> 01:04:18,061
AND WE ARE STILL WORKING 

1690
01:04:18,061 --> 01:04:20,230
TOGETHER ON OTHER RESEARCH.  WE 

1691
01:04:20,230 --> 01:04:22,999
HAVE A WHOLE BODY OF WORK 

1692
01:04:22,999 --> 01:04:23,934
FOCUSED ON COMMUNITY HEALTH 

1693
01:04:23,934 --> 01:04:26,370
WORKER INTERVENTIONS TO IMPROVE 

1694
01:04:26,370 --> 01:04:29,139
CARE FOR LATINOS WITH KIDNEY 

1695
01:04:29,139 --> 01:04:30,273
DISEASE, WE'VE CONDUCTED A 

1696
01:04:30,273 --> 01:04:32,142
SINGLE ARM STUDY, A RANDOMIZED 

1697
01:04:32,142 --> 01:04:33,810
CONTROL TRIAL AND NOW WE'RE 

1698
01:04:33,810 --> 01:04:36,113
TESTING AN ADAPTED VERSION OF A 

1699
01:04:36,113 --> 01:04:38,448
NAVIGATE KIDNEY INTERVENTION IN 

1700
01:04:38,448 --> 01:04:41,952
A LARGE-SCALE RCT WE'RE ALSO 

1701
01:04:41,952 --> 01:04:44,421
ENGAGED IN TRANSPLANT ADVOCACY 

1702
01:04:44,421 --> 01:04:45,655
RESEARCH AND POLICY WORK AND 

1703
01:04:45,655 --> 01:04:47,023
CANCER RESEARCH AND POLICY WORK 

1704
01:04:47,023 --> 01:04:50,594
AND SO THIS IS A GROUP THAT HAS 

1705
01:04:50,594 --> 01:04:52,362
MEANINGFULLY BEEN PART OF THE 

1706
01:04:52,362 --> 01:04:56,333
WORK FOR OVER TEN YEARS AND WITH

1707
01:04:56,333 --> 01:04:58,368
EVERY PROJECT THAT WE TAKE ON WE

1708
01:04:58,368 --> 01:05:00,036
TAKE IT ON INTENTIONALLY WITH 

1709
01:05:00,036 --> 01:05:01,638
THE PURPOSE OF CHANGING POLICY 

1710
01:05:01,638 --> 01:05:04,474
IN THE FUTURE.  OR INFORMING 

1711
01:05:04,474 --> 01:05:06,476
POLICY CHANGE.  AND SO THANK YOU

1712
01:05:06,476 --> 01:05:07,210
AND THANK YOU TO EVERYONE THAT 

1713
01:05:07,210 --> 01:05:09,513
HAS BEEN PART OF THIS WORK 

1714
01:05:09,513 --> 01:05:11,481
BECAUSE THIS IS CERTAINLY A 

1715
01:05:11,481 --> 01:05:13,450
JOURNEY I HAVE NOT DONE ON MY 

1716
01:05:13,450 --> 01:05:14,918
OWN.  IT HAS BEEN WITH PATIENTS 

1717
01:05:14,918 --> 01:05:15,552
AND MANY OTHER PARTNERS.  THANK 

1718
01:05:15,552 --> 01:05:23,527
YOU.

1719
01:05:23,527 --> 01:05:24,995
>> THANK YOU SO MUCH TO
EACH OF 

1720
01:05:24,995 --> 01:05:29,966
OUR PANELISTS.  REALLY 

1721
01:05:29,966 --> 01:05:31,001
INSPIRING, GROUNDING TALKS AND I

1722
01:05:31,001 --> 01:05:35,038
WOULD LIKE TO OPEN IT UP TO THE 

1723
01:05:35,038 --> 01:05:37,474
AUDIENCE TO RAISE ANY QUESTIONS 

1724
01:05:37,474 --> 01:05:40,210
MENTS FOR THE PANELISTS.  

1725
01:05:40,210 --> 01:05:41,344
WE'VE GOT 20 MINUTES I BELIEVE 

1726
01:05:41,344 --> 01:05:45,715
TO HAVE A DISCUSSION TOGETHERA  

1727
01:05:45,715 --> 01:05:50,987
I'LL JUST REFLECT AS WE WAIT

1728
01:05:50,987 --> 01:05:52,589
THESE TO COME IN WE HEARD ABOUT

1729
01:05:52,589 --> 01:05:54,024
A RANGE CONDITIONS AND 

1730
01:05:54,024 --> 01:05:56,760
CHALLENGES MANY DIVERSE 

1731
01:05:56,760 --> 01:05:58,128
SETTINGS.  WHERE HEALTH EQUITY 

1732
01:05:58,128 --> 01:05:59,863
HAS BEEN CENTERED AND 

1733
01:05:59,863 --> 01:06:00,764
IMPLEMENTATION SCIENCE 

1734
01:06:00,764 --> 01:06:03,567
ESSENTIALLY AS A TOOL.  AND 

1735
01:06:03,567 --> 01:06:04,201
THERE HAVE BEEN SOME THEMES 

1736
01:06:04,201 --> 01:06:06,703
THROUGHOUT EACH OF THE 

1737
01:06:06,703 --> 01:06:07,404
PRESENTATIONS THAT MIGHT BE 

1738
01:06:07,404 --> 01:06:08,138
WORTH DURING THE COURSE OF THE 

1739
01:06:08,138 --> 01:06:09,372
TRIALLING DOWN INTO A LITTLE BIT

1740
01:06:09,372 --> 01:06:11,508
MORE.  AND I WOULD LOVE TO HEAR 

1741
01:06:11,508 --> 01:06:14,778
FROM EACH OF YOU ABOUT 

1742
01:06:14,778 --> 01:06:16,012
OPPORTUNITIES AND CHALLENGES 

1743
01:06:16,012 --> 01:06:18,782
PARTICULARLY LET'S MAYBE START 

1744
01:06:18,782 --> 01:06:22,786
WITH PARTNERSHIPS AND 

1745
01:06:22,786 --> 01:06:25,722
RELATIONSHIPS.  YOU'VE GOT 

1746
01:06:25,722 --> 01:06:26,756
SUCCESS STORIES BUT I'M SURE 

1747
01:06:26,756 --> 01:06:28,391
WITHOUT CHALLENGES.  IF YOU CAN 

1748
01:06:28,391 --> 01:06:29,860
TALK ABOUT IN THE RESEARCH 

1749
01:06:29,860 --> 01:06:31,862
STRUCTURE WHAT ARE SOME 

1750
01:06:31,862 --> 01:06:33,096
CHALLENGES TO RELATIONSHIP 

1751
01:06:33,096 --> 01:06:36,800
FORMING AND SUSTAINING THAT WE 

1752
01:06:36,800 --> 01:06:47,210
MIGHT WANT TO ADDRESS?

1753
01:06:50,881 --> 01:06:54,784
>> I CAN DIVE IN.  OF
COURSE I 

1754
01:06:54,784 --> 01:06:59,256
WANT TO SAY THANK YOU.  THIS 

1755
01:06:59,256 --> 01:07:01,424
SHOWS THE ART OF THIS WORK IS 

1756
01:07:01,424 --> 01:07:02,692
NOT SHORT-TERM.  IT'S ACTUALLY 

1757
01:07:02,692 --> 01:07:03,627
LONG-TERM.  SO THE CHALLENGES 

1758
01:07:03,627 --> 01:07:05,562
THAT WE FACE AND THE WORK THAT 

1759
01:07:05,562 --> 01:07:06,530
WE DO.  THROUGH THE FIRST TRIAL 

1760
01:07:06,530 --> 01:07:09,866
THAT I SHOWED YOU, I RUN A 

1761
01:07:09,866 --> 01:07:11,635
CLINIC.  I DIDN'T TALK ABOUT MY 

1762
01:07:11,635 --> 01:07:14,070
OWN PERSONAL STORY ABOUT THAT.  

1763
01:07:14,070 --> 01:07:15,906
MY UNCLE DIED ACTUALLY FROM 

1764
01:07:15,906 --> 01:07:22,245
KIDNEY DIALYSIS, 1994, HE DIED 

1765
01:07:22,245 --> 01:07:28,385
IN NIGERIA.  IN NIGERIA THEY 

1766
01:07:28,385 --> 01:07:29,653
DIDN'T HAVE THE SUSTAINABILITY. 

1767
01:07:29,653 --> 01:07:30,787
BUT THE STORY I WAS GOING TO 

1768
01:07:30,787 --> 01:07:34,357
TELL IS THE FACT THAT WHEN WE 

1769
01:07:34,357 --> 01:07:38,228
SAW PATIENTS, A PERCENT OF THE 

1770
01:07:38,228 --> 01:07:40,797
PATIENTS HAVE COMPLICATIONS.  

1771
01:07:40,797 --> 01:07:44,968
AND I BEGAN TO ASK MYSELF, WHAT 

1772
01:07:44,968 --> 01:07:47,804
IS IT WITH THE TRIAL AT THAT 

1773
01:07:47,804 --> 01:07:49,439
TIME, WE'RE RUNNING THE SECOND 

1774
01:07:49,439 --> 01:07:50,674
ONE AND IT BECAME VERY CLEAR 

1775
01:07:50,674 --> 01:07:54,678
THAT WE DON'T HAVE DATA TO SHOW 

1776
01:07:54,678 --> 01:07:57,881
HOW WELL THE COMMUNITY LED 

1777
01:07:57,881 --> 01:07:59,215
INTERVENTIONS WITH THIS 

1778
01:07:59,215 --> 01:08:02,285
POTENTIAL.  THIS IS WAY BACK 

1779
01:08:02,285 --> 01:08:04,220
2008 AND I WENT TO THE 

1780
01:08:04,220 --> 01:08:05,255
DEPARTMENT OF HEALTH.  ALSO 

1781
01:08:05,255 --> 01:08:07,791
MINORITY HEALTH AND SAID WE NEED

1782
01:08:07,791 --> 01:08:09,559
TO START LOOKING AT CHURCHES 

1783
01:08:09,559 --> 01:08:12,128
WHERE WE CAN HAVE REAL DATA.  

1784
01:08:12,128 --> 01:08:14,297
AND THEY SAID NOT SO FAST.  YOU 

1785
01:08:14,297 --> 01:08:16,600
NEED TO MEET WITH THE CLERGY.  

1786
01:08:16,600 --> 01:08:18,535
SO WE'RE HAVING MEETINGS WITH 

1787
01:08:18,535 --> 01:08:20,437
THE CLERGY EVERY MONTH, I AM 

1788
01:08:20,437 --> 01:08:22,572
INTERESTED IN OUR POTENTIAL.  

1789
01:08:22,572 --> 01:08:25,342
THAT IS THE LEAST OF THEIR 

1790
01:08:25,342 --> 01:08:26,610
PROBLEM.  THEY WERE JOINING FIRE

1791
01:08:26,610 --> 01:08:27,777
SAFETY AT THE TIME OF NEW YORK 

1792
01:08:27,777 --> 01:08:34,751
CITY BECAUSE OF THE VIOLATIONS. 

1793
01:08:34,751 --> 01:08:38,755
AND THERE WERE VICTIMS OF THIS. 

1794
01:08:38,755 --> 01:08:40,890
BUT I WAS SLAMMED DOWN ALL THE 

1795
01:08:40,890 --> 01:08:43,093
WAY TO THE NORTH IN COLUMBIA AND

1796
01:08:43,093 --> 01:08:45,128
IT TOOK THREE HOURS EVERY MONTH.

1797
01:08:45,128 --> 01:08:48,798
TO WORK WITH THEM AND THE 

1798
01:08:48,798 --> 01:08:50,800
FACULTY IS NOT WHAT I DO.  AND I

1799
01:08:50,800 --> 01:08:56,039
WAS TOLD, LOOK, THIS DOESN'T 

1800
01:08:56,039 --> 01:08:57,374
LEAD TO THIS.  TODAY, IT IS 

1801
01:08:57,374 --> 01:09:01,211
BEAUTIFUL TO SEE THAT FOLKS ARE 

1802
01:09:01,211 --> 01:09:02,646
INSPIRED AND TO SPEAK THAT 

1803
01:09:02,646 --> 01:09:03,713
LANGUAGE.  IT TOOK A LOT OF 

1804
01:09:03,713 --> 01:09:06,216
WORK.  TO ME, IT TAKES 

1805
01:09:06,216 --> 01:09:07,784
PARTNERSHIP.  AND IT TAKES 

1806
01:09:07,784 --> 01:09:09,886
HAVING A LONG VIEW THAT IT MAY 

1807
01:09:09,886 --> 01:09:12,222
NOT HAPPEN ON YOUR TENURE BUT AT

1808
01:09:12,222 --> 01:09:14,791
THE VERY LEAST ONCE YOU BUILD 

1809
01:09:14,791 --> 01:09:17,794
THAT INFRASTRUCTURE IT IS EASIER

1810
01:09:17,794 --> 01:09:19,362
TO DO A WHOLE HOST MORE.  SO 

1811
01:09:19,362 --> 01:09:21,698
WITH THAT EXPERIENCE, WASN'T A 

1812
01:09:21,698 --> 01:09:23,733
STRETCH FOR US TO PUT TOGETHER 

1813
01:09:23,733 --> 01:09:25,702
THE HEALTH AND MATERIAL SEARCH 

1814
01:09:25,702 --> 01:09:27,704
NETWORK THAT I SHARE WITH YOU 

1815
01:09:27,704 --> 01:09:31,408
ALL.  IN THREE WEEKS OR SIX 

1816
01:09:31,408 --> 01:09:33,343
WEEKS AS A PROPOSAL.  BUILD A 

1817
01:09:33,343 --> 01:09:34,744
SOLUTION AND MAKE IT SO MUCH 

1818
01:09:34,744 --> 01:09:36,012
EASIER BUT IT'S TOUGH WORK.  

1819
01:09:36,012 --> 01:09:39,916
IT'S NOT SOMETHING THAT IS 

1820
01:09:39,916 --> 01:09:42,752
INCENTIVIZED.  IT TAKES A 

1821
01:09:42,752 --> 01:09:43,987
SPECIAL PERSON TO MAKE IT 

1822
01:09:43,987 --> 01:09:47,257
HAPPE

1823
01:09:47,257 --> 01:09:47,490
HAPPEN.

1824
01:09:47,490 --> 01:09:49,559
>> I COULDN'T AGREE MORE
AND IT 

1825
01:09:49,559 --> 01:09:52,929
WAS SO WONNED AND FEEL -- 

1826
01:09:52,929 --> 01:09:54,798
WONDERFUL AND INSPIRING TO HEAR 

1827
01:09:54,798 --> 01:09:57,000
YOUR TALK. 

1828
01:09:57,000 --> 01:09:59,803
SO SOME DEGREE THE FUNDING 

1829
01:09:59,803 --> 01:10:00,804
MODELS MAKE IT CHALLENGING FOR 

1830
01:10:00,804 --> 01:10:02,772
THIS LONG-TERM EMBEDDED 

1831
01:10:02,772 --> 01:10:03,106
PARTNERSHIPS. 

1832
01:10:03,106 --> 01:10:05,642
AND, YOU KNOW, THERE'S BEEN 

1833
01:10:05,642 --> 01:10:07,911
GREAT MOVEMENT IN RECENT TIMES 

1834
01:10:07,911 --> 01:10:09,112
INCLUDING THE NEW COMPASS MODEL 

1835
01:10:09,112 --> 01:10:10,847
THAT NIH HAS SUPPORTED BUT IF 

1836
01:10:10,847 --> 01:10:13,883
YOU THINK ABOUT IT THE WAY WE 

1837
01:10:13,883 --> 01:10:15,819
FUND PROJECTS IS WE GIVE 

1838
01:10:15,819 --> 01:10:18,755
INVESTIGATORS AND INSTITUTIONS 

1839
01:10:18,755 --> 01:10:22,759
AWARDS THAT THEN DO AWARDS TO 

1840
01:10:22,759 --> 01:10:24,060
OUR ORGANIZATIONS AND THAT 

1841
01:10:24,060 --> 01:10:26,296
CHANGES THE POWER DYNAMICS.  I 

1842
01:10:26,296 --> 01:10:27,630
LOVE COMPASS BECAUSE IT FLIPS 

1843
01:10:27,630 --> 01:10:29,399
THE MODEL ON ITS HEAD AND I LOOK

1844
01:10:29,399 --> 01:10:32,802
FORWARD TO SEEING WHAT COMES OUT

1845
01:10:32,802 --> 01:10:33,837
OF THAT BUT REALLY TO DO THIS 

1846
01:10:33,837 --> 01:10:37,574
WORK WELL AND TO ENGAGE IN IT IN

1847
01:10:37,574 --> 01:10:38,808
LONG SUSTAINED MANNER IT 

1848
01:10:38,808 --> 01:10:41,111
REQUIRES EMBEDDING WITH OUR 

1849
01:10:41,111 --> 01:10:42,078
CONTEXTS THAT ARE NOT TYPICALLY 

1850
01:10:42,078 --> 01:10:45,081
OUR ACADEMIC INSTITUTIONS AND 

1851
01:10:45,081 --> 01:10:46,382
THAT CAN BE CHALLENGING FOR 

1852
01:10:46,382 --> 01:10:48,351
EARLY CAREER PEOPLE AND I AM 

1853
01:10:48,351 --> 01:10:50,386
SEEING MOVEMENT IN ACADEMIC 

1854
01:10:50,386 --> 01:10:51,988
INSTITUTIONS AROUND, YOU KNOW, 

1855
01:10:51,988 --> 01:10:53,757
PROMOTION AND TENURE, AROUND 

1856
01:10:53,757 --> 01:10:55,225
UNDERSTANDING WHAT IT TAKES TO 

1857
01:10:55,225 --> 01:10:58,762
DO THIS REALLY THOUGHTFUL, 

1858
01:10:58,762 --> 01:11:05,635
DEEPLY EMBEDDED WORK.  BUT WE'RE

1859
01:11:05,635 --> 01:11:06,870
NOT WHERE WE NEED TO BE TO MAKE 

1860
01:11:06,870 --> 01:11:08,872
THIS SUSTAINABLE AND YOU NEED TO

1861
01:11:08,872 --> 01:11:10,774
HAVE LEADERS IN THE SETTINGS 

1862
01:11:10,774 --> 01:11:12,776
THAT YOU'RE HOPING TO WORK WITH 

1863
01:11:12,776 --> 01:11:14,744
THAT ARE BOUGHT IN THAT AS A 

1864
01:11:14,744 --> 01:11:15,345
SCIENTIST YOU HAVE SOMETHING 

1865
01:11:15,345 --> 01:11:16,346
THAT CAN BE HELPFUL.  BECAUSE WE

1866
01:11:16,346 --> 01:11:18,615
HAVE A LITTLE BIT OF AN UPHILL 

1867
01:11:18,615 --> 01:11:19,849
BATTLE TO COME UP AGAINST 

1868
01:11:19,849 --> 01:11:20,984
BECAUSE WE HAVEN'T ALWAYS KIND 

1869
01:11:20,984 --> 01:11:23,853
OF PUT OTHER PEOPLE'S PRIORITIES

1870
01:11:23,853 --> 01:11:25,421
FIRST.  AND THEN FINALLY I JUST 

1871
01:11:25,421 --> 01:11:28,091
SAY, YOU KNOW, SHIFTING 

1872
01:11:28,091 --> 01:11:30,760
LANDSCAPES.  NEW PARTNERS COME 

1873
01:11:30,760 --> 01:11:32,529
INTO THE CONTEXT SO THE CONSTANT

1874
01:11:32,529 --> 01:11:33,763
CULTIVATION AND, YOU KNOW, YOU 

1875
01:11:33,763 --> 01:11:36,132
HAVE TO ALWAYS BE DOING THE 

1876
01:11:36,132 --> 01:11:36,866
WORK.  AND THAT CAN BE 

1877
01:11:36,866 --> 01:11:39,369
CHALLENGING AS WELL GIVEN THE 

1878
01:11:39,369 --> 01:11:42,772
INCENTIVES AND THE ACADEMIC 

1879
01:11:42,772 --> 01:11:43,940
STRUCTURES.

1880
01:11:43,940 --> 01:11:45,809
>> THANK YOU.  I WILL JUST
ECHO 

1881
01:11:45,809 --> 01:11:48,211
WHAT EVERYONE HAS SAID AND ADD 

1882
01:11:48,211 --> 01:11:50,613
THAT FOR US, YOU KNOW, HAVING 

1883
01:11:50,613 --> 01:11:52,782
OUR COMMUNITY STEERING COMMITTEE

1884
01:11:52,782 --> 01:11:53,783
FOR TEN YEARS HAS BEEN, YOU 

1885
01:11:53,783 --> 01:11:55,485
KNOW, A WORK OF HARD LABOR 

1886
01:11:55,485 --> 01:11:57,854
BECAUSE IT MEANS WE'VE HAD TO 

1887
01:11:57,854 --> 01:12:00,056
HAVE FUNDING FOR TEN YEARS TO 

1888
01:12:00,056 --> 01:12:01,324
MAKE SURE THAT WE CONTINUE TO 

1889
01:12:01,324 --> 01:12:04,360
COMPENSATE OUR COMMUNITY 

1890
01:12:04,360 --> 01:12:08,698
MEMBERS.  AND MOST OF THESE 

1891
01:12:08,698 --> 01:12:10,767
AWARDS ARE ONLY FIVE YEARS LONG 

1892
01:12:10,767 --> 01:12:12,302
AND THE OTHER THING I WOULD ADD 

1893
01:12:12,302 --> 01:12:14,771
CONSIDERING OTHER TYPES OF 

1894
01:12:14,771 --> 01:12:17,307
PARTNERS LIKE FOLKS IN POLICY IS

1895
01:12:17,307 --> 01:12:18,241
REALLY MEANINGFUL AND IMPORTANT 

1896
01:12:18,241 --> 01:12:20,276
BECAUSE WHEN WE THINK ABOUT 

1897
01:12:20,276 --> 01:12:22,745
PRACTICE CHANGE, THOSE ARE THE 

1898
01:12:22,745 --> 01:12:23,413
INDIVIDUALS THAT WE REALLY WANT 

1899
01:12:23,413 --> 01:12:25,215
TO DRAW IN, THAT WE WANT TO 

1900
01:12:25,215 --> 01:12:26,516
CONNECT WITH, TO INFORM SOME OF 

1901
01:12:26,516 --> 01:12:27,884
THESE RESEARCH QUESTIONS THAT 

1902
01:12:27,884 --> 01:12:30,286
WE'RE ASKING AND SO REALLY 

1903
01:12:30,286 --> 01:12:32,522
THINKING THOUGHTFULLY ABOUT WHAT

1904
01:12:32,522 --> 01:12:34,757
DOES PARTNERSHIP MEAN AND 

1905
01:12:34,757 --> 01:12:36,593
ENSURING THAT WE INCLUDE 

1906
01:12:36,593 --> 01:12:37,260
MULTILEVEL, MULTIPERSPECTIVES IN

1907
01:12:37,260 --> 01:12:39,162
THE WORK THAT WE DO.  AND 

1908
01:12:39,162 --> 01:12:42,765
THINKING ABOUT IMPLEMENTATION AT

1909
01:12:42,765 --> 01:12:44,234
THE ONSET.  

1910
01:12:44,234 --> 01:12:46,369
ABOUT, YOU KNOW, HOW IS THIS 

1911
01:12:46,369 --> 01:12:48,404
RESEARCH GOING TO MEANINGFULLY 

1912
01:12:48,404 --> 01:12:50,106
INFORM POLICY CHANGE AND HOW IS 

1913
01:12:50,106 --> 01:12:51,708
IT GOING TO CHANGE BEHAVIOR?  

1914
01:12:51,708 --> 01:12:53,209
AND SO -- THAT'S WHAT I THINK 

1915
01:12:53,209 --> 01:12:56,746
ABOUT WITH RESPECT TO 

1916
01:12:56,746 --> 01:12:59,649
SUSTAINABILITY AND IMPACT.

1917
01:12:59,649 --> 01:13:05,021
>> THANKS FOR THOSE
RESPONSE.  I

1918
01:13:05,021 --> 01:13:08,791
SEE A QUESTION IN THE CHAT THAT 

1919
01:13:08,791 --> 01:13:09,859
IS DIRECTED SPECIFICALLY TO 

1920
01:13:09,859 --> 01:13:12,795
DR. SIR VAN AT THE SCENE IF YOU 

1921
01:13:12,795 --> 01:13:20,436
WANT TO COME OFF MUTE.

1922
01:13:20,436 --> 01:13:22,005
>> THANK YOU.  I ACTUALLY
HAD A 

1923
01:13:22,005 --> 01:13:23,339
QUESTION FOR DR. SIR VAN AT THE 

1924
01:13:23,339 --> 01:13:25,475
SCENE BUT I FEEL OUR OTHER TWO 

1925
01:13:25,475 --> 01:13:26,776
PANELISTS MIGHT WANT TO WEIGH IN

1926
01:13:26,776 --> 01:13:28,811
AS WELL AND I PUT IT IN THE CHAT

1927
01:13:28,811 --> 01:13:30,146
SO YOU CAN LOOK AT IT.  BUT 

1928
01:13:30,146 --> 01:13:32,115
GIVEN THE AMAZING WORK THAT 

1929
01:13:32,115 --> 01:13:34,050
YOU'VE DONE AROUND THIS 

1930
01:13:34,050 --> 01:13:34,784
COMMUNITY ADVOCACY PROJECT HAVE 

1931
01:13:34,784 --> 01:13:37,387
YOU ACTIVELY TRIED TO COLLECT 

1932
01:13:37,387 --> 01:13:38,621
INPUT FROM COMMUNITY PARTNERS 

1933
01:13:38,621 --> 01:13:40,456
AND PATIENTS ON WHAT IT MEANS TO

1934
01:13:40,456 --> 01:13:41,491
THEM TO BE PART OF THESE 

1935
01:13:41,491 --> 01:13:44,527
COMMUNITY ENGAGED ADVOCACY 

1936
01:13:44,527 --> 01:13:45,328
PROJECTS AND WHAT ARE SOME OF 

1937
01:13:45,328 --> 01:13:47,563
THE BEST PRACTICES THAT THEY 

1938
01:13:47,563 --> 01:13:48,831
SEEM TO IDENTIFY THAT 

1939
01:13:48,831 --> 01:13:52,635
RESEARCHERS AND OTHERS CAN 

1940
01:13:52,635 --> 01:14:00,276
CONSIDER?  AND ALSO YOU DID 

1941
01:14:00,276 --> 01:14:00,910
MENTION BUILDING COMMUNITY EARLY

1942
01:14:00,910 --> 01:14:02,445
AND I AM WONDERING IF THERE'S 

1943
01:14:02,445 --> 01:14:04,847
BEEN MORE OF A PUSH TOWARDS OUR 

1944
01:14:04,847 --> 01:14:07,717
EARLY STAGE INVEST DWA TORTOISE 

1945
01:14:07,717 --> 01:14:08,952
BUILD THESE RELATIONSHIPS WITH 

1946
01:14:08,952 --> 01:14:09,786
COMMUNITY MEMBERS BEFORE THEY 

1947
01:14:09,786 --> 01:14:10,753
EVEN DESIGN THEIR RESEARCH 

1948
01:14:10,753 --> 01:14:12,388
PROJECT AND APPLY FOR FUNDING SO

1949
01:14:12,388 --> 01:14:15,425
THAT THEY INCORPORATE THE 

1950
01:14:15,425 --> 01:14:16,292
COMMUNITY'S PERSPECTIVE, NEEDS 

1951
01:14:16,292 --> 01:14:17,627
AND PRIORITIES BEFORE THEY COME 

1952
01:14:17,627 --> 01:14:22,298
IN FOR FUNDING.  THANK YOU SO 

1953
01:14:22,298 --> 01:14:22,765
MUC

1954
01:14:22,765 --> 01:14:22,966
MUCH.

1955
01:14:22,966 --> 01:14:26,769
>> THANK YOU FOR THAT
QUESTION. 

1956
01:14:26,769 --> 01:14:30,206
LY I WILL TRY TO REMEMBER 

1957
01:14:30,206 --> 01:14:30,506
EVERYTHING. 

1958
01:14:30,506 --> 01:14:32,608
I HAVE NOT COLLECTED STRUCTURED 

1959
01:14:32,608 --> 01:14:33,176
FEEDBACK ALTHOUGH THAT'S A 

1960
01:14:33,176 --> 01:14:36,612
FUTURE RESEARCH QUESTION I LOOK 

1961
01:14:36,612 --> 01:14:38,781
INTO.  BUT IT'S INTERESTING 

1962
01:14:38,781 --> 01:14:40,817
BECAUSE I WOULD SAY, SO WE HAVE 

1963
01:14:40,817 --> 01:14:42,752
OUR COMMUNITY STEERING COMMITTEE

1964
01:14:42,752 --> 01:14:44,220
MEETINGS EVERY TWO TO FOUR WEEKS

1965
01:14:44,220 --> 01:14:46,756
BUT THIS COMMUNITY ACTUALLY GETS

1966
01:14:46,756 --> 01:14:48,791
TOGETHER PROBABLY ONE OR TWO 

1967
01:14:48,791 --> 01:14:50,893
EXTRA TIMES PER MONTH BECAUSE 

1968
01:14:50,893 --> 01:14:52,862
THEY HAVE BUILT SUCH STRONG 

1969
01:14:52,862 --> 01:14:54,764
COMRADERY LIKE THEY CELEBRATE 

1970
01:14:54,764 --> 01:14:58,101
THEIR BIRTHDAYS, THEY CELEBRATE 

1971
01:14:58,101 --> 01:14:58,768
QUINCEAÑERA, THEY ARE TOGETHER 

1972
01:14:58,768 --> 01:15:01,237
ALL THE TIME.  I WOULD SAY THE 

1973
01:15:01,237 --> 01:15:03,406
MOST VALUABLE PART OF THIS IS 

1974
01:15:03,406 --> 01:15:04,707
THEY HAVE TRULY CULTIVATED 

1975
01:15:04,707 --> 01:15:10,480
COMMUNITY IN THE TRUEST SENSE.  

1976
01:15:10,480 --> 01:15:12,915
AND WHEN WE NEED AGAIN EVERY TWO

1977
01:15:12,915 --> 01:15:14,784
TO FOUR WEEKS WHAT WE END UP 

1978
01:15:14,784 --> 01:15:17,920
DOING CHANGES EACH TIME AND SO 

1979
01:15:17,920 --> 01:15:19,722
SOMETIMES WE WILL WORK ON 

1980
01:15:19,722 --> 01:15:20,790
FEEDBACK, ON PATIENT FACING 

1981
01:15:20,790 --> 01:15:22,291
MATERIALS FOR OUR CURRENT 

1982
01:15:22,291 --> 01:15:24,060
STUDIES, BUT I LOVE THAT YOU 

1983
01:15:24,060 --> 01:15:26,029
MENTIONED JUNIOR INVESTIGATORS 

1984
01:15:26,029 --> 01:15:30,233
BECAUSE WE INVITE JUNIOR 

1985
01:15:30,233 --> 01:15:32,335
INVESTIGATORS TO PRESENT THEIR 

1986
01:15:32,335 --> 01:15:33,903
RESEARCH FINDINGS AND IT IS SO 

1987
01:15:33,903 --> 01:15:35,938
FUN FOR THEM TO RECEIVE FEEDBACK

1988
01:15:35,938 --> 01:15:37,807
FROM COMMUNITY MEMBERS AND SO 

1989
01:15:37,807 --> 01:15:39,809
THAT HAS BEEN A REAL VALUE ADDED

1990
01:15:39,809 --> 01:15:41,811
TO SORT OF BRING IN OUR JUNIOR 

1991
01:15:41,811 --> 01:15:42,845
FACULTY INTO THESE MEETINGS AND 

1992
01:15:42,845 --> 01:15:44,547
WE DO THIS ACROSS THE NATION 

1993
01:15:44,547 --> 01:15:47,884
TOO.  SO OUR COMMUNITY MEETS AT 

1994
01:15:47,884 --> 01:15:48,918
A NONPROFIT COMMUNITY BASED 

1995
01:15:48,918 --> 01:15:50,119
ORGANIZATION BECAUSE IT'S THE 

1996
01:15:50,119 --> 01:15:52,755
PLACE THAT FEELS SAFE FOR THEM 

1997
01:15:52,755 --> 01:15:54,791
AND WHEN RESEARCHERS PRESENT WE 

1998
01:15:54,791 --> 01:15:57,093
BRING THEM IN VIRTUALLY AND HAVE

1999
01:15:57,093 --> 01:15:57,794
AN IN-PERSON LANGUAGE 

2000
01:15:57,794 --> 01:15:59,162
INTERPRETER.  AND SO THAT'S HOW 

2001
01:15:59,162 --> 01:16:00,830
WE'RE ABLE TO SORT OF 

2002
01:16:00,830 --> 01:16:03,633
MEANINGFULLY IMPACT RESEARCH NOT

2003
01:16:03,633 --> 01:16:05,268
JUST IN COLORADO BUT ACROSS THE 

2004
01:16:05,268 --> 01:16:07,103
COUNTRY AND AS FAR AS SKILLS, I 

2005
01:16:07,103 --> 01:16:13,609
THINK ONE OF THE -- WELL THE 

2006
01:16:13,609 --> 01:16:14,477
FOUR I DESCRIBED ARE PROBABLY 

2007
01:16:14,477 --> 01:16:16,345
KEY BUT I WOULD SAY THE 

2008
01:16:16,345 --> 01:16:16,979
RELATIONSHIP BUILDING HAS BEEN 

2009
01:16:16,979 --> 01:16:18,981
KEY BECAUSE I THINK MANY OF THEM

2010
01:16:18,981 --> 01:16:20,783
NEVER IMAGINED BEING ABLE TO 

2011
01:16:20,783 --> 01:16:22,785
CONNECT WITH, YOU KNOW, AN 

2012
01:16:22,785 --> 01:16:24,821
EXECUTIVE HOSPITAL STAFF MEMBER 

2013
01:16:24,821 --> 01:16:28,691
FOR EXAMPLE.  OR TO HAVE DINNER 

2014
01:16:28,691 --> 01:16:30,760
WITH A GROUP OF CLINICIANS.  I 

2015
01:16:30,760 --> 01:16:32,528
THINK IN BUILDING THESE 

2016
01:16:32,528 --> 01:16:33,729
RELATIONSHIPS IT HAS BEEN VERY 

2017
01:16:33,729 --> 01:16:34,664
MEANINGFUL FOR THEM BECAUSE 

2018
01:16:34,664 --> 01:16:36,432
THEY'RE ABLE TO SORT OF, UTILIZE

2019
01:16:36,432 --> 01:16:38,167
THOSE RELATIONSHIPS TO CONTINUE 

2020
01:16:38,167 --> 01:16:41,304
TO DO ADVOCACY WORK, MANY OF 

2021
01:16:41,304 --> 01:16:42,738
THEM YOU CAN SEE HAVE BECOME 

2022
01:16:42,738 --> 01:16:44,540
NATURAL LEADERS AS WELL WHICH 

2023
01:16:44,540 --> 01:16:45,975
HAS BEEN REALLY FUN AND SO I 

2024
01:16:45,975 --> 01:16:48,344
THINK FOR THEM, SORT OF TAKING 

2025
01:16:48,344 --> 01:16:50,746
ON THESE ADVOCACY SKILLS HAS 

2026
01:16:50,746 --> 01:16:53,049
BEEN VERY IMPORTANT BECAUSE 

2027
01:16:53,049 --> 01:16:54,750
THEY, YOU KNOW, SELF-EFFICACY IN

2028
01:16:54,750 --> 01:16:57,186
THE HOSPITAL BUT JUST TAKING ON 

2029
01:16:57,186 --> 01:16:57,954
ADDITIONAL ADVOCACY ISSUES ON 

2030
01:16:57,954 --> 01:17:00,156
THEIR OWN WITHOUT ME AND WITHOUT

2031
01:17:00,156 --> 01:17:01,624
OTHERS HAS BEEN VERY MEANINGFUL.

2032
01:17:01,624 --> 01:17:06,028
SORRY, I DON'T KNOW FEW  -- IF I

2033
01:17:06,028 --> 01:17:07,296
ANSWERED ALL YOUR QUESTIONS BUT 

2034
01:17:07,296 --> 01:17:08,798
I WILL LET THE OTHERS RESPOND.

2035
01:17:08,798 --> 01:17:11,334
>> I THINK YOU ANSWERED IT

2036
01:17:11,334 --> 01:17:12,135
BEAUTIFULLY BUT YES, I WOULD 

2037
01:17:12,135 --> 01:17:14,971
LIKE TO HEAR FROM THE OTHER 

2038
01:17:14,971 --> 01:17:15,872
PANELISTS.

2039
01:17:15,872 --> 01:17:19,208
>> I CAN WEIGH IN.  WHAT I
TELL 

2040
01:17:19,208 --> 01:17:21,277
MY FACULTY IS THIS, WHEN I WAS A

2041
01:17:21,277 --> 01:17:25,114
JUNIOR FACULTY AND I DESIGNED MY

2042
01:17:25,114 --> 01:17:26,749
FIRST TRIAL, THE ORIGINAL PERSON

2043
01:17:26,749 --> 01:17:28,751
HAD TO SIGN OFF.  AND HE CALLED 

2044
01:17:28,751 --> 01:17:30,753
ME AND SAID WHY ARE YOU DOING 

2045
01:17:30,753 --> 01:17:35,558
THIS WORK?  THIS IS 2008, AND I 

2046
01:17:35,558 --> 01:17:39,829
SAID, WELL, DOES EVERYONE COUNT 

2047
01:17:39,829 --> 01:17:44,433
AS THE GRANT AND HE SAID YEAH.  

2048
01:17:44,433 --> 01:17:47,470
AND I SAID LET'S TUNE IN AND SEE

2049
01:17:47,470 --> 01:17:48,771
WHAT HAPPENS.  WHEN I SEE HIM, 

2050
01:17:48,771 --> 01:17:51,607
NOW AND THEN, HE SAYS MANY YEARS

2051
01:17:51,607 --> 01:17:52,942
AGO, WHY DID YOU LEVERAGE SO 

2052
01:17:52,942 --> 01:17:56,512
MANY GRANTS.  WHAT I SAY TO 

2053
01:17:56,512 --> 01:17:59,448
JUNIOR FACULTY IS LOOK, TIME IS 

2054
01:17:59,448 --> 01:18:01,717
SHORT.  I'M IN THE MEDICAL 

2055
01:18:01,717 --> 01:18:03,119
SCHOOL.  MOST MEDICAL SCHOOLS 

2056
01:18:03,119 --> 01:18:05,655
REMOVE YOU FROM TENURE AND SO 

2057
01:18:05,655 --> 01:18:09,025
THE QUESTION THEN BECOMES KNEW 

2058
01:18:09,025 --> 01:18:12,195
WHAT DO YOU DO WITH THE TIME 

2059
01:18:12,195 --> 01:18:14,363
THAT YOU HAVE?  DON'T DO IT 

2060
01:18:14,363 --> 01:18:18,067
ALONE.  IT TAKES TIME TO BUILD 

2061
01:18:18,067 --> 01:18:19,602
TRUST.  IN WHAT IS PRESENTED, 

2062
01:18:19,602 --> 01:18:21,270
WHAT SHE'S NOT SAYING IS WHAT 

2063
01:18:21,270 --> 01:18:23,406
I'M GOING TO SAY NOW, AND THAT 

2064
01:18:23,406 --> 01:18:24,807
IS -- IT IS THAT PEOPLE DON'T 

2065
01:18:24,807 --> 01:18:28,144
CARE WHAT YOU KNOW UNTIL THEY 

2066
01:18:28,144 --> 01:18:35,818
KNOW THAT YOU CARE.  I THINK SHE

2067
01:18:35,818 --> 01:18:37,220
SHOWED SHE CARED FOR HER 

2068
01:18:37,220 --> 01:18:38,921
COMMUNITY.  AND I SAY TO PEOPLE 

2069
01:18:38,921 --> 01:18:41,224
DON'T TRY TO REINVENT THE WHEEL.

2070
01:18:41,224 --> 01:18:42,858
TRY TO WORK WITH EXISTING 

2071
01:18:42,858 --> 01:18:45,695
COMMUNITY BASED BODIES.  AT 

2072
01:18:45,695 --> 01:18:48,264
LEAST IN EVERY INSTITUTION.  

2073
01:18:48,264 --> 01:18:54,337
MAJOR ONES.  YOU HAVE THE CTS OR

2074
01:18:54,337 --> 01:18:59,976
AT LEAST TRY TO LOOK UP FROM THE

2075
01:18:59,976 --> 01:19:01,310
WEBSITE IN YOUR SCHOOL THE WORK 

2076
01:19:01,310 --> 01:19:02,812
AND YOU LINK UP WITH THEM THAT 

2077
01:19:02,812 --> 01:19:04,814
WAY YOU RIDE ON THEIR COATTAILS 

2078
01:19:04,814 --> 01:19:06,282
TO MAKE IT EASIER TO HAVE ACCESS

2079
01:19:06,282 --> 01:19:10,319
TO THE COMMUNITY.  SO DON'T STOP

2080
01:19:10,319 --> 01:19:12,722
THE WORK.  IT TAKES A LOT OF 

2081
01:19:12,722 --> 01:19:14,957
GUTS AND THESE DAYS, IN OUR 

2082
01:19:14,957 --> 01:19:19,495
INSTITUTION WE ADDED THAT ON THE

2083
01:19:19,495 --> 01:19:20,963
INSTITUTE TO FIGHT FOR HOW WE 

2084
01:19:20,963 --> 01:19:24,066
CAN PUT THAT COMMUNITY BASED 

2085
01:19:24,066 --> 01:19:25,768
WORK AND RECOGNIZE AS PART OF 

2086
01:19:25,768 --> 01:19:29,138
YOUR TENURE SO IT'S NOT JUST 

2087
01:19:29,138 --> 01:19:30,239
SERVICE.  IT'S IMPORTANT 

2088
01:19:30,239 --> 01:19:34,777
ACADEMIC SERVICE I THINK IT'S 

2089
01:19:34,777 --> 01:19:36,979
IMPORTANT TO FIND NETWORKS.

2090
01:19:36,979 --> 01:19:38,781
>> I THINK, YOU KNOW, JUST
TO 

2091
01:19:38,781 --> 01:19:40,650
AMPLIFY THE POINTS THAT HAVE 

2092
01:19:40,650 --> 01:19:42,652
BEEN MADE, I MEAN I THINK 

2093
01:19:42,652 --> 01:19:44,253
APPROACHING ALL OF THIS WITH 

2094
01:19:44,253 --> 01:19:45,454
HUMILITY WHEN I TALK TO OUR 

2095
01:19:45,454 --> 01:19:46,789
COMMUNITY PARTNERS THE THINGS 

2096
01:19:46,789 --> 01:19:48,357
THAT MEAN THE MOST TO THEM IS 

2097
01:19:48,357 --> 01:19:50,660
THAT WE'RE COMING AND SAYING 

2098
01:19:50,660 --> 01:19:52,928
WHAT KEEPS YOU UP AT NIGHT?  HOW

2099
01:19:52,928 --> 01:19:55,965
CAN I BE HELPFUL TO YOU NOT THAT

2100
01:19:55,965 --> 01:19:57,066
I HAVE THIS THING THAT I WANT 

2101
01:19:57,066 --> 01:19:58,434
YOU TO DO AND WHY AREN'T YOU 

2102
01:19:58,434 --> 01:20:00,770
DOING IT.  IT'S SO OBVIOUS AND 

2103
01:20:00,770 --> 01:20:02,471
ALSO THAT IS NOT ALWAYS WHAT 

2104
01:20:02,471 --> 01:20:04,273
PEOPLE DO.  AND SO I THINK 

2105
01:20:04,273 --> 01:20:05,808
LEADING WITH THE NEEDS OF THE 

2106
01:20:05,808 --> 01:20:06,442
COMMUNITY IS REALLY IMPORTANT 

2107
01:20:06,442 --> 01:20:08,177
AND THEN THE OTHER THING AND 

2108
01:20:08,177 --> 01:20:09,645
THIS GOES TO WHAT I WAS SAYING 

2109
01:20:09,645 --> 01:20:11,947
IN MY TALK IS LIKE, WE REALLY 

2110
01:20:11,947 --> 01:20:13,649
ARE ABLE TO EMPOWER OUR 

2111
01:20:13,649 --> 01:20:18,187
COMMUNITY MEMBERS TO BE THE 

2112
01:20:18,187 --> 01:20:19,588
EXPERTS AS DR. CERVANTES 

2113
01:20:19,588 --> 01:20:21,057
PRESENTED SO WELL SO WE DID THIS

2114
01:20:21,057 --> 01:20:22,825
THING WITH, INSTEAD OF ASSUMING 

2115
01:20:22,825 --> 01:20:24,794
THAT WE KNEW THE BEST 

2116
01:20:24,794 --> 01:20:26,195
IMPLEMENTATION STRATEGIES TO 

2117
01:20:26,195 --> 01:20:27,897
DEPLOY EVIDENCE-BASED PRACTICES 

2118
01:20:27,897 --> 01:20:32,935
WE DID AN INNOVATION TOURNAMENT 

2119
01:20:32,935 --> 01:20:34,770
WHICH IS LIKE AMERICAN IDOL BUT 

2120
01:20:34,770 --> 01:20:35,838
FOR IDEAS AND HAVE OUR COMMUNITY

2121
01:20:35,838 --> 01:20:37,840
TELL US WHAT IS NEEDED AND WE 

2122
01:20:37,840 --> 01:20:39,208
HAD THIS BIG PARTY WHERE THE 

2123
01:20:39,208 --> 01:20:41,444
COMMISSIONER WAS THERE AND ALL 

2124
01:20:41,444 --> 01:20:42,845
THE CLINICIANS WHO WERE THE 

2125
01:20:42,845 --> 01:20:44,847
WINNING FOLKS BROUGHT THEIR 

2126
01:20:44,847 --> 01:20:50,453
PARTNERS, THEIR BOSSES, THIS WAS

2127
01:20:50,453 --> 01:20:52,021
MEANINGFUL, SOMEONE CARED TO 

2128
01:20:52,021 --> 01:20:53,856
LISTEN TO THEM AND AMPLIFIED 

2129
01:20:53,856 --> 01:20:55,524
THEIR EXPERIENCE.  I THINK 

2130
01:20:55,524 --> 01:20:59,929
EMPOWERING FOLKS TO BET TTEX  T 

2131
01:20:59,929 --> 01:21:00,796
EXPERTS RATHER THAN US. 

2132
01:21:00,796 --> 01:21:02,365
BECAUSE WE'RE NOT. 

2133
01:21:02,365 --> 01:21:04,233
THE ONLY OTHER THING I WANT TO 

2134
01:21:04,233 --> 01:21:06,702
SAY ABOUT EARLY CAREER 

2135
01:21:06,702 --> 01:21:08,070
INVESTIGATORS, WHEN I WAS AT 

2136
01:21:08,070 --> 01:21:10,306
PENN WHERE THERE'S A T32 WHERE 

2137
01:21:10,306 --> 01:21:13,442
WE EM GO AHEAD POSTDOCS IN THE 

2138
01:21:13,442 --> 01:21:13,976
COMMUNITY ORGANIZATION. 

2139
01:21:13,976 --> 01:21:14,977
AND THE PROJECT WAS BASED ON A 

2140
01:21:14,977 --> 01:21:18,748
NEED FOR THAT COMMUNITY BASED 

2141
01:21:18,748 --> 01:21:21,384
ORGANIZATION.  USING THE 

2142
01:21:21,384 --> 01:21:22,318
TRAINING THEY WERE GETTING 

2143
01:21:22,318 --> 01:21:24,587
THROUGH THE T32.  PEOPLE ARE 

2144
01:21:24,587 --> 01:21:26,789
HUNGRY FOR THIS.  EARLY STAGE 

2145
01:21:26,789 --> 01:21:29,225
INVESTIGATORS WANT TO DO THIS 

2146
01:21:29,225 --> 01:21:30,760
WORK SO THE MORE WE CAN DO TO 

2147
01:21:30,760 --> 01:21:34,764
EMBED THEM THE BETTER.

2148
01:21:34,764 --> 01:21:38,734
>> APPRECIATE YOU ALL.  I
DID 

2149
01:21:38,734 --> 01:21:40,403
WANT TO PUT OUT ONE OTHER 

2150
01:21:40,403 --> 01:21:41,103
QUESTION.  ANOTHER THEME THAT 

2151
01:21:41,103 --> 01:21:42,772
RAN THROUGH ALL YOUR TALKS IS 

2152
01:21:42,772 --> 01:21:44,607
SOCIAL DETERMINANTS OF HEALTH OR

2153
01:21:44,607 --> 01:21:46,175
SOCIAL RISK AND I'M SURE YOU'RE 

2154
01:21:46,175 --> 01:21:48,811
FAMILIAR WITH IT WASN'T STATED 

2155
01:21:48,811 --> 01:21:52,381
EXPLICITLY THE NATIONAL 

2156
01:21:52,381 --> 01:21:54,517
ACADEMY'S FIVE AS.  THE 

2157
01:21:54,517 --> 01:21:57,186
AWARENESS, AWARENESS OF SOCIAL 

2158
01:21:57,186 --> 01:21:58,454
RISKS, ASSISTANCE, SO DIRECTLY 

2159
01:21:58,454 --> 01:22:00,623
SORT OF TARGETING, ADJUSTMENT OR

2160
01:22:00,623 --> 01:22:02,458
CARE IS MODIFIED, YOU KNOW, WITH

2161
01:22:02,458 --> 01:22:05,928
THE SOCIAL RISKS IN MIND, 

2162
01:22:05,928 --> 01:22:08,297
ALIGNMENT, WHERE THE SOCIAL CARE

2163
01:22:08,297 --> 01:22:10,332
ASSETS OF THE COMMUNITY ARE 

2164
01:22:10,332 --> 01:22:11,934
UNDERSTOOD AND TAKEN INTO 

2165
01:22:11,934 --> 01:22:13,769
ACCOUNT AND ADVOCACY WHICH IS 

2166
01:22:13,769 --> 01:22:15,805
PRETTY SELF DESCRIPTIVE AND I 

2167
01:22:15,805 --> 01:22:17,706
WONDER IF YOU CAN REFLECT ON AS 

2168
01:22:17,706 --> 01:22:21,744
YOU THINK OF IMPLEMENTATION 

2169
01:22:21,744 --> 01:22:22,778
SCIENCE ITS ROLE AS A TOOL.  

2170
01:22:22,778 --> 01:22:24,480
WHAT ARE THE OBVIOUS 

2171
01:22:24,480 --> 01:22:26,415
OPPORTUNITIES IF YOU HAVE THAT 

2172
01:22:26,415 --> 01:22:29,351
FRAME WO

2173
01:22:29,351 --> 01:22:33,722
FRAMEWORK IN MIND AND WHAT ARE 

2174
01:22:33,722 --> 01:22:37,226
THE MOST CHALLENGING?

2175
01:22:37,226 --> 01:22:39,395
>> I CAN TRY.  I GAVE A
TALK ON 

2176
01:22:39,395 --> 01:22:42,698
ACADEMIC HEALTH IN 2022 ON 

2177
01:22:42,698 --> 01:22:45,601
TALKING ABOUT THE CELL SCIENCE 

2178
01:22:45,601 --> 01:22:48,237
MODULES.  IT'S VERY CHALLENGING 

2179
01:22:48,237 --> 01:22:50,239
TO SHOEHORN EARLY MODELS INTO 

2180
01:22:50,239 --> 01:22:51,674
REAL LIFE EXPERIENCE SO WHAT I 

2181
01:22:51,674 --> 01:22:54,376
SAY IN THE FIELD IS THAT IT WILL

2182
01:22:54,376 --> 01:22:55,845
HAVE TO UNDERSTAND WHAT IS THE 

2183
01:22:55,845 --> 01:22:58,414
USE OF THE CONCEPTUAL MODEL?  

2184
01:22:58,414 --> 01:23:00,716
IT'S NOT HOLY GRAIL.  YOU JUST 

2185
01:23:00,716 --> 01:23:02,685
WANT TO UNDERSTAND HOW YOU 

2186
01:23:02,685 --> 01:23:03,752
ACTUALLY DECIPHER INFORMATION, 

2187
01:23:03,752 --> 01:23:06,755
HOW YOU USE THAT TO INFORM THE 

2188
01:23:06,755 --> 01:23:08,290
INTERVENTION THAT YOU HAVE.  OUR

2189
01:23:08,290 --> 01:23:09,692
SCIENTISTS ENJOY THE MODEL.  

2190
01:23:09,692 --> 01:23:18,434
WHAT I FIND THE MODELS, ONE IS 

2191
01:23:18,434 --> 01:23:21,070
GREAT.  IT'S NOT LIKE IT WAS TEN

2192
01:23:21,070 --> 01:23:24,807
YEARS AGO.  AND WE HAD ONE WITH 

2193
01:23:24,807 --> 01:23:26,141
A MODULE THAT EVERYBODY ALSO 

2194
01:23:26,141 --> 01:23:28,878
HAVE A WAY TO LOOK AT THAT LOGIC

2195
01:23:28,878 --> 01:23:30,379
MODEL.  IT TALKS ABOUT THE 

2196
01:23:30,379 --> 01:23:32,615
EVIDENCE, I THINK TALKS ABOUT 

2197
01:23:32,615 --> 01:23:34,750
YOUR CHANGING.  I THINK PEOPLE 

2198
01:23:34,750 --> 01:23:36,986
GET LOST.  SO IT'S HIGHLY 

2199
01:23:36,986 --> 01:23:38,721
CHALLENGING.  AND THEN -- THE 

2200
01:23:38,721 --> 01:23:41,624
OTHER CHALLENGE IS THAT I DON'T 

2201
01:23:41,624 --> 01:23:42,791
BELIEVE THAT IF THE ADDITIONAL 

2202
01:23:42,791 --> 01:23:44,927
SCIENCE YOU HAVE UNDERMINES 

2203
01:23:44,927 --> 01:23:45,995
TRIALS.  THAT'S FOR THE 

2204
01:23:45,995 --> 01:23:48,631
SCIENTIFIC WORLD WANTS.  WHAT IT

2205
01:23:48,631 --> 01:23:50,599
DOESN'T WANT.  LET ME TELL YOU 

2206
01:23:50,599 --> 01:23:53,002
WHY.  YOU LOOK AT THE 

2207
01:23:53,002 --> 01:23:55,070
BOUNDARIES.  YOU LOOK AT THE 

2208
01:23:55,070 --> 01:23:56,405
CHALLENGE.  THERE'S THE PATIENTS

2209
01:23:56,405 --> 01:23:58,707
AROUND.  WHEN YOU DO THAT THE 

2210
01:23:58,707 --> 01:24:00,709
HEALTH CARE SYSTEM CHANGES.  IT 

2211
01:24:00,709 --> 01:24:02,211
DOESN'T WAIT.  THINGS ARE 

2212
01:24:02,211 --> 01:24:04,947
HAPPENING EVERYDAY.  COMMUNITIES

2213
01:24:04,947 --> 01:24:06,749
CHANGE TOO BY THE WAY.  QUICKLY.

2214
01:24:06,749 --> 01:24:08,317
WE HAVE TO REIMAGINE WHAT THE 

2215
01:24:08,317 --> 01:24:10,219
CLINICAL TRIAL CAN HELP US TO DO

2216
01:24:10,219 --> 01:24:12,254
HERE.  THE REASON IS NOT HOLY 

2217
01:24:12,254 --> 01:24:12,988
GRAIL.  CONTEXT IS DIFFERENT IN 

2218
01:24:12,988 --> 01:24:15,858
EVERY PLACE.  IF YOU IMPLEMENT 

2219
01:24:15,858 --> 01:24:17,326
IT IN CHICAGO.  IT DOESN'T NEED 

2220
01:24:17,326 --> 01:24:19,695
TO WORK IN ARIZONA, OR PHOENIX, 

2221
01:24:19,695 --> 01:24:21,230
OR WORK IN NEW YORK CITY.  SO WE

2222
01:24:21,230 --> 01:24:24,800
HAVE TO UNDERSTAND THAT AND THE 

2223
01:24:24,800 --> 01:24:26,769
CONTEXT CHANGES OVER TIME AS 

2224
01:24:26,769 --> 01:24:29,605
WELL SO AROUND THAT TIME, GUESS 

2225
01:24:29,605 --> 01:24:31,407
WHAT, YOUR PREMISE HAS ALREADY 

2226
01:24:31,407 --> 01:24:32,341
CHANGED WHICH MEANS YOUR 

2227
01:24:32,341 --> 01:24:33,776
INTERVENTIONS SO TO ME IT IS 

2228
01:24:33,776 --> 01:24:36,211
THE -- WITHIN SYSTEM CHANGE THAT

2229
01:24:36,211 --> 01:24:38,480
IT IS VERY IMPORTANT.  IF YOU 

2230
01:24:38,480 --> 01:24:39,815
THINK ABOUT TIME SAVING ANALYSIS

2231
01:24:39,815 --> 01:24:42,651
TO HELP US MAKE THIS HAPPEN AND 

2232
01:24:42,651 --> 01:24:45,220
YOU CAN ADD THAT.  SO THAT'S MY 

2233
01:24:45,220 --> 01:24:46,755
OWN FOR THE CHALLENGES HOLD FOR 

2234
01:24:46,755 --> 01:24:48,724
US IS LOOKING FOR THAT 

2235
01:24:48,724 --> 01:24:51,293
INNOVATIVE METHOD THAT YOU CAN 

2236
01:24:51,293 --> 01:24:58,500
USE IN THE INTONATION.

2237
01:24:58,500 --> 01:25:00,035
>> I THINK THAT IS RIGHT. 
I 

2238
01:25:00,035 --> 01:25:01,337
THINK AS A FIELD WE HAVE 

2239
01:25:01,337 --> 01:25:02,471
CENTERED EQUITY AND THINKING 

2240
01:25:02,471 --> 01:25:04,306
ABOUT HOW SUH EFFECT OUR ABILITY

2241
01:25:04,306 --> 01:25:06,775
TO IMPLEMENT OUR THINGS LIKE I 

2242
01:25:06,775 --> 01:25:07,810
THINK WE HAVE THAT AWARENESS 

2243
01:25:07,810 --> 01:25:08,611
PIECE COVERED AT THIS POINT 

2244
01:25:08,611 --> 01:25:12,081
WE'VE STARTED TO INTEGRATE THESE

2245
01:25:12,081 --> 01:25:14,516
CONCEPTS INTO OUR CONCEPTUAL 

2246
01:25:14,516 --> 01:25:15,117
FRAMEWORKS ALTHOUGH I AGREE 

2247
01:25:15,117 --> 01:25:16,318
THERE ARE TOO MANY.  I THINK 

2248
01:25:16,318 --> 01:25:17,653
PROBABLY THE AREA FOR FUTURE 

2249
01:25:17,653 --> 01:25:18,754
STUDY IS REALLY THINKING ABOUT 

2250
01:25:18,754 --> 01:25:21,256
MORE EQUITY FOCUSED 

2251
01:25:21,256 --> 01:25:22,691
IMPLEMENTATION STRATEGIES.  WE 

2252
01:25:22,691 --> 01:25:25,995
TEND TO FOCUS ON CLINICIANS 

2253
01:25:25,995 --> 01:25:26,729
MAYBE ORGANIZATIONS WHEN WE ARE 

2254
01:25:26,729 --> 01:25:29,198
DOING OUR STUDIES AND I THINK 

2255
01:25:29,198 --> 01:25:30,599
REALLY WHAT OUR PRESENTERS DID 

2256
01:25:30,599 --> 01:25:32,968
SUCH A BEAUTIFUL JOB OF TODAY IS

2257
01:25:32,968 --> 01:25:34,536
SHOWING HOW THIS MULTILEVEL 

2258
01:25:34,536 --> 01:25:36,572
APPROACH IS SO MUCH MORE 

2259
01:25:36,572 --> 01:25:37,573
POWERFUL.  AND SO I THINK THAT 

2260
01:25:37,573 --> 01:25:39,742
FOR ME, I THINK, AND I'M NOT 

2261
01:25:39,742 --> 01:25:41,677
SURE WHICH A THAT FALLS INTO.  

2262
01:25:41,677 --> 01:25:45,914
BUT I THINK THAT'S THE AREA FOR 

2263
01:25:45,914 --> 01:25:47,916
FUTURE WORK.

2264
01:25:47,916 --> 01:25:51,186
>> YEAH, AND MICHELE, HAS
PUT A 

2265
01:25:51,186 --> 01:25:53,022
DIFFERENT SPIN ON MY QUESTION.  

2266
01:25:53,022 --> 01:25:57,526
I WOULD LOVE TO HEAR YOU ADDRESS

2267
01:25:57,526 --> 01:26:00,062
DR. CERVANTES AS WE WRAP UP I 

2268
01:26:00,062 --> 01:26:07,636
CAN SEE THAT IN THE CHAT.  SO IN

2269
01:26:07,636 --> 01:26:11,807
TERMS OF THE ADVOCACY AND THE 

2270
01:26:11,807 --> 01:26:14,476
POLICY CHANGE THAT YOUR GROUP 

2271
01:26:14,476 --> 01:26:15,177
UNDERTOOK.  CAN YOU SPEAK MORE 

2272
01:26:15,177 --> 01:26:22,751
TO THE COMMUNITY EXPECTATIONS?

2273
01:26:22,751 --> 01:26:24,687
>> YEAH WITH RESPECT TO
ADVOCACY

2274
01:26:24,687 --> 01:26:26,622
AND SOME OF THE FRAMEWORKS.  I 

2275
01:26:26,622 --> 01:26:28,057
THINK, YOU KNOW, ONCE BEGIN 

2276
01:26:28,057 --> 01:26:29,958
THINK IT'S CRITICALLY IMPORTANT 

2277
01:26:29,958 --> 01:26:32,027
TO THINK ABOUT THE CHANGE THAT 

2278
01:26:32,027 --> 01:26:33,295
WE WANT TO SEE.  YOU KNOW, THE 

2279
01:26:33,295 --> 01:26:34,763
OUTCOME THAT WE WANT TO SEE AND 

2280
01:26:34,763 --> 01:26:36,765
WHAT ARE THE STUDIES THAT WILL 

2281
01:26:36,765 --> 01:26:39,301
HELP US GET TO THAT PRACTICE 

2282
01:26:39,301 --> 01:26:41,870
CHANGE OUTCOME.  AND FROM THE 

2283
01:26:41,870 --> 01:26:44,306
COMMUNITY PERSPECTIVE, WHEN WE 

2284
01:26:44,306 --> 01:26:47,776
STARTED THIS WORK I'M NOT SURE 

2285
01:26:47,776 --> 01:26:50,179
THAT THEY EXPECTED THE CHANGE TO

2286
01:26:50,179 --> 01:26:51,513
HAPPEN SO QUICKLY.  YOU KNOW, IT

2287
01:26:51,513 --> 01:26:52,448
HAPPENED JUST FOUR YEARS AFTER 

2288
01:26:52,448 --> 01:26:54,750
HILDA PASSED AWAY.  BUT THEY 

2289
01:26:54,750 --> 01:26:56,719
WERE DETERMINED.  AND SO THEIR 

2290
01:26:56,719 --> 01:26:58,487
EXPECTATION WAS WE ARE GOING TO 

2291
01:26:58,487 --> 01:26:59,388
CHANGE THIS REGARDLESS OF HOW 

2292
01:26:59,388 --> 01:27:01,156
MANY YEARS IT TAKES TO CHANGE 

2293
01:27:01,156 --> 01:27:03,926
THIS.  AND I THINK MOVING 

2294
01:27:03,926 --> 01:27:05,227
FORWARD, THE CHALLENGES IN 

2295
01:27:05,227 --> 01:27:06,628
CONSIDERING THE SOCIAL 

2296
01:27:06,628 --> 01:27:08,464
DETERMINANTS OF HEALTH IS THAT, 

2297
01:27:08,464 --> 01:27:09,431
FROM MY PERSPECTIVE, SOME OF 

2298
01:27:09,431 --> 01:27:10,933
THEM ARE MODIFIABLE AND SOME OF 

2299
01:27:10,933 --> 01:27:14,036
THEM ARE A LITTLE MORE 

2300
01:27:14,036 --> 01:27:17,473
CHALLENGING TO MODIFY.  

2301
01:27:17,473 --> 01:27:18,741
ESPECIALLY GIVING SORT OF 

2302
01:27:18,741 --> 01:27:23,412
CHANGING STRUCTURES AND 

2303
01:27:23,412 --> 01:27:24,813
ADMINISTRATIONS AND SO YOU KNOW 

2304
01:27:24,813 --> 01:27:27,349
THERE ARE CERTAIN GROUPS THAT 

2305
01:27:27,349 --> 01:27:30,652
WILL BE EXCLUDED MOVING FORWARD 

2306
01:27:30,652 --> 01:27:32,654
AND SO I THINK YOU KNOW, FOR MY 

2307
01:27:32,654 --> 01:27:34,757
WORK AT LEAST, IT'S INCREASINGLY

2308
01:27:34,757 --> 01:27:37,626
IMPORTANT TO REALLY THINK ABOUT 

2309
01:27:37,626 --> 01:27:41,463
THE STRUCTURES THAT REDUCE THE 

2310
01:27:41,463 --> 01:27:42,631
QUALITY OF HEALTH BECAUSE 

2311
01:27:42,631 --> 01:27:45,100
CERTAIN GROUPS ARE EXCLUDED AND 

2312
01:27:45,100 --> 01:27:48,837
HOW WE SORT OF MOVE FORWARD WITH

2313
01:27:48,837 --> 01:27:53,142
POLICY CHANGE AND RESEARCH.

2314
01:27:53,142 --> 01:27:54,209
>> GRATEFUL TO EACH OF YOU
FOR 

2315
01:27:54,209 --> 01:27:57,446
YOUR INSIGHTS, YOUR PERSPECTIVE,

2316
01:27:57,446 --> 01:27:58,747
YOUR TIME, THIS IS ABSOLUTELY TO

2317
01:27:58,747 --> 01:28:00,816
ECHO THIS THE CHAT A FABULOUS 

2318
01:28:00,816 --> 01:28:01,750
SESSION.  THANK YOU SO MUCH AND 

2319
01:28:01,750 --> 01:28:04,119
WE'LL LET YOU KNOW WHEN THE LINK

2320
01:28:04,119 --> 01:28:05,554
IS AVAILABLE.

2321
01:28:05,554 --> 01:28:06,855
>> THANK YOU.  THANK YOU
VERY 

2322
01:28:06,855 --> 01:28:07,189
MUCH.

2323
01:28:07,189 --> 01:28:09,458
>> TAKE CARE.

2324
01:28:09,458 --> 01:28:09,992
>> THANK YOU.

2325
01:28:09,992 --> 01:28:20,536
GUESS WE'LL SEE YOU
GUYS. .