ALL RIGHT, SO LET'S GET
STARTED THIS MORNING.
THANK YOU ALL FOR JOINING US
AGAIN TODAY'S.
MY NAME IS JOHN GREYSON, I'M
FROM THE NATIONAL INSTITUTE OF
NURSING RESEARCH AND I'M PROUD
TO BE ONE OF THE CO-CHAIRS OF
THE IMPROVE COORDINATING
COMMITTEE.
SO WE HEARD SOME GREAT
PERSPECTIVES AND LEARNED ABOUT
SOME OUTSTANDING SCIENCE FROM
OUR INVESTIGATORS AND COMMUNITY
PARTNERS AND TECHNOLOGY TEAMS ON
DAY ONE AND I'M REALLY LOOKING
FORWARD TO HEARING MORE FROM
MANY MORE OF OUR IMPROVE
PARTNERS ON DAY TWO.
YESTERDAY YOU HEARD FROM TWO OF
THE IMPROVE EXECUTIVE CO-CHAIRS,
DR. BIANCHI AND DR. CLAYTON, AND
TO START US OFF TODAY, I'M VERY
PLEASED TO INTRODUCE THE THIRD
CO-CHAIR, DR. SHANNON ZENK,
DIRECTOR OF THE NATIONAL
INSTITUTE OF NURSING RESEARCH
AND ALSO MY BOSS.
SHE'LL SAY A FEW WORDS ABOUT
IMPROVE'S EMPHASIS ON THE
RELATIONSHIPS BETWEEN SOCIAL
DETERMINANTS OF HEALTH AND
HEALTH EQUITY AND MATERNAL
MORBIDITY AND MORTALITY.
DR. ZENK JOINED NINR AS ITS
DIRECTOR IN 2020, WHERE SHE LED
THE DEVELOPMENT OF A NEW
STRATEGIC VISION AND STRATEGIC
PLAN FOR THE INSTITUTE.
THAT CENTERS ON SOCIAL
DETERMINANTS OF HEALTH AND
HEALTH EQUITY IN THE ROLE OF
NURSES AND NURSE SCIENTISTS IN
THE RESEARCH LANDSCAPE.
DR. ZENK ALSO LEADS THE
NEIGHBORHOODS AND HEALTH LAB IN
THE NATIONAL INSTITUTE ON
MINORITY HEALTH AND HEALTH
DISPARITIES INTRAMURAL PROGRAM
AND HER RESEARCH CENTERS ON
ENVIRONMENTAL EXPOSURES AND
INJUSTICE AND THE ROLE THOSE
PLAY IN HEALTH DISPARITIES.
WITH THE ULTIMATE GOAL OF
PRODUCING EVIDENCE TO HELP
ELIMINATE RACIAL/ETHNIC AND
SOCIOECONOMIC HEALTH
DISPARITIES.
SO WITHOUT FURTHER DELAY, I'D
LIKE TO INTRODUCE DR. SHANNON
ZENK.
[APPLAUSE]
>> GOOD MORNING TO EVERYONE AND
WELCOME TO DAY TWO OF THE
IMPROVE INITIATIVE'S FIFTH
ANNIVERSARY MEETING.
WELCOME.
WE LEARNED YESTERDAY AND AS WE
WILL SEE AGAIN TODAY THAT
IMPROVE HAS MADE TREMENDOUS
PROGRESS BECAUSE OF YOU OVER THE
LAST FIVE YEARS.
AND IT'S LAID A STRONG
FOUNDATION FOR FUTURE
DISCOVERIES THAT WILL HOPEFULLY
SIGNIFICANTLY REDUCE THE RATES
OF MATERNAL MORBIDITY AND
MORTALITY IN THE U.S. AND THE
TREMENDOUS DISPARITIES WE SEE IN
THEM.
WE HAVE ANOTHER PACKED AGENDA
TODAY, SHOWCASING THE RESEARCH
AND ACHIEVEMENTS OF THE MANY
INVESTIGATORS WHO HAVE RECEIVED
FUNDING UNDER IMPROVE.
SO I'M GOING TO KEEP MY REMARKS
BRIEF, BUT I WOULD LIKE TO TALK
ABOUT ONE ASPECT OF IMPROVE THAT
I AM ESPECIALLY PROUD OF, AND
THAT IS IMPROVE'S FOCUS ON THE
SOCIAL DETERMINANTS OF HEALTH.
AND HEALTH EQUITY.
MAYBE I DO NEXT SLIDE.
THAT WILL HELP.
MAYBE.
SO MANY OF YOU ALREADY KNOW THIS
BUT THE CONTRIBUTIONS OF THE
SOCIAL DETERMINANTS OF HEALTH TO
PUBLIC HEALTH ISSUES LIKE
MATERNAL MORBIDITY AND MORTALITY
ARE CERTAINLY PROFOUND.
FACTORS AT MULTIPLE LEVELS FROM
BIOLOGICAL TO SOCIETAL INTERACT
TO INITIATE MATERNAL HEALTH. SO
WE'RE STRICTING OUR FOCUS TO
ONLY THE MOST PROC MALL OF THE S
OF THE CONTRIBUTING FACTORS AND
CAUSES REALLY PROVIDES AN
INCOMPLETE UNDERSTANDING AT BEST
AND CAN BE MISLEADING, BUT
ULTIMATELY MISDIRECTS RESOURCES
AND CAN OVERLOOK SOLUTIONS.
TO IMPROVE MATERNAL HEALTH
OUTCOMES AND ELIMINATE
DISPARITIES, OUR RESEARCH MUST
EXTEND WELL BEYOND THE HOSPITAL
AND CLINIC WALLS TO PRIORITIZE
SOCIAL DETERMINANTS OF HEALTH,
OR THE CONDITIONS IN WHICH
PEOPLE ARE BORN, GROW, LEARN,
WORK, PLAY, LIVE AND AGE.
AND THE WIDER SET OF STRUCTURAL
FACTORS THAT SHAPE THOSE
CONDITIONS.
AND WE HAVE TO PRIORITIZE THOSE
CONDITIONS ON PAR WITH THE MORE
PROXIMAL CAUSES OF MATERNAL
MORBIDITY AND MORTALITY.
NIH AS A WHOLE IS COMMITTED TO
ADVANCING INOWE VAW INNOVATIVE N
THE SOCIAL DETERMINANTS OF
HEALTH WITH THE ESTABLISHMENT OF
AN NIH-WIDE RESEARCH
COORDINATING COMMITTEE.
AND THAT'S ALSO WHY WE'VE WORKED
REALLY HARD TO INTEGRATE A FOCUS
ON SOCIAL DETERMINANTS OF HEALTH
INTO IMPROVE.
I'M GOING TO SHARE JUST A TINY
EXAMPLE OF WHY.
SO THE MATERNAL VULNERABILITY
INDEX YOU MAY HAVE SEEN THIS
BEFORE, IT GIVES US A PICTURE OF
WHERE AND WHY BIRTHING PEOPLE
ARE MOST VULNERABLE TO POOR
MATERNAL HEALTH OUTCOMES.
THE VULNERABILITY INDEX
CONSIDERS PHYSICAL HEALTH,
MENTAL HEALTH, AND SUBSTANCE
USE.
BUT IMPORTANTLY, IT ALSO
INCORPORATES SOCIOECONOMIC
FACTORS SUCH AS POVERTY AND
EDUCATIONAL ATTAINMENT.
ENVIRONMENTAL FACTORS SUCH AS
VIOLENCE, CRIME, TRANSPORTATION,
HOUSING, AND POLLUTION.
AS WELL AS THE ACCESSIBILITY AND
AFFORDABILITY OF HEALTHCARE.
THE INDEX HIGHLIGHTS THAT WE
MUST PAY ATTENTION TO ALL OF
THESE FACTORS, INCLUDING SOCIAL
DETERMINANTS OF HEALTH, AS ROOT
CAUSES IN ORDER TO IMPROVE
MATERNAL HEALTH OUTCOMES.
AS MANY PRESENTATIONS
HIGHLIGHTED YESTERDAY, EACH
STATE, COUNTY AND COMMUNITY WILL
HAVE UNIQUE AND DIFFERENT ISSUES
TO ADDRESS THAT WILL REQUIRE
INTERVENTIONS, TARGETED TO
SPECIFIC POPULATIONS, AND
CIRCUMSTANCES IN ORDER TO
IMPROVE OUTCOMES.
SO A FOCUS ON SOCIAL
DETERMINANTS OF HEALTH THEN IS
ABSOLUTELY CRITICAL TO
ADDRESSING THE LARGE AND HIGHLY
TROUBLING DISPARITIES IN
MATERNAL MORBIDITY AND MORTALITY
THAT WE SEE BASED ON RACE,
ETHNICITY, SOCIOECONOMIC STATUS,
AS WELL AS OTHER FACTORS.
FOR EXAMPLE, BLACK AND AMERICAN
INDIAN/ALASKA NATIVE BIRTHING
PEOPLE ARE 2 TO 4 TIMES MORE
LIKELY TO DIE OF
PREGNANCY-RELATED CAUSES IN THE
UNITED STATES THAN THEIR WHITE
COUNTERPARTS.
LOOKING AGAIN AT THE
VULNERABILITY INDEX, WE SEE
BLACK AND AMERICAN INDIAN,
ALASKA NATIVE BIRTHING PEOPLE
ARE MORE LIKELY THAN WHITE
COUNTERPARTS TO LIVE IN AREAS
WITH HIGH VULNERABILITY TO POOR
MATERNAL HEALTH OUTCOMES.
SO WE NEED TO BETTER UNDERSTAND
THE STRUCTURAL AND SOCIAL
FACTORS ROOTED IN STRUCTURAL
RACISM AND OTHER DISCRIMINATORY
SYSTEMS THAT LEAD TO THESE
DISPARITIES AND IMPORTANTLY TO
IDENTIFY EFFECTIVE SOLUTIONS AND
IMPLEMENTATION STRATEGIES.
TO DO THIS, WE NEED TO WORK
WITHIN AND PARTNER WITH THOSE
COMMUNITIES THAT ARE MOST
AFFECTED.
WE SAW THE SLIDE YESTERDAY BUT I
WANTED TO EMPHASIZE THAT WE HAVE
REALLY STRATEGICALLY MADE A
DELIBERATE EFFORT TO SUPPORT
PROJECTS UNDER THE VARIOUS
IMPROVE PROGRAMS ACROSS THE U.S.
INCLUDING THOSE WITH THE HIGHEST
VULNERABILITY AND NEED.
WITHIN EACH OF THE IMPROVE
PROGRAMS, THERE ARE EFFORTS TO
WORK WITH COMMUNITIES TO BETTER
UNDERSTAND AND ADDRESS SOCIAL
DETERMINANTS OF HEALTH AT THE
COMMUNITY AND STRUCTURAL LEVEL,
AND SOCIAL RISKS AND PROTECTIVE
FACTORS AT THE INDIVIDUAL AND
INTERPERSONAL LEVELS, AND THE
IMPACT THAT THEY HAVE ON
MATERNAL HEALTH.
FOR EXAMPLE, THE MA TECI TERN HH
RESEARCH CENTERS OF EXCELLENCE
INCLUDE PRODUCTS THAT ADDRESS
HOUSING, TRANSPORTATION, FOOD
SECURITY, ACCESS TO CARE, AND
OTHER SOCIAL DETERMINANTS OF
HEALTH AND SOCIAL RISKS.
IN THE RADX TECH FOR MATERNAL
HEALTH CHALLENGE, WE KNOW THAT
LOCATION IMPACTS ACCESS TO
TRANSPORTATION, HEALTHCARE AND
OTHER SOCIAL DETERMINANTS OF
MATERNITY CARE.
SEVERAL OF THE DEVICES THAT HAVE
BEEN DEVELOPED ARE DESIGNED TO
OVERCOME THESE SOCIAL BARRIERS
AND BRIDGE THE GAP BETWEEN
PATIENTS AND PROVIDERS.
IN THE CONNECTING THE COMMUNITY
FOR MATERNAL HEALTH CHALLENGE,
THE CONNECTION IS EVEN MORE
EXPLICIT.
SOCIAL DETERMINANTS OF HEALTH
ARE THE FOUNDATION FOR THE
RESEARCH QUESTIONS THAT MANY OF
YOU ARE ADDRESSING, AND THAT
CONNECTING THE COMMUNITY WINNERS
ARE EXPLORING.
AND THE SAME IS TRUE IN THE
COMMUNITY IMPLEMENTATION
PROGRAM.
WHERE AWARDEES PARTNER WITH
COMMUNITIES TO MORE EFFECTIVELY
UNDERSTAND ENABLING FACTORS AND
BARRIERS RELATED TO SOCIAL
DETERMINANTS OF HEALTH.
AS PART OF THE PROCESS TO ADOPT
INTERVENTIONS AT THE COMMUNITY
LEVEL.
SO AS I SAID, I AM REALLY PROUD
OF WHAT WE HAVE ACHIEVED
TOGETHER SO FAR IN IMPROVE, AND
I REALLY CAN'T WAIT TO SEE WHAT
WILL COME NEXT.
THE WORK YOU'RE DOING THROUGH
IMPROVE WILL PROVIDE IMPORTANT
NEW KNOWLEDGE TO ADDRESS THE
SOCIAL AND STRUCTURAL DRIVERS OF
MATERNAL HEALTH AND I'M LOOKING
FORWARD TO HEARING THE
PRESENTATIONS AND LEARNING MORE
TODAY.
SO WITH THAT, LET'S GET STARTED.
I AM VERY PLEASED TO TURN THE
MEETING OVER TO OUR MODERATORS,
DFOR THE NEXT SESSION, WHICH IS
INTERSECTIONS BETWEEN SOCIAL AND
STRUCTURAL DETERMINANTS OF
HEALTH AND MATERNAL MORBIDITY
AND MORTALITY.
SO WELCOME TO DAY TWO, AND ENJOY
THE MEETING.
[APPLAUSE]
>> THANK YOU, EVERYONE, AND GOOD
MORNING.
WE'D LIKE TO INTRODUCE OUR FIRST
SPEAKER TODAY IN THE SESSION,
INTERSECTIONS BETWEEN SOCIAL AND
STRUCTURAL DETERMINE FLANTS OF
HEALTH AND MATERNAL MORBIDITY
AND MORTALITY.
FIRST UP, WE HAVE JULIA DICKSON
GOMEZ AND DALVERY BLACKWELL.
[APPLAUSE]
A
>> THANK YOU, EVERYONE.
, FOR
COMING TODAY.
I'M GOING TO START OFF WITH A
CONFESSION.
I'M NOT ACTUALLY A MATERNAL
HEALTH EXPERT.
I'M HERE BECAUSE OF THE HOUSING.
>> ALL RIGHT, LET'S START OVER.
THANK YOU, EVERYONE, FOR COMING.
I'M HERE TO PRESENT HOME, WHICH
IS ABOUT HOUSING INSECURITY AND
HOUSING STABILITY AND THE
EFFECTS THAT IT HAS ON MATERNAL
HEALTH.
I'M HERE PRESENTING TODAY WITH
DALVERY BLACKWELL, PART OF OUR
COMMUNITY ENGAGEMENT PROJECT, SO
TOGETHER, WE ARE HOME TEAM.
THIS IS A VERY INTERDISCIPLINARY
RESEARCH PROJECT AND YOU'LL SEE
WHY.
I'LL TAKE THIS SLIDE JUST TO
SHOW YOU MY TEAM.
WE HAVE PSYCHOLOGISTS, A
SOCIOLOGIST, A GEOGRAPHER.
ALONG WITH AN OB-GYN.
NOW I'M GOING TO TURN IT OVER TO
DALVERY, WHO WILL TELL A LITTLE
BIT ABOUT WHY HOUSING.
>> GOOD MORNING, EVERYONE.
I DO HAVE A LOUD VOICE, I'M
SORRY.
I'LL TRY TO TONE IT DOWN.
I'M DALVERY BLACKWELL, I SERVE
AS EXECUTIVE DIRECTOR OF THE
AMERICAN BREASTFEEDING NETWORK.
WE'RE 15 YEARS YOUNG.
OUR MISSION IMPACT IS TO
ADVOCATE FOR BREASTFEEDING
EQUITY AND MATERNAL CHILD
HEALTH.
I'M JUST GOING TO GET STARTED
WITH OUR PRESENTATION TO SHARE
ANOTHER REMINDER THAT HOUSING
SHORTAGE UNFORTUNATELY HAS
CAUSED AN INCREASE AS WE KNOW IN
HOMELESSNESS AND ALSO IN HOUSING
INSECURITY AND UNFORTUNATELY THE
HIGH COST OF HOME OWNERSHIP.
WE KNOW THAT THIS HOUSING CRISIS
IN HOME INSTABILITY INTERSECTS
WITH MANY, MANY SOCIAL
DETERMINANTS OF HEALTH.
AND AS A RESULT, UNFORTUNATELY,
OUR POPULATION IS CHALLENGED
WITH MENTAL, BEHAVIORAL,
PHYSICAL WELL-BEING THAT
DECLINES.
IN MILWAUKEE, WISCONSIN ARE WE
ACTUALLY WORK IN SOUTHEASTERN
WISCONSIN, BIRTH WORKERS ARE
CHALLENGED EACH AND EVERY DAY TO
SUPPORT FAMILIES WITH SAFE,
AFFORDABLE HOUSING, AND WITH THE
VERY VULNERABLE POPULATION OF
BLACK BIRTHING PEOPLE.
SO I'M GOING TO SHARE THE SLI
SLIDES.
MILWAUKEE MIRRORS MOST OF OUR
COUNTRY AND SURPASSES THE
COUNTRY IN RACE RESIDENTIAL
SEGREGATION, DISPARITIES,
PREGNANCY OUTCOMES AND
UNFORTUNATE EVICTION RATES.
WHICH JULIA WILL TALK MORE
ABOUT.
AGING HOUSING AND INFRASTRUCTURE
INCLUDES HIGH LEVEL OF LEAD
EXPOSURE, DISPROPORTIONATELY
IMPACTING LOW INCOME AND
MINORITY POPULATIONS, PEOPLE OF
COLOR COMMUNITIES.
NEEDS ASSESSMENT INDICATE
MEDICAL MISTRUST UNFORTUNATELY,
AS WE'VE LEARNED THROUGHOUT OUR
TIME TOGETHER, AND MISTRUST AND
HOUSING LARGEST UNMET NEED AMONG
PREGNANT PEOPLE LIVING IN
MILWAUKEE.
EVICTION RATES ARE AMONG THE
HIGHEST UNITED STATES, WITH
16,000 INDIVIDUALS.
DISPLACED PER
YEAR.
STRESS FROM UNSAFE AND
UNSANITARY LIVING CONDITIONS
CONTRIBUTES POORLY TO PREGNANCY
OUTCOMES, INCLUDING PRETERM
BIRTH AS WE KNOW, AND LOW BIRTH
WEIGHT.
AND NOW I'M GOING TO TURN IT
BACK OVER TO MY PARTNER, JULIE.
>> SO HOW I BECAME INVOLVED IN
THIS IS BECAUSE I HAVE HAD A
LONG HISTORY OF WORKING IN
HOUSING AND LOOKING AT HOW
HOUSING AFFECTS HEALTH.
SO THE SPECIFIC AIMS OF THIS
PROJECT ARELILY TO LOOK AT
PERSONAL AND NEIGHBORHOOD
CHARACTERISTICS THAT WILL LEAD
TO INCREASED HOUSING STABILITY
AMONG BIRTHING PEOPLE.
SO -- AND THEN AIM TWO IS TO
EXPLORE THE IMPACT OF HOUSING
INSTABILITY AND HOMELESSNESS AND
NEIGHBORHOOD CONDITIONS ON THE
PHYSICAL AND MENTAL HEALTH OF
PREGNANT PEOPLE, AND THEN
FINALLY, TO IDENTIFY THE SERVICE
NEEDS OF PREGNANT PEOPLE.
SO YEAR ONE WAS PHASE ONE, AND
I'M HAPPY TO REPORT THAT WE
MOSTLY COMPLETED EVERYTHING WE
NEEDED TO DO.
WE FORMED A CAB AND PERFORMED A
QUALITATIVE NEEDS ASSESSMENT AND
FINALIZED OUR SURVEY PROTOCOL.
THIS IS A PICTURE OF I THINK OUR
VERY FIRST COMMUNITY ADVISORY
BOARD.
WE HAVE MEMBERS -- OH, GOSH,
FROM THE PUBLIC HOUSING
AUTHORITY, FROM FEDERALLY
QUALIFIED HEALTH CENTERS, FROM
THE DEPARTMENT OF HEALTH
SERVICES, HOUSING ADVOCATES,
PEOPLE WHO PROVIDE EMERGENCY
SHELTER, MPS, AS WELL AS OB-GYN.
WE MET FIVE YEARS -- OR FIVE
TIMES IN THE FIRST YEAR.
AND BASICALLY COVERED ALL OF THE
STUDY PROTOCOL, AND FINALIZED IT
AND ALSO GOT A REALLY GOOD
ENVIRONMENTAL SCAN OF THE
SITUATION IN MILWAUKEE.
THIS IS OUR MODEL.
AS WE WERE TALKING ABOUT
STRUCTURAL DETERMINANTS OF
HEALTH, IT'S ALWAYS VERY
DIFFICULT TO FIND THE LINKS
BETWEEN THE LARGEST STRUCTURAL
FACTORS LIKE HOUSING AND ACTUAL
OUTCOMES.
SO AS USUAL, I HAVE A MARMOT
MODEL THAT SHOWS MEDIATING OR
MODERATING POTENTIAL FACTORS.
SO WE'RE NOT ONLY LOOKING AT THE
HOUSING STATUS, BUT WE'RE
LOOKING AT THE COMMUNITY
EFFECTS, HOUSING STABILITY,
MEANING HOW LIKELY IS IT THAT A
PERSON IS GOING TO BE ABLE TO
STAY WHERE THEY ARE.
SOCIAL SUPPORT AND ALL THE REST,
AND THEN LOOKING AT HOW THAT
AFFECTS THE BIRTH OUTCOMES.
ONE OF THE THINGS THAT I THINK
IS REALLY UNIQUE ABOUT OUR
PROJECT IS THAT WE ARE GOING TO
BE MEASURING ALLOSTATIC LOAD.
THIS IS KIND OF A PROXY MEASURE
FOR THE EFFECT OF WEATHERING ON
THE BODY IF ANYONE HAS HEARD OF
THAT.
BASICALLY IT'S A WAY OF
MEASURING CHRONIC STRESS AND
INFLAMMATION, AND THE
PSYCHOLOGIST TERRY CASINI, WHO
IS ONE OF THE PARTNERS IN THIS
PROJECT, HAS DONE A LOT ON
TRAUMA AND STRESS.
OUR HOUSING HISTORY MATRIX IS
VERY DETAILED.
USUALLY IN MOST STUDIES, THERE
IS A DICHOTOMOUS MEASURE, IF
YOU'RE HOUSED OR UNHOUSED.
WOULD HE WE ARE ACTUALLY GEOCODR
ADDRESSES SO WE CAN MAP THEM
SPATIALLY AND DO GEOSPATIAL
ANALYSES, BUT IN ADDITION TO
THAT, WHEN WE ASK PEOPLE ABOUT
THEIR HOUSING, WE WILL BE ASKING
ABOUT THE HOUSING CONDITIONS.
FOR EXAMPLE, PRESENCE OF MOLD,
FLOODING, THE NUMBER OF PEOPLE
IN THE APARTMENT AND THE NUMBER
OF ROOMS, KIND OF TO GET A
MEASURE OF OVERCROWDING.
THE RENT AND UTILITIES, HOW MUCH
ALL THE EXPENSES ARE TOGETHER,
AND EVICTIONS AND OTHER FORCED
MOVES AND HOUSING SATISFACTION.
LIKE MOST OF YOU, WE'LL ALSO BE
MEASURING A LOT OF THE MENTAL
AND PHYSICAL OUTCOMES AS WELL AS
OTHER EXPOSURES, LIKE INTIMATE
PARTNER VIOLENCE, BUT OUR MAIN
OUTCOMES WILL BE PHYSICAL AND
MENTAL HEALTH.
ALONG WITH SOME OF THE
NEIGHBORHOOD DEPRIVATION, WE
ALSO WANT TO LOOK AT THE
POSITIVE AND THE ASSETS IN THE
COMMUNITY TO BE ABLE TO AMPLIFY
AND BUILD ON THOSE.
HERE YOU SEE SOME LOVELY
PICTURES THAT DALVERY IS IN WITH
SOME OF THE COMMUNITY EVENTS
THAT THE AFRICAN AMERICAN
BREASTFEEDING NETWORK ORGANIZES.
BUT I THINK YOU CAN ALSO SEE IF
YOU DIDN'T SEE THIS SOMEWHERE
HOW BEAUTIFUL OUR CITY ACTUALLY
IS WITH THE PARKS.
BUT OF COURSE WE'RE ALSO
MEASURING THE OTHER THINGS THAT
HAVE A NEGATIVE IMPACT ON
HEALTH, LIKE VIOLENCE, OH, I
ALREADY TALKED ABOUT THIS,
DIDN'T I?
OH, THE RACIAL SEGREGATION AND
MULTIPLE, MULTIPLE MEASURES OF
DISADVANTAGE.
ONE OF THE THINGS WE TALKED
ABOUT IN OUR CAB IS DIFFERENT
WAYS OF ACTUALLY MEASURING
SOCIAL VULNERABILITY AND WHICH
WOULD BE MOST APPROPRIATE.
TO USE PROBABLY -- I THINK WE
WILL USE A LOT OF DIFFERENT
ONES, BUT ALSO WE'LL BE LACKING
LOOKINGAT THE EFFECT OF RACIAL
SEGREGATION AND HOUSING
DISCRIMINATION.
WE TALKED A LOT ABOUT THIS WITH
THE CAB, BECAUSE, OF COURSE,
RACE IS VERY DIFFICULT TO
CAPTURE, AND -- I'M VERY SORRY.
AND IT CAN BE A PROTECTIVE
FACTOR SOMETIMES IF YOU'RE IN A
RACIALLY SEGREGATED COMMUNITY OR
IT CAN BE A RISK FACTOR.
IT REALLY DEPENDS ON THE
CONTEXT.
THERE ARE PROTECTIVE AND
INSULATING EFFECTS.
WE DID AN ENVIRONMENTAL SCAN
AGAIN OF -- THIS WAS FROM THE
CENTRAL REFERRAL, CENTRALIZED
REFERRAL FOR THE HOUSING.
I DON'T KNOW IF ANYBODY KNOWS,
IN EVERY MUNICIPALITY, HOUSING
SERVICES, YOU HAVE TO HAVE
INTAKE.
THIS IS TO MEASURE PEOPLE'S
VULNERABILITY AND MAKE SURE THAT
EACH PERSON -- OR THAT PEOPLE
GET HOUSING AND PRIORITIZE
HOUSING WHO ARE THE MOST
VULNERABLE.
WE HAD PR PREGNANT WOMEN, BUT
PREGNANCY ACTUALLY ISN'T A
VULNERABILITY INDEX, OR IS NOT A
MEASURE OF VULNERABILITY THAT
PRIORITIZES YOU FOR HOUSING.
WE'VE ALSO DONE SOME IN DEPTH
INTERVIEWS WITH WOMEN WHO ARE
FACING HOUSING INSTABILITY, AND
I'LL JUST SHARE ONE QUOTE WITH
YOU.
THIS IS FROM A WOMAN WHO DID NOT
EXPERIENCE HOMELESSNESS BUT HAD
A HARD TIME MAKING ENDS MEET.
AND ACTUALLY WAS TALKING A BIT
ABOUT FEELING LIKE SHE SHOULD BE
ABLE TO DO THIS, AND SHE FELT SO
ASHAMED THAT SHE FELT LIKE
KILLING HERSELF SOMETIMES.
I MEAN, I THINK THE TRUTH OF THE
MATTER IS THAT NOBODY CAN MAKE
ENDS MEET.
WORKING A REGULAR JOB WITH
CHILDREN AND AFFORDING HOUSING.
AND I'LL HAND IT BACK TO
DALVERY.
>> OKAY.
I THINK WE GOT AN INDICATION
WE'VE GOT 2 MINUTES.
I'M GOING TO GO THROUGH THE
SLIDES QUICKLY.
SO OUR NEXT TEPS.
LONGITUDAL SURVEY THIS MONTH,
WE'RE REALLY EXCITED ABOUT THAT.
JULIE TALKED A LITTLE BIT ABOUT
THAT.
ALSO A PHOTO VOICE PROJECT IS
COMING UP IN OUR COLLABORATION
WITH MKE-EVICT AND LANDLORD
PROJECT.
SO A LITTLE BIT ABOUT THE
PHOTOVOICE PROJECT.
IT'S A PARTICIPATORY PROCESS IN
WHICH PEOPLE ARE GIVEN PROMPTS
AND A CAMERA TO TAKE PICTURES,
FOLLOWED BY GROUP INTERVIEWS AND
OFTEN PRESENTATIONS TO
OUTSIDERS.
GOOD FOR BETTER UNDERSTANDING
LINKS BETWEEN HOUSING AND HEALTH
BUT ALSO ADVOCACY, WHICH IS
REALLY IMPORTANT.
AND WE PLAN TO USE THIS TO SHOW
DURING OUR ANNUAL ASCEND RETREAT
THAT'S COMING UP IN 2025.
A LITTLE BIT ABOUT MKE-EVICT AND
LANDLORD PROJECT COLLABORATION.
EVICTION RECORDS HAVE TRA BEEN
TRACKED IN MILWAUKEE SINCE 2000
AT ADDRESS LEVEL.
LANDLORD MAPPER FROM MILWAUKEE
PROPERTY OWNERSHIP NETWORK HAS
BEEN WORKING TO IDENTIFY RENTAL
PROPERTY OWNERS.
GEOCODED HOUSING DATA FROM OUR
PROJECT CAN ALSO BE LINKED TO
THIS DATA.
POWERFUL TOOLS FOR ADVOCATING AS
WE FIGHT AGAINST HOUSING
OWNERSHIP OBSCURITY.
AND WE JUST WANT TO TAKE THIS
OPPORTUNITY TO THANK IMPROVE --
THE IMPROVE INITIATIVE FOR THIS
WONDERFUL OPPORTUNITY TO WORK TO
IMPROVE THE HEALTH OUTCOMES IN
MATERNAL CHILD HEALTH.
THANK YOU SO MUCH.
[APPLAUSE]
>> THANK YOU SO MUCH.
WE'LL TAKE QUESTIONS FROM THE
AUDIENCE, AND FOR THOSE THAT ARE
LISTENING IN VIRTUALLY, WE HAVE
THE QUESTION AND ANSWER SESSION
OPEN SO CAN YOU JUST YOU CAN DRR
QUESTIONS INTO THAT CHAT BOX.
DO WE HAVE ANY QUESTIONS?
WE DO HAVE ONE.
>> GOOD MORNING.
OUTSTANDING PRESENTATION.
I WANTED TO HEAR A LITTLE BIT
MORE ABOUT PREGNANCY AS IT
RELATES TO NOT BEING A FACTOR
FOR PRIORITIZING HOUSING.
THAT'S WHAT I HEARD YOU SAY.
IS THAT THE ISSUE NATIONALLY?
IS THAT SOMETHING THAT IS, YOU
KNOW -- IF YOU COULD SAY A
LITTLE MORE ABOUT THAT BECAUSE
PREGNANCY IS ACUTELY AN ISSUE IF
HOUSING IS NOT AVAILABLE.
>> SO THERE WAS A LOT OF
MOVEMENT I THINK ABOUT 10 YEARS
AGO TO EXPAND PERMANENT
SUPPORTIVE HOUSING TO HOUSE THE
SO-CALLED CHRONICALLY HOMELESS,
AND THOSE ARE PEOPLE WHO HAVE
BEEN HOMELESS, LIVING ON THE
STREET FOR A YEAR, OR WHO HAVE
HAD THREE PERIODS OF
HOMELESSNESS WITHIN THE LAST
THREE YEARS, I THINK.
AND IN ADDITION TO THAT, THEY
HAVE TO HAVE A QUALIFYING
CONDITION, SO SERIOUS MENTAL
ILLNESS OR HIV OR SUBSTANCE USE.
SO THIS WAS -- IT HAS BEEN RU --
ROLLED OUT TO HOUSE A LOT OF
VETERANS.
THERE WAS A LOT OF MONEY ROLLED
OUT TO STOP HOMELESSNESS AMONG
VETERANS AND ALSO, I THINK IT
WAS TO REALLY FOCUS ON THAT
GROUP OF SERIOUSLY MENTALLY ILL
AND CHRONICALLY HOMELESS.
IN TERMS OF WHAT THERE ARE FOR
PEOPLE WHO ARE JUST LOW INCOME,
THERE IS SECTION 8 OR HOUSING
CHOICE VOUCHERS, BUT AS YOU
KNOW, THOSE ARE VERY HARD TO
GET.
THERE ARE RAPID REHOUSING
PROGRAMS IN MANY CITIES.
MILWAUKEE HAS ONE OF THOSE, AND
IT'S AN INTERESTING, I THINK,
MODEL WHERE THE HOUSING
ASSISTANCE IS VERY TEMPORARY,
3 TO 6 MONTHS, AND JUST ENOUGH
TIME TO GET PEOPLE ON THEIR
FEET.
SO I THINK THERE'S GROWING
CONCERN ABOUT THAT, AND
DEFINITELY MOVEMENT FOR
EXPANDING HOUSING.
THERE'S ALSO SOME MOVEMENT
AROUND BASIC INCOME, PROVIDING
THAT FOR PREGNANT PEOPLE, AND
THERE'S SOME THINKING ABOUT
ACTUALLY USING MEDICAID IN MANY
CASES FOR PAYING FOR HOUSING.
IF YOU THINK ABOUT IT, HOW CAN
YOU BE HEALTHY AND DEALING WITH
SERIOUS CONDITIONS.
>> THANK YOU SO MUCH.
THANK YOU VERY MUCH.
[APPLAUSE]
NEXT WE HAVE DR. MARY SHAW FROM
JACKSON STATE UNIVERSITY, PART
OF THE MISSISSIPPI DELTA CENTER
OF EXCELLENCE IN MATERNAL
HEALTH.
[APPLAUSE]
>> GOOD MORNING.
CAN YOU HEAR ME?
GOOD MORNING.
GLAD TO BE HERE THIS MORNING.
I'M GOING TO MAKE SURE YOU KNOW
MY PARTNERS IN MY TEAM, AND IF I
LOSE MY VOICE, THEY'RE GOING TO
COME UP, SO WE HAVE SOMEONE HERE
FROM EACH ONE OF THE PROJECTS.
SO I'M GLAD TO BE HERE THIS
MORNING.
I REPRESENT THE MISSISSIPPI
DELTA CENTER OF EXCELLENCE IN
MATERNAL HEALTH, WHICH IS
ACTUALLY HOUSED AT JACKSON STATE
UNIVERSITY, WHICH IS AN HBCU
LOCATED IN JACKSON, MISSISSIPPI.
WE'RE VERY EXCITED TO BE PART OF
THIS INITIATIVE.
IT'S A COLLABORATIVE, AND IT'S
BEEN THIS FIRST YEAR THAT WE
JUST FINISHED HAS BEEN ONE THAT
HAS HELPED US TO REMEMBER, ONE,
WE ARE IN MISSISSIPPI.
I THINK I DON'T HAVE TO TELL YOU
A LOT ABOUT THE STATE OF
MISSISSIPPI.
WE COME IN KIND OF AT THE BOTTOM
ON ALMOST EVERYTHING.
SO WHAT I CALLED THE TITLE OF
THIS PRESENTATION WAS THE
SITUATION ROOM AS IT RELATES TO
RURAL MISSISSIPPI, THE SPECIFIC
COUNTIES THAT WE'RE FOCUSED ON.
AND I LIKE TO START OFF THE
PRESENTATION BY SIMPLY GIVING
CONTEXT, WHICH IS WHEN YOU'RE IN
MISSISSIPPI, THE REST OF AMERICA
SOMETIMES DOESN'T SEEM QUITE
REAL, AND WHEN YOU'RE IN THE
REST OF AMERICA, MISSISSIPPI
DOESN'T SEEM REAL.
NOW THOSE OF WHO YOU HAVE SPENT
TIME IN MISSISSIPPI KNOW IT'S A
BEAUTIFUL STATE BUT I THINK YOU
ALSO HAVE TO KNOW THAT THERE IS
A HISTORY OF ONE OF THE THINGS
THAT WE'RE SUPPOSED TO BE
ADDRESSING HERE IN THIS SESSION,
WHICH IS THOSE STRUCTURAL
DETERMINANTS OF HEALTH, AND I
THINK IT'S AN EXCELLENT PLACE TO
TALK ABOUT THAT INTERSECTION
BETWEEN SOCIAL DETERMINANTS OF
HEALTH AS WELL AS THE STRUCTURAL
DETERMINANTS OF HEALTH.
SO I'M GOING TO GIVE THIS A SHOT
AND SEE HOW WELL WE CAN DO IT.
THIS IS A COLLABORATIVE, AND I
THINK THE COLLABORATIVE ACTUALLY
LOOKS A LOT LIKE SOME OF THE
ISSUES THAT WE DEAL WITH IN THE
MISSISSIPPI DELTA.
SO THE COLLABORATIVE CONSISTS OF
JACKSON STATE UNIVERSITY HBCU,
MISSISSIPPI STATE DEPARTMENT OF
HEALTH, UMMC, THE LARGE MEDICAL
CENTER WHICH IS LOCATED WHERE WE
ARE, HARVARD UNIVERSITY SCHOOL
OF PUBLIC HEALTH, WHICH THEY
HAVE BEEN JUST REALLY PHENOMENAL
IN WORKING WITH US, AND THEN WE
HAVE A GROUP CALLED CONVERGE,
WHICH IS HELPING US OUT WITH THE
TITLE 10 SERVICES IN
MISSISSIPPI, PARTICULARLY IN THE
RURAL COUNTIES, AND THEN THE
MOST IMPORTANT GROUP IS WHAT
WE'VE REFERRED TO AND ORGANIZED
AS MOMMYCARE POSTPARTUM
COMMUNITY NETWORK.
AND THAT IS STILL BEING FORMED.
SO THE MULTIPLE P.I. LEADERSHIP
STRUCTURE IS WHAT WE ARE USING
IN THIS PARTICULAR PROJECT.
AND IF YOU CAN IMAGINE, WE'VE
GOT FIVE DIFFERENT ENTITIES
COMING TOGETHER.
OURS IS A NEW STARTUP, WE WERE
NOT ALL WORKING TOGETHER
COLLABORATIVELY AROUND MATERNAL
HEALTH WHEN WE STARTED.
SO WE'VE HAD SOME GROWING PAINS,
LIKE ANYONE ELSE, BUT THIS IS
THE MULTIPLE P.I. STRUCTURE THAT
WE HAVE.
DR. HENNING, AND I THINK
DR. MAZOO, I BELIEVE HE'S HERE
TODAY.
DR. POLK, WE'VE HAD SOME CHANGES
IN OUR CORE LEADERSHIP, WE HAVE
ANOTHER DESIGNATED P.I. WHO WILL
BE JOINING US, MYSELF, AND THEN
MS. SAMPLE IS ACTUALLY HOUSED
OUT IN THE DELTA.
I'M GOING TO SHOW YOU A MAP IN A
LITTLE BIT THAT SHOWS WE'RE
ABOUT 2 1/2 HOURS AWAY FROM THE
COUNTIES THAT ARE REALLY THE
FOCUS OF THIS POSTPARTUM CARE
PROJECT.
SO ONE OF THE GOALS, THE PRIMARY
OVERARCHING GOAL OF THIS
PARTICULAR CENTER IS TO DEAL, OF
COURSE, WITH THOSE MATERNAL
MORBIDITIES, THOSE MATERNAL
MORTALITIES THAT YOU READ ABOUT,
THAT YOU HEAR ABOUT IN THE STATE
OF MISSISSIPPI, BUT WE'RE ONLY
FOCUSING IN THE DELTA, AND IT'S
NOT ALL OF THE DELTA, IT'S
SELECTED COUNTIES THAT I'LL SHOW
YOU A MAP OF IN JUST A FEW
MINUTES.
I THINK WE MADE A LOT OF STRIDES
OVER THE YEARS IF YOU KNOW
ANYTHING ABOUT THE HISTORY OF
MISSISSIPPI, WHICH I DON'T HAVE
TIME TO GO INTO, BUT AS WE
STARTED THIS PROJECT, BECAUSE OF
THE FIVE DIFFERENT ENTITIES THAT
WERE INVOLVED, WE HAD TO AGREE
ON SOME THINGS.
AND I ALWAYS WENT BACK TO THE
STATEMENT FROM A FORMER
GOVERNOR, AND WHAT HE SAID WAS,
WHEREVER I'VE GONE, WHETHER IT'S
IN MISSISSIPPI OR WHEREVER,
IRRESPECTIVE OF RACIAL OR
CULTURAL DIFFERENCES, WE CAN
PROBABLY IN THIS ROOM AGREE ON
SEVERAL THINGS.
EVERYBODY WANTS A DECENT
EDUCATION FOR THEIR CHILDREN.
EVERYBODY WANTS A FAIR CHANCE TO
SECURE A JOB THAT WILL SUSTAIN
THEM AND THEIR FAMILY.
AND EVERYBODY WANTS TO LIVE IN A
DECENT HOUSE OR SAFE STREET, AS
MY COLLEAGUES EARLIER MENTIONED,
AND EVERYBODY WANT ACCESS TO
ADEQUATE HEALTHCARE.
AND FINALLY, EVERYBODY WANTS TO
BE TREATED WITH DIGNITY AND
RESPECT.
SO AS WE STARTED OFF THIS
PROCESS, BECAUSE EACH
INSTITUTION IS SO VERY
DIFFERENT, I THINK ONE OF THE
CHALLENGES FOR US HAS BEEN
UNDERSTANDING THE INSTITUTIONAL
CULTURES, AND THAT'S PRETTY MUCH
THE SAME THING WE HAVE TO DO IN
THE DELTA, IS UNDERSTAND THE
CULTURE IN THE DELTA IN WHICH A
LOT OF WHAT WE'RE TRYING TO TALK
ABOUT TODAY HAS HAPPENED.
SO THE CENTER HAS FOUR GOALS,
AND I THINK I MISSED YESTERDAY
BUT SOME OF THESE TOPICS HAVE
BEEN TALKED ABOUT, AND OUR FOCUS
IS POSTPARTUM CARE ONLY.
BECAUSE IN MISSISSIPPI, THE
POSTPARTUM CARE PERIOD IS WHERE
WE HAVE SEEN A LOT OF THE
MORBIDITIES AND MORTALITIES.
WE HAVE A REPRESENTATIVE HERE
FROM PROJECT 1, CLAIRE RIGHT
THERE, THEIR PROJECT IS FOCUSED
ON USING A COMMUNITY HEALTH
WORKER APPROACH TO DELIVER
POSTPARTUM CARE SERVICES WITHIN
7 TO 10 DAYS AFTER THE MOTHER
HAS BEEN DISCHARGED FROM UMMC,
THE MEDICAL CENTER.
THAT'S OUR REIF HE EVERRING
INSTITUTION.
NOW THERE ARE OTHER HOSPITALS IN
THE AREA BUT WE FOCUSED IN ON
UMMC BECAUSE IT'S ONE THAT
HANDLES HIGH RISK PREGNANCIES.
I THINK AS WE GO ALONG, THE PLAN
IS TO EXPAND INTO OTHER
HOSPITALS, THOSE HOSPITALS THAT
ARE BIRTHING HOSPITALS.
SO THEY ARE GOING TO BE USING --
AND I THINK MOST OF YOU KNOW
THAT CHW-BASED PROJECTS, THEY'VE
BEEN USED ALL OVER THE COUNTRY,
BUT WE HAVEN'T REALLY USED THEM
AS EXTENSIVELY AS WE PROBABLY
COULD IN THE MISSISSIPPI DELTA
REGION.
PROJECT 2 IS ONE OF THE PROJECTS
THAT I'M INTIMATELY CONNECTED
WITH AND WE HAVE A
REPRESENTATIVE FROM PROJECT 2,
DR. RAMUNDI IS HERE.
PROJECT 2 WAS STRUCTURED A
LITTLE MORE LOOSELY SO WE HAD
SOME LATITUDE TO USE A CBBR
APPROACH TO UNDERSTAND THOSE
WOMEN IN THE DELTA COUNTIES AND
THOSE HEALTHCARE PROVIDERS THAT
PROVIDE SERVICES AS WELL AS
IMPROVING TRUST.
NOW THAT'S A BIG AGENDA FOR US,
TRUST AND ENGAGEMENT.
TRUST IN MISSISSIPPI, TRUSTING
THE HEALTHCARE SYSTEM BUT ALSO
TRUSTING WITHIN THE COMMUNITY
NETWORKS.
SO OF COURSE THAT LED US TO AIM
THREE, WHICH IS FOCUSED ON
COMMUNITY PARTNERS.
A VERY CRITICAL PART OF OUR
PARTICULAR CENTER IS WHAT DO
THOSE RELATIONSHIPS LOOK LIKE,
AND YOU HAVE TO KEEP IN MIND THE
LONG HISTORY OF RACISM AND
OPPRESSION AND EVERYTHING THAT'S
HAPPENING IN MISSISSIPPI,
LOOKING AT WHAT THOSE
PARTNERSHIPS LOOK LIKE AND
TRYING TO CREATE MEANINGFUL AND
EQUITABLE PARTNERSHIPS.
THE LAST PART OF OUR INITIATIVE
IS, ORVETION THE TRAINING
PROGRAM, WHICH IS BEING LED BY
HARVARD, WHICH THEY HAVE A LOT
OF EXPERIENCE WITH TRAINING
PROGRAMS, SO OUR FOCUS HAS BEEN
ON CREATING SOMETHING THAT'S
VERY RESPONSIVE TO THOSE NEEDS
IN MISSISSIPPI TO UNDERSTAND THE
STRUCTURAL DETERMINANTS OF
HEALTH, AS WELL AS THE SOCIAL
DETERMINANTS OF HEALTH, AND THE
CULTURE WITHIN MISSISSIPPI.
SO HERE'S A MAP YOU SEE HERE,
AND I THINK WE TRIED TO
ILLUSTRATE WHERE THE MATERNAL
HEALTH DESERTS ARE LOCATED, AND
YOU CAN SEE THE AREAS WHERE WE
HAVE THE STARS, WHERE WE HAVE
THE CIRCLES, SO WE HAVE FIVE
COUNTIES THAT ARE THE FOCUS OF
OUR PROJECTS.
AND HOW DID WE CHOOSE THOSE FIVE
COUNTIES?
THOSE OF YOU WHO KNOW
MISSISSIPPI KNOW THAT SOME OF
THE COUNTIES THAT WE INCLUDED
ARE NOT NECESSARILY THE MOST
BARREN IN TERMS OF BEING A
MATERNAL HEALTH DESERT BUT THEY
HAVE THE HIGHEST NUMBER OF
BIRTHS FOR THE STATE OF
MISSISSIPPI, SO WE HAVE FIVE
COUNTIES THAT WE'RE LOOKING AT.
SO THOSE FIVE COUNTIES ARE IN
THE DELTA REGION, EXCEPT FOR ONE
OF THE COUNTIES, SCOTT COUNTY,
AND I'M TRYING TO SHOW YOU AN
EXAMPLE OF HOW WE LAID IT OUT,
PROJECT 1 IS BEING LED BY THE
MISSISSIPPI STATE DEPARTMENT OF
HEALTH BECAUSE THEY, OF COURSE,
HAVE LINKAGES ALL OVER THE STATE
OF MISSISSIPPI.
AND OUR FOCUS IS HIGH RISK BLACK
WOMEN.
NOW I DON'T HAVE A LOT OF TIME
TO TALK TO YOU ABOUT HOW THAT IS
DETERMINED IN THE MISSISSIPPI
DELTA, BUT WE KIND OF GROUP THEM
INTO TWO CATEGORIES, HEALTHY
PREGNANCIES AND THEN HIGH RISK
PREGNANCIES.
THE THE HIGH RISK PREGNANCIES
ARE THE ONES THAT WE ARE FOCUSED
ON.
THOSE ARE THE WOMEN THAT WILL
MORE THAN LIKELY BE REFERRED
INTO UMMC, THE MEDICAL CENTER,
BECAUSE OF THEIR HIGH RISK FOR
SOME TYPE OF MORTALITY OR
MORBIDITY ASSOCIATED WITH THE
PREGNANCY.
THE SECOND PROJECT IS HOUSED AT
JACKSON STATE UNIVERSITY WHERE
WE HAVE BEEN ENGAGED IN WORKING
WITH THE COMMUNITIES FOR A
NUMBER OF YEARS.
WE TRAIN A LOT OF THE STUDENTS
THAT COME FROM THE DELTA.
SO MORE OR LESS LOOKING AT THE
CONTEXT, THE CULTURE, THE NORMS,
THOSE RELATIONSHIPS THAT EXIST
WITHIN THE DELTA COUNTIES AN
THOSE RELATIONSHIPS THAT EXIST
BETWEEN WOMEN WHO HAVE TO
COMMUTE IN FROM THE DELTA, WHICH
I TOLD YOU IS ABOUT 2 1/2 HOURS.
SO THIS NEXT SLIDE SHOWS YOU THE
CONCEPTUALIZATION, THIS CAME
FROM OUR COMMUNITY PARTNERS.
THIS IS LED BY A YOUNG WOMAN,
RASHONDA SAMPLE, WHO MAPPED OUT
WHAT'S REALLY HAPPENING IN EACH
OF THESE COUNTIES, WHAT'S
AVAILABLE, WHAT'S NOT AVAILABLE.
WE WERE INTERESTED IN IS THERE A
BIRTHING HOSPITAL WITHIN CLOSE
PROXIMITY, CLOSER THAN COMING IN
TO UMMC, WHICH I TOLD YOU IS
2 1/2 HOURS AWAY?
WHICH KINDS OF OB-GYN SERVICES
ARE ACTUALLY AVAILABLE IN EACH
COUNTY?
SO I THINK THIS KIND OF DEPICTS
IT FOR US.
WE GOT A VERY GOOD PICTURE OF
WHAT IS HAPPENING AND WHAT'S NOT
AVAILABLE.
ONE OF THE COUNTIES THAT'S MOST
LACKING IN TERMS OF MATERNAL
HEALTH SERVICES IS CARROLL
COUNTY, AND I THINK -- THIS
LOOKS A LITTLE -- WHEN I MOVE
THE SLIDE INTO THIS
PRESENTATION, THE ARROWS WHERE
IT'S SHOWING THE DISTANCE
BEDISTANCESBETWEEN GOT A LITTLE.
YOU CAN SEE THE WOMEN THAT VISIT
CLINICS ONCE THEY'RE PREGNANT,
THEY'RE CATEGORIZED INTO TWO
GROUPS.
BUT THERE'S DISCUSSION ABOUT
HAVING AN INTERMEDIATE LEVEL
GROUP.
WE TALKED WITH ONE OF THE
NEONATAL SPECIALISTS AT UMMC,
BUT RIGHT NOW WE GROUP THEM AS
HEALTHY, MEANING YOU DON'T
NECESSARILY HAVE TO BE REFERRED
IN TO UMMC OR HIGH RISK.
AND THEN THESE WOMEN DO HAVE
OTHER OPTIONS IN THE DELTA.
BUT THE HIGH RISK ONES ARE THE
ONES THAT WE'RE PRIMARILY
FOCUSING IN ON, ON PROJECT ONE.
SO HEALTH, CULTURE AND PLACE IS
WHAT I KIND OF WANT TO TALK
ABOUT, BECAUSE THAT'S WHAT WE'RE
DEALING WITH IN MISSISSIPPI, THE
DISPARITIES ARE THERE,.
THE CULTURE HAS BEEN THE
CHALLENGE FOR US.
I'M NI'VE SPENT A LOT OF TIME TG
TO UNDERSTAND THE CULTURAL
NORMS, UNDERSTAND THE HISTORICAL
GRIEF, UND UNDERSTANDING THE
OPPRESSION AND RACISM, WE HAVE
SEVERAL DIFFERENT ENTITIES THAT
WE'RE DEALING WITH.
SYSTEMS PERVASIVE THAT THEY WERE
NOT INTENDED TO BE INCLUSIVE.
NO ONE WANTS TO TALK ABOUT THEM
BUT THEY EXIST.
AND THEY'VE ALWAYS OPERATED IN
MISSISSIPPI AND PROBABLY LAKE
MANY OTHER STATES, I'M FROM
TEXAS SO I KNOW IT EXISTS THERE
TOO, BUT I RAISED THIS QUESTION
BECAUSE I'VE WORKED IN THE
EDUCATION SYSTEM, SO
QUESTIONABLE EDUCATION,
QUESTIONABLE POLITICS THAT MORE
OR LESS DO NOT SUPPORT SOME OF
THE THINGS THAT WE'RE TRYING TO
DO.
QUESTIONABLE HEALTHCARE.
WOMEN OFTENTIMES TALK ABOUT
DISRESPECT, LACK OF
COMMUNICATION WITH PROVIDERS --
POOR COMMUNICATION WITH
PROVIDERS.
WE HAVE THE HEALTH LITERACY
ISSUES, BECAUSE IT LINKS BACK TO
SOME OF THE -- I SAY MATERNAL
HEALTH LITERACY, BUT THEN
THERE'S HEALTH LITERACY IN
GENERAL.
AND THEN BASIC SERVICES THAT
PROBABLY MOST OF US IN CITIES
TAKE FOR GRANTED, BECAUSE
REMEMBER WE'RE IN JACKSON, AND
I'M TALKING 2 1/2 HOURS AWAY.
WE TAKE CERTAIN THINGS FOR
GRANTED, BUT IN THE DELTA, YOU
CAN'T TAKE THOSE THINGS FOR
GRANTED.
FOR EXAMPLE, SOME OF THE
TECHNOLOGIES THAT WE WOULD LIKE
TO USE IN THIS PARTICULAR
INTERVENTION IN THE DELTA, IT'S
NOT GOING TO BE POSSIBLE BECAUSE
WE HAVE HUGE POCKETS WHERE
THERE'S NO BROADBAND.
SO THAT BECOMES A CHALLENGE FOR
US.
SO THE TRANSPORTATION, MAJOR,
MAJOR PROBLEM IN MISSISSIPPI, IN
THE DELTA REGIONS.
THERE'S NO PUBLIC
TRANSPORTATION.
WE'VE BEEN TALKING WITH CHURCHES
ABOUT BEING ABLE TO USE THEIR
CHURCH VANS TO TRANSPORT WOMEN
TO SERVICES AND SO FORTH, AND I
CAN'T IGNORE THIS HISTORICAL
GRIEF.
AND WHEN I SAY HISTORICAL GRIEF,
WE'VE ENGAGED FOR THE PAST YEAR
IN THESE STORYTELLING VENTURES
WITH ANOTHER COMMUNITY-BASED
ORGANIZATION CALLED ALLUVIO
COLLECTIVE AND THEY HAVE WHAT
THEY CALL A COMMUNITY APPROACH,
SO WE HAVE STORIES THAT CATALOG
THE EXPERIENCES THAT WOMEN HAVE
EITHER DELIVERING POSTPARTUM
CARE IN THE DELTA COUNTIES OR
EVEN WHEN THEY COME INTO
MISSISSIPPI AND ALSO ABOUT THE
HOSPITAL CLOSURES AND IMPACT
THAT IT'S HAD ON MATERNAL
HEALTH.
I THINK IN THIS EARLIER GROUP
THEY TALKED ABOUT UNSTABLE
HOUSING, THAT'S A MAJOR ISSUE IN
THE DELTA.
LIMITED TRANSPORTATION I TALKED
ABOUT, LIMITED BROADBAND ACCESS
AND FOOD DESERTS.
SO THESE ARE ALL DETERMINANTS OF
HEALTH.
WE ARE USING KIND OF A MODEL
THAT'S MORE SOCIAL ECOLOGICAL,
AND THAT'S ALWAYS BEEN A
CHALLENGE I THINK FOR US AS
RESEARCHERS IS THE LINKAGES
BETWEEN THEM.
WE CAN IDENTIFY WHAT'S HAPPENING
AT EACH LEVEL.
BUT I THINK THIS PICTURE DEPICTS
EXACTLY SOME OF THE KINDS OF
THINGS THAT WE'VE BEEN BETTER
TRYING TO UNDERSTAND HOW THEY
WORK, HOW WE CAN INTERVENE TO
MAKE AND IMPROVE POSTPARTUM CARE
SERVICES.
REMEMBER WE'RE ONLY DEALING WITH
POSTPARTUM CARE.
ADVANCING THIS POSTPARTUM CARE
IN RURAL MISSISSIPPI IS A LITTLE
BIT DIFFERENT FROM TRYING TO
ADVANCE POSTPARTUM CARE IF
YOU'RE IN JA JACKSON OR CLOSER O
THE UMMC.
SO UNDER THE MOMMY POSTPARTUM
CARE NETWORK, WE BEGAN LOOKING
AT WHAT ARE THE PERCEPTIONS THAT
THE WOMEN ACTUALLY HAD ABOUT THE
HEALTHCARE SYSTEMMIN SYSTEM AS S
DEFINED.
IF YOU'RE IN THE DELTA WITH ALL
THE PROGRAMMING, ALL THE -- WHAT
HOSPITALS ARE AVAILABLE AND ALL
THE MONEY THAT'S FLOWING IN, YOU
WOULD THINK THERE WOULD BE THIS
BETTER COORDINATED SYSTEM OF
CARE AND NO ONE WOULD GET
DROPPED IN THE CRACKS.
SO THAT'S ONE OF THE ISSUES THAT
WE'RE ACTUALLY DEALING WITH.
THE SECOND PART IS LOOKING AT
WHAT INTERVENTIONS WORK.
PERHAPS IT WORKED OUTSIDE THE
DELTA, WE CAN LOOK AT RURAL
COUNTIES IN OTHER PLACES AND SEE
WHAT WORKS AND THEN MOVING
TOWARDS WHAT MIGHT NEED TO BE
APPLIED OR APPROACHED HERE.
PROJECT 2 IS MUCH MORE OPEN IN
THAT WE ARE ACTUALLY STARTING
FROM THE GROUND UP, HAVING THE
WOMEN ENGAGED IN THE REST OF THE
CBPR APPROACH, TO REALLY HELP US
LOOK THROUGH FORMATIVE RESEARCH,
THEN DESIGNING THE INTERVENTION
AND THEN EVALUATING THE
INTERVENTION SO WE'RE USING WHAT
WE REFER TO AS A COMMUNITY
ACCOUNTABILITY BOARD.
WE USE THAT WORD ACCOUNTABILITY
BECAUSE SOMEWHERE WE HAD BEEN
SOMEWHERE AND HEARD SOMEONE ELSE
USING IT AND WE THOUGHT
ACCOUNTABILITY IS REALLY WHAT WE
WANT MORE OF IN THE MISSISSIPPI
DELTA.
WE'VE GOT LOTS OF THINGS GOING
ON BUT IT'S NOT WELL
COORDINATED, SO THE YOUNG LADY
WHO'S LEADING THIS COMMUNITY
PARTNERS FOR US, THEY IDENTIFIED
THE TENETS UNDER WHICH THEY
WANTED TO OPERATE AND IN THE
INTEREST OF TIME, I'M GOING TO
NOT GO THROUGH THOSE IN DETAIL,
BUT WE'RE EXCITED ABOUT THE
COMMUNITY ACCOUNTABILITY BOARD.
ACTUALLY THE FIRST MEETING OF
THAT BOARD WILL TAKE PLACE ON
FRIDAY.
I'LL BE OUT IN THE DELTA FOR
THAT BOARD MEETING.
BUT THEY HAVE BEEN WORKING WITH
OTHER ORGANIZATIONS, LIKE THEY
HAVE BABY SHOWERS, AND THE BABY
SHOWERS ARE ABLE TO BRING IN A
NUMBER OF THE PROVIDES FOR
SOCIAL SERVICES, MATERNAL
HEALTHCARE SERVICES UNDER ONE
UMBRELLA, AND IT HELPS TO
CONNECT THE WOMEN, CREATING MORE
OF A SENSE OF COMMUNITY AS WE GO
THROUGH THIS WORK.
THIS PARTICULAR DIAGRAM RIGHT
HERE ACTUALLY CAME FROM THE
YOUNG LADY WHO LEADS THE -- IS
THE DIRECTOR OF THE COMMUNITY
PARTNERS NETWORK, AND WHAT SHE'S
TRYING TO GET THEM TO DO IS
FIRST ACKNOWLEDGE, WE HAVE TO
MAKE SURE WE'RE ACKNOWLEDGING
THE PROBLEMS THE SAME WAY, OR
UNDERSTANDING THE PROBLEMS THE
SAME WAY.
REFLECT ON WHAT'S REALLY
HAPPENING IN THE DELTA FROM A
COMMUNITY MEMBER REPRESENTATIVE
PERSPECTIVE, AND THEN
REIMAGINING WHAT THEY WOULD LIKE
FOR THIS SYSTEM THAT WE'RE
TRYING TO HELP CREATE THROUGH
THIS FUNDING FROM NIH.
WHAT WOULD IT LOOK LIKE?
ONE OF THE PIECES ABOUT TRUST,
ONE OF THE QUESTIONS THAT WE'VE
ASKED IS WHAT DOES TRUST LOOK
LIKE.
SO LOOKING AT IT FROM TWO
PERSPECTIVES, THE PROVIDER
PERSPECTIVE AS WELL AS THAT
WOMAN WHO IS HAVING TO
EXPERIENCE THE HEALTHCARE
SYSTEM, WHAT SHOULD TRUST LOOK
LIKE, WHAT SHOULD IT FEEL LIKE,
WHAT SHOULD IT SOUND LIKE.
BECAUSE I DON'T THINK WE'VE EVER
REALLY HAD THAT CONVERSATION IN
THE DELTA, AND THEN FROM THE
PROVIDER PERSPECTIVE, WHAT WOULD
IT LOOK LIKE, FEEL LIKE AND
SOUND LIKE.
AND WHAT WE'RE LOOKING FOR IS
HOW DO WE CHARACTERIZE TRUST IN
THE MISSISSIPPI DELTA, BECAUSE
IT MIGHT NOT BE QUITE THE SAME
AS SOMEWHERE ELSE.
SO THAT'S BEEN A REAL BIG PIECE
THAT WE'VE KIND OF FOCUSED IN
ON.
THIS WEEK WE HAVE A
CONJUGATIONAL NETWORK TO HELP US
WORK WITH THE WOMEN WHO ARE
GROUNDED, I SAY SPIRITUALLY,
RELIGION, LOOKING AT THE
FRAMEWORK AS WELL.
THEN FINALLY THERE'S A PIECE
THAT WE'RE DEALING WITH IN
PROJECT 2 AND PROJECT 1 THAT
FOCUSES ON THE MENTAL HEALTH
PIECE.
VERY BIG CHALLENGE IN THE DELTA.
VERY FEW MENTAL HEALTH PROVIDERS
IN THE COUNTIES THAT WE'RE
LOOKING AT.
SO WHAT WE'RE HOPING TO DO IS
BETTER UNDERSTAND, WE FRAMED A
PROJECT CALL WOULD AIN'T
NOBODY'S BUSINESS BUT MY OWN,
BECAUSE WHEN YOU START TALKING
TO WOMEN ABOUT MENTAL HEALTH,
THAT IS THE FEELING, IT AIN'T
NOBODY'S BUSINESS BUT MY OWN.
SO WE'RE TRYING TO GET PAST SOME
OF THAT STIGMA ASSOCIATED WITH
MENTAL HEALTH BECAUSE IT'S A BIG
PIECE.
WHEN NIH VISITED US A COUPLE
WEEKS AGO, WE HAD SOME OF THE
WOMEN THERE AND THEY TALKED
ABOUT THE STRUGGLES AND NOT EVEN
BEING ABLE TO IDENTIFY THAT IT
WAS POSTPARTUM DEPRESSION OR
OTHER THINGS.
SO WE'RE TRYING TO HAVE THOSE
CONVERSATIONS IN AN INFORMAL
MANNER SO THAT WOMEN WILL BE
ABLE TO TALK ABOUT IT.
WE HAVE TWO PIECES PLANNED.
ONE OF THEM IS WHAT WE CALL A
WORKSHOP TO TALK ABOUT THIS
THING THAT WE DON'T WANT TO TALK
ABOUT IN OUR COMMUNITY'S MENTAL
HEALTH, WHAT DOES IT LOOK LIKE,
WHAT DOES IT FEEL LIKE, AND WHAT
EXACTLY ARE WE TALKING ABOUT.
AND I ALWAYS USE THE LANGUAGE
ALL OF US SHOULD BE SEEING
SOMEONE.
YOU KNOW, IN THIS LIFE PIECE.
THEN THE OTHER LINE IS
DEVELOPING ONLINE SUPPORT
GROUPS.
WE HAVEN'T DONE THOSE IN THE
DELTA.
IT'S GOING TO BE OUR FIRST TIME
TRYING IT, BUT WE HAVE A MODEL
THAT'S BEEN USED THROUGH THE
V.A. AND WE HAVE A YOUNG LADY
WITH THE V.A. HOSPITAL THAT'S
ACTUALLY DEVELOPING THOSE.
WE'RE GOING TO BE TRYING IT IN
YEAR TWO, STARTING IN JANUARY.
THOSE ARE BEING DEVELOPED NOW.
AND WE'RE USING THE WORKSHOP TO
KIND OF BE A PRELUDE TO WHAT
WOMEN EXPECT AND WHAT THEY'D BE
LIKE TO BE ABLE TO TALK ABOUT IN
AN ONLINE SUPPORT GROUP FORMAT.
THE LAST PIECE IS CALLED WALK A
MILE IN MY SHOES, A FORMATIVE
RESEARCH FOR PROJECT 2, WHEN
WODESIGNEDTO BETTER UNDERSTAND.
WHEN WOMEN THINK WITH POSTPARTUM
CARE, WHERE ARE ALL THE PIECES
THEY THINK ABOUT?
EVERYBODY HAS A DIFFERENT
EXPERIENCE.
SO THAT WORKSHOP IS GOING TO BE
ABOUT THAT.
AND THEN FINALLY, I MENTION THIS
FORHER, INNOVATING FORHER
MATERNAL MENTAL HEALTH PIECE,
GIVES YOU A LITTLE BIT OF
INFORMATION ABOUT HOW IT'S
DESIGNED, ONCE A WEEK THROUGH
FORMATIVE RESEARCH, ONE-HOUR
DURATION, SHE SAID SHE WOULD
ADJUST THOSE AS NEEDED DEPENDING
ON WHAT THE WOMEN WANT.
AND SHE'S GOING TO LEAD THESE
FOR A 12-WEEK SESSION.
SO WE BETDER UNDERSTAND SOME OF
THE TOPICS.
AND THEY SHE WILL ALSO BE ABLE
TO ASSESS WHETHER OR NOT A WOMAN
NEEDS TO BE REFERRED TO A MORE
SPECIFIC MENTAL HEALTH PROVIDER
AND THEY HAVE SOME LIFE HELP
MENTAL HEALTH CENTERS IN THE
DELTA.
OTHERWISE WE'D PROBABLY BE
TALKING ABOUT REFERRING OUT FOR
A MENTAL HEALTH PROVIDER IN
JACKSON, SO THEN WE GET INTO THE
TRAVEL ISSUES OR WHETHER OR NOT
TELEHEALTH IS BEING PROVIDED.
SO I WANT TO THANK YOU FOR
LISTENING.
I LEFT OUT A LOT OF SLIDES, BUT
WE ARE VERY EXCITED FOR THE
WORK.
WE HAVE A LOT OF WORK AHEAD OF
US AND SOME CHALLENGES WITHIN
OUR COLLABORATIVE THAT VERY MUCH
MIMIC SOME OF THE ISSUES WITHIN
THE MISSISSIPPI DELTA REGION AND
MISSISSIPPI IN GENERAL, SO I'M
GOING TO CONCLUDE WITH THAT.
>> THANK YOU, DR. SHAW.
[APPLAUSE]
>> THE QUESTION WAS, ARE THERE
COMMUNITY MIDWIVES IN THE DELTA
AND HOW ARE THEY INVOLVED IN
THIS PROJECT?
>> GOOD QUESTION.
WE ACTUALLY JUST HAD A --
THEY'RE NURSE-BASED MIDWIVES IN
MISSISSIPPI BUT NOT COMMUNITY IN
THE SENSE OF THAT THEY CAN EXIST
OR OPERATE OUTSIDE OF A
HOSPITAL-BASED SYSTEM.
WE ACTUALLY HAD A DISCUSSION
ABOUT THIS, I GUESS IT WAS ABOUT
FOUR OR FIVE WEEKS AGO IN ONE OF
MY CLASSES, WE HAD A RESEARCHER
OUT OF THE UNIVERSITY OF
TENNESSEE CAME AND TALKED ABOUT
RESPECTFUL MATERNITY CARE AND
SUCCESS THEY WERE HAVING WITH
MIDWIVES, BUT RIGHT NOW IN
MISSISSIPPI, NO, THE
COMMUNITY-BASED MIDWIFE OPTION
IS NOT THERE.
DOULAS, IN MISSISSIPPI WE
HAVEN'T EXPANDED MEDICAID SO
THERE ARE A LOT OF BARRIERS TO
SOME OF THOSE ADDITIONAL
SUPPORTS FOR MATERNAL
HEALTHCARE.
>> THANK YOU.
WE DON'T HAVE TIME FOR
QUESTIONS, BUT --
>> IT'S REALLY IMPORTANT.
>> OKAY.
[LAUGHTER ?CHT YOU CAN
DEFI]YOU CAN DEFINITELY TALK TOR
AT THE BREAK.
THANK YOU SO MUCH, DR. SHAW.
[APPLAUSE]
NEXT UP WE HAVE DR. RACHEL
CASKEY FROM THE UNIVERSITY OF
ILLINOIS-CHICAGO.
[APPLAUSE]
>> THANK YOU.
IT'S A PLEASURE TO BE HERE.
ON BEHALF OF OUR WHOLE TEAM,
MYSELF AND KENYA MCGREY ARE HERE
TODAY.
WE ARE ONE OF THE SITES THAT WAS
JUST RECENTLY FUNDED A FEW
MONTHS AGO, SO I'M GOING TO
LARGELY SHARE WHAT IS PLANNED TO
BE DONE.
WE DON'T HAVE AS MANY OUTCOMES
YET.
IN THE FUTURE, WE WILL SHARE
THOSE.
BUT I'D LIKE TO TALK ABOUT WHAT
WE'RE EXCITED ABOUT AND WHY WE
THINK CHICAGO AND THE STATE OF
ILLINOIS IS IMPORTANT FOR THIS
WORK.
SO I HOPE MANY OF YOU HAVE
VISITED CHICAGO.
WE'RE BIASED, IT'S A GREAT PLACE
TO BE.
BUT IT'S ALSO A REALLY CRITICAL
LOCATION FOR THE CENTER OF
EXCELLENCE.
SO PEOPLE OFTEN THINK OF CHICAGO
AS A CITY OF NEIGHBORHOODS, AND
IT IS.
IT HAS A LONG HISTORY OF VERY
DEFINED COMMUNITIES WITHIN THE
CITY.
AND EACH COMMUNITY REALLY HAS A
CULTURE AND ITS OWN VIBRANCY.
WHICH IS FUN.
YOU CAN LIVE LOTS OF DIVERSE
PLACES, ALL WITHIN ONE TOWN.
HOWEVER, WE ALSO HAVE ANOTHER
HISTORY.
A DARKER HISTORY.
WE ARE CONSIDERED, SADLY, TODAY,
ONE OF THE MOST SEGREGATED URBAN
AREAS IN THE U.S.
WE HAVE A HISTORY OF RED LINING,
WE HAVE A HISTORY OF THINGS THAT
REALLY CONTRIBUTED TO THE
TERRIBLE DISPARITIES WE SEE
TODAY FOR ALL HEALTH OUTCOMES,
INCLUDING MATERNAL HEALTH.
AS SOME OF YOU MAY HAVE READ,
THIS WAS PUBLISHED ABOUT A YEAR
OR SO AGO.
GERNTION THE CITY OF
NEIGHBORHOODS.
TWO NEIGHBORHOODS WERE LOOKED
AT: GOLD COAST, WHICH IS THE
NORTHERN RED CIRCLE YOU SEE, A
HIHISTORICALLY AFFLUENT WHITE
NEIGHBORHOOD ON THE LAKE, AND
ENGELWOOD, A HISTORICALLY LOWER
INCOME BLACK COMMUNITY.
THERE'S A LIFE EXPECTANCY GAP OF
30 YEARS.
THESE TWO COMMUNITIES ARE
APPROXIMATELY 10 MILES APART.
AND WE SEE A LIFE GAP OF 30
YEARS.
WHICH IS AWFUL.
AND SO AGAIN, ONE OF THE REASONS
WHY THOSE OF US DOING THIS WORK
ARE SO EXCITED TO BE ABLE TO
BUILD THE CENTER OF EXCELLENCE.
LIKE MANY OF YOUR STATES,
ILLINOIS HAS TERRIBLE HEALTH
DISPARITIES FOR MATERNAL HEALTH.
BLACK WOMEN ARE THREE TIMES AS
LIKELY TO DIE WITHIN A YEAR OF
PREGNANCY, HAVE THE HIGHEST
RATES OF NOT JUST SEVERE
MATERNAL MORBIDITY BUT ALL
MATERNAL MORBIDITY.
WOMEN THAT ARE PUBLICLY INSURED
ARE THREE TIMES AS LIKELY TO DIE
COMPARED TO THOSE COMMERCIALLY
INSURED, AND LIKE MISSISSIPPI,
MANY OF OUR BAD OUTCOMES HAPPEN
IN THE POSTPARTUM PERIOD.
ABOUT -- ABOUT 70% OF THE
MORTALITY AS WELL AS NEARLY ALL
THE MORBIDITY OCCURS DURING THE
POSTPARTUM PERIOD, AND NEARLY
ALL HAVE BEEN DETERMINED
PREVENTABLE.
BY OUR REVIEW
COMMITTEES, OUR MATERNAL
MORBIDITY AND MORTALITY REVIEW
COMMITTEES.
SO IN MY MIND, IN THE STATE OF
ILLINOIS, IN THE CITY OF
CHICAGO, NEARLY ALL OF THESE
DEATHS SHOULD BE NEVER EVENTS IN
HEALTHCARE.
THEY SHOULD NOT HAPPEN AND
THAT'S WHAT WE'RE HOPING TO HELP
MOVE THE NEEDLE ON.
UNIVERSITY OF ILLINOIS-CHICAGO
IS ALSO WELL POSITIONED FOR THIS
WORK.
WE ARE A MINORITY-SERVING
INSTITUTION AS A WHOLE ACROSS
THE WHOLE UNIVERSITY, AND WE ARE
ACTUALLY ONE OF THE MOST DIVERSE
PUBLIC RESEARCH INSTITUTIONS IN
THE U.S.
FROM THE HEALTHCARE AND PUBLIC
HEALTH PERSPECTIVE, UNIVERSITY
OF ILLINOIS HEALTH, WHICH IS
PART OF THE LARGER CAMPUS, IS
THE ONLY ACADEMIC MEDICAL CENTER
IN CHICAGO THAT IS PUBLIC.
THERE ARE A LOT OF INCREDIBLE
ACADEMIC AND NON-ACADEMIC
MEDICAL CENTERS IN CHICAGO.
BUT WE ARE THE ONLY ACADEMIC
MEDICAL CENTER THAT IS A PUBLIC
INSTITUTION AND A PUBLIC
HOSPITAL.
WE PRIORITIZE THE PUBLICLY
INSURED.
AND I WILL TELL YOU, AS A
CLINICIAN, IT IS AN OUTSTANDING
PLACE TO SIT.
I NEVER HAVE TO WORRY WHAT
SOMEONE'S INSURANCE IS, AND IN
FACT, WE BUILD A ROBUST TERTIARY
MEDICAL CENTER FOR PRIORITIZING
THOSE THAT COME IN WITH MEDICAID
OR ONE OF THE MEDICAID MCOs,
SO IT'S REALLY A WONDERFUL PLACE
TO WORK.
AND THEN WE HAVE THE BENEFIT OF
RURAL PARTNER CAMPUSES IN PEORIA
AND ROCKFORD, WHICH IS, OF
COURSE, ALSO IMPORTANT TO THIS
WORK.
SO BRIEFLY, OUR MATERNAL HEALTH
RESEARCH CENTER OF EXCELLENCE
BUILDS ON A LARGE DIVERSE TEAM
THAT HAS WELL OVER A DECADE OF
EXPERTISE IN THIS AREA.
I'M GOING TO SHOW YOU JUST A FEW
AREAS OF EXPERTISE IN A MOMENT.
AND OF COURSE OUR GOAL LIKE ALL
OF YOURS IS REALLY TO ADDRESS
THE MORBIDITY AND MORTALITY
ACROSS THE STATE.
SO OUR DESIGN IS USING METHODS
TO EXAMINE MECHANISMS BY WHICH
STRUCTURAL INEQUITY CONTRIBUTE
TO HEALTH DISPARITIES.
AND WE'RE LOOKING TO USE A
MULTILEVEL APPROACH, REALLY
TRYING TO PULL AWAY FROM
INDIVIDUAL CONTRIBUTORS, AND
LOOK AT STRUCTURAL AND
SYSTEM-LEVEL CONTRIBUTORS, AND
WAYS WE CAN CHANGE THOSE IN THE
CITY AND STATE.
OUR TEAM COMES FROM OVER 14
DISCIPLINES, ALL WORKING WITHIN
THE MATERNAL HEALTH SPACE FOR
MANY YEARS.
WE HAVE EDUCATION, HEALTHCARE,
PUBLIC HEALTH, WE HAVE BASIC
SCIENCES AT THE TABLE, COMMUNITY
GROUPS.
THE LIST GOES ON.
SO IT REALLY A ROBUST TEAM THAT
WE'RE LEARNING A LOT FROM EACH
OTHER IN THESE FIRST FEW MONTHS
OF OUR BUILDING FLEURCHLT SO OF
COURSE LIKE ALL OF YOU, WE HAVE
CORES.
I'M JUST GOING TO TOUCH BRIEFLY
ON THE PREMISE FOR WHICH WE
DESIGNED OUR CORES.
FOR OUR TRAINING CORE, AGAIN,
GETTING BACK TO THE MISSION OF
OUR INSTITUTION AS A WHOLE.
WE AR REALLY WANT TO BUILD A
STRUCTURE FOR ONGOING PIPELINE
OF MATERNAL HEALTH RESEARCHERS.
AND SPECIFICALLY DEVELOP A
DIVERSE PIPELINE OF MATERNAL
HEALTH RESEARCHERS COMING FROM
DIVERSE LIVED EXPERIENCE,
DIVERSE TRAINING BACKGROUNDS AND
SO FORTH.
WE HOPE TO GENERATE A LOT OF
EARLY STAGE INVESTIGATORS WHO GO
ON TO BECOME INDEPENDENT, AND UP
WITH OF THE THINGS T -- ONE OF S
THAT I'M EXCITED ABOUT IS WE ARE
PULLING IN COMMUNITY-BASED
CLINICIANS INTO OUR TRAINING
CORE.
SO ONE OF THE COMMUNITY GROUPS
WE'RE PARTNERING WITH HAS A
CONSORTIUM OF FEDERALLY
QUALIFIED HEALTH CENTERS ACROSS
THE STATE.
WE'RE ACTUALLY LOOKING FOR
CLINICIANS WHO WORK ON THE
GROUND IN COMMUNITY FQHCs TO
COME AND BE A PART OF OUR
TRAINING CORE.
PEOPLE WHO WANT TO LEARN A BIT
ABOUT RESEARCH.
MAYBE LEARN HOW TO USE DATA
WITHIN THEIR FQHC FOR CHANGE OR
FOR EVALUATION.
AND THESE ARE COMMUNITIES THAT
ARE UNDERSTUDIED BECAUSE SO MANY
OF OUR COMMUNITY FQHCs ARE
DOING SO MUCH GREAT CLINICAL
WORK, THEY DON'T HAVE TIME FOR
THIS, RIGHT?
THEY OFTEN DON'T HAVE TIME,
RESOURCES OR INFRASTRUCTURE FOR
RESEARCH.
SO WE'RE HOPING TO PROVIDE SOME
SUPPORT TO GET THEM INVOLVED.
AND THEN WE HAVE A TEAM OF
EXPERT MENTORS.
THESE ARE PEOPLE WHO SPENT THEIR
CAREER FIGURING OUT HOW TO MOST
EFFECTIVELY MENTOR ADULT
LEARNERS.
AND THEY'RE GOING TO HELP CREATE
A JOURNEYMEN T JOURNEY MENTORINR
EVERYONE REGARDLESS OF
BACKGROUND AND TRAINING.
WE'RE LEVERAGING SOME OF OUR
EXISTING TRAINING PROGRAMS AT
UNIVERSITY OF ILLINOIS.
WE HAVE A BIRCWH, WHICH IS NIH
FUNDED, WHICH IS AGAIN FOCUSED
ON JUNIOR FACILITY WHO STUDY
ISSUES RELATED TO WOMEN AND
GENDER.
WE HAVE A T32 PROGRAM ON
PRECISION MEDICINE AND WE ARE
RECRUITING POSTDOCS INTO THAT
PROGRAM WITH AN INTEREST IN
MATERNAL HEALTH RESEARCHMENT AND
OUR SCHOOL OF PUBLIC HEALTH HAS
AN ACE PROGRAM, AGAIN A JUNIOR
FACULTY PROGRAM TO BUILD
INDEPENDENT RESEARCHERS.
I MENTIONED THE COMMUNITY
CLINICIANS AT FQHCs, AND WE
ARE ALSO ENSURING THAT EVERYONE
WE HIRE TO SUPPORT THE CENTER
HAS ACCESS TO THE TRAINING CORE.
WE HIRE RESEARCH ASSISTANTS,
GRADUATE STUDENTS, COMMUNITY
MEMBERS.
ALL SORTS OF THE STAFF THAT
REALLY MAKE THESE THINGS
POSSIBLE.
WE ALSO WANT TO MAKE SURE THEY
HAVE AN OPPORTUNITY FOR THEIR
OWN CAREER DEVELOPMENT, SO
THEY'RE ACTUALLY A GROUP WITHIN
THIS TRAINING CORE THAT WE'RE
GOING TO FOCUS ON, AND AGAIN,
BASED ON THEIR BACKGROUND AND
NEEDS WILL BE TAILORED.
OUR COMMUNITY PARTNERSHIP CORE
ADDRESSES CRITICAL NEED FOR
STRUCTURED SYSTEM LEVELS
APPROACH TO ENGAGE COMMUNITIES.
WE HAVE THE OPPORTUNITY NOW TO
REALLY EXPAND ON EXISTING
PARTNERSHIPS WITH EVERTHRIVE
ILLINOIS, WHICH IS A INCREDIBLE
NON-PRO FUCT FOCUSED ON
REPRODUCTIVE JUSTICE AND BIRTH
EQUITY, AND THEN
ALLIANCECHICAGO, WHICH IS THE
GROUP OF FEDERALLY QUALIFIED
HEALTH CENTERS I MENTIONED.
WE HAVE ALREADY STARTED TO
DEVELOP OUR COMMUNITY ADVISORY
BOARD, EVERTHRIVE IS TAKING THE
LEAD AND THEY SENT OUT SOME
INITIAL INVITATIONS LAST WEEK SO
THAT'S EXCITING.
THEY'RE GOING TO BE SCHEDULING
THEIR FIRST MEETING IN A MONTH
OR SO.
AND WE'RE REALLY HOPING TO DRAW
AN EXPERTISE OF OUR COMMUNITY
MEMBERS ACROSS ALL AREAS OF THE
CENTER.
WE BUILT THIS WITH A HUMAN
CENTERED DESIGN FRAMEWORK
APPROACH.
WE REALLY TRY TO ENSURE EVERYONE
HAS AN OPPORTUNITY TO HAVE A
VOICE AT THE TABLE.
AND THEN WE WILL ALSO ANTICIPATE
BARRIERS AND BURDENS AS WE PRO
SATISFIED.
A FEW ACTIVITY EXAMPLES OF OUR
COMMUNITY ADVISORY BOARD.
AGAIN BIDIRECTIONAL, WE WANT TO
HELP BRING RESEARCH TO THE
COMMUNITY, PROVIDE OPPORTUNITIES
FOR INTRODUCTION TO WHAT OUR
RESEARCH METHODS, APPROACHES, SO
FORTH, FOR OUR COMMUNITY
STAKEHOLDERS AND COMMUNITY
GROUPS ACROSS THE STATE.
LIKEWISE WE WANT TO BRING THE
COMMUNITY VOICE TO OUR
RESEARCHERS AND MAKE SURE
THEY'RE MAKING THE COMMUNITIES
INVOLVED WITH DESIGN, BUT ALSO
THAT THEY MAKE RESULTS
DIGESTIBLE AND UNDERSTANDABLE
AND MEANINGFUL TO COMMUNITIES
THEY MAY IMPACT.
LOTS OF COMMUNITY DIALOGUES
PLANNED, AND WE ALSO ARE
PLANNING A CITIZEN SCIENTIST
PROGRAM, WHERE COMMUNITY
PARTNERS WILL WORK TOGETHER WITH
SOME OF OUR TRAINED QUALITATIVE
STAFF TO GATHER NARRATIVES
THROUGH STORY CIRCLES,
PHOTOVOICE, INTERGENERATIONAL
FAMILY HISTORIES, AND THEN
ACTUALLY USE A RESEARCH
FRAMEWORK TO ANALYZE THEIR OWN
QUALITATIVE DATA AND PRESENT
THAT BACK TO EACH OTHER AND THE
COMMUNITIES, AS WELL AS TO OUR
RESEARCHERS.
AND FINALLY OUR RESEARCH CORE IS
FOCUSED ON A PROJECT WHICH IS A
MULTILEVEL EXPOSURE TO ADVERSITY
ACROSS THE LIFECOURSE.
LOOKING AT BIOLOGICAL
IMPLICATIONS IN POSTPARTUM
WOMEN.
SO WE'RE LOOKING TO DESCRIBE
EXPOSURE TO MULTILEVEL BOTH
NEIGHBORHOOD, FAMILY AND
INDIVIDUAL ADVERSE FACTORS AMONG
POSTPARTUM PEOPLE, ASSESS THE
EFFECT OF THOSE EXPOSURES ON
PREGNANCY AND BIRTH OUTCOMES,
AND DO SOME QUALITATIVE WORK
USING PHOTOVOICE TO GET EVEN
RICHER INFORMATION.
AND OF COURSE OUR COMMUNITY
MEMBERS WILL BE INVOLVED IN
EVERY STEP OF THE PROCESS.
HERE'S JUST SOME EXAMPLES OF THE
PLANNED DATA TO BE COLLECTED AS
THIS PROJECT GETS OFF THE
GROUND.
AND FINALLY, WE HAVE STRUCTURED
OUR OWN DATA COMMITTEE, GIVEN
THE SIZE OF THESE PROJECTS, WE
THOUGHT IT WAS IMPORTANT TO HAVE
A UNIFYING STRUCTURE ACROSS THE
CENTER TO WORK WITH THE DATA
INNOVATION AND COORDINATING HUB,
OF COURSE, BUT ALSO TO ENSURE WE
ARE COLLECTING GOOD DATA ACROSS
ALL OF OUR CORES, AND DOING IT
AHEAD OF TIME.
SO WE DON'T -- WE'RE NOT TWO
YEARS IN, AND WONDERING WHY
DIDN'T WE COLLECT THIS, THAT OR
THE OTHER.
SO THIS GROUP IS WORKING ACROSS
ALL THE CORES REALLY, ENSURING
THAT WE'RE GETTING GOOD ROBUST
BOTH QUANTITATIVE AND
QUALITATIVE DATA AS APPROPRIATE.
AND THEY'RE ALSO SERVING AS A
MENTORSHIP GROUP TO TRAIN AND
EDUCATE THE WORKFORCE, AND THEN
THIS DATA WILL BE AVAILABLE NOT
JUST TO SHARE WITH PARTNERS
OUTSIDE OF UIC, BUT TO SHARE
ACROSS UIC AND WITH COMMUNITY
PARTNERS.
AND I'M GOING TO STOP THERE AND
TAKE YOUR QUESTIONS.
THANK YOU.
[APPLAUSE]
>> THANK YOU SO MUCH.
DO WE HAVE ANY QUESTIONS IN THE
AUDIENCE?
SO I HAVE A QUESTION FOR YOU.
IN TERMS OF ANALYZING THAT
REALLY RICH QUALITATIVE DATA,
FROM PHOTOVOICE, LISTENING
SESSIONS, DO YOU SEE TOOLS LIKE
A.I. BEING USEFUL IN THAT, AND
IF SO, WHAT ARE THE POTENTIAL
BIASES THAT WE KNOW A.I. HAS,
WHAT COULD THAT BRING TO THAT
SPECIFIC --
>> THAT'S A REALLY GOOD
QUESTION.
I'M SURE MANY OF US ARE
STRUGGLING TO FIGURE OUT HOW TO
INCORPORATE A.I. THESE DAYS.
WE HAVE A LOT OF BURGEONING A.I.
RESEARCHERS AT UNIVERSITY OF
ILLINOIS, WHICH WE CAN LEAN ON,
AND SO THE SHORT ANSWER IS, I
THINK THERE'S A ROLE, THE LONG
ANSWER IS, I DON'T THINK WE KNOW
YET, BECAUSE OF COURSE THERE'S
INTRINSIC BIAS IN EVERYTHING,
RIGHT?
A.I. IS TRAINED ON DATA AND
SCIENCE WITHIN THE LARGER
INTERNET, AND THOSE COULD BE
BIASED IN AND OF ITSELF, SO I
DON'T KNOW HOW WE'RE GOING TO DO
THIS, BUT WE HAVE A LOT OF SMART
PEOPLE THINKING ABOUT IT, SO IT
A GREAT QUESTION.
>> WE HAVE A QUESTION IN THE
AUDIENCE.
>> HELLO, THANK YOU FOR YOUR
PRESENTATION.
I'M FROM NATURE.
I LOVE EVERYTHING I SEE.
I'M FROM ST. LOUIS AND I HAVE
CLOSE TIES TO CHICAGO.
TOWARDS THE SYSTEMIC ANGLE OF
PRIORITIES AND STRATEGY, I SAW
THERE'S MULTIPLE DIFFERENT
SECTORS EVEN WITHIN UIC THAT
WOULD BE INVOLVED, SO HOW WILL
THE ENGAGEMENT BE IN TERMS OF,
LIKE, SYSTEMIC CHANGE IN TERMS
OF POLICY CHANGES, IMPROVING
ACCESS TO DIFFERENT RESOURCES,
AND EVEN THE BIGGER FACTORS OF,
LIKE, THE RACIAL AND ECONOMIC
DISPARITIES, MCDADEING THAT
LEVEL OF SYSTEMIC CHANGE?
>> THAT'S REALLY THE CRITICAL
END GAME, RIGHT?
IS WE NEED TO REALLY MAKE THE
SUSTAINABLE CHANGE, WE NEED TO
GO ALL THE WAY UP TO THE
POLICYMAKERS, THE LEGISLATORS.
SO WE HAVE STRATEGICALLY
INCLUDED PEOPLE ON THE TEAM THAT
HAVE A LOT OF EXPERIENCE IN THAT
SPACE, POLICY DEVELOPMENT AT THE
STATE LEVEL, ADVOCACY, AND WE
WORK VERY CLOSELY WITH OUR STATE
PARTNERS AT BOTH CHICAGO
DEPARTMENT OF PUBLIC HEALTH AND
ILLINOIS DEPARTMENT OF PUBLIC
HEALTH, AS WELL AS SOME OF OUR
ELECTED OFFICIALS.
I WOULD HAVE LOVED TO, YOU KNOW,
BELIEVE THAT EVERYTHING WE DO
WILL MAKE IT ALL THE WAY UP, BUT
I DO FIND THAT IN ILLINOIS, IF
YOU HAVE A THOUGHTFUL APPROACH
AND YOU CAN SHOW YOU'VE DONE A
GOOD JOB LOOKING AT THE ISSUE,
RIGHT, YOU'VE STUDIED IT
PROPERLY, YOU'VE ENGAGED THE
RIGHT VOICES, I HAVE BEEN VERY
PLEASANTLY SURPRISED AT HOW WELL
PEOPLE LISTEN.
WHERE IT GOES FROM THERE IS HARD
TO SAY.
BUT I THINK WE'VE SEEN SOME GOOD
SUCCESS.
WE'RE QUICK TO EXPAND MEDICAID.
WE EXPANDED THE MEDICAID
POSTPARTUM COVERAGE UP TO 12
MONTHS EARLY ON, WE WERE ONE OF
THE FIRST STATES TO DO THAT, SO
WE HAVE A STATE VERY INTERESTED
IN SUPPORTING THESE OUTCOMES, SO
I'M CAUTIOUSLY OPTIMISTIC.
WE HAD ACTUALLY SOME OF OUR
STATE ELECTED REPRESENTATIVES AT
OUR KICKOFF EVENT AFTER WE WERE
FUNDED, AND THAT WAS ON -- WE
DIDN'T INVITE THEM, THEY OFFERED
TO COME, WHICH I FEEL WAS
MEANINGFUL.
>> THANK YOU.
>> GREAT, THANK YOU SO MUCH.
[APPLAUSE]
NOW I'D LIKE TO INTRODUCE OUR
LAST GROUP OF SPEAKERS,
DR. MCKENNAN, DR. ELLIOTT AND
DR. MCCORMACK FROM SOUTH DAKOTA,
ON IMPROVING RURAL MATERNAL
HEALTH, PERSPECTIVES FROM SOUTH
DAKOTA.
>> GOOD MORNING, PRESSURE TO BE
HERE.
I'M AMY ELLIOTT, CHIEF RESEARCH
OFFICER AT AVERA, ALSO PROFESSOR
AND DIVISION CHIEF IN THE
UNIVERSITY OF SOUTH DAKOTA
SCHOOL OF MEDICINE.
UNLIKE A LOT OF AREAS AND MANY
OF YOUR LOCATIONS, OUR CLINICAL
RESEARCH TENDS TO EXIST WITHIN
COMMUNITY HOSPITALS RATHER THAN
ACADEMIC MEDICAL CENTERS.
SO THAT GIVES US SOME DISTINCT
ADVANTAGES AND POSES SOME
CHALLENGES AS WELL.
SO WE'RE HAPPY TO LET YOU KNOW A
LITTLE ABOUT OUR AREA.
SO SOUTH DAKOTA, FOR THOSE OF
WHO YOU AREN'T FAMILIAR, IS YOU
SEE ON THE ONE MAP, THERE'S SOME
SHADED AREAS THAT SHOW YOU THE
NINE TRIBAL NATIONS THAT EXIST
WITHIN OUR STATE.
ON THE OTHER SIDE, THE BLUE AND
THE YELLOW, SHOWS THE RURALITY
OF THE STATE.
OUR STATE IS FLANKED BY CITIES
ON THE EAST AND WEST SIDE.
I DID HAVE TO SMILE THIS MORNING
WHEN OUR COLLEAGUES FROM
MISSISSIPPI DESCRIBED THE NUMBER
OF HOURS IT TAKES TO DRIVE
SOMEWHERE.
I THINK THAT'S A TRUE LITMUS OF
SOMEONE WHO LIVES IN A RURAL
AREA.
TO GET FROM ONE SIDE OF THE
STATE TO THE OTHER IS SIX HOURS.
AND WE HAVE AN 80-MILE AN HOUR
SPEED LIMIT.
SO THE AVERA HEALTH SYSTEM
COVERS QUITE A BIT, ABOUT TWO
THIRDS OF THE STATE.
37 ACUTE CARE HOSPITALS, OVER
200 OUTPATIENT CLINICS, SO THE
CLINICAL PARTNERSHIPS OF THIS
ARE SOMETHING THAT WE'RE VERY
EXCITED ABOUT INCORPORATING
WITHIN OUR CENTER OF EXCELLENCE.
THE STARS ON THIS DETECT WHERE E
OUR RESEARCH OFFICES ARE.
SO WE HAVE ONE ON THE EAST SIDE
OF THE STATE, RAPID CITY, PINE
RIDGE, WHICH IS OUR LARGEST
AMERICAN INDIAN TRIBAL NATION,
AND THEN ALSO IN PEERE, IN THE
MIDDLE OF THE STATE.
HERE'S OUR LEAPER SHIP.
FOR MATERNAL HEALTH OUTCOMES,
OUR POPULATION OF OUR STATE IS
LARGELY WHITE WITH ABOUT 76.9%
OF WOMEN OF CHILD BEARING AGE
FALLING INTO THAT CATEGORY, AND
OUR AMERICAN INDIAN RATE FOR
WOMEN OF CHILD BEARING AGE IS
9.3%.
THE SEVERE MATERNAL MORTALITY,
ABOUT 79 -- 72.9 PER THOUSAND
DELIVERIES.
AND WHAT YOU CAN SEE FROM THE
BAR GRAPH ON HERE IS THAT HAS
BEEN STEADILY INCREASING OVER
THE PAST FEW YEARS.
SO IN TERMS OF OUR PREGNANCY-ROW
PREGNANCY-RELATED DEATHS, THIS
IS WHERE THE HEALTH DISPARITIES
START TO COME SCREAMING OFF OF
THE PAGE.
ON THE GREEN CHART THAT YOU SEE,
IF THERE WAS NO HEALTH
DISPARITIES, THOSE LINES WOULD
BE STRAIGHT.
MEANING THAT THE PROPORTION OF
BIRTHS WITHIN THE STATE WAS
EQUAL TO THE OUTCOME.
AND WHAT YOU CAN SEE FROM THE
MIDDLE GREEN LINE IS THAT OUR
AMERICAN INDIAN MATERNAL
MORTALITY RATE IS ABOUT 4 TIMES
WHAT YOU WOULD EXPECT FOR THE
PERCENT OF BIRTHS WITHIN OUR
AREA.
SO WE'VE TALKED A LOT ABOUT
BARRIERS TO ACCESS AND WE'RE NO
DIFFERENT THAN MANY OF YOUR
STATES, WHERE WE HAVE A LARGE
PERCENT OF MATERNITY CARE
DESERTS, OUR DISTRIBUTION OF
OBSTETRIC PROVIDERS IS QUITE
SPARSE, AND ACCESS TO HOSPITALS.
AND SO THERE'S ACTUALLY 78.8% OF
OUR COUNTIES THAT HAVE NO
HOSPITAL OR BIRTH CENTER, SO
IT'S NOT EVEN A MATTER SOMETIMES
OF ACCESS, IT'S A MATTER OF THEY
PHYSICALLY DO NOT EXIST.
AND HOW IS IT THAT WE CAN GET
CARE?
NEARLY 1 IN 4 WOMEN IN OUR AREA
HAVE NO BIRTHING HOSPITAL WITHIN
30 MINUTES, COMPARED TO 9.7% OF
THE UNITED STATES.
SO WHAT THIS MEANS IS, THERE'S A
LOT OF TIME ON THE ROAD
TRAVELING.
SOME CAN TRAVEL UP TO 118 MILES.
AGAIN, 128 MINUTES, AND THEN
UNDER NORMAL TRAFFIC CONDITIONS,
9.1% OF THE WOMEN LIVE OVER 60
MINUTES AWAY.
AND THEN, OF COURSE, IT SOUTH
DAKOTA.
SO I'M GOING TO NOW TURN IT OVER
TO MY COLLEAGUE AND OUR PROJECT
DIRECTOR FOR OUR CENTER OF
EXCELLENCE, DR. LACEY MCCORMACK.
[APPLAUSE]
>> THANK YOU.
SO WE TALK A LOT ABOUT ACCESS IN
SOUTH DAKOTA WHEN WE TALK ABOUT
MATERNAL HEALTHCARE, MATERNAL
HEALTH SERVICES, SO THINGS LIKE
DOES IT EXIST, CAN I GET THERE,
HOW LONG DOES IT TAKE TO GET
THERE.
WE ALSO HAVE TO CONSIDER THINGS
LIKE DO I HAVE TO MISS WORK IN
ORDER TO MAKE THESE
APPOINTMENTS, HOW CAN I GET
CHILD CARE ARRANGED, THINGS LIKE
THAT.
AS WE CONTINUE TO DIVE INTO THE
SOCIAL AND STRUCTURAL
DETERMINANTS OF HEALTH AROUND
HEALTHCARE AND SUPPORT SERVICES
IN SOUTH DAKOTA, IT ALSO BECOMES
AN ISSUE OF WHAT IS AVAILABLE.
IS IT A SPECIALTY SERVICE?
HOW LONG DO I HAVE TO TRAVEL FOR
ROUTINE CARE OR HIGH RISK CARE?
AND I'LL JUST GIVE YOU AN
EXAMPLE.
SO BEFORE I MOVED TO THE M
METROPOLIS OF SIOUX FALLS, SOUTH
DAKOTA, I LIVED IN A TOWN THAT
HAD ABOUT 24,000 PEOPLE, AND MY
SECOND PREGNANCY WAS HIGH RISK
AND THERE WAS NOT AN O.B.
PROVIDER IN MY TOWN OF 24,000
PEOPLE TO PROVIDE CARE.
SO I HAD TWO OPTIONS.
ONE OF THEM WAS TO DRIVE TWO
HOURS ROUND TRIP FOR ALL OF MY
APPOINTMENTS OR WAIT FOR A
TRAVELING OB PROVIDER TO COME TO
MY TOWN ON A SPECIFIC DAY, AT A
SPECIFIC TIME, AND RECEIVED CARE
IN THAT WAY.
SO I WAS FORTUNATE ENOUGH TO BE
ABLE TO GET CARE, AND I
UNDERSTAND THAT IS A PRIVILEGE
BUT IT ALSO BEGS THE QUESTION OF
WHAT HAPPENS IF I HAVE AN ISSUE
WITH THAT PROVIDER, OR IF I
DON'T TRUST THEM FOR SOME
REASON, OR IF MY CARE IS NOT OF
QUALITY FOR SOME REASON.
THERE WOULD BE NO OTHER OPTION
FOR ME, I WOULD THEN HAVE TO
TRAVEL.
SO IT'S NOT JUST ABOUT IF IT
EXISTS AND IF I CAN GET TO IT.
IT'S REALLY ABOUT THE CHOICE
THAT I HAVE IN THAT MATTER.
AND SO THERE ARE INDIVIDUALS WHO
HAVE ISSUES WITH THE CARE SYSTEM
AND THE QUALITY, AND WILL CHOOSE
NO CARE OVER THE CHOICES THAT
THEY HAVE AVAILABLE TO THEM.
I LIKE TO PUT CONTEXT UP HERE AS
WELL.
ALONG WITH THIS BEAUTIFUL
PICTURE OF A SMALL TOWN IN SOUTH
DAKOTA, BECAUSE IT'S IMPORTANT
TO KEEP IN MIND IF PEOPLE CAN DO
THE THINGS WE ARE TELLING THEM
TO DO.
SO IF WE ARE TELLING PEOPLE TO
EAT MORE FRUITS AND VEGETABLING
DURING PREGNANCY, ARE THOSE
KINDS OF THINGS AVAILABLE IN THE
COMMUNITIES THAT THEY LIVE IN?
I CAN TELL YOU THAT IN THIS
TOWN, YOU WOULD HAVE TO DRIVE AN
HOUR TO GET TO THE NEAREST
GROCERY STORE, AND THAT SORT OF
CHANGES HOW YOU SHOP AND HOW YOU
MEAL PLAN AND THINGS LIKE THAT.
SO BEING AWARE OF THE
ENVIRONMENTS IN WHICH PEOPLE
LIVE, AND ASKS THAT WE'RE MAKING
OF THEM.
THE OTHER THING THAT I WANTED TO
POINT OUT ABOUT DETERMINANTS IS
THAT IS NOT JUST FOR OUR
PATIENTS OR THOSE THAT ARE
SEEKING CARE, IT'S ALSO FOR OUR
PROVIDERS.
SO FOR THE PROVIDERS THAT ARE IN
THE SMALL COMMUNITIES, THEY'RE
USUALLY TRAINED IN
INTERDISCIPLINARY SETTINGS, BUT
THEN GO OFF AND PRACTICE ON
THEIR OWN.
AND DON'T NECESSARILY HAVE A
SUPPORT NETWORK THAT THEY CAN
LEAN ON.
THEY'RE NOT NECESSARILY SEEING
THINGS ALL OF THE TIME AND
KEEPING THEIR SKILLS UP TO DATE,
AND THEY DON'T NECESSARILY HAVE
ACCESS TO TRAINING OPPORTUNITIES
TO STAY UP TO DATE.
OR IF THEY DO, THEY CAN'T LEAVE
THEIR CLINIC BECAUSE THREAR THE
ONLY PROVIDER AND IT'S JUST NOT
POSSIBLE.
SO THOSE ARE THE KINDS OF THINGS
THAT WE ARE WORKING WITH IN
SOUTH DAKOTA.
OUR CENTER OF EXCELLENCE IS
REALLY FOCUSED ON ACCESS AND NOT
JUST BARRIERS TO ACCESS BUT ALSO
SOLUTIONS.
AND SOLUTIONS THAT WORK FOR
PATIENTS, PROVIDERS AND
POLICYMAKERS.
AND THAT IS WOVEN INTO ALL OF
OUR DIFFERENT COMPONENTS,
INCLUDING COMMUNITY
PARTNERSHIPS, TRAINING, AS WELL
AS OUR RESEARCH PROJECT.
WE ARE FOCUSING OUR CENTER ON
RURAL AND AMERICAN INDIAN
POPULATIONS, AND THIS REALLY
BUILDS ON DECADES OF WORK IN OUR
COMMUNITIES WITH THESE
POPULATIONS.
SO WE CAME INTO OUR CENTER OF
EXCELLENCE WITH A LOT OF
COMMUNITY PARTNERSHIPS ALREADY
BUILT, AND WE'RE SEEING
OURSELVES AS A PLATFORM FOR
BRINGING PEOPLE TOGETHER,
LEVERAGING RESOURCES AND
EXPERTISE, AND MOVING THE NEEDLE
IN THE MATERNAL HEALTH SPACE IN
SOUTH DAKOTA IN A MEANINGFUL AND
SUSTAINABLE WAY.
AND THIS IS ESPECIALLY IMPORTANT
TO US BECAUSE AS YOU CAN
IMAGINE, THE MATERNAL HEALTH
SPACE IN SOUTH DAKOTA IS
RELATIVELY SMALL, AND PEOPLE ARE
ASKED TO DO A LOT OF THINGS, SO
WE WANT TO OPTIMIZE PEOPLE'S
TIME AND KEEP PEOPLE FROM
BURNING OUT.
SO IN ADDITION TO REGULARLY
MEETING WITH PARTNERS
INDIVIDUALLY, WE BRING THEM ALL
TOGETHER EACH YEAR AT A SUMMIT.
THIS HAS BEEN A REALLY GREAT WAY
FOR PEOPLE TO MEET EACH OTHER,
AND FOR US TO BRING PEOPLE
TOGETHER THAT WE KNOW SHOULD
MEET AND SHOULD TALK.
OF COURSE THERE ARE BARRIERS TO
GETTING PEOPLE TO A SUMMIT LIKE
THIS AND WE HAVE WORKED TO
ADDRESS THOSE IN A COUPLE
DIFFERENT WAYS.
SO WE HOLD THIS ON ALTERNATING
SIDES OF THE STATE.
WE PROVIDE TRAVEL SCHOLARSHIPS
FOR PEOPLE TO ATTEND.
WE OFFER CONTINUING EDUCATION
FOR PEOPLE TO ATTEND.
OUR FIRST SUMMIT WAS REALLY
GREAT.
WE FOCUSED SORT OF ON SETTING
THE LANDSCAPE FOR MATERNAL
HEALTH IN SOUTH DAKOTA, AND WHAT
IT WILL LOOK LIKE THROUGHOUT THE
SEVEN YEARS OF THIS CENTER OF
EXCELLENCE.
WE FOCUSED ON SHARING
PERSPECTIVES, BOTH PROVIDER AND
PATIENT PERSPECTIVES, SHARING
DATA AND SHARING STORIES, AND I
AM PROUD TO SAY THAT WE ASKED
HARD QUESTIONS, AND WE TALKED
ABOUT UNCOMFORTABLE THINGS, BUT
WHAT WE SAW COME OUT OF THIS IS
PEOPLE REALLY HAVING AN
UNDERSTANDING OF WHAT'S
HAPPENING IN THEIR COMMUNITY
THAT THEY DIDN'T HAVE BEFORE.
SO WE HAD A LOT OF ATTENDEES
SAYING THAT I DIDN'T KNOW THAT
MY NEIGHBORS WERE EXPERIENCING
THIS, OR THAT THINGS WERE THIS
BAD.
WE ALSO HEARD A LOT OF PEOPLE
SAYING THEY MADE CONNECTIONS
WITH FACILITIES THAT THEY
WOULDN'T HAVE OTHERWISE.
YOU HAVE TO GET IN-PERSON, HEAR
THOSE THINGS AND MEET THOSE
PEOPLE TO MAKE THOSE
CONNECTIONS.
EXAMPLE BEING WORKING AT A LOCAL
FACILITY TO CREATE A BIRTH PLAN
THAT CAN BE TAKEN TO A
DELIVERING FACILITY.
THAT WAS SOMETHING THAT CAME OUT
OF THE SUMMIT.
ONE OF THE OTHER THINGS WE'VE
BEEN HEARING A LOT IS AROUND THE
NEED FOR PROVIDER TRAINING.
THIS WAS COMING UP IN
CONVERSATIONS AT OUR SUMMIT, AS
WELL AS OUR INDIVIDUAL
CONVERSATIONS, AND SOMETHING
THAT WE HEAR ALL THE TIME IS
THAT IF YOU ARE A HOSPITAL THAT
DOES NOT DO DELIVERIES, YOU DO
DELIVERIES.
AND SO WE'VE GOT AN EXAMPLE OF
THAT HERE, SO THESE ARE A COUPLE
OF PICTURES FROM WAGNER, SOUTH
DAKOTA.
THIS IS A PLACE WHERE PRENATAL
CARE IS PROVIDED BUT THE
DELIVERING HOSPITAL IS AN HOUR
AWAY.
THERE IS THIS COMMUNITY
HOSPITAL, AND THEY DO EMERGENCY
DELIVERIES WHEN THEY HAVE TO.
THEY ACTUALLY DO THE MOST OR
NEARLY THE MOST EMERGENCY
DELIVERIES IN OUR HEALTHCARE
FOOTPRINT.
AND SO WHAT THIS MEANS IS THAT
WE HAVE MANY TIMES PRETERM OR
HIGH RISK PREGNANCIES SHOW UP IN
OUR EMERGENCY ROOM FOR
DELIVERIES.
WE ALSO HAVE INDIAN HEALTH
SERVICE PATIENTS THAT ARE
SHOWING UP AT THIS COMMUNITY
HOSPITAL, AND NEED TO WORK ON
THE RELATIONSHIP BETWEEN THOSE
TWO FACILITIES SO THAT EVERYONE
CAN BEST SERVE THEIR PATIENTS.
SO WE RAN INTO A SITUATION WHERE
IHS WAS REQUESTING SORT OF
TRAINING AROUND CULTURALLY
COMPETENT CARE SO THAT THEIR
PATIENTS COULD RECEIVE THAT WHEN
THEY WERE AT THE HOSPITAL, AND
THEN WE WERE ALSO HAVING
HOSPITAL STAFF TELL US THAT THEY
NEEDED TRAINING ON THESE
EMERGENCY DELIVERIES THAT THEY
WERE DOING.
SO WHAT CAME OUT OF THIS WAS
REALLY A VERY NICE, ORGANIZED
AND VERY REALISTIC MANNEQUINS
SORT OF SIMULATION TRAINING.
SO THE GOAL OF OUR TRAINING WAS
TO SIMULATE MATERNAL AND NEWBORN
EMERGENCY DELIVERY SITUATIONS,
SO PEOPLE WERE ABLE TO DO A
DELIVERY, THEN ALSO INTUBATE THE
BABY AND THEN THERE WAS A SECOND
SCENARIO WHERE THE STAFF HAD TO
DEAL WITH A POSTPARTUM
HEMORRHAGE IN THE EMERGENCY
DEPARTMENT.
IN ADDITION TO JUST GETTING
PRACTICE WITH THESE SKILLS, THE
GOALS WERE ALSO TO EMPROVE
PRACTICES RELATED TO QUALITY OF
CARE, SAFETY OF CARE AND THEN
AGAIN CULTURALLY APPROPRIATE
CARE.
SO IN ADDITION TO THE SIMULATION
TRAINING WITH THE MANNEQUINS,
OUR IHS PARTNERS WERE ALSO THERE
TO DELIVER SORT OF A LITTLE
WORKSHOP ON CULTURALLY COMPETENT
CARE AND PRACTICES, WHICH LED TO
SOME REALLY GREAT DISCUSSIONS
BETWEEN THESE TWO ORGANIZATIONS,
AND AGAIN, HOW TO BEST SERVE
PATIENTS.
SO WE HAD AMAZING PARTICIPATION
IN THIS SIMULATION TRAINING
EVENT IN WAGNER, SOUTH DAKOTA.
AGAIN, ABOUT 1500 PEOPLE ARE IN
WAGNER, AND THEY HAVE ABOUT 8 TO
10 OF THESE EMERGENCY DELIVERIES
PER YEAR, BUT WE SAW REALLY
GREAT PARTICIPATION IN STAFF
FROM BOTH IHS AND THE WAGNER
COMMUNITY HOSPITAL.
AGAIN, WE WORKED REALLY HARD TO
MAKE THIS TRAINING AS EASY AS
POSSIBLE FOR PEOPLE TO ATTEND,
SO WE TOOK THE TRAINING TO THEM.
WAGNER IS ABOUT 2 1/2 HOURS FROM
SIOUX FALLS, WHERE WE ARE
LOCATED, BUT WE'RE ABLE TO GET
THIS ORGANIZED, GET CONTINUING
EDUCATION UNITS FOR IT, BRING
THE MANNEQUINS, BRING THE
TRAINERS TO WAGNER AND THEN ALSO
HAVE DIFFERENT SESSIONS
THROUGHOUT THE DAY SO THAT
EVERYBODY COULD ATTEND.
AND WE ENDED UP TRAINING OVER
90% OF THE STAFF AT THESE
FACILITIES.
WE HAVE HELD TWO OF THESE
TRAININGS NOW IN TWO DIFFERENT
LOCATIONS, AND WE'VE TRAINED
ALMOST 100 INDIVIDUALS.
AND IN ADDITION TO THE TRAINING
THAT IS BEING PROVIDED, IT'S
REALLY THIS RELATIONSHIP
BUILDING BETWEEN ORGANIZATIONS.
PEOPLE HAVE MET EACH OTHER.
THEY HAVE PUT A FACE TO A PHONE
CALL, AND THEY NOW KNOW THAT
THEY CAN WORK TOGETHER IN THESE
DIFFERENT WAYS.
I DO HAVE SOME EXCITING UPDATES
FROM OUR SIMULATION TRAINING
THAT WAS HELD JUST A COUPLE OF
MONTHS AGO.
IT'S NOT JUST ABOUT THE TRAINING
AND THE SKILLS AND
RELATIONSHIPS, IT'S ALSO PUTTING
THIS TO USE IN DIFFERENT WAYS.
SO AFTER THE TRAINING, THE
WAGNER HOSPITAL ORDERED A COUPLE
OF THE -- I'M GOING TO GET THE
NAMES WRONG -- THE JADA DEVICE
FOR POSTPARTUM HEMORRHAGE AND
ONE OF THE NICU BEDS THAT THEY
HAD USED IN THE SIMULATION
TRAINING SO THEY COULD HAVE THAT
DURING THEIR EMERGENCY
DELIVERIES.
THEY WERE REALLY EXCITED ABOUT
THAT, UNFORTUNATELY THERE HAD
BEEN AN EMERGENCY DELIVERY
BEFORE THE EQUIPMENT HAD BEEN
DELIVERED.
HOWEVER, BECAUSE OF THE
TRAINING, THEY KNEW WHO TO
COMMUNICATE WITH, HOW TO
COMMUNICATE WITH THEM AND FELT
AS GOOD AS THEY POSSIBLY COULD
IN THAT SITUATION, EVEN THOUGH
IT WAS A REALLY HIGH STRESS
SITUATION.
THERE ARE ALSO SOME OTHER
POLICIES THAT HAVE CHANGED AS A
RESULT OF THIS TRAINING.
WE SPENT A LOT OF TIME TALKING
ABOUT THE IMPORTANCE OF THE
PLACENTA TO OUR AMERICAN INDIAN
PATIENTS, AND WANTING TO GET
THAT IF AT ALL POSSIBLE SO THE
HOSPITAL WAS ABLE TO CHANGE
POLICIES RELATED TO RELEASE OF
THE PLACENTA IF A PATIENT WAS
NOT BEING TRANSFERRED.
THERE'S ALSO ONGOING TALKS ABOUT
HOW IHS AND THE WAGNER HOSPITAL
CAN COMMUNICATE BETTER ABOUT
THESE HIGH RISK PATIENTS, AND
THEY'RE IN THE PROCESS OF
SETTING UP DIFFERENT CARE
CONFERENCES TO ENSURE THE
HIGHEST POSSIBLE CARE AND THE
MOST INFORMATION BEING SHARED
BETWEEN THOSE TWO FACILITIES.
I REALLY LIKED THIS PIECE OF
FEEDBACK FROM ONE OF OUR
ATTENDEES.
IT SAYS I THINK THIS ACTIVITY
WILL INCREASE EVERYONE'S
PERFORMANCE.
IT WAS GOOD TO BRING STAFF
TOGETHER AND DISCUSS HOW WE CAN
BETTER OURSELVES AND OUR
THINKING TO HELP UNDERSTAND OUR
PATIENTS SO THEY CAN GET THE
BEST POSSIBLE OUTCOMES.
IT ALSO CREATED A GOOD
DISCUSSION BETWEEN THE TWO
FACILITIES ON HOW WE CAN WORK
TOGETHER INSTEAD OF FEELING LIKE
WE'RE COMPETING WITH ONE
ANOTHER.
AND I THINK THIS IS REALLY WHAT
WE WERE HOPING TO SEE WITH THIS
TRAINING, AND BECAUSE OF ITS
SUCCESS, WE HAVE QUITE A FEW OF
THESE LINED UP IN DIFFERENT
RURAL COMMUNITIES, BRINGING
DIFFERENT FACILITIES OR
DIFFERENT COMMUNITIES TOGETHER
TO WORK TOGETHER AND RECEIVE
THIS TRAINING ON BOTH SKILLS AND
CULTURAL COMPETENCY.
SO WE KNOW WE ARE CHANGING
PATIENT AND PROVIDER LIVES AND
HAVING AN IMPACT ON POLICIES IN
ORGANIZATIONS.
BUT THAT'S NOT GOOD ENOUGH FOR
US.
WE HAVE TO DO MORE AND WE HAVE
TO DO BIGGER THINGS AND ONE OF
THE WAYS WE ENVISION DOING THIS
IS THROUGH OUR TRANSFORMATION
BOARD.
SO THIS IS PART OF OUR COMMUNITY
PARTNER COMPONENT, AND IT BRINGS
TOGETHER LEADERS AND
ORGANIZATIONAL CHANGE MAKERS
THAT CAN HELP US TAKE WHAT WE'RE
LEARNING THROUGH OUR CENTER OF
EXCELLENCE AND THROUGH ITS
RESEARCH, AND TURN IT INTO
POLICY AND SYSTEMS LEVEL
CHANGES.
SO THESE ARE PEOPLE WHO CAN TELL
US NO, THIS WON'T WORK AND THIS
IS WHY, OR YES, WE WANT TO MAKE
THIS HAPPEN, HOW CAN WE GET
THERE.
WE ARE IN A REALLY UNIQUE SPACE,
I THINK, BECAUSE OF THE
COMMUNITY-BASED WORK WE DO
WITHIN THE HEALTH SYSTEM AND
WHERE WE SIT IN HEALTHCARE AND
RESEARCH.
AND ALSO BECAUSE WE HAVE SUCH
MOTIVATED PARTNERS WHO ARE
REALLY INTERESTED IN FINDING
SOLUTIONS TO THESE ISSUES WE ARE
FACING IN SOUTH DAKOTA.
SO WITH THAT, I WOULD LIKE TO
LEAVE YOU WITH THE SAVE THE DATE
FOR OUR MARCH SUMMIT IN MARCH.
WE WOULD LOVE TO HAVE YOU THERE
SO YOU CAN LEARN MORE ABOUT
SOUTH DAKOTA AND WHAT WE'RE
DOING WITH OUR CENTER OF
EXCELLENCE.
THANK YOU.
[APPLAUSE]
>> THANK YOU SO MUCH.
WE HAVE TIME FOR MAYBE ONE QUICK
QUESTION.
DOES ANYONE HAVE A QUESTION IN
THE AUDIENCE WHO'D LIKE TO COME
UP?
GOING ONCE, GOING TWICE.
OKAY.
>> THANK YOU.
THANK YOU FOR YOUR PRESENTATION.
I'M FROM M NEVADA AND WE HAVE A
HUGE RURAL POPULATION IN OUR
STATE AS WELL.
IT'S SOMETHING ALL OF OUR
LEGISLATORS TALK ABOUT AND OUR
PROVIDERS, AND IT'S SOMETHING
THAT WE HAVEN'T QUITE FIGURED
OUT HOW TO GET THROUGH AND THE
TRAINING COMPONENT IS HUGE.
SO I'M CURIOUS AS TO WHAT KIND
OF COLLABORATION YOU'RE
INTERESTED IN FOR OTHER STATES
THAT EXPERIENCE A LOT OF RURAL
CHALLENGES AND HOW TO BRING
TRAININGS LIKE THIS TO OUR
COMMUNITIES AS WELL.
>> I LOVE THAT.
I'M GUESSING YOU DESCRIBE
DISTANCE IN TERMS OF HOURS TOO.
>> MANY, MANY HOURS.
>> WE LOVE TO COLLABORATE AND
WOULD BE HAPPY TO SHARE HOW
WE'RE ACCOMPLISHING IT AND THE
PIECES THAT WE'VE BROUGHT
TOGETHER TO BE ABLE TO SEE WHAT
PIECINGSPIECES YOU MAY HAVE.
EVERYTHING WE DO IS IN
COLLABORATION, SO LET'S CONNECT
AND SEE IF WE CAN HELP AT LEAST
SHARE YOU OUR STORY.
>> THANKS.
>> GREAT, THANK YOU SO MUCH.
GIVE EVERYBODY A HAND.
[APPLAUSE]
SO WE ARE NOW DONE WITH THE
FOURTH SESSION OF THE MEETING.
WE WERE GOING TO GO ON BREAK FOR
10 MINUTES, SO WE WILL START
BACK UP AGAIN AT 10:50.
IF YOU ARE PRESENTING IN SESSION
5, PART 1, PLEASE MEET DOWN HERE
ABOUT THREE MINUTES BEFORE WE
START.
THANK YOU.
>> SO YOU DIDN'T COME HERE TO
HEAR ME TALK.
YOU CAME HERE TO HEAR OTHER
PEOPLE, SUPER AWESOME PEOPLE
TALK.
FIRST UP, WE'RE GOING TO HEAR
FROM STANFORD PRIHSM.
WE'RE GOING TO HEAR FROM DRS.
IGBINOSA AND LYELLE, AND I'M
GOING TO TURN IT RIGHT OVER TO
YOU TO JUMP IN.
>> THANK YOU, CAN YOU HEAR ME?
HI.
I'M DR. DEIRDRE LYELL, PROFESSOR
OF MATERNAL FETAL MEDICINE AT
STANFORD AS WELL AS NEW CHAIR,
PREVENTING INEQUITIES IN
HEMORRHAGE-RELATED SEVERE
MATERNAL MORBIDITY.
>> GOOD MORNING.
I'M IRO IGBINOSA, WOMEN'S
REPRODUCTIVE HEALTH RESEARCH
SCHOLAR IN MATERNAL FETAL
MEDICINE.
>> I'LL GET STARTED.
I WOULD LIKE TO FIRST
ACKNOWLEDGE THAT WE ARE
PRESENTING BUT ONE PIECE OF
LARGER BODY OF WORK AND OUR GOAL
AND OUR VISION IS TO IMPROVE
MATERNAL HEALTH BY REDUCING THE
ILL PIMPACT OF POSTPARTUM -- SON
DEFICIENCY ANEMIA IN PREGNANCY
IS A PUBLIC HEALTH ISSUE.
IT AFFECTS ABOUT 40% OF
PREGNANCIES WORLDWIDE.
THE LIGHT PINK SHOWS AREAS WHERE
THE PREVALENCE IS LESS THAN 20%
AND THE DARKER MAROON SHOWS
AREAS WHERE THE PREVALENCE IS
GREATER THAN 40%, AND SOME OF
THIS IS DUE TO SOCIAL
DETERMINANTS OF HEALTH AND
ACCESS IN THOSE COUNTRIES.
HOWEVER THAT DOESN'T TELL A
COMPLETE STORY.
WWE KNOW IRON DEFICIENCY, THE
PRECURSOR TO IRON DEFICIENCY
ANEMIA IS VERY COMMON IN AREAS
WITH HIGH RESOURCE SETTINGS.
SO FOR EXAMPLE IN THE STUDY OF
OVER 40 PREGNANCIES, WE SAW IRON
DEFICIENCY AFFECTED MORE THAN
50% OF PREGNANCIES IN A HIGH
RESOURCE SETTING.
25% OF PREGNANCIES WERE
COMPLICATE BID SEVERE IRON
DEFICIENCY AND PROBABLY MORE
STRIKINGLY, 40% OF PREGNANCIES
WEREN'T EVEN SCREEN DOLLARS.
SO WHY IS THIS IMPORTANT?
WE KNOW IN PREGNANCY, ANEMIA,
ONE OF THE MOST COMMON CAUSES IS
IRON DEFICIENCY, AND THAT IRON
HELPS BUILD RED BLOOD CELLS,
WHICH THEN ARE IMPORTANT TO
DELIVER OXYGEN AND NUTRIENTS SO
MOM AND BABY.
AND THERE'S A LOT OF OTHER
FUNCTIONS, BUT WE WON'T GO INTO
DETAIL.
AND CONSEQUENCES OF IRON
DEFICIENCY AND/OR IRON
DEFICIENCY ANEMIA CAN BE FOR MOM
OR FOR BABY.
SO FOR THE MOTHER, WE MIGHT SEE
FATIGUE, SHORTNESS OF BREATH,
DEPRESSION, FOO TEA.
WE MIGHT SEE DELIVERY RELATED
COMPLICATIONS, PARTICULARLY
HEMORRHAGE, POSTPARTUM
HEMORRHAGE, BLOOD TRANSFUSION,
HIGHER RISK FOR PREECLAMPSIA AND
CESAREAN DELIVERY.
ALONG THE INFANT FETAL SPECTRUM,
WE CAN SEE STILLBIRTH, PRETERM
BIRTH, LOW INFANT BIRTH WEIGHT
AND NEURODEVELOPMENTAL ISSUES.
SO WHO DOES THIS IMPACT IN
PREGNANCY?
IN SHORT, EVERYONE.
THIS IS DATA OUT OF CALIFORNIA
FROM OUR TEAM WHERE WE LOOKED AT
OVER 4 MILLION BIRTHS, BIRTHS
ADMISSIONS LINKED TO BIRTH
CERTIFICATE DATA, AND WE LOOKED
AT THE RATES OF ANEMIA AT THE
TIME OF BIRTH ADMISSION AND WE
STRATIFY THAT BY RACE AND
ETHNICITY.
SO A FEW THINGS WE SAW OVER THE
PAST ALMOST 10 YEARS, THAT
ANEMIA INCREASED FOR EVERYONE,
AND THAT BLACK PREGNANT
PEOPLE/BIRTHING PEOPLE HAVE THE
HIGHEST RATES OF ANEMIA, AND
THEN THAT DISPARITY BETWEEN
BLACK AND WHITE WAS PERSISTENT
AND INCREASE DOLLARS OVER TIME.
INCREASED OVER TIME.
AND SO THE OTHER THING THAT WE
ASK OURSELVES IS THAT HOW DO
DIFFERENCES IN THESE DISPARITIES
IN ANEMIA CONTRIBUTE TO
DIFFERENCES IN DISPARITIES IN
SEVERE MATERNAL MORBIDITY, ALSO
KNOWN AS A NEAR MISS OR ALMOST
NEAR MISS EVENT IN PREGNANCY.
FOR THIS DATA WE USE THE CDC
INDEX.
SO WHAT WE FOUND WAS THAT ANEMIA
MAY BE RESPONSIBLE FOR ABOUT
1 IN 5 CASES OF SEVERE MATERNAL
MORBIDITY AMONG BLACK PREGNANT
INDIVIDUALS, AND HISPANIC OR
LATINX PREGNANT INDIVIDUALS.
AND IN UP TO 1 IN 9 IN ASIAN
PREGNANT PEOPLE.
SO WHAT WE FIND IS THAT ANEMIA
CONTRIBUTES TO MATERNAL
MORBIDITY AND THERE ARE
VARIANCES BY RACE AND ETHNICITY.
AND SO YOU MIGHT ASK YOURSELF,
WHY IS THIS AN ISSUE, THESE
PEOPLE HAVE HAD PRENATAL CARE
AND WE'VE ADJUSTED FOR COMMON
SOCIAL DETERMINANTS BUT IT STILL
EXISTS.
SCREENING FOR IRON DEFICIENCY IS
OFTEN INADEQUATE, IT'S
UNRECOGNIZED AS A PROBLEM BY
PROVIDERS IN OUR PATIENTS.
THERE'S A LOT OF DIFFERENT
APPROACHES TO EVALUATION AND
TREATMENT, AND THE TREATMENTS,
THE MOST COMMON BEING ORAL IRON,
IS NOT THE MOST EASY TO TAKE.
THERE'S A LOT OF SIDE EFFECTS,
PARTICULARLY G.I.
AND THEN WE ALSO HAVE TO TALK
ABOUT THE PRESENCE OF STRUCTURAL
RISM, AND AS EVIDENCED IN
HISTORICAL RACE-BASED CUTOFFS
FOR ANEMIA.
SO FOR EXAMPLE, PRIOR TO 2021,
WE SEE THAT A BLACK PREGNANT
PATIENT NEEDED A HEMOGLOBIN LESS
THAN 10.2 AND IN THE THIRD
TRIMESTER RECEIVED TREATMENT FOR
ANEMIA AS OPPOSED TO A NON-BLACK
PATIENT WHO WOULD RECEIVE
TREATMENT FOR ANEMIA WITH A
HEMOGLOBIN LESS THAN 11 IN THE
FIRST OR THIRD.
SO THESE KIND OF CUTOFFS AND
THESE DISPARITIES CONTRIBUTE TO
KIND OF THE DISPARITIES THAT WE
SEE TODAY.
WE SAW LOOKING AT DATA,
SECONDARY LOOK OF A TRIAL OF
I.V. IRON.
WE SAW BLACK PATIENTS WERE MORE
LIKELY TO PRESENT AT DELIVERY
WITH ANEMIA, COMPARED TO
NON-WHITE PATIENTS.
AND THEN THAT ANEMIA INCREASED
THE ODDS OF BLOOD TRANSFUSION.
AND SO WHY DOES THIS MATTER?
WHY DOES THIS TREATMENT AND
THESE CUTOFFS MATTER?
BECAUSE IRON THERAPY IMPROVES
OUTCOMES.
AND JUST AT A BASIC LEVEL, WE
KNOW ORAL IRON IMPROVES
OUTCOMES.
THIS STUDY OUT OF BAYLOR COLLEGE
OF MEDICINE, TEXAS HAD ABOUT
7400 PATIENTS, RETROSPECTIVELY
OUT OF THEIR REGISTRY.
SO A FEW KEY FINDINGS WERE THAT
ONLY 36% WERE SUCCESSFULLY
TREATED, SO IT GIVES OPTIONS FOR
US TO CONSIDER WHAT ELSE ARE WE
CONSIDERING IN OUR BAG, IN OUR
TOOLKIT OF HOW WE APPROACH
TREATMENT OF ANEMIA, AND THEN
PERHAPS MORE WHAT STOOD OUT TO
ME WAS 46% WERE UNTREATED AND
THAT WAS MOST LIKELY TO BE
UNDERREPRESENTED MINORITIES.
AND IN THIS SAMPLE SIZE, THAT
GROUP WAS IN PARTICULAR HISPANIC
OR LATINX.
THEN THERE WAS A LACK OF
CONFIRMATION OF THE CAUSE OF
ANEMIA.
OUR ABSENCE -- AND ABSENCE OF
PROTOCOLS TO TREAT AND MONITOR
THE RESPONSE.
MEANING THAT YOU STARTED ON A
TREATMENT, DID YOU GET BETTER,
DID YOU NOT, HOW DID WE MEASURE
THAT.
WE DON'T HAVE THAT WELL
OUTLINED.
WHAT I WANTED TO KIND OF ALSO
SHOW YOU IS THAT WE HAVE THREE
CATEGORIES.
THOSE WHO WERE UNTREATED,
UNSUCCESSFULLY TREATED MEANING
THEY RECEIVED SOME TREATMENT BUT
THEY DIDN'T RESOLVE THEIR ANEMIA
BY THE TIME THEY DELIVERED OR
SUCCESSFULLY TREATED, THEIR
ANEMIA WAS CORRECTED BEFORE THEY
DELIVERED.
SO WE SEE THAT POSTPARTUM
HEMORRHAGE, BLOOD TRANSFUSION,
CESAREAN DELIVERY, AND
HYSTERECTOMY HAVE PRETTY HIGH
ODDS IN UNTREATED AND
UNSUCCESSFULLY TREATED G TREATE.
BY THE TIME WE GET TO
SUCCESSFULLY TREATED, THE ODDS
GO DOWN.
IT DOESN'T GO AWAY COMPLETELY
BECAUSE THERE ARE ALSO OTHER
CONTRIBUTING FACTORS TO
DISPARITIES, BUT WE'RE JUST
TALKING ABOUT ONE COMPONENT, CAN
WE PROVIDE EQUITABLE
EVIDENCE-BASED CARE FOR THE
TREATMENT OF ANEMIA.
AND THEN THE OTHER THING WE SEE
IS FOR PRETERM BIRTH, THAT
SUCCESSFUL TREATMENT OF ANEMIA
CAN BE PROTECTIVE ALSO FOR
PRE-ECLAMPSIA SO WITH THAT, I
WILL TURN TO MY COLLEAGUE,
DEIRDRE LYELL, TO KIND OF TALK
ABOUT WHAT WE'LL BE DOING WITH
PRIHSM.
>> GREAT.
THANK YOU, DR. IGBINOSA.
SO BASED ON WANTING TO
UNDERSTAND THIS PROBLEM, WE
CONDUCTED PILOT WORK WITH OUR
COMMUNITY PARTNER, BLACKWELLNESS
AND PROSPERITY CENTER IN FRESNO,
CALIFORNIA, AN CONDUCTED
QUALITATIVE WORK INTERVIEWS
AMONG BLACK AND HISPANIC LATINX
PREGNANT PEOPLE, IN THIS CASE,
WOMEN, WITH LIVED EXPERIENCE OF
ANEMIA IN PREGNANCY.
AND IDENTIFIED SEVERAL KEY
THEMES: A FEELING OF LACK OF
INFORMATION FROM THE PROVIDER,
DISMISSAL OF SYMPTOMS, TREATMENT
CHALLENGES WHEN TAKING
TREATMENT, AS DR. IGBINOSA
MENTIONED, AS WELL AS A VERY
STRONG INTEREST AND DESIRE FOR
PATIENT-CENTERED CARE AND MUCH
GREATER INFORMATION.
WE HAD MANY, MANY QUOTES, AND WE
PRESENTED THIS WORK AT THE
SOCIETY FOR MATERNAL FETAL
MEDICINE ANNUAL MEETING IN 2024.
I WANT TO READ THE LAST ONE.
"WE NEED TO FIND A WAY TO
NAVIGATE CONVERSATIONS AROUND
THE PROCESS OF BIRTH,, BRINGING
A CHILD INTO THIS WORLD,
POSTPARTUM HEALING AND
DEPRESSION IN A WAY THAT WE
DON'T INSTILL FEAR BUT GIVE
INSIGHT."
SO THIS IS OUR PROJECT OVERVIEW.
IT'S KIND OF A BUSY SLIDE.
I'M GOING TO WALK YOU THROUGH
IT.
AT THE CORE R. CORE, WE ARE
DEVELOPING A PATIENT INFORMED
EVIDENCE-BASED ANEMIA TREATMENT
AND PREVENTION TOOLKIT IN ORDER
TO REDUCE ANEMIA AT BIRTH
ADMISSION AS WELL AS DISPARITIES
AND IMPROVE OUTCOMES
PARTICULARLY THOSE RELATED TO
POSTPARTUM HEMORRHAGE AND SEVERE
MATERNAL MORBIDITY AND REDUCE
DISPARITIES IN THOSE OUTCOMES.
AND WE WILL TEST THE -- FIRST
OUR AIMS ARE SEQUENTIAL.
AIM ONE IS REALLY TO CREATE THAT
TOOLKIT.
AGAIN IT'S GOING TO BE
PATIENT-INFORMED AND
CLINICIAN-INFORMED AS WELL,
EVIDENCE-BASED.
IN AIM 2, WE'RE GOING TO TEST
THE TOOLKIT AT HOSPITALS AMONG
NINE DIFFERENT -- OR EIGHT
DIFFERENT PILOT SITES, NINE
DIFFERENT HOSPITALS, IN ORDER TO
UNDERSTAND IS IT WORKING.
THROUGH THE CMQCC MATERNAL DATA
CENTER, WE CAN ACTUALLY MEASURE
AT EACH OF THESE SITES THINGS
LIKE HEMOGLOBIN AT BIRTH
ADMISSION, QUANTITATIVE BLOOD
LOSS AT DELIVERY, AS WELL AS
BLOOD TRANSFUSION, NEARLY
REALTIME, IT'S DATA THAT ARE 45
DAYS OLD BUT THROUGH THE SAME
CMQCC MATERNAL DATA CENTER.
AND BASED ON HOW WE'RE DOING,
WHETHER OR NOT WE'RE MOVING THAT
NEEDLE, ARE WE IMPROVING BIRTH
ADMISSION AND AIM THREE IS WHERE
WE REALLY HOPE TO MEASURE AND
IDENTIFY ANY DIFFERENCES IN
SEVERE MATERNAL MORBIDITY.
ACTUALLY WANT TO MENTION ONE
MORE THING THAT FOR PROVIDERS,
PART OF THE TOOLKIT IN ADDITION
TO OUTLINES THROUGH
EVIDENCE-BASED STREAMLINED
PRACTICE OF HOW YOU IDENTIFY
ANEMIA, HOW DO YOU IDENTIFY IRON
DEFICIENCY, THAT'S A KEY
COMPONENT, THERE'S A LOT OF
EDUCATION AS WELL FOR THE
PROVIDERS.
I THINK RIGHT NOW, THERE'S CLEAR
EVIDENCE THAT MANY PROVIDERS DO
LITTLE MORE THAN JUST SAY HERE
YOU HAVE ANEMIA, TAKE THIS PILL.
HOW DO YOU TAKE IT, WHEN DO YOU
TAKE IT, WHAT MEDS DO YOU TAKE
IT WITH, WHAT MEDS DO YOU AVOID
TAKING IT WITH.
THESE ARE ALL IMPORTANT TOO,
WHILE PROVIDING EHR ELECTRONIC
HEALTH RECORD TOOLS, AS WELL AS
IV IRON GUIDELINES AND
PROTOCOLS, JUST A WHOLE LOT
MORE, JUST APPROACHING THIS IN A
HOLISTIC MANNER, BOTH FROM OUR
PATIENTS AND FOR OUR PROVIDERS.
AS I MENTIONED OUR AIMS ARE
SEQUENTIAL.
OUR TOP ROW SHOWS YOU THE
TIMELINE.
BUT AGAIN THIS IS WORK THAT WE
NEED CLINICIANS AND COMMUNITY
WORKING TOGETHER.
WE CAN'T -- NEITHER OF US CAN DO
THIS ALONE TO SOLVE THIS.
OUR COMMUNITY ADVISORY BOARD OR
ANEMIA COMMUNITY LIEDER SHIP
GROUP, ACLG, IS WITH US THE
ENTIRE TEUM AND THEY WILL
CONTINUOUSLY HELP US TO EVALUATE
OUR PATIENT-FACING MATERIALS,
PATIENT EDUCATION TOOLS, AS WELL
AS WORK ON MESSAGING THROUGHOUT
THE COMMUNITY AS WELL ON WHY
ANEMIA MATTERS.
NOW IN ORDER TO REALLY GET THIS
RIGHT WE BUILD OUR TOOLKIT, WE
WANT TO ENSURE WE'RE INCLUDING
THE RIGHT GROUPS.
THIS INCLUDES PATIENTS AS I'VE
MENTIONED, BOTH THROUGH THE
ANEMIA COMMUNITY LEADERSHIP
GROUP AND OTHER.
CLINICIAN, MIDWIVES, BIRTH
WORKERS AND COMMUNITY-BASED
ORGANIZATIONS, WHILE
ACKNOWLEDGING THE ROLE OF SOCIAL
DETERMINANTS OF HEALTH IN THIS
PROBLEM AND WHAT WE NEED FOR THE
SOLUTION.
TO HELP US TO ACHIEVE THIS,
WE'RE COMPREHENSIVELY USING
THESE TWO FRAME WORKS.
FOR AIM ONE OUR FRAMEWORK
INCLUDES THE PATHWAYS TO RACIAL
AND ETHNIC DISPARITIES IN SEVERE
MATERNAL MORBIDITY AND MORTALITY
MODEL.
TO ENSURE THAT WE'RE TALKING TO
ALL OF THE CORRECT KEY PLAYERS
AND NOT JUST AT THE CLINIC OR
THE ACADEMIC LEVEL, BUT ALSO AT
THE INDIVIDUAL AND COMMUNITY
LEVEL.
WE'RE ALSO USING THE NIMH
FRAMEWORK FOR THE RESEARCH
COMPONENT, AND THIS FRAMEWORK IS
REFLECTED IN OUR INTERVIEW
GUIDES THAT WE'VE CREATED AND IT
CONSIDERS THESE LEVELS OF
INFLUENCE THAT YOU SEE AT THE
TOP, INDIVIDUAL, INTERPERSONAL,
COMMUNITY AND SOCIETAL.
AND HEALTH OUT COME LEVELS OR
HEALTH OUTCOMES THAT ARE SHOWN
AT THE BOTTOM, THE INDIVIDUAL
HEALTH, FAMILY AND
ORGANIZATIONAL HEALTH, COMMUNITY
HEALTH, AS WELL AS POPULATION
HEALTH.
AND THIS IS WHERE WE ARE NOW.
UNDER THE LEADERSHIP OF
BLACKWELLNESS AND PROSPERITY
CENTER, WE HAVE BUILT OUT A
LARGER ANEMIA COMMUNITY
LEADERSHIP GROUP, AND THEY HAVE
CREATED AND WE'VE CO-CREATED
INTERVIEW AND FOCUS GUIDES, AND
ULTIMATELY WE WILL -- THEY WILL
HELP US TO INFORM THE
PATIENT-CENTERED TOOLS.
RIGHT NOW ONE CHALLENGE IS WE'RE
STUCK WITHIN THE STANFORD IRB.
WE'VE WORKED A LOT ON PROJECT
TWO SORT OF IN TANDEM, SO THAT
WE'RE READY TO HIT THE ROAD AS
SOON AS WE GET THE FINAL IRB
APPROVAL, WHICH WE ARE EXPECTING
THIS WEEK.
THESE ARE MANY OF THE PEOPLE
INVOLVED AND NOT EVERYBODY ON
THE LEFT, YOU SEE BLACKWELLNESS
AND PROSPERITY CENTER LEADERSHIP
FOUNDED AND LED BY THE
INDOMITABLE CHANTE DAVIS BULCH
WHO IS PRESIDENT AND CEO AND HAS
DONE MANY GREAT THINGS
THROUGHOUT CALIFORNIA FOR THE
COMMUNITY.
ON THE RIGHT ARE SOME OF OUR
CLINICIAN LEADERS THROUGHOUT
CALIFORNIA AND OREGON WHO HAVE
BEEN PASSIONATE ABOUT WORKING
TOWARD ENDING ANEMIA AT BIRTH
ADMISSION FOR ACTUALLY WE'VE
BEEN GATHERING TOGETHER FOR MORE
THAN THREE YEARS NOW.
DR. IGBINOSA YOU SEE AND
DR. SUSAN PEREZ WHO YOU SAW
YESTERDAY, SHE'S WORKING WITH
THE NEW ORLEANS GROUP AS WELL
AND SHE'S LEADING OUR
QUALITATIVE WORK.
I KNOW THAT WE'RE LOW ON TIME.
I'VE ALREADY MENTIONED OUR AIMS
TWO AND THREE.
I JUST WANT TO END OR NEARLY END
COMMENTING ON OUR IMPLEMENTATION
FRAMEWORK.
THIS FRAMEWORK, IT'S REALLY
IMPORTANT BECAUSE WHEN YOU THINK
ABOUT HOW IN ADDITION TO
MOTIVATE THE THE COMMUNITY,
WE'RE ASKING A LOT OF OUR
PROVIDERS, SO WE'RE USING THE
COM-B MODEL THAT'S CAPABILITY,
OPPORTUNITY AND MOTIVATION.
THIS IS ESSENTIALLY A FRAMEWORK
FROM IMPLEMENTATION SCIENCE THAT
IDENTIFIES THREE CRUCIAL FACTORS
ABOVE THAT GOVERN BEHAVIOR AND
THAT REALLY NEED TO BE ADDRESSED
WHEN A NEW CLINICAL PRACTICE, IF
WE WANT TO BE FULLY IMPLEMENTED.
WE'RE ALSO USING THE BEHAVIOR
CHANGE WE'LL THAT BUILDS ON THE
COM-B FRAMEWORK AND THAT JUST
OFFERS A NUMBER OF DIFFERENT
SUGGESTIONS AND STRA STRATEGIES
THROUGH THE MULTITUDE OF
DIFFERENT CLINICS WE'LL BE
WORKING WITH IN ORDER TO MAKE
THIS CHANGE.
WE ALSO KIND OF ALWAYS CIRCLE
BACK TO THE WHY OF THIS PROBLEM,
WHY DOES IT MATTER, WHY IS IT
IMPORTANT, WHY SHOULD PROVIDERS
MAKE CHANGE?
FINALLY I JUST WANT TO
ACKNOWLEDGE THE REST OF OUR
CENTER, PROJECT 2 IS REDUCING
RACIAL INEQUITIES IN CESAREAN
BIRTH, THAT'S LED BY DR. ELLIOTT
MANE, WHO'S HERE.
WE KNOW CESAREAN IS A MAJOR
DRIVER OF POSTPARTUM HEMORRHAGE,
BLOOD TRANSFUSIONS AND
INEQUITIES IN SEVERE MATERNAL
MORBIDITIES.
WE'RE AIMED AT REDUCING CESAREAN
FURTHER BUT PARTICULARLY
REDUCING THOSE INEQUITIES, WHICH
WHILE CESAREAN HAS FALLEN, THE
EQUITY GAP HAS NOT AND WE'RE
REALLY DIGGING INTO WHY AND HOW
DO WE CHANGE THAT.
AS WELL AS A TRAINING COMPONENT
AND A COMMUNITY ENGAGEMENT AND
PARTNERSHIP IMOANT LED BY
DR. SUSAN CARMICHAEL WHO'S ALSO
HERE.
SHE'S ALSO A CO-PI OF THE ENTIRE
PROJECT WITH DR. YASSER
AL-SAYEK.
OUR TEAM IS GROWING ALL THE TIME
AND WE HAVE PEOPLE NOT REFLECTED
HERE, BUT WE WANT TO THANK THE
NIH, AND IMPROVE FOR THE
OPPORTUNITY TO REALLY WORK
TOWARD MAKING CHANGE IN SO MANY
DIFFERENT INCREDIBLE, IMPORTANT
AREAS THAT YOU'VE HEARD ABOUT
TODAY AND YESTERDAY.
THANK YOU.
[APPLAUSE]
>> FANTASTIC PRESENTATION.
THANK YOU SO MUCH.
LET'S OPEN IT UP FOR QUESTIONS.
I'M A LITTLE BLINDED HERE, BUT I
THINK I SEE SOMEONE MAKING THEIR
WAY TO A MICROPHONE.
COME ON DOWN!
YOU'RE THE FIRST CONTESTANT.
>> AND AS SHE'S COMING DOWN, I
INVITE PEOPLE ON ZOOM TO PUT
INTO THE QA BOX IF YOU HAVE ANY
QUESTIONS AS WELL.
>> THANK YOU SO MUCH.
THIS IS FASCINATING WORK.
I REALLY APPRECIATE WHAT YOU'RE
DOING.
I WAS CURIOUS THAT YOU HAVE A
SLIDE WHERE IT'S SHOWING THE
DIFFERENCES IN BLOOD TRANSFUSION
AND HYSTERECTOMY AMONG THOSE WHO
ARE TREATED AND THEN THOSE
UNSUCCESSFULLY TREATED AND
UNTREATED, AND IT LOOKED LIKE
THE RISK OF THOSE TWO ARE HIGHER
IN THOSE WHO WERE UNSUCCESSFULLY
TREATED.
DO YOU HAVE ANY IDEA WHY THAT
IS?
>> THANK YOU.
SO I THINK THAT REFRACTORY GROUP
IS ALSO A WAY WE THINK ABOUT IT,
AND THERE'S A LOT OF DIFFERENT
HYPOTHESES, AND I THINK THAT
LOOKS INTO MORE OF THE SOCIAL
DETERMINANTS, LIKE WHERE WERE
THEY STARTING, LIKE THEIR
HEMOGLOBIN, SO WHAT IS THAT GAP
THAT YOU'RE TRYING TO ACHIEVE BY
THE TIME THAT THEY DELIVER?
SO I THINK A KEY THING ABOUT
THAT STUDY IS THAT THEY ONLY USE
ORAL IRON, AND THERE'S SO MANY
OTHER TOOLS AVAILABLE, AND ARE
THOSE PATIENTS -- WOULD THEY
HAVE BEEN BETTER OFF IF THEY
RECEIVED I.V. IRON?
ESPECIALLY IF THEY HAD SIDE
EFFECTS, ET CETERA, SO SOME OF
OUR FOCUS GROUPS THAT WE'VE DONE
WITH BLACKWELLNESS AND
PROSPERITY HAS REALLY POINTED
OUT, WELL, THEY SAY I WILL HAVE
DIFFICULTY TAKING THE STANDARD
OF CARE, WHICH IS ORAL IRON, BUT
AN ALTERNATIVE OPTION IS NOT
PROVIDED.
SO I THINK -- AND THAT
REFRACTORY GROUP WAS MOSTLY
UNDER URM, SO I THINK THERE'S
OTHER OPPORTUNITIES FOR US WHEN
DEVELOPING THIS TOOLKIT.
>> THANK YOU.
THAT'S VERY HELPFUL.
>> EXCELLENT.
WE HAVE TIME FOR ONE MORE QUICK
QUESTION.
>> JUST WANTED TO ASK A QUICK
QUESTION ABOUT THE C-SECTION
PROJECT BECAUSE RELI THE LEADERS
IN THAT FIELD, C-SECTION IN
NEW YORK STATE IS HIGH.
ARE YOU FOCUSING ON MTSB, WHAT
ARE YOU FOCUSING ON IN THAT
PROJECT?
JUST CURIOUS.
>> YOU LEADI LEAD THE C-SECTION.
WE'RE WORKING WITH A VARIETY OF
COMMUNITY GROUPS TO IDENTIFY --
WE HAVE HOSPITALS IN CALIFORNIA
THAT HAVE DONE VERY WELL WITH
C-SECTION AND VERY WELL WITH
BLACK BIRTHING PERSON C-SECTIONS
AND OTHERS THAT HAVE VERY HIGH
RATES -- AND THERE'S NO
DIFFERENCE IN THEIR SOCIAL
DETERMINANTS, MEDICAL
COMPLICATION RATES AND SO FORTH,
SO THAT KIND OF VARIATION IS
REALLY A OPPORTUNITY TO
INVESTIGATE WHY, WHY DO SOME
HOSPITALS DO WELL, SOME
COMMUNITIES DO WELL AND OTHERS
DO NOT.
SO WE'RE IN THE MIDDLE OF THAT
RIGHT NOW, AND THAT'S GOING TO
LEAD US TO HAVE EXEMPLARS AND TO
HAVE LEARNINGS THAT WE CAN
SPREAD TO THE REST OF THE STATE.
WE FOLLOW THAT WITH THE DATA
CENTER ON A MONTHLY BASIS, SO
STRATIFIED BY RACE AND
ETHNICITY.
AND WE HAVE A WHOLE SERIES OF
TOOLS THAT WE'VE DEVELOPED TO
ADDRESS SOME OF THE STRUCTURAL
ISSUES IN HOSPITALS SUCH AS THE
CULTURE, WHICH IS PROBABLY THE
BIGGEST DRIVER IN THE HOSPITAL
FOR DIFFERENTIAL RATES OF
C-SECTION, AND BASICALLY, FOR
EXAMPLE, A TOOL THAT'S A
COMMITMENT DOCUMENT THAT ALL THE
STAFF, THE NURSES AND PHYSICIANS
COMMIT TO HOW YOU TREAT THEM.
NEW YORK STATE IS DOING
SOMETHING LIKE THIS AS WELL, BUT
THIS IS REALLY A VERY PERSONAL
DOCUMENT THAT'S POSTED ON THE
WALL AND IS SIGNED OFF BY EVERY
PHYSICIAN AND NURSE IN THE
HOSPITAL.
SO THOSE ARE SOME OF THE
INTERVENTIONS THAT WE'RE LOOKING
AT.
>> FANTASTIC.
LET'S THANK AN AWESOME
PRESENTATION FROM DRS. IGBINOSA
AND LYELL.
[APPLAUSE]
CHRISTINE, COME ON DOWN.
SO LET ME INTRODUCE CHRISTINE
GARNER FROM TEXAS TECH
UNIVERSITY WHO IS WORKING WITH
ONE OF THE IMPROVE CIP PROGRAMS.
CHRISTINE, PLEASE TAKE IT AWAY.
>> THANK YOU VERY MUCH.
FIRST LET ME SAY, IT IS TRULY A
PRIVILEGE TO BE HERE AT THE NIH
WITH ALL OF YOU WHO ARE DOING
SUCH WONDERFUL WORK TO IMPROVE
MATERNAL HEALTH IN THIS NATION.
IT'S GREAT TO BE HERE.
THANK YOU FOR THE OPPORTUNITY.
SO I AM AN ASSISTANT PROFESSOR
AT TEXAS TECH UNIVERSITY HEALTH
SCIENCES CENTER IN THE
DEPARTMENT OF OBSTETRICS AND
GYNECOLOGY.
AND I AM THE PRINCIPAL
INVESTIGATOR FOR THE VIBRANT
MOMS COALITION, WHICH IS THE
IMPROVE GROUP IN THE STATE OF
TEXAS.
AND WE HAVE DECIDED AS A
COALITION TO WORK ON ADDRESSING
PRE-ECLAMPSIA IN OUR REGION.
I HAVE NO CONFLICTS OF INTEREST.
I DO HAVE FUNDING SOURCES
THROUGH THE IMPROVE PROGRAM.
AND NIMHD.
AND BEFORE I REALLY GET INTO
PRE-ECLAMPSIA, I WOULD LIKE TO
RECOGNIZE MY FANTASTIC TEAM FOR
VIBRANT MOMS.
DR. JULIE ST. JOHN, WHO WAS ON
THE PANEL YESTERDAY, AND
DR. STEPHANIE STROEVER WHO'S NOT
HERE AND OUR COMMUNITY LEADS ARE
JUST INCREDIBLE.
CASIE STOUGHTON AND CINDI WYNIA
WITH AMARILLO PUBLIC HEALTH.
WE HAVE TWO COALITION CO-CHAIRS,
SEVERAL OTHER KEY PERSONNEL WITH
A VARIETY OF BACKGROUND AND
EXPERIENCE, AND SOME STUDENTS.
SO WE'LL START WITH A LITTLE BIT
ABOUT WHAT PRE-ECLAMPSIA IS,
PREVALENCE, AND PREVENTION,
SCREENING, BLOOD PRESSURE
MANAGEMENT AND SOME
CONSIDERATIONS FOR
IMPLEMENTATION OF THESE
PREVENTION AND SCREENING
RECOMMENDATIONS.
SO FIRST, WHAT IS PRE-ECLAMPSIA?
IT IS THE -- WORLDWIDE, IT IS
THE SECOND LEADING CAUSE OF
MATERNAL MORTALITY AND
MORBIDITY, AND IN THE U.S., 4%
OF PREGNANCIES ARE AFFECTED BY
PRE-ECLAMPSIA.
IT'S CHARACTERIZED BY NEW ONSET
OF HYPERTENSION DURING
PREGNANCY, AND IT'S A
HYPERTENSIVE DISORDER OF
PREGNANCY, AND IT AFFECTS
MULTIPLE SYSTEMS IN THE BODY,
WITH INFLAMMATION.
IT CAN BE VERY SEVERE.
CONSEQUENCES FOR THE MOTHER
INCLUDE CESAREAN DELIVERY,
STROKE, ECLAMPSIA, WHICH IS THE
SEVEREST FORM OF PRE-ECLAMPSIA
THAT OCCURS WITH SEIZURE, ORGAN
FAILURE, PRETERM BIRTH,
INTRAUTERINE GROWTH FAILURE FOR
THE INFANT, LOW BIRTH WEIGHT AND
STILLBIRTH.
SO THERE ARE REALLY SUBSTANTIAL
CONSEQUENCES TO THIS.
THE EXACT PATHOPHYSIOLOGY OF
PRE-ECLAMPSIA REMAINS SOMEWHAT
ILL LOU SIEVE, BUT THERE HAS
ELUSIVE, BUT THERE HAS BEEN A
LOT OF RESEARCH IN THIS AREA TO
TRY TO FIGURE OUT WHAT THIS IS
ALL ABOUT.
SO WHAT THEY FIGURED OUT IS THAT
THERE'S SOMETHING ABNORMAL WITH
THE PRESENTATION THAT'S HAPPENS
AND IT'S PROPOSED THAT SOME --
THAT THE TROPHOBLAST IS NOT
EMBEDDING INTO THE UTERINE WALL
PROPERLY AND SO THE BLOOD
PERFUSION IS RATHER POOR, WHICH
RESULTS IN PLACENTAL FACTORS
BEING CREATED THAT GOES OUT INTO
THE BLOODSTREAM, AND CAUSING
SYSTEMIC ENDOTHELIAL DYSFUNCTION
AND SYSTEMIC VASCULAR PROBLEMS.
UNFORTUNATELY THERE ARE NO
PREDICTIVE TESTS FOR
PREECLAMPSIA, AT LEAST NOT YET.
THEY'RE MAKING SOME PROGRESS IN
IDENTIFYING SOME POTENTIAL
FACTORS LIKE SFLT 1 THAT MAY
PREDIPREDICT SEVERITY OF
PRE-ECLAMPSIA BUT IT DOES NOT
PREDICT WHO WILL GET
PRE-ECLAMPSIA.
IT'S REALLY UNPREDICTABLE.
SOMEONE MAY HAVE GESTATIONAL
HYPERTENSION THROUGHOUT
PREGNANCY AND IT REMAINS SORT OF
STABLE, AND OTHERS MAY RAPIDLY
WORSEN, RESULTING IN SEVERE
HEALTH CONSEQUENCES FOR BOTH THE
MOTHER AND INFANT.
ADDITIONALLY, IT CAN EVEN OCCUR
POSTPARTUM.
SO SOMEONE MAY NOT HAVE SYMPTOMS
OF PREECLAMPSIA DURING
PREGNANCY, BUT THEN IN THE FIRST
ESPECIALLY 7 TO 10 DAYS AFTER
DELIVERY, THEY MAY DEVELOP
PRE-ECLAMPSIA.
SO GESTATIONAL HYPERTENSION IS
SOMETHING NOT TO BE IGNORED
DURING PREGNANCY.
IT'S DIAGNOSED WITH SYSTOLIC
BLOOD PRESSURE OF GREATER THAN
140 AND DIASTOLIC GREATER THAN
90.
PRE-ECLAMPSIA IS THAT
HYPERTENSION ALONG WITH ANOTHER
SYMPTOM OF ORGAN DYSFUNCTION,
AND THOSE INCLUDE PROTEINURIA,
THROMBOCYTOPENIA, RENAL
INSUFFICIENCY, IMPAIRED LIVER
FUNCTION, PULMONARY EDEMA, AND
CEREBRAL OR VISUAL SYMPTOMS, AND
THEN SEVERE PRE-ECLAMPSIA IS
WHEN THAT HYPERTENSION IS
HIGHER.
SO EXCEEDING 160 SYSTOLIC OR 110
DIASTOLIC, ALONG WITH ANOTHER
ONE OF THOSE SYMPTOMS.
SO OVER THE PAST 20 YEARS,
HYPERTENSIVE DISORDERS OF
PREGNANCY HAVE INCREASED PRETTY
SUBSTANTIALLY.
SO ON THE LEFT FIGURE, IN THE
BLUE LINE, WE SEE THE -- WE SEE
INCREASES IN CHRONIC
HYPERTENSION OVER THE PAST 20
YEARS, AND IN THAT BLACK LINE
ABOVE IT, THAT'S THE PREVALENCE
OF HYPERTENSIVE DISORDERS OF
PREGNANCY.
SO ON AN ANNUAL AVERAGE BASIS,
HYPERTENSIVE DISORDERS OF
PREGNANCY HAVE INCREASED 4.1%
PER YEAR OVER THE PAST 20 YEARS.
A LITTLE GOOD NEWS IS THAT
ECLAMPSIA HAS DECREASED OVER
THIS TIME, PROBABLY BECAUSE
WE'RE IDENTIFYING PRE-ECLAMPSIA
AND POSSIBLY MANAGING IT BET E
BUT WE STILL HAVE A VERY LARGE
INCREASE IN PRE-ECLAMPSIA.
SO THERE ARE NUMEROUS RISK
FACTORS FOR PRE-ECLAMPSIA, AND
I'M NOT GOING TO STATE THEM ALL,
BUT I THINK IT'S IMPORTANT THAT
ACOG IN THEIR PRACTICE BULLETIN
ABOUT GESTATIONAL HYPERTENSIVE
DISORDERS STATES THAT IT'S
IMPORTANT TO REMEMBER THAT MOST
CASES OF PRE-ECLAMPSIA OCCUR IN
HEALTHY NULLIPARIS WOMEN WITH NO
OBVIOUS RISK FACTORS.
SO WHILE THERE ARE MANY RISK
FACTORS, THEY AREN'T NECESSARY
TO DEVELOP PRE-ECLAMPSIA.
HERE ARE SOME OF THE WARNING
SIGNS.
THIS IS AN INFOGRAPHIC PUT OUT
BY ACOG.
AND IF A PATIENT EXPERIENCES ANY
OF THESE THINGS DURING
PREGNANCY, THEY SHOULD
IMMEDIATELY CONTACT THEIR
PHYSICIAN AND SEEK MEDICAL HELP.
GOOD NEWS IS THAT PRE-ECLAMPSIA
MAY BE PREVENTED WITH USE OF
LOW-DOSE ASPIRIN DURING
PREGNANCY.
SO IN 2021, THE U.S. PREVENTIVE
SERVICES TASK FORCE PUBLISHED A
RECOMMENDATION FOR USE OF
81 MILLIGRAMS OF ASPIRIN DAILY
STARTING AFTER 12 WEEKS OF
PREGNANCY TO PREVENT
PRE-ECLAMPSIA.
EVIDENCE ALSO SUGGESTS THAT
LOW-DOSE ASPIRIN SHOULD
POTENTIALLY BE STARTED BEFORE 16
WEEKS TO BE THE MOST EFFECTIVE.
THIS ISN'T PART OF THEIR
RECOMMENDATION YET.
AND RESEARCH IS ONGOING TO
EXAMINE EFFICACY OF DIFFERENT
DOSES OF ASPIRIN, AS WELL AS
VARIATIONS IN TIMING AND
DURATION OF ASPIRIN USE.
SO LOW-DOSE ASPIRIN INHIBITS THE
COX-1 ENZYME, I'M NOT GOING TO
GO INTO DETAIL ON THIS, BUT IT
INHIBITS THE COX-1 ENZYME WHICH
LEADS TO A REDUCTION IN
THROMBOXANE A2, IT REDUCES
PLATELET PRODUCTION AND
AGGREGATION, IT DECREASES
INFLAMMATION AND MAY HELP WITH
ENDOTHELIAL FUNCTION.
SO LOW-DOSE ASPIRIN IS
RECOMMENDED FOR ANYONE WITH ONE
HIGH LEVEL RISK FACTOR OR TWO OR
MORE MODERATE RISK FACTOR.
SO HIGH LEVEL RISK FACTORS FOR
PRE-ECLAMPSIA INCLUDE A PREVIOUS
HISTORY OF PRE-ECLAMPSIA,
MULTI-FETAL GESTATION, SO TWINS
OR TRIPLETS, CHRONIC
HYPERTENSION, HAVING TYPE 1 OR
TYPE 2 DIABETES, KIDNEY DISEASE
OR AN AUTOIMMUNE DISEASE.
SO ANY OF THOSE THINGS, IF YOU
ENTER PREGNANCY WITH ANY OF
THOSE THINGS, YOU SHOULD BE
TAKING LOW-DOSE ASPIRIN AFTER 12
WEEKS OF PREGNANCY.
MODERATE RISK FACTORS INCLUDE
OBESITY, FAMILY HISTORY OF
PRE-ECLAMPSIA, BLACK INDIVIDUALS
AND INDIVIDUALS WITH LOW INCOME,
THOSE ARE RISK FACTORS, AS WELL
AS BEING OVER THE AGE OF 35.
SO -- OH, AND A PREVIOUS ADVERSE
PREGNANCY OUT COME.
SO YOU CAN IMAGINE THAT THERE
ARE LOTS OF PEOPLE WHO MAY
BENEFIT FROM TAKING LOW-DOSE
ASPIRIN DURING PREGNANCY.
SO IN THINKING ABOUT WHO MAY BE
AT RISK FOR PRE-ECLAMPSIA AND
HOW THOSE PEOPLE MAY LEARN ABOUT
THEIR RISK FOR PRE-ECLAMPSIA OR
LEARN ABOUT LOW-DOSE ASPIRIN,
WE'VE SEEN A COUPLE TIMES WITHIN
THE LAST DAY AND A HALF, BUT
THIS IS IMPORTANT BECAUSE IF
THEY'RE NOT ABLE TO ACCESS CARE
OR HAVE THEIR RISK ASSESSED,
THIS IS GOING TO BE DIFFICULT,
AND IT SOMETHING WE NEED TO BE
ABLE TO OVERCOME.
PREGNANT INDIVIDUALS WHO LIVE IN
MATERNITY CARE DESERTS USUALLY
ENTER PREGNANCY WITH POOR
HEALTH, THEY RECEIVE LESS
PRENATAL CARE, THEY HAVE HIGHER
PRETERM BIRTH RATES, AND IN OUR
EXPERIENCE, IN OUR RESEARCH IN
RURAL TEXAS, THEY OFTEN HAVE
DELAYED TIMING OF ENTRY INTO
PRENATAL CARE DUE TO A VARIETY
OF FACTORS BETWEEN DISTANCE TO
ACCESS -- ACCESS PRENATAL VISITS
OR DELAYS IN GETTING ON TO
MEDICAID.
SO PRE-ECLAMPSIA SCREENING IS
DONE THROUGH BLOOD PRESSURE
SCREENING, AND THIS IS REALLY
CRUCIAL FOR DETECTION OF HIGH
BLOOD PRESSURE, SO THAT IT CAN
BE MANAGED.
SO HIGH PRESSURE CAN BE MANAGED
DURING PREGNANCY.
BECAUSE ALL WOMEN ARE AT RISK OF
DEVELOPING HIGH BLOOD PRESSURE
OR PRE-ECLAMPSIA DURING
PREGNANCY, IT'S RECOMMENDED THAT
ALL WOMEN IS BLOOD PRESSURE
SCREENED DURING PREGNANCY, AND
THIS IS DONE WITH STANDARD BLOOD
PRESSURE MEASUREMENTS, AND IT
SHOULD BE DONE AT EACH PRENATAL
VISIT SO THERE ARE TYPICALLY
ABOUT 14 STANDARD VISITS DURING
PRENATAL CARE.
SO HERE ARE THE GUIDELINES OF
HOW BLOOD PRESSURE SHOULD BE
CHECKED, AND SO I JUST WOULD
LIKE US TO CONSIDER HOW THESE
THINGS -- HOW THESE THINGS ARE
CARRIED OUT IN PRACTICE.
IF THE PATIENT IS SUPPOSED TO BE
SITTING AT REST FOR 5 MINUTES
PRIOR TO THAT BLOOD PRESSURE
CHECK, IS THAT HAPPENING?
IF THEY'RE SUPPOSED TO BE
SITTING WITH THEIR BACK
SUPPORTED, THAT MEANS NOT ON AN
EXAM TABLE.
SO THINKING ABOUT HOW ACCURATE
OUR BLOOD PRESSURE CHECKS ARE.
ADDITIONALLY, HOW DOES THIS
TRANSLATE TO MONITORING IN
DIFFERENT SETTINGS?
WHETHER AT HOME OR IN -- FOR
VIRTUAL CARE, DIFFERENT THINGS,
SO JUST THINGS TO THINK ABOUT.
SO THE GOAL FOR BLOOD PRESSURE
MANAGEMENT DURING PREGNANCY IS
TO KEEP BLOOD PRESSURE, THE
SYSTOLIC BETWEEN 140 AND THE
DIASTOLIC MEASUREMENT BELOW 90.
AND GUIDELINES FROM THE CHAP
TRIAL GAVE US EVIDENCE THAT
ADDRESSING MILD HYPERTENSION
DURING PREGNANCY WAS BENEFICIAL
OVER ONLY ADDRESSING IT WHEN IT
GET TO A SEVERE LEVEL.
SO ADDRESSING AND TREATING BLOOD
PRESSURE TO MAINTAIN THESE
LEVELS IS ASSOCIATED WITH
REDUCED RISK OF SEVERE AND ANY
PRE-ECLAMPSIA, AS WELL AS
REDUCED RISK OF MEDICALLY
INDICATED PRETERM BIRTH OR ANY
PRETERM BIRTH.
SO IF SOMEONE ENTERS PREGNANCY
WITH HYPERTENSION, THEY SHOULD
CONTINUE ANTIHYPERTENSIVE
THERAPY DURING THEIR PREGNANCY,
OR THEY SHOULD BE THEIR
ANTIHYPERTENSIVE SHOULD BE
CHANGED TO BE COMPATIBLE WITH
PREGNANCY.
ANYONE WITH NEW ONSET MILD
HYPERTENSION DURING PREGNANCY
SHOULD BE INITIATED WITH
ANTIHYPERTENSIVE MEDICATIONS,
AND ANYONE WITH SEVERE
HYPERTENSION THAT IS 160 OVER
110 THAT'S CONFIRMED AFTER 15
MINUTES SHOULD INITIATE AS SOON
AS POSSIBLE OR WITHIN AN HOUR OF
IDENTIFYING THIS LEVEL OF BLOOD
PRESSURE MEASUREMENTS.
THESE ARE THE RECOMMENDATIONS
FROM ACOG FOR TREATMENT OF
SEVERE HYPERTENSION DURING
PREGNANCY, AND TWO OF THESE
MEDICATIONS ARE INTRAVENOUS
INFUSIONS AND ONE IS AN
IMMEDIATE RELEASE.
THERE ARE NO SUCH SPECIFIC
RECOMMENDATIONS FOR TREATMENT OF
MILD HYPERTENSION DURING
PREGNANCY, BUT THERE ARE A
COUPLE OF THINGS THAT ARE PRETTY
COMMON LIKE LABETALOL AND
EXTENDED RELEASE -- SO IN
THINKING ABOUT HOW THESE
RECOMMENDATIONS CAN REASONABLY
BE CARRIED OUT IN THE U.S., I'D
LIKE US TO CONSIDER WHAT SOME OF
OUR NEEDS ARE, WHAT IS THE
CURRENT STATE OF THINGS.
SO SOCIAL DETERMINANTS OF HEALTH
IMPACT MANY ASPECTS OF ACCESS
AND UPTAKE OF PRENATAL CARE.
INCLUDING PRE-ECLAMPSIA
PREVENTION THROUGH LOW-DOSE
ASPIRIN, SCREENING AND BLOOD
PRESSURE MANAGEMENT.
TO INITIATE LOW-DOSE ASPIRIN,
TIMELY ENTRY INTO PRENATAL CARE
IN THE FIRST TRIMESTER IS REALLY
IMPORTANT.
IF WE'RE EXPECTING AND
RECOMMENDING THAT PREGNANT
INDIVIDUALS START LOW-DOSE
ASPIRIN AFTER 12 WEEKS, IN ORDER
TO GET THAT INFORMATION, THEY
WOULD HAVE NEEDED TO RECEIVE
THAT RECOMMENDATION PRIOR TO
THAT TIME.
ADDITIONALLY, AN ADEQUATE NUMBER
OF PRENATAL CARE VISITS IS
NEEDED FOR ADEQUATE FREQUENCY OF
BLOOD PRESSURE CHECKS, AS WELL
AS MONITORING OF
ANTIHYPERTENSIVE THERAPIES.
SO A QUARTER OF PREGNANT
INDIVIDUALS IN THE U.S. RECEIVE
LESS THAN AN ADEQUATE NUMBER OF
RENATAL VISITS, SO THAT'S A LOT
OF PEOPLE WHO MAY NOT BE GETTING
THE RECOMMENDATION, SCREENING
AND MONITORING THAT THEY NEED.
ADDITIONALLY, TYPICALLY THE ONE
POSTPARTUM VISIT THAT MOST
PEOPLE ARE ABLE TO GET OCCURS
AROUND SIX WEEKS POSTPARTUM.
WHICH IS SORT OF AT THE END OF
THAT RISK PERIOD FOR WHEN
PRE-ECLAMPSIA, POSTPARTUM
PRE-ECLAMPSIA MAY DEVELOP, AND
OF COURSE IMPROVED HEALTH OF
WOMEN PRIOR TO PREGNANCY WOULD
CERTAINLY HELP REDUCE RISK
FACTORS FOR PRE-ECLAMPSIA AND
IMPROVE OVERALL OUTCOMES.
I KNOW THAT THERE ARE A COUPLE
OF GROUPS ADDRESSING
PRECONCEPTION HEALTH AND OTHER
LIFESTYLE FACTORS.
SO I APPLAUD THAT WORK.
SO JUST TO SUMMARIZE,
PRE-ECLAMPSIA IS A MAJOR
CONTRIBUTOR TO MATERNAL
MORBIDITY AND MORTALITY, AND ITS
PREVALENCE IS INCREASING.
LOW-DOSE ASPIRIN AFTER 12 WEEKS
OF PREGNANCY MAY BE EFFECTIVE AT
PREVENTING PRE-ECLAMPSIA.
BLOOD PRESSURE MONITORING IS
IMPORTANT TO DETECT -- DETECT
AND THEN START TREATMENT FOR
HYPERTENSION, AND IMPROVED
ACCESS AND EQUITY TO PRENATAL
AND POSTPARTUM CARE IS NEEDED.
THANK YOU.
[APPLAUSE]
>> THANK YOU SO MUCH.
WE'RE RUNNING A LITTLE BEHIND SO
WE'RE GOING TO HAVE TIME FOR ONE
QUESTION, I BELIEVE WE HAVE ONE
ONLINE.
>> WE HAVE TWO ONLINE AND I'LL
GET TO THE ONE THAT WAS ENTERED
FIRST.
SO HOW IS RACE/ETHNICITY A RISK
FACTOR FOR DISEASE IF IT IS A
SOCIAL CONSTRUCT?
IT SAYS SINCE RACE/ETHNICITY IS
A SOCIAL CONSTRUCT, HOW ARE WE
STRATIFYING AS A RISK FACTOR FOR
DISEASE?
>> SO BLACK INDIVIDUALS ARE AT
HIGHER RISK FOR PRE-ECLAMPSIA.
AND I THINK WE DON'T KNOW
ENTIRELY WHY THAT IS.
BUT THEY ARE.
SO THAT'S DEFINITELY SOMETHING
THAT NEEDS TO BE CONSIDERED ON
THAT LIST OF MODERATE RISK
FACTORS FOR PRE-ECLAMPSIA, BEING
BLACK IS ONE OF THOSE RISK
FACTORS.
SO I THINK THAT'S REALLY
IMPORTANT TO CONSIDER NATIONWIDE
AND I KNOW THAT THERE ARE GROUPS
SPECIFICALLY LOOKING AT
ADDRESSING PRE-ECLAMPSIA AMONG
BLACK INDIVIDUALS.
>> THANK YOU SO MUCH.
[APPLAUSE]
>> THANKS SO MUCH, CHRISTINE.
GREAT PRESENTATION.
AND THEN FOR THE LAST OF THE
SESSION BEFORE WE GO TO BREAK,
WE HAVE UMA REDDY AND -- HOLD
ON, CHEAT SHEET -- VICTORIA
ST. CLAIR.
SO I'M GOING TO TURN IT STRAIGHT
OVER TO YOU GUYS.
>> THANK YOU.
WE'RE THRILLED TO BE PRESENTING
ON BEHALF OF NEW YORK CHAMP.
IT'S AN HONOR TO BE HERE AMONG
ALL OF YOU AT THIS WONDERFUL
MEETING SO FAR.
SO I'M UMA READY, PROFESSOR OF
OB-GYN, VICE CHAIR OF RESEARCH,
PROFESSOR OF POPULATION AND
FAMILY HEALTH AT COLUMBIA
UNIVERSITY.
>> AND I'M VICTORIA ST. CLAIR,
I'M AN MPI FOR THE NEW YORK
CHAMP CENTER OF EXCELLENCE, AND
I AM THE WOMEN'S HEALTH DIRECTOR
AT A COMMUNITY-BASED
ORGANIZATION CALLED CARIBBEAN
WOMEN'S HEALTH ASSOCIATION, IN
WHICH WE PROVIDE MATERNAL
HEALTHCARE AND OTHER
INTERVENTIONS AND RESOURCES TO
ADDRESS THE SOCIAL DETERMINANTS
OF HEALTH TO THE POPULATION MOST
AT RISK IN NEW YORK CITY.
>> SO WE WERE ASKED SPECIFICALLY
TO TALK ABOUT OUR PROJECT CALLED
LIVING HEALTHY FOR MOMS.
BUT BEFORE I DO THAT, I WANT TO
GIVE YOU THE BACKGROUND FOR NY
CHAMP.
WE'RE UNIQUE IN THAT WE HAVE
NINE PRINCIPAL INVESTIGATORS,
AND SO WE'RE A TEAM, THERE'S
MYSELF, I'M IN MATERNAL FETAL
MEDICINE SPECIALIST OB-GYN.
KELLY HALL RECENTLY MOVED TO
TULANE BUT SHE'S PART OF OUR
TEAM OF MPIs, JACQUELINE
TAYLOR, WHO REPRESENTS THE
SCHOOL OF NURSING, CORNELL.
WE HAVE LAUREN OSBOURNE, AND
MONICA SAFFORD.
AND THEN WE HAVE FOUR ESTEEMED
COMMUNITY ORGANIZATIONS WHO
PROVIDE A HUGE AMOUNT OF THE
PERINATAL SERVICES AND PROGRAMS
TO OUR BIRTHING PEOPLE IN NEW
YORK CITY.
INCLUDING CARIBBEAN WOMEN'S
HEALTH ASSOCIATION, VICTORIA
ST. CLAIR, MADELINE
DORVAL-MOLLER, NORTHERN MA HA
TAN PERINATAL PROJECT, SAVANNAH
BROWN, BLACK WOMEN'S BLUEPRINT,
AND EMILY RODRIGUEZ, WHO'S AT
THE BRIDGE DIRECTORY.
SO THE NINE OF US ARE AT THE
TABLE TOGETHER WEEK AFTER WEEK,
MAKING DECISIONS TOGETHER,
MAKING DECISIONS ON HOW WE'RE
GOING TO MAKE PROGRESS ON THE
TWO CORES AND TWO PROJECTS.
AND THE REASON I BRING IT UP IS,
IT'S NINE PEOPLE, NINE OPINIONS,
BUT WE FELT VERY STRONGLY, WE'RE
NOT JUST GOING TO BRING
COMMUNITY INPUT TO THESE
PROJECTS AND EXPERTISE.
WE WANT THEM AT THE TABLE.
SO WE'RE AT THE TABLE.
SO NOW I'LL JUST GET TO THE
BACKGROUND OF LIVING HEALTHY FOR
MOMS, THE INVESTIGATORS FOR
THIS.
SO LAUREN OSBORNE IS THE LEAD
FOR THIS, SHE'S AT CORNELL,
SHE'S A PSYCHIATRIST, EXPERT IN
PERINATAL MENTAL HEALTH.
SHE HAS DONE WORK WITH THIS
PROGRAM CALLED THINKING HEALTHY
PROGRAM IN LOW INCOME COUNTRY,
WHICH LIVING HEALTHY FOR MOMS IS
ADAPTED BY -- IT INVOLVES
COGNITIVE BEHAVIORAL THERAPY,
CBT, AND HAS BEEN SHOWN TO
DECREASE DRAMATICALLY THE
INCIDENCE OF POSTPARTUM
DEPREPTION.
I MYSELF AS I SAID AM A MATERNAL
FETAL MEDICINE SPECIALIST AND
RANDOMIZED CONTROL TRIALS IS MY
AREA OF EXPERTISE.
MAN KA SAFFORD WHO IS AN
INTERNIST SPECIALIZED IN
CARDIOVASCULAR HEALTH.
SHE ALSO USED THIS THINKING
HEALTHY PROGRAM, THIS COGNITIVE
BEHAVIORAL THERAPY IN A
DIFFERENT SETTING IN RURAL
ALABAMA AMONG A PREDOMINANTLY
BLACK POPULATION TO IMPROVE
CARDIOVASCULAR OUTCOMES.
HEATHER LIPKIND, MATERNAL FETAL
MEDICINE EXPERTISE IN POSTPARTUM
CARDIOVASCULAR HEALTH, VICTORIA
ST. CLAIR WHO'S CO-ING WITH ME
AND MADELINE DORVAL-MSM OLLER,
PROVIDES A SIGNIFICANT AMOUNT OF
DOULA SERVICES FOR OUR CITY.
>> THANK YOU.
SO I'LL TALK A BIT ABOUT WHAT IS
LIVING HEALTHY FOR MOMS OR LH
MOMS.
IT IS A RANDOMIZED CONTROL TRIAL
RESEARCH STUDY THAT IS AIMED TO
ADDRESS THE LEADING CAUSES OF
SHORT-TERM MATERNAL MORBIDITY
AND LONG TERM MATERNAL
MORBIDITY, SO IT'S INTENDED TO
ADDRESS BOTH SHORT AND LONG-TERM
AS WE SEE PARTICULARLY IN THE
POSTPARTUM PERIOD OF ONCE
MATERNAL HEALTH JOURNEY.
WE'LL BE DOING THIS BY
ADDRESSING MENTAL HEALTH, MORE
SPECIFICALLY POSTPARTUM
DEPREPTION, AND CARDIOVASCULAR
CONDITIONS, AND HOW WILL WE BE
DOING THIS?
WE'RE COMPARING THE
EFFECTIVENESS OF OUR LIVING
HEALTHY FOR MOMS INTERVENTION
AGAINST THE ATTENTION CONTROL.
THE LIVING HEALTHY FOR MOMS
INTERVENTION UTILIZES THE
PRINCIPLES OF COGNITIVE
BEHAVIORAL THERAPY OR CBT, AS
WELL AS HEALTHY LIFESTYLE
PROGRAM, AND THIS WILL BE DONE
THROUGH PATIENT ACTIVATED
LEARNING SYSTEM OR PALS AS WE
REFER TO IT, WHICH IS A SERIES
OF PATIENT-CENTERED, PATIENT
LANGUAGE VIBL VIDEOS THAT WILL
BE DEVELOPED BY OUR DOULA,
AGAINST THE ATTENTION CONTROL,
WHICH IS STANDARD DOULA CARE.
BOTH THE ATTENTION CONTROL AND
THE INTERVENTION WILL BE
DELIVERED BY DOULAS, AND WHEN I
SAY DOULAS, I MEAN
COMMUNITY-BASED DOULAS THAT WORK
WITH CARIBBEAN WOMEN'S HEALTH
ASSOCIATION AND NORTHERN
MANHATTAN PERINATAL -- IT MEANS
THE DOULAS ARE REPRESENTATIVE OF
THE COMMUNITIES THEY SERVE, THEY
ARE MEMBERS OF THE COMMUNITIES
THEY SERVE, AND THEY HAVE THE
CULTURAL HUMILITY AND
COMPETENCIES IN ORDER TO BEST --
THAT BEST EQUIP THEM TO SUPPORT
THE POPULATION OR THE
PARTICIPANTS IN THE STUDY.
THE THREE HOSPITAL SITES IN
WHICH PARTICIPANTS WILL BE
RECRUITED FROM ARE NEW YORK
PRESBYTERIAN BROOKLYN METHODIST
HOSPITAL IN BROOKLYN, QUEENS
HOSPITAL, WHICH IS A NEW YORK
CITY HEALTH AND HOSPITALS PUBLIC
HOSPITAL IN QUEENS, AND THE
NEW YORK PRESBYTERIAN ALLEN
HOSPITAL IN UPPER MANHATTAN.
THE AIMS FOR LIVING HEALTHY FOR
MOMS IS TO TEST THE
EFFECTIVENESS IN A HYBRID TYPE H
APPROXIMATELY 600 PARTICIPANTS.
THE PARTICIPANTS WILL BE 18 OR
OLDER WHO HAVE GIVEN BIRTH TO A
SINGLETON, SO SINGLE BIRTH, NO
MULTIPLES AT BIRTH.
THEY WILL BE SELF-IDENTIFIED AS
BLACK AND/OR HISPANIC AND BE
RECIPIENTS OF MEDICAID.
THE AIM IS TO LOWER THE
INCIDENCE OF POSTPARTUM
DEPRESSION, IMPROVEMENT IN
CARDIOVASCULAR HEALTH, AND
BETTER QUALITY OF LIFE.
THE SECOND AIM IS TO ANALYZE THE
EFFECTS ON HEALTHCARE
UTILIZATION, INCLUDING EARLY
POSTPARTUM PROVIDER CONTACT, SO
SEVEN DAYS IN THE POSTPARTUM
PERIOD, AS WELL AS SIX-WEEK
VISITS, AND MEASURE PARTICIPANT
SATISFACTION WITH POSTPARTUM
CARE.
AND THE THIRD AIM IS TO
INVESTIGATE THE IMPLEMENTATION
PROCESS AND THE OUTCOMES OF THE
LH MOMS INTERVENTION.
THE OUTCOMES ARE TO REDUCE OR
ELIMINATE POSTPARTUM DEPRESSION
UTILIZING THE MEASURE OF THE
EDINBURGH POSTNATAL DEPRESSION
SCORE WHICH THE VALUE OF GREATER
THAN OR EQUAL TO 9, AND IMPROVE
CARDIOVASCULAR HEALTH USING THE
A HSM AHA'S HEART SCORE, AND SEY
OUTCOMES ARE INCLUDING BUT NOT
LIMITED TO RESILIENCE, SOCIAL
SUPPORT, REDUCTION OF ANXIETY
AND POSTPARTUM DEPRESSION.
OR PTSD.
HEALTHCARE UTILIZATION AND
SATISFACTION WITH POSTPARTUM
CARE IN THE IMPLEMENTATION
PROCESS.
WE WANT TO FOCUS A BIT MORE ON
WHAT DOES AIM THREE MEAN IN THIS
RESEARCH STUDY.
WE WANT TO MAKE SURE THAT WE ARE
EVALUATING OUR INTERVENTION IN
THE IMPLEMENTATION PHASE ACROSS
THE SIX-MONTH PERIOD.
SIX MONTHS, 18 MONTHS OF RCT
RECRUITMENT.
WE WILL BE RECRUITING
PARTICIPANTS FROM THE RANDOMIZED
CONTROL TRIAL, HEALTHCARE
PROVIDERS, AND DOULAS AT EACH OF
THE RESPECTIVE SITES.
AND WAIL W WE'LL WORK WITH OUR B
TO FINALIZE PLANS FOR DATA
COLLECTION INSTRUMENTS.
AND THIS WILL BE DONE OVER THE
COURSE OF SURVEYS, FOCUS GROUPS
AND KEY INFORMANT INTERVIEWS.
>> SO THE STUDY DESIGN IS A TYPE
1 HYBRID EFFECTIVENESS
IMPLEMENTATION DESIGN, SO WHAT
IS THAT?
SO WE'RE ASSESSING THE
INTERVENTIONS' EFFECTIVENESS,
LIVING HEALTHY FOR MOMS, AND ITS
EFFECT ON THE OUTCOMES, BUT
WE'RE ALSO GOING TO EXAMINE THE
IMPLEMENTATION PROCESSES.
SO THIS SHOWS WHAT THE LIVING
HEALTHY FOR MOMS INTERVENTION
IS.
IT'S A NOVEL POSTPARTUM
EMERGENCY DETECTION SYSTEM FOR
THE FIRST SEVEN DAYS POST
DISCHARGE.
THEN STRUCTURAL BEHAVIORAL
INTERVENTION DESIGNED TO PREVENT
POSTPARTUM DEPRESSION SYMPTOMS
AND IMPROVE CARDIOVASCULAR
HEALTH THROUGH THE LIVING
HEALTHY FOR MOMS PROGRAM, AND
THEN WE'RE LEVERAGING EXISTING
INFRASTRUCTURE AND RELATIONSHIPS
BY TRAINING COMMUNITY DOULAS TO
DELIVER THE INTERVENTION.
SO IN THE FIRST YEAR, THESE
ARE -- WE'VE ALREADY REFINED THE
INTERVENTION WITH FOCUS GROUPS
AND DOULA WORKING GROUPS.
WE'VE HAD WORKING FOCUS GROUPS
WITH BIRTHING PEOPLE, HEALTHCARE
PROFESSIONALS, WIDE VARIETY OF
HEALTHCARE PROFESSIONALS, WITH
DOULAS, WITH HOSPITAL
STAKEHOLDERS.
WE'RE TRAINING AND CERTIFYING
THE INITIAL -- WE TRAINED THE
INITIAL GROUP OF DOULAS TO
DELIVER THE INTERVENTION.
SO WE ARE POISED TO ENROLL AND
RANDOMIZE 200 BIRTHING
INDIVIDUALS AT THE FIRST
HOSPITAL, WHICH IS BROOKLYN
METHODIST.
EACH INDIVIDUAL WILL BE ENROLLED
FOR SIX MONTHS.
THAT'S WHERE WE GET TO PRIMARY
FOLLOW-UP, AND EACH HOSPITAL
WILL BE ENROLLING PATIENTS OVER
THE FIRST -- OVER 18 MONTHS, AND
THEN AFTER THEY'RE DONE WITH
ENROLLING AND FOLLOW-UP, WE'LL
THEN DO AN IMPLEMENTATION
EVALUATION OVER SIX MONTHS AT
EACH SITE.
AND THIS IS JUST OUR TIMELINE
OVER THE SEVEN YEARS.
SO THE FIRST YEAR WAS A DEVELOP
MEANT PHASE.
I. ALSO WANT TO MENTION, WE HAVE
A CHARGE BOARD, SO THIS IS THE
COMMUNITY HOSPITAL ACADEMIC
RESEARCH GOVERNANCE ADVISORY
BOARD, AND SO LIVING HEALTHY FOR
MOMS WAS PRESENTED TO THEM TWICE
FOR THEIR INPUT.
SO THIS BOARD HAS A NEW YORK
STATE DEPARTMENT OF HEALTH, THE
CITY DEPARTMENT OF HEALTH, ACOG
DISTRICT 2, SO THERE'S A SAFE
MOTHER INITIATIVE IN OUR STATE.
WHICH INVOLVES, OUT OF 123
HOSPITALS IN NEW YORK STATE, 117
OF THEM, AND THEY'VE BEEN
INSTRUMENTAL IN IMPLEMENTING
SAFETY BUNDLES ON HEMORRHAGE,
PRE-ECLAMPSIA, SO THEY'RE PART
OF THE BOARD.
AND WE'VE ENGAGED MAJOR HEALTH
SYSTEMS, MOUNT SINAI, IT'S ALSO
A SITE FOR OUR INTERVENTION.
SO THEY'RE THE LARGEST MUNICIPAL
DELIVERY SYSTEM IN THE COUNTRY,
AND THEY DELIVER 50% OF BLACK
BIRTHING PEOPLE IN NEW YORK
CITY, AND A MAJORITY OF MEDICAID
RECIPIENTS IN NEW YORK CITY OF
TWO PERINATAL PROGRAMS
THROUGHOUT THE STATE.
AND WE'RE INTERESTED ALSO IN NOT
JUST URBAN SETTINGS, BUT RURAL
SETTINGS, UNIVERSITY OF
ROCHESTER IS A PARTNER, IN YEAR
5 AND 6, WE'LL BE LOOKING AT
ADAPTATIONS OF THIS PROGRAM FOR
MORE RURAL SETTING.
AND THEN IN YEAR 7, OBVIOUSLY
BESIDES ANALYSIS, WE'LL USE THIS
CHARGE BOARD TO HELP DISSEMINATE
THE RESEARCH FINDINGS AND
IMPLEMENTATION.
SO THIS JUST SHOWS A SCHEMATIC
OF THE LIVING HEALTHY FOR MOMS
ARM AND THE ATTENTION CONTROL
ARM.
SO THE ATTENTION CONTROL ARM
THAT IS DOULA CARE, ROUTINE
DOULA CARE, BUT THERE'S NOT THE
COGNITIVE -- IT'S NOT EMBEDDED
IN COGNITIVE BEHAVIORAL THERAPY
AND THE MOTIVATIONAL
INTERVIEWING THAT HAPPENS IN THE
LIVING HEALTHY FOR MOMS ARM.
SO ON THE POSTPARTUM BOARD,
BLOOD PRESSURE CUFFS WILL BE
GIVEN, GIVEN EDUCATION ABOUT
POSTPARTUM COMPLICATIONS AND
INTRODUCTION TO THE DOULA.
AND THEN AFTERWARDS, ONE TO
SEVEN DAYS, BOTH ARMS WILL BE
DOING DAILY HOME BLOOD PRESSURE
MONITORING BUT THERE WILL BE
DAILY DOULA OUTREACH FOR, BUT
THESE SESSION TOPICS FOR LIVING
HEALTHY FOR MOMS WAS -- IT WAS
DEVISED IN CONJUNCTION WITH
BIRTHING PEOPLE DOULAS, AND SO
THESE SESSIONS, THE TIMING OF
THEM, THEIR CONTENT, AND AS
VICTORIA MENTIONED, A KEY
COMPONENT IS PALS, PATIENT
ACTIVATED LEARNING SYSTEM, SO
THIS ACTUALLY, MONICA SAFFORD
CAME UP WITH DEVICE AND WE'RE
OPTING IN FOR PERINATAL FOR THIS
USE BUT IT REALLY TARGETS LOW
LITERACY MARGINALIZED
POPULATIONS, AB SO THROUGH
INTERACTIVE VIDEOS, ACTIVITIES,
CBT, REALLY REFRAMING AND
EMBEDDING THIS EDUCATION TO
IMPROVE OUTCOMES.
THE DATA COLLECTION POINTS,
HEALTH SURVEYS, BLOOD PRESSURE,
HEIGHT, WEIGHT, POINT-OF-CARE
TESTING WILL BE DONE AT
BASELINE, SIX WEEKS POSTPARTUM
AND SIX MONTHS POSTPARTUM.
WE HAVE DATA AND SAFETY
MONITORING BOARD, WHICH IS --
GAVE US EXCELLENT INPUT TO
REFINE ALSO THE STUDY.
IN TERMS OF IMPLEMENTATION
EVALUATION, WE'RE GOING TO USE A
RE-AIM FRAMEWORK, SO WHO ARE THE
PATIENTS INTENDED TO PARTICIPATE
AND BENEFIT FROM LIVING HEALTHY
FOR MOMS, WHAT ARE THE MOST
IMPORTANT BENEFITS WE'RE TRYING
TO ACHIEVE, WHAT IS THE
LIKELIHOOD OF A NEGATIVE OUT
COME, WHERE WAS LIVING HEALTHY
FOR MOMS APPLIED AND BY WHOM,
HOW CONSISTENTLY WAS IT
DELIVERED, HOW MUCH DID IT COST,
WHY DID THE RESULTS HAPPEN THAT
WE GOT, AND THEN MAINTENANCE,
WHEN DID LIVING HEALTHY FOR MOMS
BECOME OPERATIONAL, HOW WAS IT
SUSTAINED, AND HOW ARE
INDIVIDUAL RESULTS SUSTAINED.
WE'RE ALSO USING THE CIFR
CONSTRUCT, SO WHAT ARE THE
ADVANTAGES TO LIVING HEALTHY FOR
MOMS VERSUS USUAL CARE, DO WE
HAVE SUFFICIENT PARTNERSHIPS AND
CONNECTIONS TO CARRY IT OUT, HOW
HARD WILL IT BE TO IMPLEMENT
COMMUNICATION BETWEEN PROVIDERS
AND THE HOSPITAL SYSTEM, AND THE
LIVING FOR HEALTHY MOMS PROGRAM.
THE INDIVIDUAL LEVEL, IS THE
HOSPITAL LEADERSHIP GOING TO BE
ENTHUSIASTIC ABOUT THIS PROGRAM,
AND WILL IT BE HARD TO FIND
STRATEGIES TO FIX -- TO TAILOR
THIS TO THE IMPLEMENTATION
PROCESS.
WE'RE GOOD.
I TALK QUICKLY BECAUSE I'M FROM
NEW YORK ORIGINALLY, SO -- IN
TERMS OF -- SO WE FINISHED,
WE'RE STARTING YEAR TWO, WE'RE
THRILLED WE FINISHED THE DOULA
TRAINING AND CERTIFICATION, WE
TRAINED ATTENTION CONTROL
DOULAS, HIRED A RECRUITER FROM
THE COMMUNITY AT BROOKLYN
METHODIST, FINALIZED AND
TRANSLATED ALL THE INTERVENTION
MATERIALS SO THERE'S A
PARTICIPANT ACTIVITY BOOK, THE
DOULA REFERENCE MANUAL, THE
PATIENT ACTIVATED LEARNING
CONTENT.
WE'VE OBTAINED IRB APPROVAL TO
DO THE STUDY, AND THEN THE
LATEST THING IS COMMON DATA
ELEMENTS, SO WE HAD A MEETING
AND NIH HELD A MEETING ABOUT THE
DESIRE TO IMPLEMENT THE COMMON
DATA ELEMENTS ACROSS ALL THE
STUDIES, SO THOSE FORMS AND
ELEMENTS ARE BEING EMBEDDED, SO
WE'RE ABOUT TO -- I SAID
OCTOBER, IT'S GOING TO BE
NOVEMBER, BUT WE'RE READY TO
RECRUIT AT BROOKLYN METHODIST.
AND I JUST WANT TO SAY ON BEHALF
OF NEW YORK CHAMP, WE CALL
OURSELVES NEW YORK CHAMPIONS,
WE'RE JUST SO THANKFUL TO BE A
PART OF THIS INITIATIVE AND HAVE
THIS OPPORTUNITY, SO THANK YOU
SO MUCH.
[APPLAUSE]
>> THANK YOU SO MUCH, UMA, THAT
WAS FON TAS TICK.
FANTASTIC.
I KNOW WE'RE UP AGAINST THE
BREAK BUT WE'RE GOING TO OPEN IT
UP FOR ONE QUESTION IF ANYONE IN
THE AUDIENCE WANTS TO STEP
FORWARD?
NO PRESSURE BECAUSE IT'S THE
ONLY QUESTION.
WE HAVE A TAKER.
>> VERY QUICK QUESTION AND I MAY
HAVE MISSED IT WHEN I DARTED OUT
FOR THE RESTROOM.
CAN YOU SHARE FOR YOUR
INTERVENTION WHEN YOU'RE
RECRUITING?
IS IT DURING LATE PREGNANCY,
POSTPARTUM?
CAN YOU SHARE A LITTLE ABOUT THE
RECRUITMENT PROCESS?
>> EXCELLENT QUESTION.
WE'RE RECRUISING POSTPARTUM,
RIGHT AFTER DELIVERY, IN THE
HOSPITAL.
>> WELL, LET'S THANK UMA AND
VICTORIA FOR A FANTASTIC
PRESENTATION.
IT WAS AWESOME.
ALSO AGAIN THANKS TO CHRISTINE
GARNER AND IRO AND DEIRDRE FOR
THEIR PRESENTATIONS.
WE DO HAVE TWO MORE
PRESENTATIONS AFTER THE BREAK,
SO WE WILL BE STARTING UP AGAIN
PROMPTLY AT 1:30, AND PRESUMING
THAT THERE'S NO OTHER
HOUSEKEEPING, BON APPETIT, ENJOY
THE POSTER AND DEMO SESSION AND
WE'LL BE BACK AT 1:30 EASTERN TIME.
FANTASTIC! ALL RIGHT.
SO WE HAVE TWO -- TO CLOSE THE
SESSION WE HAVE TWO MORE AWESOME
PRESENTATIONS, FIRST UP, SAMEER,
COME ON DOWN.
SAMEER IS FROM CARDIEX, IS GOING
TO TALK ABOUT DETECTING THE
UNDETECTED.
COME ON DOWN.
>> GOOD AFTERNOON.
CAN YOU HEAR ME?
AWESOME.
I'M SAMEER MOLVI, TODAY
INTRODUCING YOU TO OUR
INNOVATIVE SOLUTIONS FOR EARLY
DETECTION AND INTERVENTION OF
PREECLAMPSIA.
PREECLAMPSIA AFFECTS
APPROXIMATELY 8% OF PREGNANCIES,
AND WHICH CAN ALSO LEAD TO FETAL
AND MATERNAL MORBIDITY.
AT CARDIEX WE BELIEVE ADVANCE
THE VASCULAR BIOMARKERS CAN
PROVIDE DEEPER INSIGHTS INTO
THIS CONDITION, MORE PRECISE
MONITORING AND INTERVENTION IN
CLINICS AND REMOTELY.
THERE WE GO.
ALL RIGHT.
SO OUR CONNECT VASCULAR MELT
MONITORING PLATFORM IS DESIGNED
TO DIAGNOSE, INTERVENE, MANAGE
ARTERIAL HEALTH, CONTINUOUS AND
COMPREHENSIVE MONITORING, BUILD
ON THE TECHNOLOGY WHICH PROVIDES
INSIGHT INTO CENTRAL BLOOD
PRESSURE AND ARTERIAL, TWO CRE
MANAGEMENTS IN PREECLAMPSIA AND
OTHER CARDIAC CONDITIONS.
THE SEAMLESS INTEGRATION MAKES
THIS UNIQUE, CAN BE INCORPORATED
INTO EXISTING CARE PATHWAYS FOR
PREGNANT WOMEN, REIMBURSEMENT
THROUGH CODE, THUS MAKING IT
PRACTICAL AND FINANCIALLY
BENEFICIAL FOR HEALTHCARE
PROVIDERS.
NOW, AT THE HEART OF OUR CONNECT
PLATFORM IS OUR CONNEQT PULSE
VASCULAR BIOMETRIC MONITORING,
WE GOT APPROVAL, COMPRISE HENCE
SIV AND BRACHIAL BLOOD PRESSURE,
INSIGHT INTO ARTERIAL STIFFNESS
AND CARDIAC PROFUSION
EFFICIENCY.
OVER 2500 PEER-REVIEWED
PUBLICATIONS, TECHNOLOGIES LIKE
THIS ARE VALIDATED AND TRUSTED
BY EXPERTS WORLDWIDE.
LET ME TELL YOU MORE ABOUT THE
CONNECT PULSE, WE CAN MEASURE
VASCULAR BIOMARKERS LIKE CENTRAL
BLOOD PRESSURE WHICH IS THE
PRESSURE AT YOUR HEART AND
ASCENDING AORTIC VALVE AND
AUGMENTATION INDEX, KEY
INDICATOR OF ARTERIAL STIFFNESS
IDENTIFYING EARLY SIGNS OF
CARDIOVASCULAR STRESS, SIGNAL TO
THE ONSET OF CONDITIONS SUCH AS
PREECLAMPSIA.
ONE OF THE MOST EXCITING
APPLICATIONS OF THIS TECHNOLOGY
IS THE UTILITY IN PREGNANCY CARE
IN GENERAL, REMOTELY MONITORING
KEY CARDIOVASCULAR METRICS CAN
DETECT EARLY SIGNS OF
HYPERTENSIVE DISORDERS LONG
BEFORE THAT -- TRADITIONAL MIGT
PICK THEM UP ALLOWING FOR TIMELY
INTERVENTION, GIVING PROVIDERS
ABILITY TO EFFECTIVELY MANAGE
HIGHER RISK PREGNANCIES.
ALL RIGHT.
NEXT SLIDE.
STUDIES HAVE SHOWN SIGNIFICANT
IMPACT ON PREGNANCY OUTCOMES.
FOR EXAMPLE RESEARCH INDICATES
HAVING HAD PREECLAMPSIA ADDS SIX
YEARS TO VASCULAR AGING,
DETECTING THESE CHANGES EARLY AS
POSSIBLE IS SO CRUCIAL.
BY TRACKING, WE CAN PREDICT
PREECLAMPSIA, IMPROVE OUTCOMES
FOR MOTHERS AND BABIES.
SO OUR COMPREHENSIVE
PREECLAMPSIA RISK ASSESSMENT AND
MONITORING WORKFLOW INCLUDES IN
CLINIC AND AT HOME MONITORING.
THROUGHOUT PREGNANCY REGULAR
VISITS AND ONGOING MONITORING
ALLOWS TRACKING OF CHANGES,
ENABLING TIMELY INTERVENTIONS,
ENSURING MOTHERS AND HEALTHCARE
PROVIDERS ARE WELL EQUIPPED TO
MANAGE PREGNANCY-RELATED RISKS.
FOR PROVIDERS, OUR SOLUTIONS
OFFER EARLY DETECTION AND
ONGOING MONITORING WHILE
PROVIDING VITAL DATA THAT ALLOWS
FOR EARLIER AND MORE PRECISE
ENTER
INTERVENTION, IDENTIFYING
CHANGES EARLIER AND CAN OFFER
MORE PERSONALIZED CARE AND
IMPROVE PATIENT OUTCOMES WHILE
BENEFITING FROM CPE CODES FOR
REIMBURSEMENT.
NOW, FOR EXPECTING MOMS, THE
PLATFORM OFFERS EASY ACCESS TO
PERSONALIZE THE HEALTH DATA WITH
CONTINUOUS MONITORING OF CENTRAL
BLOOD PRESSURE, ARTERIAL
STIFFNESS, MOTHERS CAN STAY
INFORMED ABOUT THEIR HEART
HEALTH THROUGHOUT PREGNANCY
GIVING PEACE OF MIND THAT THEY
HAVE ADDITIONAL LAYER OF CARE
BEYOND STANDARD BLOOD PRESSURE
MONITORING.
AND NOW A SNEAK PEEK, WE'RE
WORKING ON THE CONNEQT BAND,
MONITORING KEY METRICS-LIKE
CENTRAL BLOOD PRESSURE AND
ARTERIAL STIFFNESS, AND WHICH
ARE IMPORTANT DURING PREGNANCY
AS I MENTIONED BEFORE.
THE BAND IS BUILT ON OUR
VALIDATED PLATFORM AND OFFERS
24/7 MONITORING IN THE
COMFORTABLE WEARABLE FORMAT
MAKING IT EASIER TO MANAGE
HEALTH THROUGHOUT PREGNANCY.
AND WE'VE HAD SOME RECOGNITIONS
ALONG THE WAY, WE ALSO WERE
THANKFULLY WON THE RADx
MATERNAL HEALTH CHALLENGE,
RECOGNITIONS ALONG THE WAY.
THANK YOU FOR YOUR TIME.
WE'RE DRIVEN TO IMPROVE MATERNAL
HEALTH THROUGH ADVANCE THE
ARTERIAL HEALTH MONITORING AND
OFFER BETTER TOOLS FOR
MONITORING CONDITIONS SUCH AS
PREECLAMPSIA AND AIM -- I'M
HAPPY TO ANSWER QUESTIONS.
>> EXCITING TECHNOLOGY, PLEASE
GO AHEAD.
>> OKAY.
I THINK IT'S REMARKABLE THAT
YOU'VE BEEN ABLE TO CRACK THE
REIMBURSEMENT PATH SO WELL.
MY QUESTION IS, IF YOU COULD
EXPAND UPON THAT, ESPECIALLY
WITH YOUR CONNECT BAND COMING
OUT IF YOU THINK THE DEVICE WILL
BE FULLY REIMBURSABLE DOES THE
PATIENT HAVE ANY COSTS AT ALL
AND HOW COMPELLING FOR A
PROVIDER TO JUMP ON BOARD AND
START USING YOUR TECHNOLOGY.
>> YEAH, ABSOLUTELY GOOD
QUESTION.
SO, WE ARE WORKING OUT OUR
PRICING MODELS AT THE MOMENT AS
WELL.
IT'S SOMETHING WE'RE LOOKING
INTO.
WE'RE LOOKING INTO PROVIDING
MORE HEALTH SERVICES AS OUR WAY
OF PROVIDING THE SERVICE TO
USERS.
THIS INCLUDES, YOU KNOW,
PROVIDING ANYONE THAT A HEART IS
ABLE TO TAKE THE ASSESSMENT, NOT
JUST PREGNANT WOMEN IN THIS
CASE, FOR EXAMPLE, RIGHT?
WE'RE LOOKING TO PROVIDE A
SERVICE AT THE PRICE RANGE OF
TWO TO THREE HUNDRED DOLLARS AT
THE MOMENT SO IT'S AVAILABLE TO
EVERYONE.
>> FANTASTIC.
ANY OTHER QUESTIONS FOR SAMEER?
IT WAS SO CLEAR AND EXACTLY
CONCISE.
OH, ONE MORE, SORRY.
PLEASE GO AHEAD.
>> FOR THE BANDS, ARE THEY
REUSABLE AND HOW LONG WOULD IT
LAST?
IF I'M A PERSON NOT PREGNANT AND
WANTS TO MONITOR MY BLOOD
PRESSURE BECAUSE I HAVE CHRONIC
HYPERTENSION.
>> WE'RE LOOKING FOR IT TO LAST
ABOUT FIVE DAYS AT THE MOMENT.
IT'S RECHARGEABLE.
>> DO WE HAVE TIME FOR ONE
QUESTION FROM ONLINE?
SO THE QUESTION FROM ONLINE IS
FROM SUSAN HAHN, HOW DOES THE
DATA GET TO THE TREATING
CLINICIAN, DOES IT REQUIRE WI-FI
AND INTERNET?
>> YES, SO OUR DATA IS
TRANSFERRED FROM HARDWARE TO
MOBILE APPLICATION OR TABLET
APPLICATION VIA BLUETOOTH, WENT
VIA WI-FI TO THE BACK END, THE
PORTAL.
WHEN YOU TAKE THE READING THE
DATA IS SENT ACROSS, ONCE YOU
CONNECT YOUR MOBILE APPLICATION
IT'S RIGHT THERE WITH TRANSIS
ANALYSIS READY FOR THE PHYSICIAN
OR HEALTHCARE PROVIDER.
THANK YOU VERY MUCH, EVERYBODY.
>> COME ON DOWN, WILL.
NEXT PRESENTATION IS FROM WILL,
PYRAMES.
>> WILL SUTHERLAND FROM PYRAMES,
CHIEF OPERATING OFFICER WHICH
MEANS THEY DON'T LET ME OUT IN
PUBLIC OFTEN TO TALK TO PEOPLE
LIKE YOU.
I'LL DO MY BEST AND SEE IF I CAN
FILL THE SHOES.
I WANTED TO START OUT BY
THANKING NIH AND PARTICULARLY
THE RADx PROGRAM FOR THIS
PROGRAM THAT WE PARTICIPATED IN.
THE AWARDS ARE VERY IMPORTANT TO
SMALL START-UP COMPANIES LIKE
OURS WHERE THE FINANCIAL
RESOURCES ARE PRECIOUS AND THIS
GIVES US AN EXTRA BOOST TO FOCUS
IN ON A CRITICAL AREA OF HEALTH.
BUT THE PROGRAM ITSELF GAVE US
MUCH MORE THAN JUST FINANCIAL
SUPPORT.
THE PROGRAM PROVIDED SOME GREAT
RESOURCES AND FEEDBACK AND
DIRECTION THAT REALLY HELPED
ADVANCE OUR EFFORTS ON OUR
PRODUCTS WHILE FOCUSING IN ON
THE MATERNAL HEALTH CHALLENGE,
IT'S BEEN VALUABLE AND I THANK
RADx FOR THAT PROGRAM.
A LITTLE BIT ABOUT PYRAMES AS A
COMPANY, WE'VE GOT AN ALWAYS-ON
BLOOD PRESSURE MONITORING
TECHNOLOGY.
THE CORE OF THE TECHNOLOGY CAME
OUT OF A LAB AT STANFORD, A
SENSOR THAT'S ULTRA SENSITIVE,
WORN ON THE WRIST OR OVER ANY
ARTERIAL PULSE POINT.
WE'RE ABLE TO PICK UP DEFLECTION
OF THE SKIN AND USING MACHINE
LEARNING AND ARTIFICIAL
INTELLIGENCE METHODS DEVELOPED
ALGORITHMS THAT CAN EXTRACT THE
BLOOD PRESSURE OF THE PATIENT
FROM THAT.
AND THAT PROCESSING OF DATA IS
DONE ON A MOBILE DEVICE SO THE
WRIST JUST COLLECTS THE SENSOR
DATA, AND THEN TRANSFERS IT TO
THE MOBILE DEVICE.
WE'VE BEEN IN EXISTENCE SINCE
2016.
AND LAST YEAR WE WERE CLEARED
FOR OUR VERY FIRST PRODUCT,
TARGETED AT NEONATAL INFANTS, IN
THE NICU, WHERE REALLY THE STATE
OF CARE IF YOU NEEDS TO MONITOR
BLOOD PRESSURE IS AN ARTERIAL
LINE AND MORE NEEDLES BEING
STUCK INTO THESE LITTLE PRECIOUS
BABIES IS NOT A VERY GOOD
SOLUTION.
SO WE'RE CLEARED ON THAT AND
CURRENTLY WORKING ON THE
COMMERCIALIZATION OF THAT
PRODUCT.
AND WE WANTED TO TURN OUR
ATTENTION TO ADULT MONITORING
AND BECAUSE OF THIS PROGRAM WE
STARTED WITH MATERNAL HEALTH IN
THE POSTPARTUM PERIOD, EASILY
EXTENDSABLE IN THE PERINATAL
OPPORTUNITIES, BUT THEY'VE THEN
FOLLOWING THAT WOULD BE ELDER
CARE, GENERAL HYPERTENSION
MARKET, ADULT OPPORTUNITIES
WITHIN THE HOSPITALS AND CLINICS
FOR EMERGENCY RARE AND OPERATING
ROOMS.
SO WE'VE GOT A NICE ROAD MAP OF
PRODUCTS TO ROLL OUT OVER TIME.
OKAY.
I DIDN'T REALIZE MY SLIDE IS A
PROGRESSIVE ONE HERE.
SO, ALWAYS ON BLOOD PRESSURE
MONITORING IS VALUABLE AT ALL
STAGES OF LIFE STARTING WITH
INFANTS, GOING THROUGH
CHILDHOOD, THROUGHOUT -- WITH
EMERGENCIES, MATERNAL HEALTH
OPPORTUNITY, AND WE GET TO THE
GENERAL HYPERTENSION MARKET.
THERE'S A LOT OF NEED FOR BLOOD
PRESSURE MONITORING TO IMPROVE
OVER WHAT WE'VE GOT TODAY.
AND I THINK CHRISTINE DID A VERY
GOOD JOB OUTLINING THE CHALLENGE
TODAY OF PREECLAMPSIA AND
HYPERTENSION IN GENERAL, BUT ONE
OF THE THINGS THAT WE FOUND IN
THE -- GOING IN THIS PROGRAM IS
THAT THE CURRENT SOLUTION FOR
POSTPARTUM WOMEN IF THEY REALLY
NEED IT IS TO SEND THEM HOME
WITH A CUFF, AND THE CUFFS ARE
JUST -- THEY ARE UNCOMFORTABLE,
THEY ARE INCONVENIENT.
THEY ARE NOT -- THE ACCURACY IS
A LITTLE SUSPECT AT TIMES
ESPECIALLY FOR PEOPLE NOT
FAMILIAR WITH USING BLOOD
PRESSURE CUFFS.
AND ONE OF THE BIGGEST FEEDBACKS
WE GOT WAS USER COMPLIANCE IS
VERY POOR.
WHILE THEY ARE SENDING PATIENTS
HOME, THEY REALLY WANT TO KNOW
HOW THEY ARE DOING, ARE THEY
TRENDING UP, IS THE CONDITION
STABLE, WHAT'S GOING ON WITH THE
PATIENT, THEY OFTEN FOUND THEY
HAVE TO CALL TWICE A DAY TO GET
TWO MEASUREMENTS A DAY AND EVEN
THEN THAT WAS A STRETCH OF
TRYING TO GET COMPLIANCE FROM
THE PATIENTS.
AND AS WE'VE HEARD OVER THE LAST
TWO DAYS, VISITS TO THE DOCTORS
ARE DIFFICULT IN THESE CARE
DESERTS, AND SO IF YOU'RE LUCKY
YOU'LL GET A FOLLOW-UP TWO WEEKS
AFTER BIRTH, OFTEN IT'S SIX
WEEKS, SO YOU'RE NOT GETTING
MONITORING DURING THIS CRITICAL
PERIOD SIX WEEKS AFTER BIRTH.
AND AS I MENTIONED, THE TWO
MEASUREMENTS A DAY IS WHEN
YOU'RE LUCKY OFTEN IT'S ONE OR
TWO A WEEK, IF THAT AT ALL.
AND SO WE COME TO THE BOSIMI
SOLUTION.
THERE'S THREE ELEMENTS OF IT.
ONE IS THE SENSOR BAND WHICH AS
I SAID IS A FOAM BAND WORN ON
THE WRIST.
IT'S VERY LIGHT, COMFORTABLE,
EASY TO USE.
IN FACT SOME OF THE FEEDBACK WE
GOT FROM THE HOME LABS GROUP LED
TO USABILITY IMPROVEMENTS OF
THAT BAND.
WE FIND YOU CAN PUT IT ON AND
JUST WEAR IT AND GO ABOUT LIVING
LIFE, AND NOT REALLY PAY ANY
ATTENTION TO IT.
THE APP IS WORKING IN THE
BACKGROUND ON THE USER'S MOBILE
DEVICE, WHICH EVERYBODY HAS A
MOBILE DEVICE, CELL PHONE OR
TABLET OR SOMETHING LIKE THAT.
AND THERE'S A LOT YOU CAN DO
THERE, BUT ONE OF THE THINGS WE
LEARNED FROM OUR KOLs, WE PUT
EFFORT IN, STILL WORKING ON,
TRYING TO GIVE MORE THAN JUST A
NUMBER, THAT PATIENT ENGAGEMENT
EMPOWERMENT BY EDUCATING AND
GIVING THEM ACCESS TO RESOURCES
AND HINTS FOR MANAGING BLOOD
PRESSURE WAS ONE OF THE THINGS
THAT WAS GOING TO MAKE THE
PATIENT'S HEALTH COME OUT BETTER
IN THE LONG RUN, AND WE HAVE
THIS REMOTE MONITORING LINK TO
THE CLOUD, WHICH IS INTENDED TO
WHEN THERE'S ALERTS OR THE
DOCTOR WANTS TO CHECK IN WITH
THE PATIENT, HAVING A TELEHEALTH
CALL, THEY CAN LOOK AND SEE
WHAT'S HAPPENING WITH THE
PATIENT OVER THE LAST COUPLE OF
WEEKS, AND GET -- WHY IS THERE
AN ALERT, WHAT'S BEEN HAPPENING
OVER THE LAST FEW HOURS, AND
THEY CAN RECOMMEND COURSES OF
ACTION ADJUSTMENTS TO MEDICATION
OR WE NEED TO SEE YOU, COME IN
RIGHT AWAY.
WHERE WE SEE OURSELVES FITTING
WITH OUR EMERGING TECHNOLOGIES
IS THAT IT'S VERY COMFORTABLE
AND IT'S VERY ACCURATE WHICH
PUTS US IN THE UPPER QUADRANT
WHERE WE WANT TO BE.
WE THINK WE'VE GOT A COMPELLING
SOLUTION THERE.
AND THEN HERE IS A LOOK AT OUR
PYRAMES TEAM, A SMALL GROUP OF
PEOPLE WORKING HARD TOWARDS THIS
OBJECTIVE.
THANK YOU VERY MUCH.
>> VERY COOL TECHNOLOGY.
CERTAINLY AN AREA THAT I HAVE
GREAT INTEREST IN TERMS OF
ADHERENCE AND DATA COLLECTION.
DO WE HAVE A QUESTION?
COME ON DOWN.
>> I DO.
CHRIS FROM MIRACLE CENTER,
MICHIGAN.
I WAS TALKING TO I GUESS ONE OF
OUR COMPETITORS YESTERDAY HERE.
DO YOU WORRY ABOUT THE
POSSIBILITY OF ACTUALLY, YOU
KNOW, UNINTENDED CONSEQUENCE,
YOU KNOW, WITH CONTINUOUS WEAR
PERHAPS SOMEBODY WITH HIGH BLOOD
PRESSURE WILL, YOU KNOW, GET
ANXIOUS AND SORT OF GO INTO MORE
ANXIETY AND MORE CONSTANTLY
CHECKING AND LOOKING AT THEIR
PHONE?
>> IT'S A VERY GOOD QUESTION.
ESPECIALLY A NEW MOTHER WHO HAS
A LOT GOING ON, YOU KNOW, ONE
HIGH BLOOD PRESSURE READING
COULD GET SOMEBODY EVEN MORE
ANXIOUS AND PUMP UP THE BLOOD
PRESSURE EVEN HIGHER.
ONE OF THE THINGS WE'RE TRYING
TO BUILD IN IS PROGRESSIVE
ALERTS, TO WHERE THE VERY FIRST
READING WE MAY OR MAY NOT EVEN
DISPLAY BUT INSTEAD OF TAKING --
WE GET SIX WEEKS OF LIGHT
ONCE AND HOUR, WE MEET CHECK IN
15 MINUTES TO SEE WHAT'S GOING
AND ESTABLISH A TREND BEFORE
ALERTING THE PATIENT THERE'S A
HIGH BLOOD PRESSURE READING.
ONE OF THE CHALLENGES THAT I WAS
HIGHLIGHTING IS JUST GETTING
FEMUR LOOK AT THE DEVICE AND
MAKE SURE IT'S ON AND THEY ARE
WEARING IT AND, YOU KNOW, THAT
YOU'RE GETTING READINGS IS A
CHALLENGE WE'RE TRYING TO
OVERCOME.
AND WE THINK GETTING MORE DATA
IS MORE VALUABLE THAN
SUPPRESSING THAT DATA.
>> THANKS AGAIN TO WILL AND
SAMEER, BOTH OF OUR AFTERNOON
PRESENTERS.
ALSO THANKS AGAIN TO OUR EARLIER
ROUND PRESENTERS.
WE'RE GOING TO MOVE TO THE NEXT
SESSION.
IF YOU ARE PRESENTING AT THE
NEXT SESSION, YOU SEE THESE
CHAIRS UP HERE THAT SAY
RESERVED?
THEY ARE RESERVED FOR YOU.
COME ON DOWN.
>> WELCOME TO SESSION 6, WHICH
IS USING DATA AND POLICY TO BEND
THE CURVE OF MATERNAL MORBIDITY
AND MORTALITY.
I'M CAMILLE FABIYI, JOINING ME
IS MEGAN MITCHELL.
>> ON A PROGRAM OFFICER AT
NICHD, MEGAN MITCHELL.
>> WE'LL HAVE OUR FIRST
PRESENTER COME ON UP.
AND INTRODUCE THEMSELVES AND GET
US STARTED.
THANK YOU.
>> THANK YOU.
GOOD AFTERNOON.
I'M DARA MENDEZ, ASSOCIATE
PROFESSOR OF EPIDEMIOLOGY AT
UNIVERSITY OF PITTSBURGH AND
CO-P.I. OF EMBRACE.
I'M GOING TO HONE IN ON THE
ASPECTS OF DATA AND POLICY,
PROVIDING AN OVERVIEW OF EMBRACE
AND THE WORK WE'RE DOING.
SO I'M THRILLED TO SHARE ABOUT
EMBRACE AND TALK ABOUT OUR DATA
TRANSPARENCY WORK.
AND AT THE VERY END IF I HAVE A
COUPLE MINUTES, I'M NOT OVER
TIME, I'LL SHARE ABOUT A
SEPARATE NINR-FUNDED STUDY UNDER
THE "IMPROVE" INITIATIVE THAT
HAS A DATA CHALLENGE, I WOULD
LIKE TO SHARE WITH THE AUDIENCE.
SO EMBRACE INCLUDES RESEARCHERS
ACROSS MULTIPLE DIVISIONS AT THE
UNIVERSITY OF PITTSBURGH AS WELL
AS MULTIPLE COMMUNITY PARTNERED
ORGANIZATIONS, WE'RE A WIDE
NETWORK.
THIS INCLUDES PITT SCHOOL OF
MEDICINE, PUBLIC HEALTH,
NURSING, EDUCATION, CENTER FOR
HEALTH EQUITY, CONVERGE CENTER,
UNIVERSITY OF PITTSBURGH MEDICAL
CENTER, MIDWIFE CENTER,
FEDERALLY QUALIFIED HEALTH
CENTER, HEALTHY START PITTSBURGH
IS OUR CORE COMMUNITY LEAD,
JOURNEY LIGHTER WHICH IS A
COMMUNITY-BASTED EDUCATION,
BLACK WOMEN'S POLICY CENTER, THE
COUNTY HEALTH DEPARTMENT AND I
COULD GO ON.
A WIDE NETWORK OF BRILLIANCE AND
WORK FOCUS ON HEALTH EQUITY AND
REPRODUCTIVE JUSTICE.
THIS IS OUR CENTER LEADERSHIP.
I'M HERE ON BEHALF OF A NUMBER
OF COLLEAGUES AND PARTNERS
INCLUDING DR. TALABI, DR.
SIMHAN, CLINICIANS AND LEADERS
IN OUR REGION RELATED TO
MATERNAL HEALTH AND JUSTICE,
ALSO COMMUNITY AND TRAINING AND
RESEARCH PROJECT CO-LEADS SO OUR
CENTER IS REALLY BASED ON
ACADEMIC LEADERSHIP AND
COMMUNITY LEADERSHIP, REALLY
CRITICAL AND IMPORTANT FOR OUR
WORK.
THAT INCLUDES NGOZI TIBBS, A
LONG-TERM HISTORY AND EXPERTISE
AROUND TRAINING AND COMMUNITY
PARTNERED WORK.
DR. KATHY HAGGERTY IS A LEAD IN
TRAINING AND DEVELOPMENT OF
ACADEMIC RESEARCHERS, AND THEN
MAIN RESEARCH PROJECT WHICH I'LL
TALK ABOUT FUNDED INCLUDES OUR
COMMUNITY HEALTH LEADER STATEY
BARTLETT AND CINDY SALTER.
AND COMMUNITY COMPONENT IS
LEADER FROM HEALTHY START
PITTSBURGH AND DR. OGHIFIOBIBI
IN PEDIATRICS AND DR. ASHLEY
HILL WHO WAS AT UNIVERSITY OF
PITTSBURGH BUT NOW AT UIC, WE
HAVE A BRILLIANT CONNECTION NOW
BETWEEN OUR TWO CENTERS.
SIMILAR TO OTHER CENTERS, OUR
REGION EXPERIENCES TREMENDOUS
RACIAL AND ECONOMIC INEQUITIES
IN MATERNAL HEALTH OUTCOMES IN
ALLEGHENY COUNTY, THE RESULT OF
A LONG HISTORY OF STRUCTURAL
RACISM AND OPPRESSION THAT HAS
REINFORCED TRADITIONAL POWER
DYNAMICS AND INEQUALITIES.
ANDS LISTENING TO THE
PRESENTATION EARLIER FROM
MISSISSIPPI, LIKE PITTSBURGH IS
SOMETIMES CONSIDERED THE
MISSISSIPPI OF THE NORTH.
IT'S BEEN CLAIMED THE MOST
LIVABLE CITY BUT THE QUESTION IS
FOR WHOM, RIGHT?
SO BEING AN APARTHEID CITY THAT
HAS REINFORCED INEQUITIES WE SEE
IN HEALTH AS WELL.
BUT EMBRACE BUILDS UPON A LONG
HISTORY OF COMMUNITY PARTNERS
THROUGH OUR INFANT MORTALITY
STRATEGIC PLAN COMMITTEE WHICH
IS NOW KNOWN AS THE BEST
ALLEGHENY INITIATIVE WHICH HAS
FUNNED BY CITY MATCH OVER THE
PAST DECADE, AND IS BEST BABY
ZONE DESIGNATION.
THEN ALSO KEY WORK THROUGH OUR
MATERNAL AND CHILD HEALTH
STRATEGY TEAM.
AND THIS LED TO THE DEVELOPMENT
OF THE BIRTH PLAN, OUR BLUEPRINT
FOR THE CENTER.
THE BIRTH PLAN INCLUDES THESE
FOUR KEY ACTION AREAS WE'VE USED
AS A FRAMEWORK AS WELL FOR OUR
WORK FOR THE CENTER.
THE SITUATION IS TO ADVANCE
MATERNAL REPRODUCTIVE HEALTH
EQUITY AND JUSTICE FOR
MULTI-DISCIPLINARY RESEARCH,
TRAINING, PRACTICE AND POLICY
EFFORTS FOCUSED ON BLACK
BIRTHING PEOPLE IN ALLEGHENY
COUNTY AND SURROUNDING REGION.
OUR WORK IS FOUNDATIONAL AROUND
APPLICATIONS OF REPRODUCTIVE
JUSTICE, PUBLIC HEALTH CRITICAL
RACE PRACTICE WHICH IS CENTERING
ON THE MARGIN, CENTERING THE
COMMUNITY DISPROPORTIONATELY
EXCLUDED, OVER TIME AND
THROUGHOUT HISTORY.
EMBRACE TAKES A MULTI-LEVEL
APPROACH SO THAT INCLUDES OUR
COMMUNITY AND BEHAVIORAL
HEALTH-RELATED INTERVENTION,
HEALTH CARE SYSTEMS
INTERVENTION, AND STRUCTURAL
POLICY.
AND WE WERE SPECIFICALLY FUNDED
UNDER THE CENTER OF EXCELLENCE
MODEL, FOR OUR HEALTHCARE
SYSTEMS INTERVENTION, SO THE
OTHER TWO INTERVENTIONS WERE NOT
SPECIFICALLY FUNDED UNDER CENTER
OF EXCELLENCE BUT WE'RE MOVING
FORWARD WITH A NUMBER OF
PROJECTS RELATED TO THAT WORK.
HERE ARE FOUR AIMS FOR THE
CENTER, TO ADVANCE
INTERDISCIPLINARY RESEARCH
GUIDED BY REPRODUCTIVE JUSTICE
TO HELP US IDENTIFY AND
AMELIORATE CAUSES AND
CONSEQUENCES OF ADVERSE MATERNAL
REPRODUCTIVE HEALTH AND
WELL-BEING FOR BLACK PEOPLE.
TWO, DEVELOP, IMPLEMENT, AND
EVALUATE MULTI LEVEL TRAINING,
IMPLEMENT TRAINING AND EDUCATION
FOR EMBRACE PARTNERS, AND
PROMOTE BIDIRECTIONAL
COLLABORATIONS WITH ONGOING
COMMUNITY-LED BLACK-LED AND
EQUITY-CENTERED EFFORTS, THE
PREMISE IS NOTHING ABOUT US
WITHOUT US, A PHRASE WE TALK
ABOUT, OUR COMMUNITY PARTNERS AS
WELL.
WE HAVE THREE PROJECTS IN
ADDITION TO COMMUNITY COMPONENT
AND TRAINING COMPONENT FOR OUR
CENTER, I'M GOING TO HONE IN ON
THE COMMUNITY, TRAINING, AND
SPECIFICALLY INTERVENTION FUNDED
BY EMBRACE, GOING THROUGH THEM
QUICKLY AND TALK ABOUT THE DATA
TRANSPARENCY WORK THAT LED TO
SOME CURRENT WORK.
SO THE COMMUNITY COMPONENT IN
OUR COLLABORATOR WILL BE
INTEGRATING ALL ASPECT OF THE
RESEARCH LIFE CYCLE AND
TRAINING, AND ALSO JUST GENERAL
COMMUNICATION AND ENGAGEMENT
AROUND DISSEMINATION OF RESEARCH
AS WELL AS OUR DATA JUSTICE
WHICH I'LL TALK ABOUT.
THE TRAINING COMPONENT WILL
PROVIDE COMMUNITY PARTNER
RESEARCH, PRACTICE,
INTERVENTION, THIS IS ALSO
BIDIRECTIONAL SUPPORT AND
EDUCATION FOR THOSE WHO ARE IN
THE ACADEMIC SPACE AND THOSE
OUTSIDE OF THE ACADEMIC SPACE,
REALLY LED BY OUR COMMUNITY
PARTNERS AS WELL, AROUND
PROVIDING TRAINING AND CAPACITY
BUILDING AROUND REPRODUCTIVE
JUSTICE AND ANTI-RACIST
PRACTICE.
AND THEN FINALLY OUR KEY
RESEARCH PROJECT THAT WAS FUNDED
IS WITHIN THE IMPLICIT NETWORK,
FOR 15 YEARS EIGHT PITTSBURGH
SITES IMPLEMENTED INTERCONCEPTAL
CARE AND TRIMESTER CARE THROUGH
THE NETWORK INCLUDING 38 SITES
AND RESIDENCIES THROUGHOUT THE
REGION.
AND THIS NETWORK HAS PROVIDED
CARE AS A PART OF WELL CHILD
VISITS, WITH THE FOURTH
TRIMESTER INTERCONCEPTIONAL
MODEL THE FOCUS HAS BEEN ON
INFANT OUTCOMES AND THE WELL
CHILD VISIT TO ENGAGE WITH THE
POSTPARTUM PERSON TO EXPAND AND
INTEGRATE REPRODUCTIVE JUSTICE
WITHIN THE FOURTH TRIMESTER.
FOUR AIMS, ONE IS PILOT AIMS AS
WELL, WHICH IS UNDER AIM 3, TO
ALSO PILOT A CASH TRANSFER
INTERVENTION.
SO IN ADDITION TO THE TWO
COMPONENTS IN OUR RESEARCH STUDY
WE HAVE A DATA WORKING GROUP OR
DATA JUSTICE WORKING GROUP AS
WELL AS COMMUNICATIONS AND
DISSEMINATION WORKING GROUP.
I'LL SPEND TIME TALKING ABOUT
OUR DATA JUSTICE WORK, AND WHAT
HAS LED TO WHAT WE'RE DOING NOW
AND MENTION AS WELL WITH OUR
COMMUNICATIONS AND DISSEMINATION
WORKING GROUP WE HAVE A NUMBER
OF ARTISTS, ARTIST IN RESIDENCE,
AND THOSE IN THE SPACE OF
DISSEMINATION OF COMMUNICATION
ABOUT WORK BEYOND SORT OF
TYPICAL TRADITIONAL RESEARCH
METHODOLOGIES.
OUR DATA MEASUREMENT ANALYTICS
WORKING GROUP WORKING WITH OUR
PROJECT LEADS AND COMMUNITY
COMPONENT AS WELL AS TRAINING
COMPONENT, OUR COMMUNITY
COMPONENT ALSO INCLUDES
COMMUNITY HEALTH ADVOCATES WHO
WILL BE INVOLVED IN DATA JUSTICE
AND TRANSPARENCY.
SOME OF THE LEAD FOLKS INVOLVED
IN THAT WORK INCLUDE BOB, ASHLEY
HILL, WHO IS BETWEEN BOTH OF OUR
CENTERS HERE AT PITT, ALSO AT
UIC, AND THEN THE WESTERN
PENNSYLVANIA DATA CENTER, TO
PROVIDE DATA JUSTICE AND
LITERACY TRAINING TO ALL OF OUR
PARTNERS, AND THEN PERFORM DATA
MONITORING AND PUBLIC ACCESS TO
DATA AND TRAINING.
AND SOME OF THE WORK THAT LED US
TO THAT IS OUR DATA TRANSPARENCY
PROJECT.
THIS WAS FUNDED BY FIRST STEPS
AND BEYOND AN INITIATIVE OF
ALLEGHENY HEALTH NETWORK AND THE
MAIN OBJECTIVE WAS TO CREATE A
STRUCTURE TO HOST DATA AS A
NEUTRAL BROKER FOR A NUMBER OF
WHAT WE CONSIDER HEALTH METRICS
AND ALSO SOCIAL DETERMINANTS OF
HEALTH METRICS.
ONE MAIN OUTCOME WAS A DATA
ASSET MAP WHICH I'LL SHOW YOU.
ONE OF THE KEY LEARNINGS FROM
THAT PROCESS WAS THAT WE CAN
BUILD A DATA WAREHOUSE, BUT THE
ASUM
ASSUMPTION IF WE BUILD IT FOLKS
WILL COME AT A COMMUNITY LEVEL
IS NOT THE NEEDS OF THE
COMMUNITY AND WAYS THEY MIGHT
USE THAT DATA.
AND SO WITH THIS DATA ASSET MAP
WHICH IS VERY MUCH IN ALIGNMENT
WITH THE WORK THAT IS HAPPENING
WITH OUR DATA HUB FOR THE
CENTERS, IS REALLY TO DESCRIBE
THE MCH LANDSCAPE AMONG NINE
DOMAINS IN THE REGION.
THIS IS A FEW EXAMPLES, THAT
INCLUDES PREGNANCY-RELATED
HYPERTENSION, PRE-CONCEPTIONAL
HEALTH DOMAIN, ET CETERA.
AND
AND SO, AS A RESULT WE LEARNED
HAVING DATA AVAILABLE GOES
BEYOND CREATING A WAREHOUSE AND
TOOL THAT SOMETIMES LIVES ONLINE
MAY NOT BE ACCESSIBLE.
AS A PART OF THAT WORK THROUGH
THE FIRST STEPS AND BEYOND
INITIATIVE AND OUR
COLLABORATION, THE WESTERN
PENNSYLVANIA REGIONAL DATA
CENTER THROUGH UNIVERSITY OF
PITTSBURGH DEVELOPED A LITERACY
WORKSHOP PARTLY TO SHIFT FOLK
FROM US CREATING A DATA
WAREHOUSE TO THE EXPECTATION
THAT WE ARE CREATING A SPACE FOR
COMMUNITY PARTNERS TO LEARN
ABOUT WHAT DATA IS AVAILABLE BUT
WHAT DATA -- HOW DATA CAN WORK
FOR THEM.
WHAT ARE THE DATA POINTS THAT
EXIST AND WHAT ARE THE ONES THAT
DO NOT EXIST THAT WOULD BE
USEFUL FOR THEIR WORK ON THE
COMMUNITY LEVEL.
SO JUST SOME OF THE NEXT STEPS
SPECIFICALLY WITH OUR DATA
WORKING GROUP THIS IS NOT
OVERALL FOR EMBRACE, I'M OPEN TO
ANSWERING ANY QUESTIONS RELATED
TO THAT, ELEVATE OUR DATA
JUSTICE LITERACY WORKSHOP AND
OUR TRAININGS WHICH ONCE AGAIN
IS A CORE ELEMENT OF OUR
COMMUNITY COMPONENT WORK FOR THE
CENTER.
AND OUR TRAINING COMPONENT
COLLABORATE ONCE AGAIN OUR DATA
WORKING GROUP WILL BE WORKING
ACROSS THE CENTERS SO
COLLABORATING WITH
INTERCONCEPTIONAL CARE FOR
EMBRACER PROJECT AND ENGAGE WITH
DATA INNOVATION HUB.
HOW MUCH TIME DO I HAVE?
OKAY.
I'M GOING TO TAKE TWO MINUTES TO
JUST SHARE SOMETHING BRIEF.
WHICH IS SEPARATE FROM OUR WORK
FROM EMBRACE BUT IN CONCERT AND
ALIGNMENT.
I MENTIONED THE FOURTH
STRUCTURAL POLICY RELATED
INTERVENTION THAT WAS NOT
FUNDED, THE WORK IS SYNERGY
ISTIC,
THE STREAMR STUDY TO INVESTIGATE
THREE CORE MEDICAID POLICIES
RELATED TO ADDRESSING MATERNAL
HEALTH IN THE STATE OF
PENNSYLVANIA.
TWO OF THOSE POLICIES IN
PARTICULAR FOCUS ON BLACK
POPULATIONS.
SO OUR STATE IS ONE OF I THINK
THE ONLY STATE IN WHICH THEIR
HEALTHCARE QUALITY METRICS AND
SPECIFICALLY FINANCING IS TIED
TO IMPROVEMENT OF OUTCOMES FOR
BLACK INDIVIDUALS SO NOT JUST
ACROSS EVERY POPULATION BUT
SPECIFICALLY FOR BLACK
INDIVIDUALS WHO OUR STUDY IS
FOCUSED ON EVALUATING AND WHAT
DOES IMPLEMENTATION OF THAT
ACTUALLY REALLY LOOK LIKE, SO I
CAN ANSWER QUESTIONS ABOUT THAT.
THIS IS OUR PROTOCOL FOR ANYONE
WHO WANTS TO READ A LITTLE BIT
MORE ABOUT OUR PROTOCOL.
IT PROVIDES A LITTLE MORE
DETAILS IN THAT WE ARE -- WE
ENGAGED IN QUALITATIVE WORK WITH
ADMINISTRATORS OF BE OBSTETRICD
PEDIATRIC PROVIDERS, AND DOULAS.
THIS GIVES RESULTS FROM OUR
CONVERSATIONS WITH MCOs WHICH
IS VERY INTERESTING.
THE REASON I WANTED TO BRING
THIS TO YOU TODAY IS BECAUSE
THERE IS CURRENTLY ON THE TABLE
CMS IS CONSIDERING THE WAYS IN
WHICH WE ACCESS THIS DATA, SO
FOR THOSE WHO MAY NOT BE
FAMILIAR, YOU CAN HAVE SORT OF
PHYSICAL ACCESS OF MEDICAID
CLAIMS, MEDICARE CLAIMS DATA.
WHAT IS BEING PROPOSED NOW IS TO
USE WHAT WOULD BE CONSIDERED AN
ONLINE FORMAT AS THE NUMBER OF
IMPLICATIONS FOR ACCESS, FOR
COST, AND SO OUR TEAM HAS SENT A
RESPONSE TO CMS REQUEST FOR
INFORMATION.
MY UNDERSTANDING THAT POLICY
CHANGE HAS BEEN PUT ON HOLD BUT
I THINK AT THE BOTTOM, THE END
OF THE DAY, IT HAS IMPLICATIONS
FROM PEOPLE USING THIS DATA TO
UNDERSTAND MATERNAL MORTALITY OR
MORBIDITY, MORBIDITY
SPECIFICALLY ACROSS THE U.S.
I WILL STOP THERE.
THANK YOU, AND TAKE ANY
QUESTIONS.
>> I'D LIKE TO INVITE ANYONE IN
PERSON TO COME TO THE MIC AND
VIRTUAL ATTENDEES PLEASE USE THE
Q&A BOX TO SUBMIT QUESTIONS
ONLINE.
ARE THERE ANY QUESTIONS?
>> MIRACLE CENTER MICHIGAN.
HAVE YOU GIVEN THOUGHT OR
PERHAPS THE STREAMR PROJECT TO
USING MEDICAID, YOU KNOW, BIRTH
RECORDS, DEATH RECORDS, CLAIMS,
THESE ARE DATA COLLECTED BY THE
STATE, LINKABLE IN THEORY, I'M
WONDERING IF YOU CONSIDER THAT
AS A SOURCE OF DATA, CMS IS
PRICY.
>> THE STREAMR STUDY WE ARE, SO
THAT'S THE R01-FUNDED STUDY I
MENTIONED.
ANOTHER PCORI-FUNDED STUDY IS
ACROSS EIGHT STATES THROUGH THE
MODERN INITIATIVE.
YES, WE ARE.
LOCALLY WE'VE NOT LINKED THOSE
DATASETS.
RIGHT NOW WE'RE LOOKING AT
LINKAGE BETWEEN VITAL STATISTICS
AND MEDICAID DATA.
WE HAVE A RELATIONSHIP WITH THE
STATE OF PENNSYLVANIA TO BE ABLE
TO DO THAT.
AND THEN THE CENSUS DATA WHICH
IS VERY EXPENSIVE SO FOR
COMMUNITY MEMBER OR RESEARCHER
TO PAY NEXT TO $30,000 A YEAR
FOR VIRTUAL ACCESS IS VERY
LIMITED.
>> CAN YOU EXPLAIN WHAT YOU MEAN
BY DATA JUSTICE AND WHAT IN A
LOOKS LIKE IN PRACTICE?
>> YEAH, ABSOLUTELY.
SO, WE ARE WORKING WITH A NUMBER
OF COMMUNITY PARTNERS THROUGH
THE HEALTHY START SO THAT
INCLUDES OUR COMMUNITY HEALTH
ADVOCATES, WESTERN PENNSYLVANIA
REGIONAL DATA CENTER, AND THEN A
NUMBER OF OUR I WOULD SAY
PARTNERS BOTH IN THE ACADEMIC
AND NON-ACADEMIC SETTING TO
REALLY IMPLEMENT PRINCIPLES
AROUND WHAT ARE THE WAYS IN
WHICH WE ARTICULATE WHAT IS
DATA, LIKE WHAT IS VALUED AT
DATA, WHAT ARE THE WAYS IN WHICH
BOTH FROM QUANTITATIVE AND
QUALITATIVE PERSPECTIVES THE
WAYS IN WHICH WE MIGHT ACCESS
THAT INFORMATION AND THAT DATA
AND HOW IT'S DISSEMINATED.
A KEY ELEMENT WITH THE JUSTICE
WORKING GROUP, DIDN'T MENTION
THIS CONTEXT, BUT SOME OF THAT
WORK ACTUALLY STARTED DURING THE
PANDEMIC THROUGH THE BLACK
EQUITY COALITION, WHICH HAS BEEN
A COALITION OF PARTNERS WHO CAME
TOGETHER AROUND THE FACT THAT
THEY COULD NOT GET ACCESS TO
DATA, COULD NOT UNDERSTAND WHAT
WAS HAPPENING DURING THE
PANDEMIC AND SO THAT WORK REALLY
SORT OF DEVELOPED WITHIN THAT
SPACE, AND HAS MADE CONNECTIONS
TO OUR BROADER WORK WITHIN
EMBRACE AND MATERNAL HEALTH
SPACE LOCALLY FOR US.
>> NEXT PRESENTER, UNIVERSITY OF
OKLAHOMA PLEASE JOIN US AND
INTRODUCE YOURSELF.
>> LEREMY COLF WITH UNIVERSITY
OF OKLAHOMA, MORE SPECIFICALLY
WITH AN ADMINISTRATIVE
SUPPLEMENT GRANT TO THAT, TO
CREATE DATA CAPACITY AND DATA
RESOURCES FOR MATERNAL HEALTH
RESERVERS FOR CIRCLE AND FOR THE
REST OF YOU AS WELL.
AND SO I'M GOING TO BE TALKING
ABOUT THAT AND WHAT WE'RE
CREATING.
SINCE THIS IS USING DATA AND
POLICY TO BEND THE MATERNAL
HEALTH CURVE I THOUGHT I WOULD
TAKE ADVANTAGE OF MY PREVIOUS
BACKGROUND, AND BEING NEW TO
ACADEMIA, BEFORE THAT I DID
HEALTH POLICY AND DATA POLICY,
AT HOMELAND SECURITY AT HEALTH
AND HUMAN SERVICES AND THE WHITE
HOUSE, SO I THOUGHT I DON'T HAVE
ANY CLASSES TO LECTURE IN THIS
WEEK SO I GET TO LECTURE TO YOU
ABOUT DATA POLICY AND HEALTH
POLICY WITH THE IDEA THAT WE
HAVE SO MANY GREAT PRESENTATIONS
YESTERDAY ABOUT WHEREE WE'RE
GOING AND WHAT DO WE DO NEXT.
WHEN WE FIND OUT INFORMATION
ABOUT VULNERABLE COMMUNITIES AND
INDIVIDUALS AND HEALTH
INEQUITIES, HOW DO WE USE THAT
TO HELP MATERNAL POPULATIONS TO
HAVE BETTER OUTCOMES AND SO
UNFORTUNATELY THE BEST ANSWERS
FOR THAT ARE DATA AND POLICY
WHICH NOBODY REALLY LIKES TO
HEAR, BUT HOPEFULLY IF WE CAN
TALK ABOUT THEM WE CAN HAVE A
BETTER OPPORTUNITY TO IMPLEMENT
ALL OF THE GREAT WORK THAT YOU
ALL ARE DOING.
SO, YOU KNOW THIS WAY BETTER
THAN I DO, BUT MATERNAL
MORTALITY IS A REALLY BIG DEAL
AND A REALLY BIG ISSUE.
IT'S GETTING BETTER IN MOST OF
THE WORLD.
BETWEEN 2000 AND 2020 DECREASED
34% ACROSS THE WORLD.
YOU CAN SEE THAT IN PLACES LIKE
THE U.K., AND SWEDEN, THAT HAVE
BOTH GONE DOWN DURING THAT TIME
PERIOD.
IN CONTRAST TO THAT, THE UNITED
STATES STARTED OUT WORSE AND HAS
GOTTEN DRAMATICALLY WORSE.
WHAT IS IT THAT WE'RE DOING
WRONG?
WHY ARE WE GETTING WORSE THAN
OTHER PLACES ARE GETTING BETTER.
THE NETHERLANDS STARTED OUT
WORSE THAN UNITED STATES AND GOT
MUCH, MUCH BETTER, WHAT ARE THEY
DOING RIGHT THAT WE'RE NOT
DOING?
THE ANSWERS ARE DATA AND POLICY.
SO, THEY CREATED -- THEY WERE
TROUBLED BY THEIR POOR MATERNAL
MORTALITY IN THIS 2000
MEASUREMENT AND DECIDED THEY
WERE GOING TO DO SOMETHING ABOUT
IT.
THEY CREATED THIS NATIONAL
PERINATAL REGISTRY, COLLECT
UNIFORM DATA EACH YEAR ON
LOCATIONS AND OUTCOMES, THEY
USED THAT DATA TO CONDUCT
RESEARCH, ESTABLISHED NATIONAL
STEERING COMMITTEE, STAKEHOLDER
ADVISORY GROUPS DOING LISTENING
SESSIONS, TALKING TO DOCTORS,
INVESTIGATING CASES, AND THEN
THEY USED THAT RESEARCH TO
DEVELOP EVIDENCE-BASED
INTERVENTIONS AND POLICY
SOLUTIONS.
THEY WERE IDENTIFYING GEOGRAPHIC
BARRIERS TO CARE AND ELIMINATING
THEM.
THEY WERE AUDITING PRE-TERM
DEATH, INSTITUTED PRENATAL
SCREENING, ESTABLISHED A
COMMISSION ON PRENATAL CARE.
THIS IS BASED OFF THE 2000
REPORT, 2001 WAS THE FIRST YEAR
THEY STARTED COLLECTING UNIFORM
DATA EVERY YEAR.
FIRST REPORTS AND RESULTS CAME
OUT IN 2007 WITH THE FOLLOW-UP
IN 2013.
SO WITH THOSE NUMBERS SPOUTED AT
YOU, LOOK AT WHAT HAPPENED.
THEY WENT FROM ONE OF THE WORST
AMONG DEVELOPING NATIONS IN
2000, STARTED COLLECTING THIS
DATA, USED IT FOR POLICY
SOLUTIONS IN 2007 AND 2013,
EVERY YEAR THEY KEEP GETTING
BETTER.
HOW CAN WE USE WHAT WE'VE
LEARNED AND VOLUME POLICY
SOLUTIONS THAT WORK IN THE
UNITED STATES?
WHY DOESN'T IT ALREADY EXIST
HERE?
WHY DON'T WE HAVE A CLEAR
DATASET WE CAN USE FOR THE EXACT
SAME THINGS THEY ARE DOING?
IT'S COMPLICATED.
PART IS THE MULTI-PAYER SYSTEM
IN THE UNITED STATES, RESULTS IN
VERY FRAGMENTED DATA.
I WAS PART OF CONVERTING OUR
HOSPITAL AND HEALTHCARE SYSTEM
FROM AN OLD ELECTRONIC HEALTH
RECORD TO EPIC, EVEN WITHIN OUR
HOSPITAL WE HAD 13 DIFFERENT
ELECTRONIC HEALTH RECORDS, ALL
ON DIFFERENT THINGS.
IF YOU WENT FROM AMBULATORY TO
INPATIENT OR AMBULATORY TO
AMBULATORY COULDN'T TRANSFER
YOUR RECORDS, JUST WITH OUR
DOCTORS IN OUR HOSPITAL.
TALK ABOUT TRANSFERRING TO A
NATIONWIDE DATASET, TRYING TO
GET UNIFORM INFORMATION IT JUST
DOESN'T HAPPEN.
THERE'S LACK OF
INTEROPERABILITY, WE CAN'T GET
THEM OVER, FHIR AND HL7 HELPED
BUT WE JUST AREN'T THERE YET.
EVEN IF WE WERE, THERE IS A LACK
OF DATA ON U3 POPULATIONS, THE
GROUPS YOU CARE ABOUT HAVE LESS
DATA THAN EVERYBODY ELSE.
AND SO HOW DO WE HAVE EQUITABLE
DATA TO GET TO EQUITY
AND
SOLUTIONS.
IT'S ESTIMATED TO BE WORTH $300
TO $450 BILLION A YEAR SO WHY
WOULD ANYBODY SHARE DATA WHEN
THEY CAN MAKE SO MUCH MONEY OFF
IT OTHERWISE?
THERE'S VERY LITTLE MONEY FOR
DATASET CURATION AND CREATION OF
NEW DATASETS.
IT'S STARTING TO CHANGE.
THAT'S WHY I WAS EXCITED WHEN
THEY HAD ADMINISTRATIVE
SUPPLEMENT DATA OPTION.
NORMALLY WE AS RESEARCHERS ARE
JUDGED, WE GET PROMOTION,
TENURE, BUILDING A DATASET HELPS
EVERYBODY BUT YOU UNLESS YOU
KEEP IT FOR YOURSELF.
THIEVES ARE NOT WAYS WE CAN
ADVANCE WHAT'S HAPPENING IN THE
COUNTRY, ONLY WHEN WE HAVE AND
SHARE UNIFORM DATASETS SO
EVERYONE CAN DO RESEARCH THAT
WE'RE MAKING ADVANCES.
SO THESE ARE THE DISINCENTIVES
FOR RESEARCHERS AND DATA OWNERS
TO SHARE WHAT THEY ALREADY HAVE.
SO, THE PURPOSE OF THIS SESSION
TO USE DATA AND POLICY TO BEND
THIS CURVE, WE'LL TALK ABOUT THE
DATASET THAT WE'RE CREATING BUT
ALSO WHAT DOES THAT MEAN WITH
POLICY?
HOPEFULLY I'VE CONVINCE YOU HAD
BUILDING A DATASET IS A GOOD
IDEA.
WHERE DOES IT GET USED AND DO WE
HAVE INFRASTRUCTURE AND FORMAT
TO USE IT.
THERE ARE GREAT THINGS ONGOING
ALSO HAVING STRUGGLES IN THE
POLICY WORLD.
THE BIGGEST OPPORTUNITY FOR THIS
AND BIGGEST CHANGE RECENTLY IS
FEDERAL LAW, EVIDENCE ACT OF
2018, ALSO KNOWN AS THE
FOUNDATIONS FOR EVIDENCE-BASED
POLICY MAKING ACT OF 2018,
PASSED IN 2019 BUT THAT'S WHEN
IT WAS PROPOSED AND ORIGINATED.
IT'S THIS COOL LAW THAT IS
INTENDED TO INCREASE DATA
AVAILABILITY AND DATA USE SO
THAT WE WILL USE IT TO IMPROVE
OUR POLICIES AND LEGISLATIONS.
IT WILL -- IT'S INTENDED TO
BUILD THE DATA, REQUIRE EVIDENCE
BUILDING PLANS AND STRATEGIC
PLANS, IDENTIFY POLICY RELEVANT
SOLUTION, WHAT DATA ARE NEEDED
TO DO THAT, WHAT THE RESEARCH
QUESTIONS ARE, WHO CAN DO THAT
RESEARCH, AND HOW THAT RESEARCH
WILL THEN LEAD INTO POLICY.
THERE'S REGULAR REPORTING.
THERE'S EVALUATIONS.
THERE'S PROGRESS.
THERE'S METADATA, BUT ONE OF THE
COOL PARTS OF IT IN ADDITION TO,
HEY, LET'S USE THIS EVIDENCE TO
IMPROVE OUR POLICIES AND IMPROVE
OUR LEGISLATION, IT ALSO HAS THE
OPEN GOVERNMENT DATA ACT AS PAT
OF THE IT, FEDERAL DEPARTMENTS
AND AGENCIES WITH STATISTICAL
DATA HAVE TO MAKE THAT DATA
PUBLICLY AVAILABLE IN MACHINE
READABLE FORMAT, COMMON DATA
ELEMENT, ALL THE THINGS WE WANT
TO DO THE RESEARCH WE HAVE.
IT'S AMAZING, BUT THERE'S NO
MONEY TO DO IT.
THE DIFFERENCE BETWEEN
CONGRESSIONAL AUTHORIZATION,
CREATING A LAW TO DO IT, AND
SAYING THOU SHALT DO THIS AND
THEN ASSIGNING MONEY TO IT ARE
TWO VERY DIFFERENT THINGS.
SO, ALL OF THIS IS AN INCREDIBLE
AMOUNT OF WORK.
IF YOU CURATED DATASETS YOU KNOW
HOW HARD IT IS TO CONTINUALLY
UPDATE TO COLLECT DATA, MAKE IT
MACHINE READABLE TO VALIDATE, TO
VERIFY, TO FACT CHECK, TO
RESPOND TO ALL OF THE QUESTIONS,
TO PUT IT IN FORMATS THAT OTHER
PEOPLE CAN USE.
TO FIX GLITCHES THAT GO WRONG.
THERE IS NO MONEY GIVEN TO ANY
PART OF THE FEDERAL GOVERNMENT
TO ACCOMPLISH THIS.
SO, NIH AND ALL OF THEIR DATA
HAVE TO EITHER TAKE AWAY MONEY
FROM GRANTS OR ADMINISTRATION,
AND/OR TAKE AWAY STAFF TO BE
DOING THIS INSTEAD OF WHAT THE
OTHER THINGS THEY ARE MANDATED
TO DO.
THAT'S TRUE ACROSS GOVERNMENT.
SO IT BECOMES VERY, VERY
CHALLENGING TO MAKE IT HAPPEN.
SO, WHERE DOES THIS GO?
THE ANSWER IS IT'S COMPLICATED
BUT THERE'S REALLY GOOD THINGS
HAPPENING AND OPPORTUNITIES FOR
US AS THE RESEARCH COMMUNITY.
WHEN I WAS GOING ABOUT CREATING
OUR DATASET TO HELP ALL OF YOU,
THERE ARE A LOT OF DATASETS AND
DIFFERENT WAYS TO CREATE THINGS.
ONE IS SURVEYS.
A LOT OF YOU TALKED ABOUT
SURVEYS AND VALUE OF GOING INTO
THE COMMUNITY AND UNDERSTANDING
NEEDS OF INDIVIDUALS, NEEDS OF
GROUPS.
IT'S PARTICIPATION BASED.
YOU GET PEOPLE TO BE PART OF IT,
INDIVIDUAL STORIES, THAT
IMPACTFUL WHY DOES THIS MATTER,
IMPACTS THIS PERSON, THIS GROUP.
THOSE ARE GREAT BUT ARE REALLY
HARD TO DESIGN.
THEY ARE LOW SAMPLE SIZES,
POTENTIAL BIAS WITH THE LOW
SAMPLE SIZE, MIGHT BE MISSING
PEOPLE, YOU DON'T KNOW IF THEY
AP MY TO EVERY -- APPLY TO EVEY
GROUP.
THERE ARE REGISTRATION, COHORT
TEMPORAL DATA EXTENDS OVER TIME
LIKE THE NETHERLANDS THAT YOU
CAN FOLLOW AND MAKE CHANGES AND
EVALUATE WHETHER OR NOT CHANGES
WERE IMPACTFUL.
BUT IT'S HARD TO RECRUIT PEOPLE
TO REGISTRIES.
AGAIN, THERE ARE LOW SAMPLE
SIZE, POTENTIAL BIAS.
LOOKING AT OLD CHARTS IS GREAT.
THERE'S LOTS OF HEALTH RECORDS
BUT IT CAN BE HARD TO
EXPERIMENTALLY CONTROL.
HOW DO YOU KNOW WHAT HAPPENED
AND WHAT CHANGED IN THAT TIME?
AND SO THE ONE WE DECIDED TO GO
WITH WAS POPULATION LEVEL.
THERE'S NO INDIVIDUAL
INFORMATION.
IT DOESN'T HAVE A LOT OF WHAT
ALL ARE MOST INTERESTED IN.
BUT IT HAS REALLY LARGE SAMPLE
SIZES AND REPRESENTS THE ENTIRE
COMMUNITY.
AND SO IT'S NOT OPPOSITE WHAT
YOU'RE DOING IN RESEARCH BUT
WHAT IT DOES IS ALLOW YOU TO
TAKE WHAT YOU'RE DOING AND
CONTEXTUALIZE IT.
DOES WHAT I'M FINDING HERE
REPRESENT MY UNIQUE POPULATION,
BUT NEEDS A DIFFERENT DATA AND
POLICY SOLUTION OR DOES IT
EXTEND TO A BROADER GROUP OR IS
IT REPRESENTATIVE OF THE U.S. AS
A WHOLE, HOW CAN YOU FIND
SOLUTIONS OTHER PLACES AND SEE
IF THEY ARE GOING TO APPLY TO
WHAT YOU'RE DOING HERE?
THIS IS THE ONLY WAY WE COULD
GET A NATIONWIDE DATASET FOR
COMPARISON AND TO LOOK AT
SPECIFIC POPULATIONS OF
INTEREST.
SO, OUR ADMINISTRATIVE
SUPPLEMENT IS ONE YEAR OF GREAT
AMOUNT OF MONEY BUT NOT ENOUGH
TO REALLY DO BIG MASSIVE THINGS
OVER A LARGE TIME SCALE.
AND SO WHAT WE'RE DOING IS
CREATING TAKING PUBLICLY
AVAILABLE DATA SOURCES,
AGGREGATING THEM ON A NATIONWIDE
LEVEL, WITH GEOGRAPHY, WITH
SOCIOECONOMICS, WITH
DEMOGRAPHICS, AND WITH HOSPITAL
UTILIZATION SPECIFICALLY TIED TO
PREGNANCY AT THE ZIP CODE LEVEL.
THAT WAY WE CAN LOOK AT ALL
SORTS OF FACTORS AND SEE WHICH
ONES ARE WEIGHING MOST.
WE KNOW THERE'S RACIAL-RELATED
DIFFERENTIAL OUTCOMES IN
PREGNANCY.
WE KNOW THERE'S DIFFERENCES
BETWEEN RURAL AND URBAN.
WHICH ONE IS THE DRIVING FACTOR
AND WHICH IS SECONDARY?
HOW CAN YOU LOOK AT THESE LARGE
POPULATIONS?
IS WHAT WE'RE EXPERIENCING IN
OKLAHOMA DIFFERENT THAN
MISSISSIPPI OR IN PITTSBURGH OR
ALL OF THE OTHER AREAS WHERE
THESE CENTERS ARE FOCUSED?
AND WHAT WE'RE GOING TO DO IN
THE SECOND PART OF THIS IS
DEVELOP EXAMPLE METHODS AND
CONVERT THESE DATASETS INTO
USEFUL FORMATS SO WHATEVER
FORMAT YOU'RE TRYING AND WANTING
TO USE IT IN, WHATEVER YOU'RE
MOST FAMILIAR WITH YOU CAN USE.
IN AN IDEAL WORLD WE WOULD USE
SEQUEL BUT EVERYBODY TRYING TO
LEARN SEQUEL TO APPLY IN NEW
WAYS IS NOT THE BEST WAY OF
MAKING DATA ACCESSIBLE TO
EVERYBODY.
AND SO THESE ARE SOME OF THE
DATASETS THAT WE'RE
INCORPORATING, WE'RE USING STATE
DATABASES, TO LOOK AT PREGNANCY
RELATED CCSR GROUPINGS AND PULL
THOSE OUT INDIVIDUALLY AND IN
AGGREGATE TO LOOK AT LOW AND
HIGH RISK HOSPITALIZATIONS
RELATED TO PREGNANCY AND CHILD
BIRTH.
WE'RE LOOKING AT FACTORS IN THE
SOCIAL VULNERABILITY INDEX TO
LOOK AT SOCIAL DETERMINANTS OF
HEALTH AND UNDERSTAND
INFORMATION ABOUT COMMUNITIES.
AND THEN WE'RE PULLING CENSUS
DATA TO LOOK AT AGE, SEX, RACE,
AND OTHER IDENTIFYING FACTORS SO
WE CAN LINK AND GROUP THESE TO
LOOK AT THEM INDIVIDUALLY AND
COLLECTIVELY, TO FIND OUT HOW
MUCH ALL OF THIS IS
REPRESENTATIVE.
WE'RE VERY PRELIMINARY IN ANY
SORT OF RESULTS AND ANALYSIS SO
I'LL GIVE QUICK THINGS JUST TO
SHOW HOW WE DO REPRESENTATIVE
COMPARISON.
BIRTH RATE ACROSS THE U.S. IS 11
DOWN AT THE BOTTOM.
WHEN YOU COMPARE WHAT'S
HAPPENING IN OKLAHOMA WE HAVE A
HIGHER BIRTH RATE, BIRTH RATE IS
HIGHER AMONG NON-WHITE
POPULATIONS.
WHEN WE LOOK AT RURAL AND URBAN,
BIRTH RATE IN URBAN AREAS IS
HIGHER THAN RURAL AREAS.
THIS MIGHT SEEM A LITTLE BIT ODD
UNTIL YOU LOOK AT THE POPULATION
MAP OF OKLAHOMA, 37% OF OUR
POPULATION LIVES IN TWO
COUNTIES, TWO MOST POPULOUS
COUNTIES, TWO OF THE MOST
RACIALLY DIVERSE IN THE STATE.
YOU CAN SEE HOW THIS IS A LINK
BETWEEN THE TWO, IT'S NOT --
ONLY WHEN YOU LOOK AT LARGE DATA
CAN YOU SEE THAT WASN'T
NECESSARILY LOGICAL LOOKING AT
SOME OTHER PLACES.
SO, WE'RE SEEING THAT TAKEN
TOGETHER THIS DATES BIRTHS ARE
MORE LIKELY IN URBAN AREAS, AND
AMONG NON-WHITES.
THAT DOESN'T REALLY MAP WITH
WHERE PEOPLE ARE GOING INTO THE
HOSPITALS FOR PREGNANCY-RELATED
CONDITIONS.
WE'RE SEEING THAT WHITE
EXPECTANT MOTHERS ARE SLIGHTLY
MORE LIKELY TO BE HOSPITALIZE
AND SLIGHTLY MORE LIKELY TO DIE
IN OKLAHOMA.
THAT IS NOT WHAT OTHER
RESEARCHERS HAVE SERIOUS
CONDITION, SO THIS IS AN AREA
WHERE THERE'S SOMETHING UNIQUE
HAPPENING IN OKLAHOMA.
URBAN EXPECTANT MOTHERS ARE MORE
LIKELY TO BE HOSPITALIZED BUT
RURAL MORE LIKELY TO DIE.
STATISTICS ON RURAL VERSUS
URBAN, STRONGER EFFECTS THERE.
GIVEN DEMOGRAPHICS AND BREAKDOWN
WE CAN LOOK AT MORE SPECIFIC
FACTORS BUT THESE ARE THE TYPES
OF THINGS THAT WE CAN LOOK AT.
THESE ARE PRELIMINARY RESULTS,
IT'S A NATIONWIDE DATASET WE CAN
LOOK AT IT EVERYWHERE.
SO, IN SUMMARY WHAT WE'RE TRYING
TO DO IS BUILD AND SHARE THESE
MATERNAL DATASETS.
THANKS TO THE ADMINISTRATIVE
SUPPLEMENT, I ACTUALLY AM
INCENTIVIZED TO SHARE MORE THAN
KEEP TO MYSELF AND MINE FOR
PUBLICATIONS FOR THE NEXT TEN
YEARS.
I WANT YOU TO DO IT BECAUSE I
WANT TO IMPROVE WHAT THIS IS
DOING IN THE FIELD, NO
TRADITIONAL A MATERNAL HEALTH
RESEARCH BUT IF I CAN HELP
SUPPORT YOU TO ADVANCE A CAUSE
WE ALL CARE ABOUT IT'S WHERE I'M
IN THIS FOR, TO SUPPORT
RESEARCH, MORE IMPORTANTLY TO
INFORM POLICY AND IMPROVE
OUTCOMES.
WE'RE BUILDING AND LINKING THE
DATASET ACROSS GEOGRAPHIES,
FACTORS TO UNDERSTAND
UTILIZATION AND FIND OUT WHERE
WE CAN HAVE IMPROVEMENTS,
IMPLEMENTATIONS, BE ABLE TO
EVALUATE OUTCOMES AS THE DATA
CHANGE OVER TIME.
I TALKED ABOUT PRELIMINARY
RESULTS, WHAT WE'RE SEEING.
BUT THE LEADING THING SO FAR IS
THAT THE MOST LIKELY COMMON
FACTOR AND RISK IS GEOGRAPHIC
BARRIERS TO CARE SO HOW CAN WE
OVERCOME THOSE, WITH THE NUMBER
OF RURAL HOSPITALS THAT ARE
CLOSING AND THE NUMBER OF RURAL
HOSPITALS THAT ARE ELIMINATING
THEIR MATERNAL SERVICES CARE
LINES, THIS IS ONLY GOING TO GET
WORSE.
SO IF WE HAVE BETTER DATA AND
EVIDENCE LIKE THEY DO IN FRANCE,
FOR EXAMPLE, AND IN NETHERLANDS
TO SAY THESE ARE HUGE ISSUES,
HOW CAN WE ADVOCATE FOR POLICY
AND LEGISLATURE CHANGES AND HOW
CAN WE GET HOSPITALS AND
HEALTHCARE SYSTEMS TO BETTER
ADDRESS THESE NEEDS, THEN WE'RE
ALL MOVING FORWARD.
SO A COUPLE POLICY
RECOMMENDATION, SMALL P NOT THE
BIG GOVERNMENT CHANGING IS THERE
ARE 36 STATES THAT REPORT
PREGNANCY-RELATED DATA TO -- ALL
STATES REPORT TO HCUP, 36 MAKE
IT PUBLICLY AVAILABLE, WE CAN
STAND ACROSS THE NATION.
HOSTING WORKSHOPS, STATE
DEPARTMENTS OF HEALTH CAN
DEVELOP COMMON DATA ELEMENTS SO
IT'S ALL PUBLICLY AVAILABLE IN
THE SAME FORMAT.
OKLAHOMA MAKES AN INCREDIBLE
AMOUNT OF DETAILED DATA
AVAILABLE ONLINE.
BUT IT'S DIFFERENT DATA THAN
EVERYWHERE ELSE.
WE COULD WORK ON DOING THAT
BETTER.
WE CAN INCENTIVIZE DATA SHARING
AND DATASETS IN AND OF
THEMSELVES.
SO THOSE ARE THE POLICY
RECOMMENDATIONS OF HOW WE CAN
HELP ENABLE DATA AND HELP THE
OUTCOMES.
I HOPE I DIDN'T BORE YOU TOO
MUCH BUT THERE'S MY DATA AND
POLICY LECTURE FOR THE WEEK.
>> FASCINATING.
ARE THERE ANY QUESTIONS IN THE
AUDIENCE?
>> HI.
I THINK IT'S BRINGING UP GREAT
INFORMATION.
IT'S A HUGE DIFFERENCE, WE CAN'T
GET WITH THE TYPE OF SYSTEM WE
HAVE.
MY QUESTION, WHERE DO YOU DRAW
THE DATA, ICD-10, WHERE ARE YOU
BUILDING UP, BECAUSE DATA SITES
WILL BE THE MAIN THING.
IF WE HAVE TO RELY ON DATA SAT
WE NEED TO BE SURE THE
INFORMATION COMING IN CORRECT,
OTHERWISE THEY ARE GOING TO
START TO MAKE INFERENCE, THEN
MIGHT NOT BE PROPER BUT I THINK
THE DIRECTION IS GREAT AND
HOPEFULLY WE CAN GET MORE OUT
THERE AND BUILDING DATASET I
THINK IS IMPORTANT, VERY
IMPORTANT.
>> THANKS.
THESE SPECIFICALLY BASICALLY I
FIND WHATEVER DATA ARE PUBLICLY
AVAILABLE AND USE THOSE, THEY
ARE NOT PERFECT AND I APOLOGIZE
TO ANYBODY FROM AHRQ IF I MESS
UP BY EXPLANATION BUT THE AGENCY
FOR HEALTH CARE RESEARCH AND
QUALITY, PART OF HHS, GOT A
MANDATE FROM CONGRESS TO LOOK
INTO WHY THE SAME HEALTH CARE
PROCEDURES COSTS DIFFERENT
AMOUNTS IN DIFFERENT PLACES,
MANDATORY REPORTING FOR ALL CMS
HOSPITALS TO REPORT THESE DATA
AND THEY DO ALL SORTS OF AMAZING
THINGS WITH THEM AND MAKE THE
DATA PUBLICLY AVAILABLE SO IT'S
BASED ON THEIR GROUPINGS OF
ICD-10 CATEGORIES, CCSR-PLUS
AVAILABLE SINCE 2016, SO ICD-10
DIFFERENT THAN ICD-9 PREVIOUSLY,
BASED ON DISCHARGE DATA AND
ICD-10 PRIMARY AND SECONDARY
CODES.
>> MY QUESTION BUILDING ON THAT.
THANK YOU FOR YOUR TALK.
IT'S GOING TO BE POWERFUL TO
CONNECT DATASETS, THERE'S A LOT
OF INFORMATION WE CAN GET OUT OF
THEM.
RELATED TO THE QUESTION JUST
ASKED, DO YOU ANTICIPATE IN
PLACES WITH HOME BIRTHS OR
THINGS LIKE THAT?
>> YEAH, THERE'S A DECENT AMOUNT
OF MISSING DATA, WE'RE TRYING TO
FIND WAYS TO ADD THOSE IN.
THERE'S ALSO SUPPRESSION.
SO IF THERE ARE 10 OR FEWER OF A
SPECIFIC DIAGNOSIS GROUP IN A
COUNTY IT GETS SUPPRESSED.
BUT IT DIDN'T INCLUDE IT IN THE
PROPOSAL BUT IT'S MUCH HARDER TO
DO BUT LOOKING AT OVERALL BIRTH
NUMBERS AND THEN ACCOUNTING FOR
WHAT IS MISSING THEN YOU'RE
INCLUDING BIRTHS HAPPENING
OUTSIDE OF HOSPITALS OUTSIDE THE
HEALTHCARE SYSTEM, STILL MISSING
BIRTHS THAT AREN'T REPORTED FOR
A BIRTH CERTIFICATE, BUT THOSE
ARE MUCH SMALLER NUMBERS.
LOOKING AT STATISTICAL METHODS
HOW WE CANNOT REIDENTIFY
DE-IDENTIFIED DATA BUT ACCOUNT
FOR IT IN OTHER WAYS.
BEYOND OF SCOPE BUT WHERE I'M
TRYING TO GO NEXT AND LOOKING AT
MORE SPECIFIC OUTCOMES.
>> WE'RE CLOSE TO TIME.
MAYBE WE CAN CATCH UP AT BREAK.
>> SURE.
>> WE'RE PLEASED TO INTRODUCE
OUR NEXT SPEAKER.
DR. GAMBLE FROM THE TULANE
UNIVERSITY SOUTHERN CENTER FOR
MATERNAL HEALTH EQUITY CENTER OF
EXCELLENCE.
>> IT'S AN HONOR TO PRESENT ON
THE CENTER FOR MATERNAL HEALTH
EQUITY, FUNDED TO TULANE
UNIVERSITY SCHOOL OF PUBLIC
HEALTH AND TROPICAL MEDICINE.
I'M ABBY GAMBLE, NOT AT TULANE
UNIVERSITY.
I AM FACULTY AT THE UNIVERSITY
OF MISSISSIPPI MEDICAL CENTER.
AND I'M A PART OF ONE OF THREE
RESEARCH PROJECTS UNDERSTOOD THE
SOUTHERN CENTER.
ONE OF WHICH THAT'S THE PROJECT
WHICH I'LL PRESENT TO YOU TODAY
WHICH IS THE IMPACT OF MEDICAID
POSTPARTUM EXTENSION AND
MANDATED POSTPARTUM DEPRESSION
SCREENING, CARE FOR GESTATIONAL
DIABETES AND HYPERTENSIVE
DISORDERS IN PREGNANCY.
I WILL REFER TO THIS AS RP 3, AS
YOU CAN TELL IT'S A LONG TITLE
AND WE'RE FUNDED BY THE
"IMPROVE" INITIATIVE.
THE OVERALL GOAL OF THE SOUTHERN
CENTER IS TO ESTABLISH A
MATERNAL HEALTH RESEARCH CENTER
THAT'S EMBEDDED WITHIN
HISTORICAL COMMUNITY
PARTNERSHIPS AND EXISTING
INFRASTRUCTURE TO BUILD AND
STRENGTHEN A NETWORK FOR
IMPROVED MATERNAL HEALTH IN THE
GULF SOUTH.
IN ADDITION TO OUR
ADMINISTRATIVE CORES, OUR
TRAINING CORE AND OUR COMMUNITY
ACCOUNTABILITY CORE, WE HAVE
THREE R01-LEVEL RESEARCH
PROJECTS THAT ARE FUNDED UNDER
THE SOUTHERN CENTER.
THESE PROJECTS SPAN THE SOCIAL
ECOLOGICAL MODEL SEEKING TO
ADDRESS SOCIAL AND STRUCTURAL
BARRIERS TO EQUITABLE MATERNITY
HEALTHCARE AND HEALTH OUTCOMES.
SO, RP 3 FOCUSES ON POLICY
LEVEL, SPECIFICALLY MEDICAID
POSTPARTUM COVERAGE EXTENSION
AND OTHER HEALTH POLICIES LIKE
POSTPARTUM DEPRESSION SCREENING
MANDATES.
IN THE FIRST YEAR TRAINEESES LED
A HISTORICAL POLICY SCAN LOOKING
AT MATERNAL HEALTH LEGISLATION
ENACTED ACROSS THREE STATES,
LOUISIANA AND MISSISSIPPI AND
ARKANSAS BETWEEN 2018 AND 2023.
THEY FOUND 40 POLICIES IN ALL
ENACTED ACROSS ALL THREE STATES,
25 OF WHICH WERE ENACTED IN
LOUISIANA, 11 IN ARKANSAS, 4 IN
MISSISSIPPI.
WE ALREADY KNOW THAT THERE THERE
DIFFERENCES IN TERMS OF WHAT THE
POLICY LANDSCAPE LOOKS LIKE.
IMPORTANTLY IN TERMS OF MEDICAID
POSTPARTUM COVERAGE EXTENSION,
EXTENSION HAS BEEN IMPROVED IN
BOTH LOUISIANA AND MISSISSIPPI
BUT NOT IN ARKANSAS.
AND THEN IN TERMS OF POSTPARTUM
DEPRESSION SCREENING MANDATES
THERE ARE MANDATES IN LOUISIANA
AND ARKANSAS BUT NOT
MISSISSIPPI.
AND THEN IN TERMS OF OVERALL
MEDICAID EXPANSION, LOUISIANA
AND ARKANSAS ARE EXPANSION
STATES AND MISSISSIPPI IS NOT.
AGAIN, DIVERSE LANDSCAPES IN
TERMS OF POLICY, SIMILAR HEALTH
OUTCOMES.
MEDICAID POSTPARTUM EXTENSION
AND OTHER MATERNAL HEALTH
POLICIES HAVE PARTICULAR
IMPLICATIONS FOR PREGNANCIES
COMPLICATED BY GESTATIONAL
DIABETES, SPECIFICALLY IN THE
POSTPARTUM PERIOD WE KNOW THAT
BIRTHING PERSONS WHO EXPERIENCE
GESTATIONAL DIABETES, 70% WILL
DEVELOP TYPE 2 DIABETES WITHIN
THREE YEARS AFTER THEIR
PREGNANCY.
SIMILAR WITH HYPERTENSIVE
DISORDERS IN PREGNANCY,
SPECIFICALLY GESTATIONAL
HYPERTENSION OR PREECLAMPSIA, 1
IN 5 THOSE BIRTHING PERSONS
REMAIN HYPERTENSIVE AT 3 MONTHS
POST-DELIVERY.
COMBINED, PREGNANCIES
COMPLICATED BY GDM OR
HYPERTENSIVE DISORDERS IN
PREGNANCY HAVE INCREASED RISK
FOR POSTPARTUM DEPRESSION.
WHAT DOES THAT HAVE TO DO WITH
MEDICAID AND OTHER POLICIES?
HISTORICALLY MEDICAID COVERAGE
WAS MANDATED TO LAST UP TO 60
DAYS POST-DELIVERY.
WHEN YOU COMPARE THAT WITH THE
ACOG GUIDELINES FOR PREVENTIVE
CARE IN THE POSTPARTUM PERIOD,
MOST OF THOSE BIRTHING PERSONS
WOULD LOSE ELIGIBILITY AND
ESSENTIALLY THEIR ACCESS TO CARE
AND THEY WOULD LOSE THAT ACCESS
TO THE PREVENTIVE CARE SERVICES
THAT IS RECOMMENDED BY ACOG.
UNDER THE EXTENSION UP TO 12
MONTHS POSTPARTUM THESE WOMEN
NOW HAVE ACCESS TO CARE,
IMPORTANT PREVENTIVE CARE,
SPECIFICALLY BLOOD GLUCOSE AND
BLOOD PRESSURE MONITORING AND
FOR THOSE THAT DEVELOP TYPE 2
DIABETES OR HYPERTENSION GETTING
THEIR CONDITIONS UNDER CONTROL
AND MANAGING CARE AND HAVING
ACCESS TO SCREENING AND
HEALTHCARE SERVICES FOR
POSTPARTUM DEPRESSION.
BUT WE KNOW THAT POLICY ALONE IS
NOT ENOUGH TO TRANSLATE INTO
HEALTH CARE PRACTICES AND
IMPROVED HEALTH OUTCOMES.
WE ALSO KNOW THERE ARE GAPS IN
POLICY RESEARCH.
SO, WE HAVE A VERY SMALL
EMPIRICAL EVIDENCE BASE THAT
SUPPORTS POLICY STRATEGIES TO
IMPROVE POSTPARTUM CARE.
WE ALSO KNOW THAT IN TERMS OF
POLICY EVALUATIONS THERE'S A
LACK OF INDIVIDUAL LEVEL COST
EFFECTIVENESS EVALUATIONS AND
THAT NONE OF ECONOMIC
EVALUATIONS AT THE INDIVIDUAL
LEVEL HAVE REALLY USED
DISTRIBUTIONAL COST EFFECTIVE
MODELS TO LOOK AT DIFFERENCES IN
SUBPOPULATIONS, REALLY IMPORTANT
FOR EXPLORING HEALTH EQUITY AND
HEALTH DISPARITY CONCERNS.
AND THEN LAST, THERE'S COMPLEX
CONTEXTUAL FACTORS AT THE MICRO
LEVEL THAT IMPACT HOW THESE
POLICIES TRANSLATE FROM, SAY,
FEDERAL TO STATE, DOWN TO THE
HEALTH SYSTEMS, PROVIDER AND
THEN THE ACTUAL PATIENT LEVEL.
IT'S IMPORTANT TO UNDERSTAND
THOSE THINGS IN ORDER TO CREATE
BETTER INTERVENTIONS FOR
IMPLEMENTATION AND
DISSEMINATION.
SO THE PURPOSE OF RP3, WE'RE
WANTING TO IDENTIFY
IMPLEMENTATION STRATEGIES THAT
AIM TO IMPROVE MATERNAL
POSTPARTUM HEALTH PARTICULARLY
IN PREGNANCIES COMPLICATED BY
GDM OR HYPERTENSION.
IN SHORT, OVERALL PROVIDES
FRAMEWORK FOR US TO DISENTANGLE
AND HOPEFULLY UNDERSTAND THOSE
COMPLEX DYNAMICS WITHIN AND
ACROSS SETTINGS AND LEVELS, AS
THEY CONVERGE ON THE HEALTHCARE
UTILIZATION, HEALTHCARE ACCESS,
OUTCOMES, SOCIETAL IMPACTS,
PARTICULARLY HEALTHCARE COSTS.
SO IN AIM 1, WE'RE LOOKING TO
EVALUATE OVERALL EFFECTIVENESS
OF MEDICAID POSTPARTUM EXTENSION
AND POSTPARTUM DEPRESSION
SCREENING, POSTPARTUM DEPRESSION
SCREENING, RATES OF DIAGNOSIS
FOR DIABETES, HYPERTENSION,
POSTPARTUM DEPRESSION,
HYPERTENSION AND DIABETES
CONTROL, EXPLORING DISPARITIES
AND LOOKING AT UTILIZATION
PRACTICES, THERE WILL BE A
COMPARISON NOT NECESSARILY ALL
OF THIS COMPARED TO ARKANSAS BUT
IN THE CONTEXT OF THE
DIFFERENTIAL POLICIES ACROSS
STATES WE'LL LOOK AT THOSE
DIFFERENCES.
AIM 2, WE WILL EXAMINE
CROSS-EFFECTIVENESS.
AND THEN WITH AIM 3, THIS WILL
BE ENGAGING MULTIPLE
STAKEHOLDERS ACROSS THREE STATES
TO UNDERSTAND THE DIFFERENT
CONTEXTUAL FACTORS THAT LEAD TO
APPROXIMATELY SHY -- POLICY SAY
DOPINGS.
WE HAVE INTERVIEWS TO UNDERSTAND
HOW CHANGES IN POLICY ARE BEING
IMPLEMENTED AT THE HEALTHCARE
SYSTEMS LEVEL AND PROVIDERS.
WE'LL USE GROUP CONCEPT MAPPING
WITH STAKEHOLDERS AND
POLICYMAKERS TO UNDERSTAND WHAT
ARE THE MOST IMPORTANT FACTORS
LEADING TO MATERNAL HEALTH
POLICY IN THE RESPECTIVE STATES,
AND WE'LL DO A COMBINATION OF
LONGITUDINAL INTERVIEWS AND
GROUP CONCEPT MAPPING WITH
PATIENTS DIAGNOSED WITH
GESTATIONAL DIABETES OR
HYPERTENSIVE DISORDERS IN
PREGNANCY, STARTING IN THE
PREGNANCY PERIOD AND FALLING
INTO THE POSTPARTUM PERIOD SO WE
CAN UNDERSTAND NOT JUST
EXPERIENCES OF HEALTHCARE DURING
PREGNANCY BUT THERE'S ALSO THE
CONTINUITY OF CARE FROM
PREGNANCY TO POSTPARTUM PERIOD
AND HOW MEDICAID POSTPARTUM
EXTENSION IS IMPACTING THEIR
UTILIZATION AND EXPERIENCES OF
CARE FOLLOWING THOSE DIAGNOSES
IN PREGNANCY.
WE HAVE SEVERAL POPULATION
HEALTH IMPLICATIONS.
SO THE OUTCOMES OF RP3 WE HOPE
TO USE TO BETTER INFORM
PATIENT-CENTERED STRATEGIES FOR
INTERVENTIONS THAT WILL COME IN
THE FUTURE, USING
COMMUNITY-BASED PRINCIPLES.
WE'RE LOOKING AT EXPLORING
BARRIERS TO CARE ACROSS MULTIPLE
LEVELS AND PERSPECTIVES TO
INFORM FUTURE POLICY STRATEGY
AND TO GENERATE IMPORTANT DATA
THAT'S NEEDED TO BETTER
DISSEMINATE AND IMPLEMENT
PRACTICES ACROSS THESE DIFFERENT
SETTINGS AND THROUGHOUT THE
UNITED STATES.
OUR PROGRESS TO DATE, AS I
MENTIONED WE HAVE PUBLISHED A
HISTORICAL POLICY SURVEILLANCE
FROM 2018 TO 2023, OUR TRAINEES
ARE CURRENTLY WORKING WITH OUR
IMPLEMENTATION HUB TO CONTINUE
TO MONITOR POLICY THAT IS BEING
NOT JUST ENACTED BUT INTRODUCE
AND WHAT'S HAPPENING TO POLICIES
AND BILLS ONCE INTRODUCED, HOW
THEY ARE PROGRESSING THROUGH THE
LEGISLATIVE PROS IS. -- PROCESS.
WE ARE EXPLORING THE
COST-BENEFIT OF POSTPARTUM
DEPRESSION SCREENING TREATMENT
AND PREVENTION STRATEGIES, WE
SHOULD BE SENDING THAT OUT FOR
PEER REVIEW BEFORE THE END OF
THE CALENDAR YEAR, AND WE ALSO
HAVE A SEPARATE GROUP OF
TRAINEES THAT ARE CONDUCTING THE
SAME SYSTEMATIC REVIEW USING
A.I. AND SO THAT WE HOPE TO HAVE
PUBLISHED IN THE FIRST QUARTER
OF 2025.
WE HAVE DATA USE AGREEMENTS
UNDERWAY, SUBMITTED DATA REQUEST
TO RESDAC, UMC AND TULANE HAVE A
PRELIMINARY ELECTRONIC HEALTH
RECORD DATASET THAT WE'RE
WORKING WITH RIGHT NOW TO BETTER
PREPARE THE DATASET SO WE CAN
LINK A SUBSET OF DATA TO OUR
MEDICAID CLAIMS ONCE WE RECEIVE
THOSE AND FOR OUR AIM 3 WORK WE
HAVE OUR IRB UNDER WAY, WORKING
ON RELIANCE AGREEMENTS ACROSS
OUR SITES AND HOPE TO BEGIN OUR
DATA COLLECTION, RECRUITMENT AND
DATA COLLECTION IN JANUARY OF
2025.
AND THAT IS RP3 FOR THE SOUTHERN
CENTER, A SMALL PORTION, LISTED
HERE, DOES NOT INCLUDE
INVESTIGATORS AND COMMUNITY
PARTNERS FOR OUR OTHER RESEARCH
PROJECTS.
WITH THAT I WILL OPEN UP FOR
QUESTIONS.
>> WE HAVE SIX MINUTES FOR
QUESTIONS BEFORE WE TAKE A
BREAK.
I'D LIKE TO INVITE ANYBODY IN
THE AUDIENCE IN PERSON TO COME
TO THE MIC.
AGAIN VIRTUALLY IF YOU HAVE
ATTENDEES ONLINE CAN SUBMIT
QUESTIONS TO THE Q&A BOX.
ANY QUESTIONS?
>> YOU MENTIONED DIFFERENTIAL
IMPLEMENTATION OF MEDICAID.
CAN YOU EXPAND MORE ABOUT THAT?
WHEN WE VISITED YOUR SITE THAT
WAS SOMETHING THAT WE WERE NOT
SO AWARE OF, SO CAN YOU EXPAND A
LITTLE BIT MORE.
>> ABOUT MEDICAID POSTPARTUM
EXTENSION IN PARTICULAR?
YEAH, SO, ACROSS DIFFERENT
SITES, LOOKING AT THE IMPACTS OF
EXTENSION ON HEALTHCARE
UTILIZATION AND HEALTHCARE COST
ACROSS THE THREE STATES WHERE
MISSISSIPPI AND LOUISIANA BOTH
HAVE EXTENSION, ARKANSAS DOES
NOT, BUT UNDERSTANDING JUST
HAVING THAT STATE-LEVEL POLICY
DOESN'T NECESSARILY TRANSLATE TO
BEST PRACTICES AT THE HEALTHCARE
LEVEL.
AND HOW PATIENTS ARE
EXPERIENCING THAT HEALTH CARE.
AND SO WE HOPE WITH AIM 3 WHEN
WE TALK WITH PATIENTS AND
PROVIDERS AND HEALTH CARE SYSTEM
ADMINISTRATORS TO UNDERSTAND
WHAT THEY ARE DOING IN RESPONSE
TO THAT LEGISLATION THAT WILL
HELP US BETTER UNDERSTAND LIKE
WHAT ARE THE BARRIERS AND
FACILITATORS AT THOSE LEVELS,
WHAT INTERVENTIONS ARE NEEDED TO
SUPPORT CREATING LIKE BEST
PRACTICES FOR CARE, IN RESPONSE
TO THAT POLICY THAT PATIENTS NOW
HAVE ACCESS TO CARE FOR UP TO 12
MONTHS POSTPARTUM.
ONE OF THE BEST EXAMPLES AT THE
UNIVERSITY OF MISSISSIPPI
MEDICAL CENTER THE MAJORITY OF
BIRTHING PEOPLE THAT DELIVER AT
OUR HOSPITAL DON'T RECEIVE
POSTPARTUM CARE IN OUR HOSPITAL
SYSTEM.
MAJORITY OF THEM GO BACK TO
THEIR COMMUNITY HEALTH CENTER TO
RECEIVE CARE.
SO THERE'S REALLY NO
UNDERSTANDING OF WHAT'S
HAPPENING IN THAT TRANSLATION.
THERE REALLY ARE NO BEST
PRACTICES FOR MAKING THOSE WARM
HANDOFFS, THAT WILL HELP US
BETTER UNDERSTAND WHAT
INTERVENTIONS OR APPROACHES WE
COULD POTENTIALLY EXPLORE IN THE
FUTURE.
>> THANK YOU FOR THAT.
I HAVE A MEASUREMENT QUESTION.
IN GEORGIA, WE EXTEND THE
MEDICAID UNDER THE PUBLIC HEALTH
EMERGENCY AND THEN IN 2021 THAT
BECAME MORE FORMALIZED, WE'VE
BEEN TRYING TO STUDY A NUMBER OF
OUTCOMES RELATED TO THAT
EXTENSION, AMONG THEM LOOKING AT
SCREENING FOR POSTPARTUM
DEPRESSION BUT WE'VE HAD ISSUES
WITH EVEN HOW IT'S CODED,
WHETHER IT'S CAPTURED, PERHAPS
IT HAS TO DO WITH BILLING, A
NUMBER OF THINGS, OFTENTIMES
SCREENINGS ARE NOT MEASURED,
SOCIAL DETERMINANTS ARE NOT
MEASURED UNIFORMLY.
I WAS WONDERING HOW YOU'RE
MEASURING AND IF YOU'VE HAD
SUCCESS IN HELPING PROVIDERS IN
PRACTICES REALIZE CODING FOR
THAT SCREENING IS IMPORTANT IN
THE STATE IN WHICH YOU'RE
WORKING.
>> GREAT QUESTION, SOMETHING
THAT OUR DATA WORKING GROUP IS
CURRENTLY WORKING THROUGH.
AS I SAID, WE DON'T HAVE OUR
MEDICAID CLAIMS DATA YET BUT
WE'RE WORKING WITH PRELIMINARY
DATASET FROM OUR EHR.
WE'RE MAPPING OUR EHR DATA TO
THE PCORnet MODEL, AND HOPING
THAT AT LEAST IN MISSISSIPPI AND
I THINK WE CAN DO THIS WITH A
SUBSET OF DATA IN LOUISIANA WE
CAN ALSO USE OMOP AS WELL.
SO WE KNOW THERE ARE GOING TO BE
CHALLENGES, WHAT THE CHALLENGES
ARE YET WE DON'T KNOW.
WE'RE JUST STARTING THAT WORK
RIGHT NOW.
WE DO KNOW THAT WE ANTICIPATE
THAT SCREENING FOR POSTPARTUM
DEPRESSION IS NOT GOING TO BE
COMMON AT LEAST IN MISSISSIPPI,
NO MANDATE FOR IT, AND WE HAVE A
SHORTAGE OF MENTAL HEALTH CARE
PROVIDERS.
SO PEOPLE DON'T SCREEN BECAUSE
THEY DON'T HAVE ANYWHERE TO
REFER THEM TO.
SO, WE HYPOTHESIZE IT'S WHAT
WE'RE GOING TO FIND, AND SO THAT
WILL HELP US BETTER RESPOND, YOU
KNOW, GOING FORWARD.
WE HAVE TO ADDRESS THE
HEALTHCARE SHORTAGE.
IF WE'RE GOING TO START
SCREENING WE HAVE TO HAVE A WAY
TO RESPOND TO WHAT THE NEEDS
ARE.
I'M NOT SURE IN LOUISIANA
WHAT -- WHEN THE POSTPARTUM
MANDATE WENT INTO EFFECT, I
BELIEVE TEST LAST -- IT WAS LAST
YEAR SO I THINK THEY ARE
ANTICIPATING ONCE WE FIGURE OUT
HOW TO SEARCH AND CODE FOR
EVERYTHING ANTICIPATING INCREASE
IN SCREENING PRACTICES, AND
WE'RE CURIOUS TO SEE WHAT WE'RE
GOING TO FIND IN TERMS OF
TREATMENT AND HOW THAT GOES FROM
THERE WITH THE DATA THAT WE
HAVE.
>> ANY OTHER QUESTIONS FROM
IN-PERSON AUDIENCE OR -- NOTHING
ONLINE RIGHT NOW.
IF THERE'S QUESTIONS PLEASE FEEL
FREE TO COME.
HEARING THAT, WE'LL TAKE A BRIEF
BREAK FROM 2:50 TO THREE 3:00.
>> WE'RE GOING TO GET STARTED
WITH PART 2 OF SESSION 6, USING
DATA AND POLICY TO BEND THE
CURVE OF MATERNAL MORBIDITY AND
MORTALITY.
OUR FIRST PRESENTER IS READY TO
START.
PLEASE INTRODUCE YOURSELF AND WE
WILL GO AHEAD AND START.
THANK YOU.
>> HI.
I'M DR. CHERYL McFARLAND,
CENTRAL JERSEY FAMILY HEALTH
CONSORTIUM.
AND TODAY I'M GOING TO TALK
ABOUT A PREGNANCY, PRE-PREGNANCY
MATERNAL MORBIDITY ALGORITHM
WE'VE DEVELOPED.
I'LL JUST DO THIS.
OKAY.
SO THIS WORK WOULD NOT HAVE BEEN
POSSIBLE WOULD YOU THE
CONNECTING THE COMMUNITY,
MATERNITY HEALTH CHALLENGE
THROUGH NIH.
WE HAVE BEEN ABLE TO COMPLETE
THIS PROJECT AND CONTINUE TO
WORK ON IMPROVING OUR OUTCOMES,
AND MOVING FORWARD, IT WOULD NOT
BE POSSIBLE WITHOUT NIH.
SO JUST A LITTLE BIT ABOUT OUR
ORGANIZATION.
WE ARE A 501(c)3 LICENSE AND
REGULATED BY NEW JERSEY
DEPARTMENT OF HEALTH, A
MATERNAL-CHILD HEALTH
CONSORTIUM, WE DO QUALITY
IMPROVEMENT DATA FOR THE
BIRTHING FACILITIES IN THE
CENTRAL REGION OF NEW JERSEY.
THANKS TO IMPROVE WE'VE ADDED TO
OUR REPERTOIRE RESEARCH.
SO, YOU'VE SEEN THESE NUMBERS.
80% OF MATERNAL DEATHS OR MORE
ARE PREVENTIBLE.
IT'S ESTIMATED THAT THERE'S
ABOUT 700 WOMEN WHO DIE EACH
YEAR DURING BIRTH.
THAT'S ONLY THE TIP OF THE
PROVERBIAL ICEBERG.
MATERNITY -- SEVERE MATERNAL
MORBIDITY IMPACTS NEARLY 50,000
WOMEN PER YEAR, POSSIBLY MORE.
THIS PROJECT HAD THREE MAIN
AIMS, THE FIRST AIM WAS TO LOOK
AT SEVERE MATERNAL MORBIDITY
OVER TIME.
WE KNOW THAT SEVERE MATERNAL
MORBIDITY IS INCREASE INCREASIT
DON'T HAVE A GOOD UNDERSTANDING
HOW.
POSTER UPSTAIRS IS OUR FIRST
RESEARCH AIM WHERE WE TALK ABOUT
THE CHANGE IN MATERNAL MORBIDITY
OVER TIME.
SECOND AIM IS TO LOOK AT
PREDICTORS OF MATERNAL
MORBIDITY, AND THEN FINALLY THE
THIRD AIM WHICH I'LL BE
PRESENTING ON NOW IS TO CREATE
AND ALGORITHM TO PREDICT WHETHER
A WOMAN -- WHETHER A BIRTHING
PERSON WILL EXPERIENCE MATERNAL
MORBIDITY PRIOR TO BIRTH.
SO, LOOKING AT YOUR FIRST
PRENATAL VISIT ARE YOU AT RISK
FOR SEVERE MATERNAL MORBIDITY?
SO, OUR -- WE DID A
RETROSPECTIVE COHORT STUDY USING
MARKET SCAN MULTI-STATE MEDICAID
AND COMMERCIAL CLAIMS DATA.
WE HAVE A SAMPLE OF OVER A
MILLION BIRTHS BETWEEN 2019 AND
2022.
OVERALL, THE ANALYTIC COHORT
COMPRISED OF, LIKE I SAID, JUST
OVER A MILLION BIRTHS, 864,000
MOTHERS, AND WE DID MACHINE
LEARNING MODELS, AND WE TRAINED
ON 80% OF THE SAMPLE, AND DID
VALIDATION ON 20% OF THE SAMPLE.
THIS STUDY WAS APPROVED THROUGH
RUTGERS IRB AND VIRUS IRB.
WE HAD EXPERIENCE IN MATERNAL
MORTALITY REVIEW, AND I ALSO
WORK ON A PROJECT LOOKING AT
PEDIATRIC MEDICAL COMPLEXITY.
WITH THE PROBLEMS WE WERE SEEING
IN MATERNAL MORTALITY, I WAS
VERY INTERESTED IN USING THE
WORK THAT WAS DONE ON OTHER
CHRONIC DISEASE ALGORITHMS TO
DETERMINE IF WE COULD USE THAT
TO PREDICT SEVERE MATERNAL
MORBIDITY AND POTENTIALLY
PREVENT MATERNAL DEATHS.
SO WE LOOKED AT THE LITERATURE,
WE HAD A CLINICAL OVERSIGHT
COMMITTEE THAT LOOKED AT OUR
BODY SYSTEMS.
WE LITERALLY WENT THROUGH ALL OF
THE ICD-10 CODES, CLUMPED INTO
BODY SYSTEMS, AND WORKED WITH
OUR CLINICAL OVERSIGHT COMMITTEE
TO HELP DEVELOP THIS ALGORITHM.
WE DID SOME EXPLORATORY DATA
ANALYSIS.
THEN WE DETERMINED WHICH MACHINE
LEARNING PROCESS WE SHOULD USE,
SO WE LOOKED AT RANDOM FORESTS
AND EXTREME GRADIENT BOOSTING.
WE LOOKED AT IMBALANCE IN THE
MODELS AND PUNISHING THE MODELS
FOR FALSE POSITIVES AND FALSE
NEGATIVES.
AND ULTIMATELY DETERMINED WHICH
FEATURES WERE THE MOST IMPORTANT
IN THE MODEL.
SO JUST A LITTLE BIT OF
INFORMATION ABOUT OUR SAMPLE,
USING THE TRUVIAN MARKET SCAN
DATA THERE ARE LIMITATIONS.
COMMERCIAL INSURANCE, THEY DID
NOT HAVE RACE/ETHNICITY.
FOR THE MEDICAID INSURANCE, THEY
DIDN'T HAVE STATES.
SO ORIGINALLY WE WANTED TO LOOK
AT COMMUNITY LEVEL BUT WITH THE
USE OF THE MARKET SCAN DATA WE
MOVED TO STATE LEVEL.
SO THERE'S SOME DIFFERENCES IN
MEDICAID VERSUS COMMERCIAL DATA.
WHAT I WANT TO DRAW OUR
ATTENTION TO IS THE
CHARACTERISTICS, THESE BODY
SYSTEM CHARACTERISTICS BY SEVERE
MATERNAL MORBIDITY AND NO SEVERE
MATERNAL MORBIDITY.
YOU CAN SEE MENTAL HEALTH IS THE
HIGHEST MORBIDITY IN THE
POPULATION.
SO, 30% WITH NO SEVERE MATERNAL
MORBIDITY HAVE MENTAL HEALTH
CONDITIONS, 53% SEVERE MATERNAL
MORBIDITY.
FREQUENCY DISTRIBUTION IS
RELATIVELY SIMILAR IN BOTH
GROUPS EXCEPT EVERY SINGLE
FACTOR IS HIGHER AMONG THE
SEVERE MATERNAL MORBIDITY GROUP.
LET'S TALK ABOUT RESULTS.
OVERALL WE RAN THREE MODELS.
LOGISTIC REGRESSION WHICH IS
USED A LOT IN RESEARCH.
AND IN EPIDEMIC SETTINGS.
IT WAS NOT GOOD WITH PREDICTING
MATERNAL MORBIDITY, SENSITIVITY.
SPECIFICITY WAS HIGH, WE
ULTIMATELY CAME TO THE EXTREME
GRADIENT BOOSTING METHOD, WHICH
GAVE US 82.5, ALMOST 82.6%
SENSITIVITY MEANING BEING ABLE
TO PREDICT MATERNAL MORBIDITY
BASED ON PRE-PREGNANCY
DIAGNOSIS.
WITH SPECIFICITY OF ALMOST 96%,
OVERALL ACCURACY OF ALMOST 94%.
SO THIS IS A REALLY GOOD
INDICATOR THAT WE CAN USE
DIAGNOSTIC CRITERIA TO PREDICT
MATERNAL MORBIDITY.
THIS IS A SHAPELY ADDITIVE
EXPLANATION, IT GIVES
TRANSPARENCY AND EXPLANATION OF
MACHINE LEARNING MODELS.
SO, WHAT WE'RE SEEING IN THIS
WATER FALL CASCADE IS THE LEVEL
OF IMPORTANCE OF EACH OF THIEVES
BODY SYSTEMS, AS WELL AS STATE
FACTORS.
SO YOU CAN SEE FOR HEMATOLOGICAL
ISSUES, THAT'S A VERY -- HAS A
VERY HIGH POSITIVE PREDICTOR FOR
SEVERE MATERNAL MORBIDITY.
AGAIN, THESE ARE PREDICTORS
PRIOR TO PREGNANCY.
FOR INSTITUTIONAL HEALTH, THIS
IS A STATE LEVEL MEASURE.
IF YOU'RE IN THE HIGHEST
QUARTILE OF INSTITUTIONAL
HEALTH, IT'S A NEGATIVE
PREDICTOR OF SEVERE MATERNAL
MORBIDITY.
MAKES SENSE, FOR THOSE WHO STUDY
SOCIAL DETERMINANTS, THE STATES
THAT HAVE THE BEST HEALTH CARE
SYSTEM, BEST INSTITUTIONAL
HEALTH, BEST FOCUS ON HEALTH, DO
BETTER AS FAR AS THESE
MORBIDITIES.
OVERALL OUR FINDINGS, IT'S NOT
SHOWN IN THE CASCADE, BUT WE DID
FIND THE USE OF WHAT WE CALLED Z
CODES, FOR THOSE FAMILY WITH
ICD-10 CODES, THEY ARE YOUR
SOCIAL DETERMINANTS OF HEALTH
CODES.
WE FOUND THAT IT INCREASED
SENSITIVITY DRAMATICALLY WHEN WE
INCLUDED THESE CODES.
HOWEVER, THE OVERALL ACCURACY
WENT DOWN.
IN THE CASCADE MODEL THAT YOU
SAW WE DIDN'T SHOW THE Z CODES.
WHAT WE'RE FINDINGS IS THESE CAN
BE VERY INFLUENTIAL IN
DETERMINING AND PREDICTING RISK.
IT'S LIKELY WE'RE NOT SEEING
THEM IN FINAL MODELS BECAUSE
THEY ARE NOT WIDELY USED BY
PHYSICIANS.
SO FOR ANY OF YOU WHO ARE
FAMILIAR WITH USING DIAGNOSTIC
CODES, WE KNOW THOSE DIAGNOSTIC
CODES CAN BE PROBLEMATIC IN THE
DATA.
Z CODES ARE NOT USED WIDELY.
HOWEVER, THINGS LIKE EXPERIENCE
OF HEMATOLOGICAL ISSUES PRIOR TO
PREGNANCY IS ALSO SIGNIFICANT,
AND YOU'RE SEEING THAT LIKE WE
TALKED EARLIER ABOUT ANEMIA, CAN
BE MONITORED AND PREVENTED.
OR ADDRESSED.
SEVERE MATERNAL MORBIDITY RISK
IS PREDICT AL R. R. --
PREDICTABLE.
WE CAN PREDICT AT 95% ACCURACY.
SOME RISK FACTORS ARE
MODIFIABLE.
YOU CAN'T CHANGE A PERSON'S
DEMOGRAPHIC CHARACTERISTICS OR
THEIR MEDICAL HISTORY.
BUT YOU CAN INTERVENE TO ADDRESS
ISSUES ASSOCIATED WITH THEIR
PRIOR MEDICAL HISTORY, AND YOU
CAN BUILD ON RESILIENCE FACTORS
SUCH AS FAMILY UNIT, COMMUNITY
UNITY THAT CAN STRENGTH BE THE
DECREASE IN SEVERE MATERNAL
MORBIDITY RISK.
TARGETING INTERACTIONS IS KEY TO
SEVERE MATERNAL MORBIDITY
PREVENTION.
CERTAIN COMBINATIONS OF RISK
FACTORS PUT YOU IN HIGH LEVELS
OF RISK.
IF YOU CAN ADDRESS THINGS LIKE
SOCIOECONOMIC STATUS, ACCESS TO
HEALTH CARE, THAT COMPOUND
EFFECT OF SEVERE MATERNAL
MORBIDITY YOU CAN POTENTIALLY
PINPOINT INTERVENTIONS TO HELP
BIRTHING PEOPLE WHO ARE AT RISK
A FEW LESSONS LEARNED, ONE THE
LIMITATIONS IN THE DATA.
WE KNOW CLAIMS DATA IS --
THERE'S SOME INACCURACIES IN
DIAGNOSTIC CODING.
CONTINUITY OF INSURANCE CHANGES.
WE CAN FOLLOW PEOPLE OVER TIME.
HOWEVER, IF THEY CHANGE INSURES,
WE CAN NO LONGER FOLLOW THEM.
SO THAT'S ONE LIMITATION.
ANOTHER LIMITATION IS THE
INABILITY TO PREDICT MORBIDITY
FOR THOSE WITH NO MEDICAL CLAIMS
HISTORY.
SO, IF YOU'RE COMING IN AND YOU
HAVE NO MEDICAL CLAIMS IN THE
THREE YEARS PRIOR TO PREGNANCY,
WE CAN'T PREDICT YOUR RISK.
BUT WE DO KNOW BASED ON OUTCOMES
THAT GROUP IS AT HIGHEST RISK.
17% OF OUR GROUP THAT HAD NO --
SORRY, OF THOSE WHO HAVE NO
PRE-PREGNANCY CLAIMS DATA, 17%
ENDED UP WITH A SEVERE MATERNAL
MORBIDITY, SO THAT'S PRETTY HIGH
NUMBER TO LOOK AT BUT WE
COULDN'T INCLUDE IT IN THE MODEL
BECAUSE WE DIDN'T HAVE THE PRIOR
DATA.
SOME LESSONS LEARNED, SO I'M
PART OF A NON-PROFIT.
WE DON'T TYPICALLY DO RESEARCH.
AND WE LEARNED A LOT FROM THE
"IMPROVE" INITIATIVE.
CONTINGENCY PLANNING WAS ONE.
OUR ORIGINAL PROPOSAL WE WERE
USING MEDICAID DATA, AND WE WERE
INTEGRATING COUNTY LEVEL FACTORS
WITHIN NEW JERSEY TO HELP
PREDICT MATERNAL MORBIDITY.
WE HAD AGREEMENT AND 18 MONTHS
LATER WE RECEIVED THE APPROVAL
TO RECEIVE THE DATA ON THE DAY
THIS REPORT WAS DUE SO WE HAD
CONTINGENCY PLANNING IN PLACE,
SO THAT WE WERE ABLE TO USE
DIFFERENT DATASET AND CHANGE OUR
AIMS A LITTLE AND WERE STILL
ABLE TO SUCCESSFULLY ACCOMPLISH
THE PROJECT.
CAPACITY BUILDING, WE SPENT A
LOTS OF TIME DURING PREPARATION
AND WAITING FOR DATA IN TRAINING
MY TEAM SO WE HAD TRAINING
SESSION HOW TO DO RESEARCH,
INTEGRATE RESEARCH INTO
PROGRAMMING.
OVERALL THE BIGGEST LESSON
LEARNED IS THAT OF MOTHERHOOD.
IT TAKES A VILLAGE.
THIS PROJECT WOULD NOT HAVE BEEN
POSSIBLE WITHOUT NIH, WITHOUT
OUR OVERSIGHT COMMITTEE THAT
HELPED US WITH THE CLINICAL AND
SOCIAL ASPECTS INCLUDED IN THE
MODEL.
MY ORGANIZATIONAL BUY-IN, I WENT
TO A SERVICE-BASED NON-PROFIT
AND SAID, HEY, I WANT TO DO
THIS.
MY ORGANIZATION SUPPORTED ME AND
WE WERE ABLE TO SUCCESSFULLY
COMPLETE THIS RESEARCH.
I COULD NOT DO IT WITHOUT MY
TEAM.
AND I WOULD BE REMISS NOT TO
MENTION MY CO-INVESTIGATOR,
LAUREN, WHO REALLY HIT THE
GROUND RUNNING WHEN WE RECEIVED
THE DATA AND REALLY ALLOWED US
TO BE SUCCESSFUL.
SO NEXT STEPS.
WE'RE NOT DONE.
WE ARE WORKING WITH OUR
OVERSIGHT COMMITTEE TO DEVELOP
THRESHOLDS OF RISK SO THAT WE
CAN STRATIFY BASED ON LEVEL OF
RISK AND OFFER SERVICES TO
REMEDIATE THAT RISK.
WE ALSO ARE WORKING ON IMPROVING
SPECIFICITY, SO REDUCING OUR
FALSE NEGATIVES, BUILDING
SUBSEQUENTS MODELS TO PREDICT
SPECIFIC TYPES OF SEVERE
MATERNAL MORE BUILDTY AND --
MORBIDITY AND KEY PERIODS OF
VULNERABILITY OF THOSE RISK.
WE'RE WORKING ON DEVELOPING A
PROGRAM AND APPLYING FOR
FUNDING.
I'M CURRENTLY IN CONVERSATIONS
WITH ONE OF THE LARGEST INSURERS
IN NEW JERSEY, AND HOPEFULLY WE
WILL BE ABLE TO SET UP A MEETING
AND DISCUSS THE POSSIBILITY OF
TESTING THIS ALGORITHM IN THEIR
PATIENT POPULATION AND OFFER
SERVICES TO THOSE AT HIGHEST
RISK.
SO, WE'RE NOT DONE.
AND WE LOOK FORWARD TO WHAT
COMES NEXT.
THANK YOU.
>> THANK YOU SO MUCH.
I WOULD LIKE TO SEE IF THERE ARE
QUESTIONS IN THE AUDIENCE.
WE MIGHT HAVE ONE.
>> HI, CHRIS AGAIN.
I CONFESS I HAVE TO LOOK AT WHAT
EXTREME GRADIENT BOOSTING IS.
I LOOKED IT UP.
I LEARNED SOMETHING IN TWO
MINUTES.
CAN YOU EXPLAIN WHAT IT IS, IT'S
A DECISION TREE AS I UNDERSTAND,
APPROACH, MORE IMPORTANTLY WHY
DO YOU THINK IT PERFORMS SO MUCH
RATHER THAN LOGISTIC MODEL?
I HAVE TO PUNT ON THAT ONE.
LAUREN, MY CO-INVESTIGATOR, IS
MY BIOSTATISTICIAN, SO SHE IS
THE ONE THAT WORKED WITH SOME
MODELS THAT FRANKLY I HAD NEVER
HEARD OF.
MY BACKGROUND I'M A SOCIOLOGIST,
LOGISTIC REGRESSION, OLS IS THE
WAY TO GO.
WE LOOKED AT SOME MACHINE
LEARNING MODELS THAT OTHERS HAVE
USED, AND SHE RAN WITH IT.
SO, IF YOU PROVIDE ME YOUR
INFORMATION, I CAN DEFINITELY
PROVIDE AN ANSWER TO THAT
QUESTION ONCE I TALK TO LAUREN.
>> DOESN'T LOOK LIKE THERE ARE
ANY OTHER QUESTIONS.
WE'LL SEE IF THERE'S ANYTHING IN
THE -- NOTHING ONLINE, OKAY.
I'M PLEASED TO INTRODUCE OUR
NEXT SPEAKER, ANDREEA CREANGA.
>> GOOD AFTERNOON, EVERYONE.
I'M REPRESENTING THE DATA
INNOVATION AND COORDINATION HUB.
I'M GOING TO CHANGE GEARS FROM
THE WONDERFUL PRESENTATION WE
HEARD BEFORE MOVING AWAY FROM
MACHINE LEARNING MODELING TO
LEARNING A LITTLE BIT ABOUT THE
DATA HUB.
SO LET ME MAKE SURE THIS IS
WORKING.
WHAT I'M GOING TO DO, I'M GOING
TO TALK ABOUT HOW WE WORK WITH
OUR CENTERS OF EXCELLENCE.
I'M GOING TO TURN YOU A LITTLE
BIT ABOUT WHAT WE LEARNED FROM
THEM OVER THE COURSE OF THE
PREVIOUS YEAR.
SO OUR SPECIFIC AIMS ARE TO
ESTABLISH COORDINATION
INFRASTRUCTURE TO FOSTER
COMMUNICATION AND COLLABORATION
ACROSS IMPROVE CENTERS OF
EXCELLENCE, DEVELOP DATA
COLLECTION ANALYSIS AND SHARING
TOOLS AND STRENGTHEN DATA SIGNS
AND INNOVATION CAPABILITYES
THROUGH TECHNICAL ASSISTANCE,
SKILLS COACHING, TRAINING AND
MENTORSHIP.
SO IN TERMS OF COORDINATION THIS
IS A SLIDE SHOWING THE
COMPOSITION OF OUR CORE TEAM.
SOME TEAM MEMBERS OFFER GENERAL
COORDINATION AND SUPPORT,
LEADERSHIP TO THE PROGRAM.
AND SOME OF OUR COLLEAGUES SERVE
AS SCIENTIFIC LIAISONS WORKING
WITH TWO OR THREE CENTERS OF
EXCELLENCE, TRYING TO SUPPORT
AND FIRST OF ALL LEARN ABOUT
NEEDS AND THEN SUPPORT AND MEET
THEIR NEEDS.
ALSO HAVE TRAINEES, A NUMBER OF
STUDENTS NOT ONLY SUPPORTING OUR
WORK AND HELPING BUT LEARNING BY
DOING IN THE PROCESS.
SO YOU ALREADY KNOW WE'RE
WORKING WITH 12 CENTERS OF
EXCELLENCE OF WHICH TWO WERE
ADDED RECENTLY IN 2024.
WE'RE VERY HAPPY TO HAVE MORE
CENTERS TO WORK WITH. WE HAVE
DEVELOPED A PUBLIC-FACING
WEBSITE FOR THE ENTIRE
INITIATIVE.
SO WE'RE TRYING TO HIGHLIGHT THE
WORK THE CENTERS ARE DOING AND
SHARE SOME OF THE RESEARCH
PROJECT THAT ARE GOING TO BE
COMING AVAILABLE VERY SOON.
AND WE DEVELOPED A COLLABORATION
PORTAL FOR OUR INTERNAL USE
WITHIN THE NETWORK.
THIS COLLABORATION PORTAL OFFERS
INDIVIDUAL WORKING SPACE FOR
EACH OF THE CENTERS, ALSO WE
HAVE A COMMON SPACE FOR THE
ENTIRE NETWORK WITH RESEARCH
LIBRARY, DISCUSSION FORUM, AND
IMPORTANTLY WE HAVE A TECHNICAL
ASSISTANCE REQUEST FORM TO WHICH
OUR CENTERS ARE ABLE TO REQUEST
TECHNICAL ASSISTANCE, SUPPORT,
CONSULTATION FROM BOTH HUBS,
DATA HUSBAND AND IMPLEMENTATION
SCIENCE.
SO YOU HAVE ALREADY LEARNED A
LOT ABOUT OUR CENTERS OF
EXCELLENCE.
AND I'M GOING TO RECAP SOME
INFORMATION, MAYBE ADD SOME NEW
INFORMATION TO YOU.
ALL OF THE CENTERS HAVE A FOCUS
ON HEALTH EQUITY.
THREE OF OUR CENTERS WORK WITH
INDIGENOUS POPULATIONS, AND THEY
ARE LISTED HERE.
WE HAVE ELEVATE, CIRCLE, AND
MARCH.
THERE IS A FOCUS ON THE
ANTENATAL AND PERINATAL CARE,
FIVE CENTERS.
THREE CENTERS FOCUSING ON BOTH.
THERE'S A VARIETY OF RESEARCH
TOPICS THAT THE CENTERS ARE
STUDYING.
AND THIS IS JUST A VERY BRIEF
GRAPHICAL DEPICTION OF THE KEY
TOPICS THEY ARE WORKING ON.
SO IF YOU'RE FOLLOWING THE
CENTERS THAT HAVE A YELLOW
MARKER, THOSE ARE CENTERS, FIVE
OF THEM WORKING ON MENTAL HEALTH
ASPECTS.
WE HAVE TWO CENTERS WORKING ON
SUBSTANCE USE DISORDER.
THOSE ARE SHOWN WITH A GREEN
CIRCLE.
WE HAVE THREE CENTERS WORKING ON
MATERNAL ANEMIA, CARDIOVASCULAR
DISEASE, HYPERTENSIVE DISORDERS
OF PREGNANCY.
WE HAVE SEVEN CENTERS ACTUALLY
LOOKING AT MATERNAL MORTALITY,
TWO ON FOOD OR HOUSING
INSECURITY AND INFLUENCE ON
MATERNAL HEALTH OUTCOMES.
EACH FOCUS AROUND QUALITY OF
CARE.
EITHER BY IMPLEMENTING QUALITY
IMPROVEMENT INITIATIVE OR USING
QUALITY CARE FRAMEWORK OR
QUALITY CARE MEASURES TO
IMPLEMENT THEIR PROGRAM AND
EVALUATE THEIR PROGRAMS AND
RESEARCH.
GIVEN THAT WE'RE WORKING WITH 12
CENTERS AND EACH OF THEM HAVE A
WIDE VARIETY OF INTEREST, HOW DO
WE COORDINATE?
FIRST, WE TRY TO LISTEN.
AND OFT LISTENING WE TRY TO
ADAPT OUR OFFERINGS TO THE
SPECIFIC NEEDS OF THE CENTER.
AND WE DO THIS BY WORKING WITH
SCIENTIFIC LIAISONS.
WE HAVE SCIENTIFIC LIAISONS
DEDICATED TO WORKING WITH
SPECIFIC CENTERS, MATCHED BASED
ON RESEARCH INTEREST AND SKILLS
AND EXPERTISE.
REGULAR CHECK-IN MEETINGS,
OFFERING TECHNICAL ASSISTANCE,
RESPOND TO REQUESTS THAT ARE
SENT TO US THROUGH THE
COLLABORATION PORTAL, SOMETIMES
VIA E-MAILS WE REACH OUT TO
P.I.s AND COLLABORATORS VIA
E-MAIL AS WELL TO SHARE
INFORMATION, TO REQUEST
INFORMATION, SO THERE'S A BACK
AND FORTH BETWEEN US AND THE
CENTERS.
WE ALSO HAVE A MONTHLY
NEWSLETTER PROVIDING REMINDERS,
INFORMATION THAT'S NEW,
REQUESTING FEEDBACK ON OUR
OFFERINGS.
AND IN JUNE OF 2024 CON
CONVENIENT INDIGENOUS MATERNAL
RESEARCH COMMUNITY OF LEARNING,
THE PURPOSE OF THIS WAS TO
CONNECT THE THREE CENTERS
WORKING WITH INDIGENOUS
POPULATIONS.
MAKING SURE WE OFFER A PLATFORM
TO LEARN FROM EACH OTHER AND
COLLABORATE WITH ONE ANOTHER.
DURING THE FIRST MEETING
CO-DESIGNED OBJECTIVES OF THE
COMMUNITY THAT YOU'RE SEEING
HERE ON THE BOTTOM OF THE SLIDE.
MOVING FORWARD WE'RE GOING USE A
SIMILAR APPROACH TO ACTUALLY
GROUP CENTERS BASED ON RESEARCH
INTERESTS, BASED ON THEIR DATA
SCIENCE NEEDS AND INTERESTS AND
WORK.
SO THAT WE ONCE AGAIN IMPROVE
COORDINATION AND COLLABORATION
ACROSS CENTERS.
PART OF THAT WORK, TECHNICAL
ASSISTANCE OVER THE NEXT YEAR,
IS GOING TO HAVE TO DO WITH
COMMON DATA ELEMENTS.
YOU'RE FAMILIAR ALREADY WITH OUR
WORK TRYING TO DEVELOP
RECOMMENDATIONS FOR COMMON DATA
ELEMENTS IN MATERNAL HEALTH.
DEFINITIONS USED CONSTRUCT, WE
USED NIH CDE DEFINITION AND TALK
ABOUT CDE BUNDLES, GROUPING OF
CDEs THAT ARE INDIVISIBLE.
THE PROCESS FOR DEVELOPING
RECOMMENDATIONS, WE DEVELOPED
FIVE-STEP PROCESS FOR DEVELOPING
THIS CDE RECOMMENDATION STARTING
WITH LANDSCAPE ANALYSIS OF
PUBLICLY AVAILABLE CDEs, CDE
REPOSITORIES, AS WELL AS REVIEW
OF PROPOSALS SUBMITTED BY
CENTERS OF EXCELLENCE MAKING
SURE WE IDENTIFY ALL THOSE
CDEs NEEDED AND OF INTEREST ON
OUR CENTERS OF EXCELLENCE.
WE FORMED TWO WORKING GROUPS
PREPARING FOR WHO DELPHI
PROCESSES.
WE HAD A WORKING GROUP FOR
BIOMEDICAL CDEs, ONE MORE
PSYCHOSOCIAL CDEs.
WE HAD A FIRST DELPHI EXERCISE
WE THOUGHT WE'VE DONE, WE
COMPLETED IN THE SPRING OF THIS
YEAR, TRYING TO PRIORITIZE
CONSTRUCTS THAT SHOULD BE
MEASURED BY ALL MATERNAL HEALTH
RESEARCHERS, TRYING CATEGORIZE
PRIORITIES IN THREE GROUPS, TIER
1, THESE WERE CDEs THAT SHOULD
BE COLLECTED BY ALL MATERNAL
HEALTH RESEARCHERS.
TIER 2 TO BE COLLECTED BY THOSE
WHO HAVE SPECIFIC INTEREST, AND
THIRD GROUP CONSTRUCTED WERE NOT
THE PRIORITY FOR THE FIELD.
AFTER THE COMPLETION OF THE
FIRST DELPHI EXERCISE WE MOVED
INTO LITERATURE REVIEW PHASE TO
IDENTIFY CDE CANDIDATES AND ALSO
TO IDENTIFY SOME OF THE
INFORMATION FROM PUBLISHED
STUDIES AROUND FEASIBILITY AND
VALIDITY OF THESE MEASURES.
WITH OUR SECOND DELPHI EXERCISE
WE'RE ABLE TO SELECT CDE
CANDIDATES.
WE HAD OUR PANELISTS RAISE THE
VISIBILITY AND VALIDITY OF THESE
MEASURES AND ENDORSE
RECOMMENDATIONS FOR OUR FINAL
CDEs.
HERE I'M SHOWING OUR PROCESS FOR
DEVELOPING -- MORE THE
BIOMEDICAL CONSTRUCT
PRIORITIZATION, STARTED WITH
267, TIER 1 BIOMEDICAL
CONSTRUCTS, THERE WERE 36 AND
COVERING ASPECTS AROUND
PREGNANCY EPISODE, DELIVERY
EPISODE, HEALTH PREGNANCY
HISTORY, MENTAL HEALTH
CONDITIONS, NEONATAL
CHARACTERISTICS AND OUTCOMES.
WE STARTED WITH 194 CONSTRUCTS
BEFORE THE FIRST DELPHI
EXERCISE, AND DELPHI 1
PRIORITIZED 23 TIER 1
PSYCHOSOCIAL CONSTRUCTING, I'M
SHOWING HERE.
THEY COVER ELEMENTS AROUND
MATERNAL MENTAL HEALTH,
SUBSTANCE USE, SOME ASPECTS
REGARDING ACCESS TO MEDICAL
CARE, BIAS AND DISCRIMINATION,
SOCIODEMOGRAPHICS.
MANY THANKS TO THE PANELISTS,
WHO SERVED IN ONE OF THESE TWO
WORKING GROUPS, SPECIAL THANKS
TO TO THE COORDINATOR ON OUR
SITE.
AND ALSO WE WORKED CLOSELY AND
COORDINATED WITH NICHD ON THIS
PROJECT, AND WE HAD TWO
COLLEAGUES PART OF THE
BIOMEDICAL WORKING GROUP, AND
ALSO HAD TWO COLLEAGUES FROM
NICHD, DR. JESSICA GLEASON AND
CAROLINE SIGNORE WHO OFFERED
COORDINATION AND SUPPORT TO THE
ENTIRE TEAM.
MOVING FORWARD IN NOVEMBER WE'RE
GOING TO SHARE WITH YOU OUR
REPORT OF CDE RECOMMENDATIONS,
WORKING HARD AT THAT.
WE'RE GOING TO TREAT THE FIRST
YEAR AS IMPLEMENTATION AND
REFINEMENT STAGE, TO TEST,
SOLICIT FEEDBACK AND PROVIDE
SOME TOOLS TO SUPPORT
IMPLEMENTATION OF THE CDEs.
AFTER THAT, THE LAST FIVE YEARS
OF OUR GRAND WE'RE GOING TO DATA
COLLECTION MODE, ON THE DATA HUB
SITE OFFER TECHNICAL ASSISTANCE
TO MAKE SURE AT THE END OF THE
GRANT PERIOD WE'RE ABLE TO
SUPPORT THE CENTERS, SUBMIT
DE-IDENTIFIED DATA TO THE
REPOSITORY.
I'M GOING TO SPEND THE LAST
COUPLE MINUTES TALKING ABOUT OUR
APPROACH TO RESEARCH CAPACITY
DEVELOPMENT WHICH IS KEY TO OUR
PROJECT.
WE HAVE ADAPTED THE GROUP
FRAMEWORK THAT HAS SIX DOMAINS
STARTING WITH SKILLS AND
CONFIDENCE BUILDING, CLOSE TO
PRACTICE, LINKAGE AND
COLLABORATION, APPROPRIATE
DISSEMINATION, AND
INFRASTRUCTURE.
THIS IS ACROSS INDIVIDUAL
RESEARCHERS, OUR CENTER OF
EXCELLENCE TEAM, THE
ORGANIZATION, ALSO OUR NETWORK,
THE IMPROVE NETWORK.
WE'RE LOOKING AT ALL THE CENTERS
OF EXCELLENCE INDIVIDUALLY TO
ASSESS THEIR NEEDS, TO MEET
NEEDS, THE ENTIRE PROGRAM AND
NETWORK WE'RE ALL PART OF.
WE'RE TRYING TO DO EVERYTHING IN
OUR POWER TO MAKE US TOGETHER
SUCCESSFUL.
TO HAVE A BASELINE TO MAKE SURE
WE KNOW THE STARTING POINT WE
CONDUCTED A RESEARCH CAPACITY
SURVEY USING SOME MEASURES FROM
THAT HOLDEN DEVELOPED.
SO BETWEEN JULY AND SEPTEMBER OF
THIS YEAR WE CONDUCTED A SURVEY
ONLINE WITH RESEARCH AFFILIATES.
ACROSS THE TEN CENTERS OF
EXCELLENCE WE'RE WORKING WITH AT
THE TIME, WE HAD 290.
OUT OF THIS, 82 RESPONDED.
WE'RE GOING TO REPEAT THIS ON AN
ANNUAL BASIS, PROBABLY BEFORE
THE BEGINNING OF THE SUMMER SO
WE HAVE BETTER RESPONSE RATE.
THE GOAL TO ASSESS INDIVIDUAL
AND ORGANIZATIONAL CAPACITY.
YOU SEE RESPONDENT
CHARACTERISTICS, ONLY 82
RESPONSES, RESPONSE RATE IF
WE'RE TO CONSIDER THE ROSTER OF
RESEARCH AFFILIATES WE HAVE THE
RESPONSE RATE IS ONLY 28%.
SO WE HAVE TO INTERPRET WITH
CAUTION THE RESULTS HERE.
WE HAD 19 RESPONDENTS WERE
P.I.s OR CO-P.I.s, 25% EARLY
INVESTIGATOR -- EARLY-STAGE
INVESTIGATORS, 50%
UNDERREPRESENTED MINORITIES IN
RESEARCH.
THIS IS THE HOLDEN VALIDATED
SCALE FOR SKILL AND CONFIDENCE.
WHAT I WANT TO MENTION, TWO
THINGS.
SO, WE ASKED RESPONDENTS TO RATE
SKILL LEVEL ON A SCALE FROM 1 TO
10.
10 BEING HIGHEST LEVEL.
ON ALL OF THE 17 ITEMS HERE FROM
THE HOLDEN MEASURE.
AND THE NUMBER ONE THING I WANT
TO MENTION, THE OVERALL MEAN WAS
7.2 OUT OF 10.
OUR CENTERS ALREADY HAVE A VERY
HIGH CAPACITY FOR CONDUCTING
RESEARCH.
THE GOOD NEWS FOR THE DATA HUB
THERE'S STILL ROOM FOR
IMPROVEMENT, STILL A WAY FOR US
TO BE USEFUL SECOND METHOD ON
THE BOTTOM, AREAS WHERE WE CAN
IMPROVE, MAYBE STRENGTHP OUR
SUPPORT, SUPPORT WE OFFER TO THE
CENTERS.
SO THOSE ITEMS WERE REGARDING
ANALYSIS OF QUANTITATIVE DATA,
PUBLICATIONS IN PEER-REVIEWED
JOURNALS AND PREPARING
APPLICATIONS.
OUR SURVEY WAS ABLE TO CONFIRM
ALL OF OUR CENTERS AND SOME
CENTER AFFILIATES WITH WORKING
CLOSELY WITHIN THEIR CENTERS AND
WORKING WITH COMMUNITY PARTNERS,
WHAT WE WANTED TO SEE A THE THIS
POINT IN TIME.
IN TERMS OF INFRASTRUCTURE,
THERE'S CENTERS OF EXCELLENCE
ARE ALREADY OFFERING A LOT OF
SUPPORT TO THEIR RESEARCHERS.
SO, WHAT I'M POINTING ON THE
BOTTOM HALF OF THE GRAPH ON THE
LEFT ARE SOME AREAS WHERE WE CAN
ACTUALLY MAKE IMPROVEMENT FAST.
ON THE RIGHT-HAND SIDE I'M
SHOWING THE BARRIERS IDENTIFIED
BY RESPONDENTS.
ONE OF THE MOST INTERESTING
FINDINGS IN MY OPINION WAS THAT
33% OF OUR RESPONDENTS REPORTED
NO BARRIER TO CONDUCTING
RESEARCH.
HOWEVER, 50% OF THE SAMPLE
ACTUALLY REPORTED COMPETING
PRIORITIES AS A KEY BARRIER TO
THEIR CONDUCTING RESEARCH.
WE ASKED ABOUT WHAT SUPPORTS ARE
NEEDED FROM THE DATA HUB, WANTED
TO ADDRESS THE NEEDS OF THE
CENTERS IN THE PROPER FASHION.
WEBINARS AND FACILITATION OF
DISCUSSIONS ACROSS CENTERS
EMERGED AS KEY NEEDS FROM THE
CENTERS, AND WAYS WE CAN
CONTRIBUTE TO THEIR WORK.
SO, I HAVE ONE MORE MINUTE TO GO
OVER TRAINING ACTIVITIES.
I'M GOING START WITH OUR MONTHLY
WEBINARS, CUSTOMIZED TO THE FEED
BACK AND NEEDS OF THE CENTERS,
SOME FUTURE TOPICS LISTED HERE
BUT ON A REGULAR BASIS WE TRIED
TO TAILOR CONTENT TO THE NEEDS
THAT OUR CENTERS HAVE.
SLIDES AND RECORDINGS ARE
AVAILABLE ON COLLABORATION
PORTAL, TRYING TO INCREASE
AROUND THE UPCOMING PROFESSIONAL
MEETINGS WITHIN HOPKINS, OUTSIDE
HOPKINS, THROUGH MONTHLY
WEBINARS.
A SCHOLARSHIP FUND IS OFFERING
$4,000 SCHOLARSHIP FOR EACH
STORY BUILD DATA SCIENCE SKILLS
AMONG RESEARCH AFFILIATES AND
TRAINEES, ABLE TO OFFER 11 SUCH
SCHOLARSHIPS LAST YEAR, HOPE TO
DOUBLE THIS NUMBER FOR THE
CURRENT YEAR.
ONE PIECE WE'RE PROUD OF IS
MATERNAL HEALTH DATA SCIENCE
PARTNERSHIP WHICH INTRODUCES
PHYSICIAN-SCIENTIST AND
Ph.D.-LEVEL SCIENTISTS AS WELL
AS MASTER LEVEL SCIENTISTS, OMOP
COMMON DATA ELEMENT, MONTHLY
TRAINING MEETINGS, WORK GROUP
MEETINGS LED BY COLLEAGUES FROM
THE PRISM CENTER, MANY THANKS TO
STEPHANIE, AND PRACTICE SESSIONS
USING DATASETS AND MEETINGS WITH
A CAREER MEANTOR.
FIRST COHORT STARTED IN
SEPTEMBER, WE HAVE SELECTED 22
FELLOWS FROM MORE THAN 40
APPLICANTS, IMPORTANT TO NOTE
FOR THE AUDIENCE 15 FELLOWS ARE
FROM NINE OF THE CENTERS OF
EXCELLENCE.
CENTERS ARE ALREADY
DISSEMINATING THEIR FINDINGS,
I'M JUST GIVING EXAMPLES OF THE
WORK THAT'S BEEN PUBLISHED IN
THE PAST THREE MONTHS.
AND ALSO WE LOOKED TO SEE WHICH
CONFERENCE ACTUALLY BENEFITED
FROM STRONG PARTICIPATION FROM
OUR CENTERS, AND THE PREGNANCY
MEETING IN 2024 EMERGES AT TOP
CONFERENCE MANY OF US ACTUALLY
WENT TO AND PARTICIPATED, HAD
ABSTRACTS OR ORAL PRESENTATIONS,
POSTER PRESENTATIONS, SO 7 OF
THE 10 HAD PRESENTATIONS, ALSO
WITNESSED COLLABORATIONS BETWEEN
THE CENTERS OF EXCELLENCE.
AND LAST BUT NOT LEAST AND MAYBE
I SHOULD MENTION THIS, IT IS MY
FAVORITE PIECE FROM YEAR 1 OF
THE PROGRAM, MATERNAL HEALTH
DATA MOSAIC TO SUPPORT DATA
SHARING AND LEARNING ACROSS
CENTERS OF EXCELLENCE BY
ADDRESSING COMMON RESEARCH
THEME, THE THEME THIS YEAR WAS
COVID-19 AND INFLUENCE ON
MATERNAL/FETAL/NEWBORN OUTCOMES.
YOU MAY HAVE SEEN POSTERS
SUBMITTED BY CENTERS, PRINTED
AND DAYS PLAYED AT THE MEETING,
EIGHT CENTERS RECEIVING AWARDS.
WE'RE GOING TO DO IT NEXT YEAR,
HOPEFULLY WITH MORE CENTERS
PARTICIPATE, MORE AWARDS TO BE
GIVEN.
THANK YOU SO MUCH.
>> THANK YOU.
WE'RE GOING TO MOVE ON FOR
TIME'S SAKE TO THE LAST
PRESENTATION BUT WE WILL HAVE
TIME FOR OPEN DISCUSSION AT
4:00.
SO LAST BUT NOT LEAST WE ARE
WELCOMING REBECCA HAMM,
UNIVERSITY OF PENNSYLVANIA
IMPLEMENTATION SCIENCE HUB.
>> I'M REPRESENTING OUR TEAM
FROM AMETHIST.
WE'RE THE OTHER RESOURCE HUB FOR
THE "IMPROVE" INITIATIVE.
I'M PRESENTING ON BEHALF OF MY
CO-DIRECTOR MEGHAN LANE-FALL.
I'M SURE EVERYBODY IS READY TO
GO HOME.
IMPLEMENTATION SCIENCE IS AN
AMAZING TOOL TO HELP ACTUALLY
BEND THE CURVE IN MATERNITY
MORBIDITY AND MORTALITY AND
SECOND HOW WE CAN HELP YOU MOVE
YOUR PROJECTS AHEAD.
SO AS MANY OF YOU PROBABLY KNOW,
QUALITY IMPROVEMENT IS A GREAT
TOOL IN AND OF ITSELF BUT HAS
ITS LIMITS.
WE CAN GO AROUND AND AROUND
DOING PDSA CYCLES AND MAY NOT
MAKE A DIFFERENCE IN OUTCOME.
THE REASON TRADITIONAL QI
DOESN'T ALWAYS WORK HEALTHCARE
IMPLENTIATION IS SO COMPLEX, YOU
TALKED ABOUT IT TODAY.
YOU KNOW, THERE ARE THE ISSUES
WHERE CLINICIANS DON'T KNOW THE
CURRENT RESEARCH, WE ALL LEARNED
SOMETHING NEW IN THE
PRESENTATIONS TODAY.
ORGANIZATIONS AND PROVIDERS LACK
THE NECESSARY TOOLS THEY NEED TO
MAKE DIFFERENCES IN THEIR
PRACTICE.
AND SOME INTERVENTIONS WHICH
SEEM EFFICACIOUS IN RESEARCH
STUDIES MAY NOT ACTUALLY MEET
THE NEEDS OF THE POPULATIONS
THAT THEY ARE INTENDED FOR OR
WHO REALLY HAVE THE BIGGEST
DISPARITIES IN THOSE OUTCOMES.
AND SO WE THINK ABOUT THESE
FACTORS THAT IMPACT OUR ATTEMPTS
TO IMPLEMENT CHANGES IN
EVIDENCE-BASED PRACTICES, AND
YOU COULD GO ON AND ON ABOUT A
LIST BUT SOME OF THEM ARE THE
PHYSICAL ENVIRONMENT WE'RE
PRACTICING IN, THE MANY
SOCIOECONOMIC AND SOCIAL
CONTEXTS YOU BROUGHT UP TODAY
AND THE HEALTH SYSTEM AND END
USER CHARACTERISTICS WE'RE
TAKING CARE OF.
IT'S REALLY NOT SURPRISING
EVIDENCE-BASED PRACTICES WE
BELIEVE COULD IMPROVE OBSTETRIC
OUTCOMES HAVEN'T MADE THEIR WAY
INTO WIDESPREAD USE.
AND SO THE GOAL OF
IMPLEMENTATION SCIENCE IS TO
HAVE A CONCRETE METHODOLOGY TO
REALLY BRIDGE THAT EVIDENCE TO
PRACTICE GAP.
ONE DEFINITION IMPLEMENTATION
SCIENCE IS THAT STUDY OF PLANNED
HUMAN BEHAVIORAL CHANGE UNDER
ORGANIZATIONAL CONSTRAINTS THAT
WE ARE ALL PRACTICING IN.
THE FIELD OF IMPLEMENTATION
SCIENCE BRINGS TOGETHER TONS OF
FIELDS, FROM PUBLIC HEALTH AND
PSYCHOLOGY, BEHAVIORAL SCIENCE
TO COMMUNITY PARTNERED RESEARCH,
TO HUMAN FACTORS, ENGINEERING,
ORGANIZATIONAL THEORY TO ANSWER
SOME QUESTIONS.
SOME FIELDS HAVE BEEN AROUND
FOREVER BUT WE HAVEN'T USED THEM
WELL IN HEALTH CARE.
YOU'VE ALL BROUGHT UP MANY
EVIDENCE-BASED PRACTICES TODAY
THAT EXIST IN MATERNAL
HEALTH
WITH GAPS.
SOME OF YOU MAY HAVE SEEN THIS
BEFORE.
IT IS THE SUBWAY MAP THAT MY
CO-DIRECTOR HELPED TO DEVELOP OF
RESEARCH IN GENERAL WHICH STARTS
UP HERE AT EFFICACY, DO WE HAVE
AN EVIDENCE-BASED PRACTICE THAT
WORKS IN CONTROLLED RESEARCH
SETTINGS?
AND THEN CAN WE PROVE
EFFECTIVENESS, DOES THAT WORK IN
THE REAL WORLD AND THE MOST
IMPORTANT QUESTION HOW DO WE GET
PEOPLE TO USE IT.
SO SOME STUDIES BROUGHT UP TODAY
LIVE IN THIS CENTRAL PART OF
HYBRID EFFECTIVENESS
IMPLEMENTATION TRIAL WORLD, WE
NEED TO LOOK AT EFFECTIVENESS
BUT ALSO ALWAYS, ALWAYS NEED TO
STUDY IMPLEMENTATION.
I WOULD ARGUE EVEN IN THAT
EFFICACY STAGE YOU'RE DOING THE
FIRST GOLD STANDARD RCT OF
SOMETHING, YOU STILL NEED TO BE
STARTING WITH ASSESSMENT OF
IMPLEMENTATION.
THERE'S SOME EVIDENCE-BASED
THING THAT NEEDS TO BE
IMPLEMENTED WITH PARTNERSHIP
WITH PATIENTS, CLIENTS,
COMMUNITIES LIKE YOU'RE DOING
YOUR WORK ALREADY,
IMPLEMENTATION SCIENCE OUTCOMES
ARE DIFFERENT THAN TRADITIONAL
EFFECTIVENESS OUTCOMES, IT'S
SOMETHING VALUABLE, A PIECE OF
DATA.
A LOT OF TIMES WHEN THINKING
ABOUT A STANDARD RANDOMIZED
TRIAL YOU'RE WORKING HOW
DIFFERENCES ARE IMPACTING THE
QUALITY OF YOUR WORK WHEN IN
REALITY CONTEXTUAL NUANCE MAKES
THIS IMPORTANT, WHAT MAKES US
ANSWER THESE QUESTIONS.
AND WE HAVE SPECIFIC LANGUAGE,
METHODS, FRAMEWORKS AND
STRATEGIES.
SO TO BRIEFLY COVER WHAT THIS
FIELD LOOKS LIKE, THERE ARE A
BREAKDOWN OF THINGS THAT FIT
INTO THE IMPLEMENTATION SCIENCE
WORLD, FRAMEWORKS, THEORIES,
MODELS, STRATEGIES, SPECIFIC
STUDY DESIGNS AND KEY TOOLS.
THERE ARE A REPOSITORY OF OVER
60 THEORY OF MODELS FRAMEWORK
SPECIFIC TO IMPLEMENTATION, MANY
OF YOU ARE USING THEM IN THE
WORK THAT YOU ARE DOING TODAY,
BUT WHAT WE KNOW IS THESE
CONCEPTUAL APPROACHES ARE SO
VALUABLE IN DRIVING
IMPLEMENTATION, DOESN'T
NECESSARILY MATTER WHICH ONE YOU
USE BUT YOU PICK ONE OR MORE
THAT FIT WITH THE WORK THAT
YOU'RE DOING TO REALLY FIGURE
OUT SOMETHING ABOUT YOUR WORK
AND CONTEXTUALIZE.
USE THESE BEFORE A PROJECT
STARTS, DURING IMPLEMENTATION OR
AFTER TO UNDERSTAND WHY YOU
SUCCEEDED OR FAILED.
THERE ARE STRATEGIES THAT ARE
HOW WE GET IMPLEMENTATION BASED
INTO PRACTICE, THERE ARE
COMPENDIUMS OF MORE THAN 50
STRATEGIES, THINGS YOU MAY BE
USING BUT MAY NOT HAVE NAMED
BIKE COMMUNITY AND STAKEHOLDER
BUY-IN AND INCENTIVES.
THE BARRIERS WE'VE ALREADY
IDENTIFIED IN YOUR WORK.
THERE ARE A SLEW OF OUTCOMES WE
CAN HELP PEOPLE STUDY CRITICAL
TO IMPLEMENTATION SUCCESS.
ACCEPTABILITY FROM THE PATIENT,
COMMUNITY, OR THE PHYSICIAN
ANGLE, ADOPTION, APPROPRIATENESS
FOR THE PLACE YOU'RE TRYING TO
IMPLEMENT, HOW FEASIBLE, ARE WE
DOING IT ACCURATELY, FIDELITY,
COST IS A CRITICAL
IMPLEMENTATION OUTCOME,
PRESENTATION, ARE PEOPLE USING
IT AND BY, YOU KNOW, DIFFERENT
CLINICIANS, AND SUSTAINABILITY
WHICH IS SO IGNORED IN OUR WORK,
CAN WE CONTINUE TO USE THESE
INTERVENTIONS OVER TIME.
THE IMPLEMENTATION SCIENCE BEGAN
IN THE BASICS OF QUALITY
IMPROVEMENT PEOPLE DOING STUDIES
SIMPLE PRE AND POST STUDIES,
DIFFERENCE IN ANALYSIS.
HOW CAN WE HELP YOU MOVE TO THE
MORE ADVANCED IMPLEMENTATION
SCIENCE STUDY DESIGNS THINKING
ABOUT SMART TRIALS OR ADAPTIVE
TRIALS THAT WILL ACTUALLY HELP
GET TRIAL TO END IN SUCCESSFUL
IMPLEMENTATION RATHER THAN
WAITING FIVE YEARS TO SEE
WHETHER YOUR THING WORKED OR
NOT.
IMPLEMENTATION SCIENCE ALSO
TAKES INTO ACCOUNT HEALTH
EQUITY.
WE KNOW WE CAN FRAME
IMPLEMENTATION SCIENCE TO FOCUS
ON HEALTH DISPARITIES, FOCUS ON
REACH FROM THE BEGINNING, DESIGN
AND SELECT INTERVENTIONS WITH
POPULATIONS IN MIND JUST LIKE
AGAIN SO MANY OF YOU ARE ALREADY
DOING.
WE CAN DEVELOP IMPLEMENTATION
STRATEGIES THAT SPECIFICALLY
REDUCE INEQUITIES IN CARE, AND
ADAPT INTERVENTIONS OTHER TIME.
AMETHIST@PENN GOAL TO HELP YOU
INCORPORATE THOSE CONCEPTS I
DISCUSSED, INTO YOUR WORK AS
MUCH AS WE CAN.
AGAIN, UNDERSTANDING THAT MANY
OF YOU ARE ALREADY DOING THAT TO
SOME AGREE.
SO WE'RE SUPPORTING
IMPLEMENTATION SCIENCE AND
MATERNAL HEALTH ACROSS IMPROVE
NETWORK, NOT JUST TO SUPPORT
CENTERS OF EXCELLENCE BUT TO
EXPAND TO THE IMPROVE PROGRAMS.
FOR THOSE WHAT DON'T KNOW ABOUT
AMETHIST WE'RE BROKEN INTO FIVE
COURSE, ADMIN AND EQUITY,
DESIGN, POLICY, AND TRAINING
CORE.
I'M GOING COVER WHAT WE'VE DONE
SO FAR IN THE SPACES AND FOCUS
ON THE FUTURE AND HOW WE CAN
HELP YOU THROUGH THE NEXT FEW
YEARS.
THIS IS JUST TO SHOW THE
LEADERSHIP.
IN TALKING ABOUT ADMIN CORE ONE
THINK THING WE ACCOMPLISHED IN
YEAR ONE IS COMPLETED A BASELINE
SURVEY.
WE GAINED INFORMATION ABOUT
WHERE THE CENTERS OF EXCELLENCE
ARE WHERE THEY WERE COMING FROM
IN TERMS OF IMPLEMENTATION
SCIENCE EXPERTISE.
THERE'S A HUGE VARIETY, WHAT WE
LEARNED.
PEOPLE ARE COMING FROM A BIG
RANGE OF IDEAS.
PEOPLE WERE PLANNING TO USE
QUALITATIVE AND MIXED METHODS,
LESS IN SOME MORE RIGOROUS
IMPLEMENTATION STUDY DESIGNS,
HALF WERE THINKING ABOUT USING
AT LEAST ONE IMPLEMENTATION
OUTCOME, MORE COMMONLY WERE
ACCEPTABILITY AND AFFORDABILITY,
EQUITY.
PEOPLE REPORTED STRENGTH IN
INCORPORATING IMPLEMENTATION
FRAMEWORKS INTO THEIR WORK BUT
LESS STRENGTH IN MEASURING
IMPLEMENTATION OUTCOMES, THESE
ARE SOME THINGS WE'VE BEEN
FOCUSED ON OVER THE NEXT YEAR.
FROM AN EQUITY COMMUNITY AND
STAKEHOLDER ENGAGEMENT
PERSPECTIVE, ANOTHER CORE I'LL
GET INTO DETAIL ABOUT, WE FOUND
ALL OF THE CENTERS OF EXCELLENCE
WERE COMING FROM A LOT OF
STRENGTHS IN THOSE PLACES, MAYBE
WE NEEDED TO CHANGE OUR ANGLE
WHERE THE CORE WAS COMING FROM.
POLICY, DISSEMINATION AND
COMMUNICATION, THERE WAS
GREATEST NEED, WE FOCUSED
DEVELOPMENT OF RESOURCES IN THIS
SPACE.
THERE WAS LESS EXPERIENCE WITH
STORY TELLING OR COMMUNICATING
WITH POLICY OR ENCOURAGING AND
COMMUNICATION-BACKED
STAKEHOLDERS IN TERMS OF
RESEARCH FINDINGS.
TRAINING AND CAPACITY IN REGARD
TO IMPLEMENTATION SCIENCE
TRAINING SPECIFICALLY REALLY
VARIED, AS YOU CAN SEE IT'S
EVENLY BROKEN DOWN BETWEEN
BEGINNER, INTERMEDIATE, ADVANCED
EXPERIENCE FROM THE
IMPLEMENTATION SCIENCE FACULTY
AND WHAT TRAINING PROGRAMS
LOOKED LIKE.
THIS FULL REPORT IS AVAILABLE TO
ALL OF YOU ON THE WEBSITE.
THE OTHER THINGS THE ADMIN CORE
WORK ON OTHER THAN COLLABORATING
WITH ALL OF YOU AND THE NICHD
AND OUR HUB IS OUR VIRTUAL SITE
VISIT COMPLETED WITH 12 COEs
AND FIRST OF THE IMPROVE CYPs.
WE'VE COLLECTED GRANTS FROM THE
MAJORITY OF CENTERS, GRANT
ABSTRACTED TO HELP YOU BEST MOVE
FORWARD.
NEXT THE YEAR 2 SURVEY WILL BE
GOING OUT, AND THE GOAL IS TO
MOVE AHEAD, REALLY NOT TO REPEAT
WHAT WE KNOW ABOUT THE WORK YOU
HAVE PLANNED BUT WHAT ARE THE
ISSUES, THE BARRIERS, HOW CAN WE
HELP YOU OVERCOME THEM.
WE PLAN TO ENGAGE OUTSIDE
COEs, AND THE AIM TO BEGIN
MIXED METHOD WORK OF THE
BARRIERS AND FACILITATORS,
YOU'LL HEAR FROM US HOW TO
ENGAGE IN THAT AND HOPE BOTH YOU
AND RESEARCHERS, TRAINEES,
COMMUNITY PARTNERS, WILL HELP
ENGAGE IN SOME OF THAT RESEARCH
FOR US TO HELP ANSWER
GENERALIZABLE QUESTIONS IN THE
SPACE.
THE EQUITY CORE'S PURCHASE TO
CONVENE EQUITY ENHANCEMENT
COLLABORATIVE, AN AMAZING
PROGRAM WITH THREE MEETINGS WITH
MULTIPLE SITES GROUPED AGAIN IN
THESE POPULATION CONTEXTS.
SIMILAR TO WHAT THE DATA HUB HAD
SPOKEN ABOUT.
THESE ARE WAYS FOR THESE GROUPS
TO COME TOGETHER AND TALK ABOUT
THE ISSUES THEY ARE HAVING IN
BOTH ENGAGING COMMUNITY PARTNERS
IN THE WORK THEY ARE DOING,
COMMUNITY PARTNERS TO TALK ABOUT
ISSUES WITH ENGAGING WITH
RESEARCHERS, AND ALSO TO TALK
ABOUT ISSUES WITH ENROLLING AND
SUSTAINING RELATIONSHIPS WITH
THE POPULATIONS THEY ARE TRYING
TO WORK WITH IN THEIR TRIALS.
SO THERE'S A COUPLE ANGLES HERE.
OUR GOAL AT THE END IS TO
GENERATE EQUITY CONSIDERATION
REPORT, THE FIRST IS WORKED ON
NOW, TAKING DATA WE'VE ATTAINED
FROM THE REPORTS LOOKING FOR
GENERALIZABLE MESSAGES , HELPING
US IN THIS ROOM AND NATIONALLY
MOVING EQUITY AHEAD.
THIS IS WHAT OUR LAB A --
COLLABORATIVE LOOKS LIKE, A
VARIETY OF SPECIALISTS TAKING
CARE OF RURAL AND INDIGENOUS
POPULATIONS, FOCUSING ON EQUITY
AND LGBTQ OR BIPOC OR
REPRODUCTIVE JUSTICE.
OUR DESIGN CORE, A GREAT WAY TO
BEGIN INITIATE YOUR RELATIONSHIP
WITH US IF YOU HAVEN'T MUCH
ALREADY IS REALLY THE PURPOSE TO
BRING TOGETHER A GROUP OF
INDIVIDUALS HERE TO SUPPORT YOU
IN THE WORK YOU'RE DOING.
WE HAVE A CONSULTANT PANEL OF
SPECIALISTS IN DIFFERENT AREAS
OF IMPLEMENTATION SCIENCE AND
CLINICAL TOPICS, BRINGING A TEAM
OF PEOPLE TOGETHER TO MEET WITH
YOU AND YOUR STUDY TEAM TO
ANSWER A TARGETED AND SPECIFIC
QUESTION.
SO WE HOLD INDIVIDUAL CONSULTS,
SUCCESSFUL FOR SOME GROUPS BUT
THAT GROUP CONSULTATION MAY BE A
NEW METHOD SO OVER THE NEXT YEAR
WE'LL WORK ON GROUP
CONSULTATIONS, PEOPLE FEEL LIKE
SPENDING AN HOUR OF TIME ON ONE
QUESTION THEY MIGHT NOT FEEL
LIKE THE QUESTION IS BIG ENOUGH.
AND SO OUR FIRST GROUP
CONSULTATION IS AT THE END OF
THIS MONTH, ON RAPID QUALITATIVE
ANALYSIS, PEOPLE CONSIDERING
USING THAT TYPE OF METHODOLOGY.
WE'RE HIGHLIGHTING CONSULTANTS
IN NEWSLETTERS, HOPEFULLY YOU'RE
GETTING THAT, IF NOT LET US
KNOW, SO YOU CAN SEE SOME AREAS
YOU NEVER EVEN THOUGHT TO
UTILIZE IN YOUR WORK SUCH AS
BEHAVIORAL ECONOMICS OR
ORGANIZATIONAL THEORY THAT MIGHT
BE HELPFUL AS WE MOVE AHEAD.
WE HELD FOUR OR FIVE TOPIC
FORUMS, MEASURING ACCEPTABILITY,
MEASURING REACH IN RESEARCH,
TURNED EACH INTO A RESOURCE
DOCUMENT, WORKING ON GETTING
THAT OUT VIA THE WEBSITE THAT
WILL HOPEFULLY GUIDE YOU THREE
UTILIZATION AT ANY POINT YOU
WANT TO REFER IT TO.
WE HAVE A MEASURE REPOSITORY
THAT HASN'T BEEN USED, IF YOU'RE
INTERESTED IN POSTING A SURVEY
OR AN INTERVIEW GUIDE FOR
SOMETHING THAT YOU'RE TRYING
ASSESS, THEN THAT IS A GREAT
PLACE TO PUT IT AND HOPEFULLY
WE'LL HAVE SOME COLLABORATION IN
THAT SPACE.
POLICY CORE FOCUSES ON MEDIA
TRAINING, OP ED AND LAY PRESS
WRITING, TEACHING OR HELPING
PATIENT PARTNERS TELL THEIR
STORIES.
WE'VE HAD A COUPLE OF THESE
POLICY-RELATED WORKSHOPS, AND
OUR PATIENT PARTNER IS AN
AMAZING SPEAKER AND HUMAN HAS A
VIDEO TO BEGIN THAT PROCESS FOR
YOU IF THAT'S SOMETHING YOU'RE
INTERESTED IN.
SHE ALSO WILL HELP YOU RECRUIT
PATIENTS TO BE PART OF TELLING
THEIR STORY AS PART OF YOUR WORK
SO THERE'S A LOT OF PIECES HERE.
POLICY DAY, FIRST ONE, PLANNED
FOR NEXT SPRING.
YOU'LL HEAR MORE ABOUT THAT.
WE KNOW POLICY CAN FEEL
OVERWHELMING WHEN YOU HAVEN'T
ACTUALLY COMPLETED YOUR RESEARCH
PROJECT, AND HAD SPECIFIC DATA
TO PRESENT AS OF YET BUT ALL OF
YOU ARE COMING FROM A PLACE
FOCUSING ON AN ISSUE THAT'S OF
CRITICAL IMPORTANCE TO LAWMAKERS
AND POLICYMAKERS AND THERE ARE
THINGS TO SAY EVEN WHERE YOU'RE
AT IN YOUR RESEARCH PROJECTS AND
YOUR CENTER.
IN TERMS OF TRAINING CORE WE
HAVE MONTHLY SEMINARS ACROSS A
TOPICS ACROSS AN ARRAY OF
ISSUES.
WE HAVE THE PENN IMPLEMENTATION
SCIENCE INSTITUTE, WE SPONSORED
11 PARTICIPANTS FROM CENTERS OF
EXCELLENCE TO COME AND DO A
MATERNAL HEALTH TRACK, AMAZING
AND INTERACTIVE.
NEXT WILL BE IN JUNE OF NEXT
YEAR.
LOOK OUT FOR A ALL FOR THAT.
WE HOLD AN ANNUAL IN-PERSON
GATHERING, THE NEXT ONE WILL BE
IN DECEMBER AT ACADEMY HEALTH,
SIGN-UPS ARE AVAILABLE IN THE
NEWSLETTER.
TRAINEE OFFICE HOURS TO TALK
ABOUT THE RESEARCH THEY ARE
DOING, GET IDEAS AND FEEDBACK.
BEGINNING THIS YEAR OUR REACH
PROGRAM WHICH TRAINS
INVESTIGATORS AND COMMUNITY
PARTNERS TO WORK TOGETHER.
WE KNOW THE COMPLEXITY OF THAT
RELATIONSHIP IS HIGH.
FINALLY, MY LAST SLIDE, PILOT
GRANT PROGRAM.
WE FUNDED THE FIRST THREE THIS
YEAR FOR EXCITING TOPICS, FOR
TWO PEOPLE FROM DIFFERENT
CENTERS OF EXCELLENCE, AND ONE
INTERNAL PERSON TO DO EXCITING
WORK ON IMPLEMENTATION SCIENCE,
SUBPROJECTS OF THEIR OVERARCHING
COE WORK AND FURTHER
IMPLEMENTATION SCIENCE, THE NEXT
CALL IN JUNE, WE'LL FOCUS ON ONE
FOR A COMMUNITY PARTNER,
MATERNAL HEALTH AND
IMPLEMENTATION RESEARCH
SCIENTIST RESEARCH SCHOLAR WHO
YOU HEARD EARLIER TODAY.
SHE HAS BEEN A FANTASTIC START
TO THE PROGRAM, DOING THAT EACH
YEAR.
NEXT APPLICATIONS OPEN IN
JANUARY, WE'RE OPENING A NURSE
SCHOLAR PROGRAM PARALLEL FOR
NEXT YEAR AS THAT.
WE HAVE INTERNAL POSTDOCS AND
SUMMER STUDENTS.
I THANK ALL OF YOU WHO
PARTICIPATED IN OUR SUMMER
STUDENTS RESEARCH PROGRAM TRYING
TO GENERATE A MEASURE TO ASSESS
QUALITY OF EQUITABLE
RELATIONSHIPS BETWEEN COMMUNITY
PARTNERS AND RESEARCHERS AND
THAT I THINK IS GOING TO BE A
REALLY EXCITING PROJECT THAT
CONTINUES TO MOVE AHEAD.
THANK YOU TO THE NIH AND THANK
YOU TO ALL OF YOU FOR LISTENING
AND CONTRIBUTING AND BEING PART
OF OUR HUB.
IF THERE'S YOU INNING -- IF
THERE'S ANYTHING YOU NEED OR
WANT FROM US WE'RE HELP TO
ADJUST SO PLEASE LET US KNOW.
>> WE HAVE ABOUT A MINUTE FOR
QUESTIONS.
IF YOU HAVE QUESTIONS COME TO
THE MIC.
>> THANK YOU FOR THAT.
EMILY LITTLE, NURTURE LEE.
I HEARD YOU HIGHLIGHT CENTERS OF
EXCELLENCE A LOT.
AND WE'RE NOT REPRESENTING A
CENTER OF EXCELLENCE, WE WERE A
CONNECTING THE COMMUNITY FOR
MATERNAL HEALTH CHALLENGE
WINNER, AND OUR RESEARCH AND
LOVE TO HEAR ABOUT ALL THESE
RESOURCES AND CURIOUS IF WE'RE
ELIGIBLE FOR COLLABORATION.
>> I APPRECIATE THAT.
OVER OUR FIRST YEAR WITH THE
INITIAL FUNDING WE WERE FOCUSED
ON FIRST CENTERS OF EXCELLENCE,
NOW THAT WE'RE EXPERIENCING THE
SPAN OF THE FULL IMPROVE
INITIATIVE OUR GOAL OVER THE
NEXT YEAR IS TO EXPAND ALL OF
THIS TO ENCOMPASS EVERYONE UNDER
THE IMPROVE UMBRELLA.
WE'LL GET CONTACTS FOR EVERYONE
AND MAKE SURE RESOURCES ARE
AVAILABLE.
>> THANK YOU.
>> THANK YOU, THANKS TO ALL THE
PRESENTERS FROM SESSION 6.
WE'LL NOW TRANSITION TO THE NEXT
SESSION AND INVITE DR. GINA WEI
TO THE STAGE.
>> HOME STRETCH.
WE HAVE ABOUT 40 PEOPLE STILL IN
ZOOM.
THAT'S A GOOD NUMBER.
I CAN'T REALLY SEE THE LIGHT
HERE, I'M GUESSING PROBABLY
40ISH AS WELL.
YEAH, WE'VE STILL GOT 80 PEOPLE
STRONG HERE, EXCELLENT.
THE FIRST THING I'M GOING TO DO
IS REVIEW.
I THANK MY COLLEAGUES AT NICHD
FOR DOING THIS.
THIS IS NOT IT.
THIS IS OUR QUESTIONS.
MAYBE IF WE CAN HAVE THE SUPPORT
BACK THERE TO PUT UP THE SLIDE.
THERE WE GO.
THERE.
EXCELLENT.
NOT THERE.
ALMOST.
95% THERE.
ALL RIGHT.
OKAY.
GREAT.
ALL RIGHT.
I MAY HAVE MESSED IT UP.
I'M GOING TO NOT TOUCH ANYTHING
AND LET YOU ALL DO IT AGAIN.
ALL RIGHT.
SO TODAY WAS ANOTHER WONDERFUL
DAY.
YESTERDAY WAS A WONDERFUL DAY,
TODAY IS A WONDERFUL DAY, I
LEARNED QUITE A LOT.
WE WANT TO THANK THE TWO NEW
AWARDEES.
[APPLAUSE]
YEAH, I DON'T KNOW IF YOU'RE
STILL HERE.
UNIVERSITY OF ILLINOIS, CHICAGO.
AND UNIVERSITY OF PITTSBURGH.
I DON'T KNOW IF YOU'RE HERE.
I DON'T WANT TO CALL YOU OUT.
YEAH, OKAY, EXCELLENT.
WELCOME.
GREAT PRESENTATIONS, GREAT TO
HAVE YOU.
IN THE MORNING WE HEARD SPECIAL
PANELS ON THEMES FROM THE SOCIAL
DETERMINANTS OF HEALTH.
REALLY TO ME IT WAS EYE OPENING,
TRANSPORTATION WITH COMMON ISSUE
FOR A FEW OF THE RURAL AREAS,
TWO HOURS TO GET TO OB.
I COUNT MYSELF FORTUNATE NOT TO
HAVE TO WORRY ABOUT THAT BUT
IT'S SOMETHING WE'RE DEALING
WITH REALITY AND TRYING TO
ADDRESS.
SO TRANSPORTATION, DISTANCE TO
CARE, LIMITED OPTIONS, MA TERCHT
-- MATERNITY DESERTS.
LONGSTANDING SYSTEMS THAT
IMPACT, HOUSING AND STABILITY,
AND FOOD INSECURITY.
WE HEARD ABOUT MEASURING
ALLOSTATIC LOAD, BIOLOGICAL
WEATHERING, INTERGENERATIONAL
TRAUMA AS WELL AS JUST
INTERVENING AT THE MULTI-LEVEL
INTERVENTIONS.
WE HEARD ABOUT THE OTHER PANELS,
WE HEARD EXCITING PANELS ON
CARDIOVASCULAR AND BLOOD HEALTH,
HOW TO OPTIMIZE INTERVENTIONS.
THERE'S TREATMENT SUPPORTS,
WE'VE GOT TWO TECHNOLOGIES THAT
WE HEARD TODAY.
AND JUST DIFFERENT ADVANCEMENTS.
WE HEARD IMPORTANCE OF ANEMIA,
HOW THAT'S PREVALENT AND
UNDERDIAGNOSED, HEMORRHAGE, ALSO
BLOOD PRESSURE AND PREECLAMPSIA
THEN WE HEARD ABOUT
OPPORTUNITIES TO TRY TO BEND THE
CURVE, THAT THE NATION IS
HEADING IN THE WRONG DIRECTION,
TO BEND IT DOWN AND IMPROVE
MATERNAL HEALTH.
SEVERAL DATA INSIGHTS,
MULTI-LEVEL AND SYSTEMS
APPROACHES WE HEARD, AND POLICY
TO IMPROVE THE OUTCOMES, MEASURE
DATA TO INFLUENCE POLICY AND
ACTUALLY MEASURED AFTERWARDS TO
CONTINUE ON.
THE AFTERNOON PANELS WE HEARD
ABOUT THE PREDICTION OF JUST
TRYING TO PREDICT TOOLS AS WELL
AS WONDERFUL RESOURCES FROM OUR
IMPLEMENTATION SCIENCE HUB AND
ALSO OUR DATA INNOVATION HUB AS
WELL.
SO I THINK THAT'S JUST BRIEF
SUMMARY, REALLY WONDERFUL TO
HEAR THE PRESENTATION AND THEN
THE ENGAGEMENT.
RIGHT NOW WE'RE GOING TO MOVE
FORWARD TO THE SESSION HERE.
OKAY.
SO, WE WANT TO HEAR FROM YOU.
WE KNOW YOU SAT HERE FOR THE
LAST TWO DAYS, YOU HEARD A LOT
OF TALKS.
YOU ENGAGED.
NOW WE REALLY WANT YOU TO COME
HELP US THINK ABOUT HOW IMPROVE
CAN MOVE FORWARD TO THE FUTURE.
THERE ARE NO GUARANTEES BUT WE
LOVE TO HEAR YOUR IDEAS.
SO YOU CAN SEE WE HAVE THREE
QUESTIONS THAT YOU CAN PICK AND
CHOOSE.
FIRST TO SHARE YOUR THOUGHTS,
COULD BE WILD, POTENTIAL FUTURE
OPPORTUNITIES, AREAS OF SCIENCE
THE IMPROVE PROGRAM COULD
ADDRESS TO ADVANCE MATERNAL
HEALTH RESEARCH, THAT'S THE
BROAD TEAM.
WHAT CAN IMPROVE DO AND THINK
WILDLY.
THE OTHER TWO ARE REFLECTION.
THE SECOND QUESTION IS WHAT
POTENTIAL NEW COLLABORATIONS
FROM PROJECTS OR FROM OTHER
IMPROVE WORK STREAMS HAVE RISEN
FROM NETWORKING OPPORTUNITIES OR
JUST FROM YOU LISTENING AND
CONNECTING WITH PEOPLE
AFTERWARDS.
SO, WE LOVE TO HEAR ABOUT THAT.
THIRD IS AGAIN EVEN MORE PERSON
DID YOU IDENTIFY ONE OR MORE NEW
IDENTITIES OR AREAS YOU PLAN TO
EXPLORE OR PURSUE FURTHER AFTER
THIS MEETING.
SO, THESE ARE THE OPEN
QUESTIONS.
THEY ARE OPEN TO BOTH THOSE ON
THE ZOOM ROOM WHICH I CAN SEE
AND ALSO FOR YOU TO SHARE.
ANY TAKERS?
GREAT, ALL RIGHT.
I CAN'T SEE SO I NEED HELP.
>> THANK YOU.
AGAIN, THANK YOU TO ALL OF YOU
FOR HOSTING THIS IN-PERSON
MEETING, EXTREMELY VALUABLE,
WE'RE ALL GRATEFUL FOR THIS
OPPORTUNITY.
I'M BIASED, BUT THE "IMPROVE"
INITIATIVE TO FOCUS ON SPEAK
BEING RESEARCHING OF TRADITIONL
AND CULTURAL PRACTICES,
INNOVATION AND NEW TECHNOLOGIES,
I LOVED HEARING ABOUT THE
WONDERFUL NEW TECHNOLOGIES THAT
WERE PROPOSED AND DEVELOPED, ALL
OF THAT IS EXTREMELY NEEDED AND
VALUABLE.
AND ALSO WE KNOW THERE ARE SOME
ANCIENT TECHNOLOGIES AND
CULTURAL TOOLS THAT HAVE NOT
GOTTEN APPROPRIATE
ACKNOWLEDGMENT AND ATTENTION
FROM THE SCIENTIFIC COMMUNITY,
CARING BEING ONE BUT POSTPARTUM
CARE PRACTICES AROUND THE WORLD,
PELVIC STEAMING, INFANT MASSAGE,
POSTPARTUM NUTRITION PRACTICES,
ALL OF THESE THINGS THAT WERE
CALLED OUT IN THE WOMEN'S HEALTH
INNOVATION OPPORTUNITY MAP BY
NIH AND GATES FOUNDATION FROM A
GLOBAL HEALTH PERSPECTIVE, I
WANTED TO PUT THAT TO THE TABLE
AS FAR AS A RESEARCH AREA THAT
COULD BE REALLY EXPLORED AND
UTILIZED TO TACKLE SOME OF THESE
POSTPARTUM HEALTH CHALLENGES IN
PARTICULAR.
THANK YOU.
>> THANK YOU.
THANK YOU.
YOU'RE THE FIRST ONE TO SPEAK
UP.
GREAT.
>> I THINK MY THOUGHT MAYBE
SPANS ALL THREE OF THOSE A BIT
BUT I THINK ONE PARTICULARLY
FRUITFUL AREA THAT IMPROVE COULD
SUPPORT IS REALLY THE NEXUS
AMONG WORKFORCE EXPANSION,
TOGETHER WITH INNOVATIONS,
TECHNOLOGIC INNOVATIONS THAT
WOULD ENABLE MORE COMMUNITY-BASE
AND HOME MONITORING TO
ACCOMPLISHING MONITORING AND
SURVEILLANCE AND THE PREGNANCY
AND POSTPARTUM PERIOD IN A WAY
THAT'S VERY CULTURALLY ENGAGE
AND ACCESSIBLE, LOOKING AT
MODELS TO REALLY ENGAGE THE
HUMAN FACTOR AND TECHNOLOGIC
FACTOR IN A WAY THAT'S MEETING
THE NEEDS OF THE COMMUNITIES
MOST AT RISK FOR THESE OUTCOMES
>> A COMMON THEME ABOUT
CULTURAL, YOU ADDED USING
TECHNOLOGY IN A RESPONSIBLE WAY.
>> SO THIS MIGHT BE TOO BIG OF A
QUESTION FOR THIS GROUP.
I MIGHT BE BIASED, WANTING TO
TALK ABOUT ONE SPECIFIC
COMPONENT OF INTERVENTION WE
USE, COMMUNITY HEALTH WORKERS,
HOME VISITING.
I'VE NOTICED THAT THIRD IF NOT
MORE OF THE CENTERS ARE IN ONE
SHAPE OR ANOTHER USE SIMILAR
TIMES OF INTERVENTIONS,
COMMUNITY HEALTH WORKERS, YET
THE BIGGEST ISSUE WE FEEL WE
DON'T HAVE SUSTAINABILITY SO
THERE'S NO SUSTAINABLE FUNDING
THAT ALLOWS LIVING WAGE, LIVABLE
WAGE FOR COMMUNITY HEALTH
WORKERS AND I WONDER, I KNOW
IMPROVE'S MISSION IS TO FUND
RESEARCH BUT IF THERE'S A WAY,
TO REALLY INFLUENCE AND COULD BE
INFLUENCE THE FEDERAL
GOVERNMENT, STATE GOVERNMENT,
WHOM EVER, A COALITION OF VERY
SMART PEOPLE WITH POWERS TO GET
TO A FUNDABLE MODEL, SUSTAINABLE
FUND AND MODEL, ONE EXAMPLE, ONE
TOOL WE HAVE EVIDENCE THAT IT
WORKS SO IT'S ONE OF THE, YOU
KNOW, THINGS, RIGHT, THAT WE'RE
TRYING TO SUSTAIN AND IMPLEMENT,
YET IT'S LIKE THE BIGGEST HURDLE
WE FACE IS SUSTAINING IT, AND
WE'RE TALKING ABOUT INDIVIDUALS,
LIVING WAGE, WE'RE TALKING ABOUT
EQUITY IN THE WORKFORCE, ALL OF
THOSE THINGS.
>> THANK YOU.
SO YOU'RE TALKING --
>> CAN I RESPOND?
>> YEAH, THANK YOU.
>> I THINK DATA, YOUR DATA IS
GOING TO BE SO IMPORTANT BECAUSE
ONCE WE HAVE DATA SHOWING AT
LEAST WITHIN THE CENTERS, THIS
IS WHAT WE HAVE BECAUSE WE'RE
NOT NECESSARILY A SERVICE
ORGANIZATION, RIGHT, BUT WE CAN
ADVOCATE WITH YOUR RESEARCH,
THAT'S THE STRENGTH OF ALL YOUR
WORK.
>> YEAH, I DON'T KNOW, KEISHA
AND I WERE TALKING ABOUT THIS
DURING BREAK.
WHAT IS IT THAT NIH COULD DO AND
WHAT IS IT THAT OTHER AGENCIES
LIKE HRSA AND CDC, SO WHAT IS
OUR SWIM LANE, WHERE CAN WE
MERGE TOGETHER TO HELP EACH
OTHER?
HRSA, THEY ARE OFFERING
SERVICES, RIGHT?
THEY DO THE HOME HEALTH CARE,
HOME VISITING NURSES PROGRAM SO
THEY HAVE THAT.
THEY ALSO HAVE PROGRAMS TO
ENABLE USE OF AIM BUNDLE.
KEISHA, ARE YOU STILL HERE?
SHE MAY HAVE LEFT.
SHE USED TO WORK AT HRSA AND SHE
SAYS OFTENTIMES WHEN HRSA
BUDGETS GET CUT THE FIRST THING
THAT GOES IS THE DATA AND
EVALUATION PIECE.
ALSO WHAT'S REALLY NEEDED IS FOR
RESEARCH DATA TO BE GENERATED TO
BE ABLE TO HELP TO IMPLEMENT
PROGRAMS OR TO SAY, OKAY, IF
THIS CAN BE IMPLEMENTABLE IN ONE
SETTING, WHAT RESEARCH IS NEEDED
IN THE WIDER SETTING, ALSO
POLICY IMPACT, ET CETERA.
GREAT QUESTION.
THIS IS SOMETHING WE WANT TO
CONTINUE TO THINK ABOUT WHERE WE
CAN SORT OF FIT THE NEED AND
ALSO CONTINUE TO WORK TOGETHER
WITH OTHER AGENCIES.
>> I WANTED TO ADD WITH THE
POTENTIAL NEW COLLABORATIONS ONE
OF THE MOST BEAUTIFUL THINGS
ABOUT THE IMPROVE MODEL WITH THE
CENTERS OF EXCELLENCE HAS BEEN
THAT COMMUNITY PARTNERSHIP
COMPONENT.
OUR CONTACT P.I. IS AN
INCREDIBLE CLINICIAN WHO REACHED
OUT TO MYSELF AND COMMUNITY
PARTNER TO SEE IF WE WANTED TO
ASSIST HER IN THIS.
WE PARTNERED TOGETHER FOR TEN
YEARS, NEVER HAD SEVEN YEARS OF
SUSTAINABLE FUNDING SO IT'S BEEN
BEAUTIFUL TO HAVE THAT KIND OF
SECURITY IN A COMMUNITY-BASED
ORGANIZATION, IT'S BEEN AWESOME.
IT'S ALSO ALLOWED US TO MAKE
CONNECTIONS, WHEN YOU'RE GETTING
YEAR TO YEAR FUNDING WITH YOUR
PARTNER YOU'RE WRITING THE NEXT
GRANT LIKE BEFORE THE ONE FIRST
IS HALFWAY DONE.
WE'VE GOT TEN TO MEET INCREDIBLE
CENTERS.
YOU THINK I'M THE ONLY ONE
HAVING PROBLEMS WITH XYZ, YOU
CONNECT ACROSS CENTERS, OH, YOU
HAD PROBLEMS WITH THAT ERA
COMMONS REGISTRATION TOO, HAD
YOU TO WRITE COMMUNITY
BIOSKETCHES IN THE MIDDLE OF THE
NIGHT TOO.
WE'RE EXCITED ABOUT THE
POTENTIAL TO SHARE OUR
EXPERIENCES IN HOPE OF
CONTRIBUTING TO POSITIVE
IMPROVEMENTS, NOT TO CRITICIZE
BUT TO SAY HOW CAN WE WELCOME
MORE PEOPLE TO THE TABLE, SO
IT'S BEEN SUCH A COOL SPACE TO
DO THAT.
THANK YOU FOR THAT.
>> THANK YOU FOR THE FEEDBACK
AND COMMENT.
YES, THANKS.
>> I'M FROM THE CIRCLE CENTER.
I THINK THIS IS A WONDERFUL
OPPORTUNITY, EXCITED TO BE HERE
AND HEAR THESE TALKS.
I LOVE THE PRESENTATIONS ON THE
TECHNOLOGIES.
I KNOW THAT OUR FLOURISH TEAM
WHICH IS FOCUSED ON FOOD
SECURITY INTERVENTION HAS BEEN
INTERESTED IN IMPLEMENTING
WEARABLES, FOR COLLABORATION.
MY BACKGROUND IS SOCIAL
DEMOGRAPHER, WORKING SOME WITH
BIOMEDICAL DATA BUT WEARABLE
DATA IS OVERWHELMING TO ME.
I THINK FOR THOSE OF US THAT DID
NOT BUILD THAT INTO OUR PROJECT
TO BEGIN WITH, IN ORDER TO DO A
GOOD JOB WITH IMPLEMENTING NEW
TECHNOLOGY, WE REALLY NEED SOME
COLLABORATION FROM THOSE OF YOU
WHO DO THIS ON A REGULAR BASIS
AND HAVE THOSE SKILLS.
SO I DON'T KNOW IF THERE'S A WAY
MAYBE THROUGH THE DATA
INNOVATION HUB OR SOME WAY TO
CONNECT THE PROJECTS, WHEN TO
ADD IN ADDITIONAL COMPONENT WITH
WEARABLES, HOW WE FIND
APPROPRIATE PARTNERS, WHAT WE DO
WITH THE VAST AMOUNT OF DATA, IF
WE ADD THAT IN.
THOSE ARE SOME THINGS I THINK
ABOUT WHEN I SEE EXCITING
OPPORTUNITIES, BUT I KNOW THE
REALITY OF HAVING A TON OF DATA.
>> THANK YOU.
>> GREAT POINTS.
WE'LL TURN ON OUR TEAM LATER BUT
I THINK AT LEAST INITIALLY
CONNECTING EVERYONE TOGETHER WAS
OUR GOAL FOR THIS SO I'M GLAD
EVERYBODY IS HERE TO HEAR THE
TECHNOLOGY TALKS AND THEN THE
NEXT PHASE IS TRYING TO FIGURE
OUT HOW TO CONNECT YOU ALL AS
YOU NEED TO WITH THE VARIOUS
ENTITIES.
>> ONE OF MY PROMPT QUESTIONS IS
ABOUT TECHNOLOGY, FOR YOU ALL TO
SHARE WHAT YOU THINK ARE THE
BENEFITS AND BARRIERS THAT YOU
SEE IN PROMOTING OR IMPLEMENTING
USE OF REMOTE MONITORING AND
POINT OF CARE DEVICES.
>> REBECCA HAD A FOLLOW-UP.
>> IT COULD RELATE TO THAT TOO.
I THINK COMBINING WHAT JESSICA
SAID IS IMPORTANT IN TERMS OF
THINKING ABOUT THE FACT THAT
SUSTAINABILITY IS A FEAR OF ALL
OF OURS, WE GO INTO THIS WORK
KNOWING WE'RE TRYING TO EITHER
GENERATE EVIDENCE OR IMPLEMENT
SOMETHING IN A WAY THAT THEN
WOULD BE GENERALIZABLE AND WE
FEAR THAT WOULD DISAPPEAR.
WHAT YOU BROUGHT UP, COMMUNITY
PARTNERS AT THE TABLE, ELEVATES
THAT.
WHAT YOU SAID ABOUT SAFETY
SCARES ME, POLICY AND
DISSEMINATION PIECE NOW, IT'S
EASY TO SAY WE'RE GOING WAIT
UNTIL WE'RE DONE WITH SEVEN-YEAR
GRANTS, WE'LL FIVE OR SIX WE'LL
THINK ABOUT IT, WE NEED TO WORK
ON IT NOW.
WAYS PEOPLE WANT TO CONTINUE TO
COLLABORATE THROUGH OUR HUB
WE'RE HAPPY TO DO THAT.
>> I THINK -- SO I'M FROM ALSO
NOT ONE OF THE MATERNAL CENTERS
OF EXCELLENCE BUT FROM THE
CONNECTING THE COMMUNITY
CHALLENGE.
AND I WORK AS A CERTIFIED NURSE
MIDWIFE IN ATLANTA.
AND LISTENING TO THESE, THINKING
ABOUT OUR PROJECT, I DO THINK
THERE'S AN OPPORTUNITY TO ENGAGE
MIDWIFERY, AND I HEARD THAT IN
OTHER PRESENTATIONS, BUT FOR
MOST OF THE PEOPLE IN THE U.S.
THE WAY MIDWIFERY OPERATES IS
OUTSIDE OF LIKE ACADEMIC MEDICAL
INSTITUTIONS SO I THINK
STRUCTURALLY IT'S HARD TO GET
THAT INTO STUFF LIKE THIS BUT
WHEN YOU'RE THINKING HOW YOU CAN
ENGAGE COMMUNITIES THERE ARE
MANY PEOPLE WHO PRACTICE
MIDWIFELY OUTSIDE OF WHAT THE
MEDICAL BOARDS ARE RECOGNIZING
BUT HAVE A LOT OF KNOWLEDGE AND
PROBABLY LIKE ARE ALREADY DOING
A LOT OF IMPROVEMENT THINGS
WE'RE LEARNING CAN BE HELPFUL,
SO I THINK FIGURING CERTAINLY
LIKE OUR STATE HAS CHALLENGES
WITH DIFFERENT TIMES OF
MIDWIVES, HAVEN'T BEEN ABLE TO
PROVIDE LICENSURE AND WORK
TOGETHER BUT I THINK, YOU KNOW,
THERE'S NO SENSE REINVENTING THE
WHEEL, IT MAKES SENSE TO ME TO
ENGAGE THAT COMMUNITY
PARTNERSHIP.
>> THANK YOU.
>> I'M NOT SURE IF WE HAVE
ONLINE QUESTIONS.
>> I'M CHECKING.
NOTHING ONLINE.
>> FOR US, IT'S A NEW COMPONENT
OF MAKING SURE THAT THERE'S
EQUITY AND THE COMMUNITY
PERSPECTIVE BECAUSE WE REALIZE
THAT MATERNITY MORBIDITY AND
MORTALITY IS MULTI-FACTORIAL,
POLICY LEVEL AND THAT THERE ARE
A LOT OF CHALLENGES IN
ADDRESSING IT.
SO WE INTENTIONALLY WROTE THE
FUNDING ANNOUNCEMENT WITH HAVING
EQUALITY IN THE COMMUNITY
PARTNERSHIP FROM THE BEGINNING.
THANK YOU ALL FOR RECOGNIZING
THAT.
AND ACTUALLY HAVING IT ACTUALLY
COME TO LIFE BECAUSE IT'S ONE
THING TO WRITE IT, IT'S ANOTHER
THING FOR IT TO MATERIALIZE SO
WE THANK YOU, HOW YOU PUT THE
CENTERS TOGETHER.
YOUR ACTIVITIES TOGETHER.
SO THAT YOU CAN REFLECT THE
COMMUNITY PERSPECTIVE IN ALL
THAT WE DO.
>> YEAH.
ALL RIGHT.
I'M JUST GOING TO SEE IF ANYBODY
WOULD LIKE TO SAY ANYTHING ELSE
BEFORE I THANK PEOPLE AND CLOSE
THE MEETING.
NO?
>> IF I MAY SUGGEST THE NEXT ONE
TO BE EXCLUSIVELY IN PERSON
PERHAPS, THE NEXT MEETING.
WE GET MORE OF US -- I MEAN, IT
WAS GREAT TO MEET AND ACTUALLY
TALK TO MANY OF YOU AS OPPOSED
TO ZOOM.
WE KNOW IT'S CHEAP BUT -- JUST A
THOUGHT.
>> ABSOLUTELY, YES.
THANK YOU.
WE'RE HOPING TO DO THIS
ANNUALLY.
>> YEAH.
I KNOW I LEARNED SO MUCH.
AND IT'S REALLY -- I DON'T KNOW
HOW TO DESCRIBE IT.
TO HAVE A COALITION OF
LIKEMINDED PASSIONATE
RESEARCHERS, COMMUNITY ENGAGED
FOLKS, AND PARTNERS, JUST ALL
TOGETHER TRYING TO TACKLE THIS
ATROCITY IN THE U.S., AND JUST
DOING IT TOGETHER AND IT'S VERY
INSPIRING AND I HOPE THAT YOU
REALLY ENJOYED THE LAST FEW DAYS
LIKE I HAD.
I WANT TO THANK NAHIDA, BUT YOU
REPRESENT ALL THE COLLEAGUES AND
THE PEOPLE THAT WORK BEHIND THE
SCENES, TO MAKE THIS HAPPEN.
IT'S REALLY -- ALL OF YOU FOR
ATTENDING, ALL OF YOU, BOTH ON
THE ZOOM AND ALSO IN PERSON, AND
YOUR PRESENTATIONS, BUT NOT JUST
YOUR PRESENTATIONS BUT WHAT YOU
ALL DID BEFORE YOU CAME HERE,
ALL OF THE WORK YOU'VE DONE THE
PAST YEAR OR EVEN BEFORE THAT,
AS PART OF THE IMPROVE FAMILY,
PART OF IMPROVE AWARDEES, IT'S
TREMENDOUS.
>> ONE MORE COMMENT.
>> SORRY, A QUICK REFLECTION.
I'M WITH THE DATA INNOVATION AND
COORDINATION HUB.
I THINK THIS IS A GREAT
OPPORTUNITY FOR US TO MAKE THOSE
CONNECTIONS, WE'VE ALL BEEN
MEETING ONLINE, AND I ECHO WHAT
CHRIS IS SAYING, THE VALUE OF
BEING IN PERSON AND FURTHER
THOSE CONNECTIONS, I WANT TO
REFLECT ON A