>> ALL RIGHT, GOOD MORNING TO
EVERYONE.
A SPECIAL WELCOME TO OUR
COUNCILMEMBERS AND TO THE NINR
SCIENCE COMMUNITY.
THE MEETING IS BEING VIDEOCAST
LIVE AND WILL BE ARCHIVED ON THE
NIH VIDEOCAST WEBSITE, SO THANK
YOU, EVERYONE, FOR JOINING US
TODAY.
SO BEFORE WE GET STARTED, I'D
LIKE TO WELCOME OUR NEW MEMBERS.
SO DR. VINCENT IS RECENTLY
APPOINTED DIRECTOR OF THE
INSTITUTE FOR POLICY SOLUTIONS
AT JOHNS HOPKINS SCHOOL OF
NURSING.
HE PREVIOUSLY SERVED AS DEAN AND
DISTINGUISHED PROFESSOR OF THE
DUKE UNIVERSITY SCHOOL OF
NURSING AND VICE CHANCELLOR FOR
NURSING AFFAIRS, WHERE HE
REALIGNED THE SCHOOL'S MISSION
AND STRATEGIC PLAN TO ADVANCE
HEALTH EQUITY AND SOCIAL
JUSTICE.
DR. GUILAMO-RAMOS STUDIES THE
ROLE OF FAMILIES IN PROMOTING
ADOLESCENT HEALTH AND HE LED THE
DEVELOPMENT OF THE FRAMEWORK FOR
HARMFUL SOCIAL DETERMINANTS OF
HEALTH MITIGATION.
AN INNOVATIVE ROAD MAP FOR THOSE
DESIGNING PROGRAMS TO MITIGATE
ADVERSE SOCIAL DETERMINANTS OF
HEALTH.
HE SERVES ON SEVERAL ADVISORY
BOARDS, HHS PANELS AND BOARD OF
DIRECTORS.
WELCOME, VINCENT.
DR. JING WANG, USING MOBILE AND
CONNECTED TECHNOLOGIES TO
OPTIMIZE LIFESTYLE INTERVENTIONS
AND IMPROVE PATIENT-CENTERED
OUTCOMES IN CHRONICALLY ILL AND
AGING POPULATIONS, ESPECIALLY
AMONG RURAL AND UNDERSERVED
POPULATIONS.
SHE PIONEERS ARTIFICIAL
INTELLIGENCE IN NURSING AND
SMART HOME INNOVATIONS FOR AGING
IN PLACE AND CARE AT HOME
DELIVERY MODELS.
SHE SERVES AS BOARD OF TRUSTEE
AT THE ROBERT WOOD JOHNSON
FOUNDATION AND HCA FLORIDA
CAPITAL HOSPITAL.
SO WELCOME, DR. WANG.
SO WELCOME TO YOU BOTH.
WELCOME TO COUNCIL.
WE ARE DELIGHTED TO HAVE YOU AND
LOOK FORWARD TO WORKING WITH
YOU.
SO I'D ALSO LIKE TO WELCOME AN
AD HOC MEMBER FOR THIS MEETING,
DR. MARIE LYNN MIRANDA IS
CHANCELLOR OF THE UNIVERSITY OF
ILLINOIS CHICAGO.
SHE IS AN ECONOMIST AND LEADER
IN THE FIELD OF GEOSPATIAL
HEALTH INFORMATICS AND IS KNOWN
FOR HER WORK IN CHILDHOOD-LED
EXPOSURE AND CLIMATE CHANGE.
CHANCELLOR MIRANDA IS THE
DIRECTOR OF THE CHILDREN'S
ENVIRONMENTAL HEALTH INITIATIVE,
A RESEARCH, EDUCATION AND
OUTREACH ORGANIZATION COMMITTED
TO FOSTERING ENVIRONMENTS WHERE
ALL PEOPLE CAN PROSPER.
WELCOME TO YOU, AND THANKS FOR
JOINING US.
SO THIS WILL SADLY BE THE LAST
MEETING FOR SEVERAL OF OUR
COUNCIL MEMBERS.
DR. MALLORY JOHNSON,
DR. CHRISTOPHER LEE, AND
DR. SYDDR. --DR. CINDY MUNRO ARS
TODAY FOR THE LAST TIME.
DR. ELIAS PROVENCIO-VASQUEZ
COULDN'T MAKE IT BUT IT WOULD
HAVE BEEN HIS LAST COUNCIL
MEETING AS WELL.
WE THANK YOU ALL FOR YOUR
SERVICE TO NINR.
THEY'VE SERVED SINCE 2021.
I PERSONALLY HAVE REALLY ENJOYED
THE OPPORTUNITY TO WORK WITH
EACH OF YOU, AND I WOULD LIKE TO
EXTEND A SPECIAL CONGRATULATIONS
TO DR. CINDY MUNRO.
SHE IS RETIRING FROM A
DISTINGUISHED CAREER IN NURSING
SCIENCE.
IN JUST A FEW SHORT DAYS.
SO A SPECIAL CONGRATULATIONS TO
YOU, AND RECOGNITION FOR YOUR
LONG AND IMPACTFUL CAREER.
THANK YOU.
SO I WILL TURN THE MEETING OVER
TO DR. ELIZABETH TARLOV, OUR
EXECUTIVE SECRETARY, WHO WILL
PROCEED WITH THE ROLL CALL.
[SPEAKER OFF MIC]
>> I CAN BARELY HEAR YOU BUT I'M
HERE.
>> THANK YOU.
YOU SHOULD HEAR ME BETTER NOW
THAT I'VE MANAGED TO TURN ON MY
MIC.
THANK YOU.
THANK YOU, DR. STONE.
ALL RIGHT.
PROCEEDING WITH THE ROLL CALL
NOW, I ASK THAT THE
COUNCILMEMBERS HERE ON THE NIH
CAMPUS IN BETHESDA, PLEASE RAISE
YOUR HAND OR SAY "PRESENT" OR
"HERE" WHEN I CALL YOUR NAME.
DR. ATKINS.
>> HERE.
>> DR. AYALA.
>> PRESENT.
>> DR. BEKEMEIER.
>> HERE.
>> PROFESSOR DAWES.
DR. FITZPATRICK.
>> PRESENT.
>> DR. RAMOS.
DR. JOHNSON.
DR. LEE.
DR. MUNRO.
DR. WANG.
AND I NOTE THAT DR. SULLIVAN IS
PRESENT AS EX-OFFICIO FOR THE
CHIEF NURSING OFFICER DEPARTMENT
OF VETERANS AFFAIRS.
AND LIEUTENANT COLONEL GARDNER
IS PRESENT AS EX-OFFICIO FOR
ASSISTANT SECRETARY OF DEFENSE
FOR HEALTH AFFAIRS.
DRWE HAVE A QUORUM FOR THIS
MEETING.
I'LL KNOW TURN TO A VOTE OR
MINUTES FOR THE JANUARY COUNCIL
MEETING, AVAILABLE IN THE
ELECTRONIC COUNCIL BOOK FOR YOUR
REVIEW.
MAY I HAVE A MOTION TO APPROVE?
>> MOVE TO APPROVE.
>> A SECOND?
>> SECOND.
>> THANK YOU.
ANY DISCUSSION?
ANY OPPOSED?
MOTION CARRIES.
NOW WE'LL MOVE ON TO A FEW WORDS
ON MEETING LOGISTICS.
COUNCILMEMBERS, WHEN YOU SPEAK,
PLEASE USE THE "PUSH TO TALK"
FEATURE ON THE MICROPHONE IN
FRONT OF YOU TO ENSURE THAT
EVERYONE CAN HEAR YOU.
AND PLEASE TURN OFF YOUR
MICROPHONE WHEN NOT IN USE.
THIS IS A ONE-DAY MEETING.
AS ALWAYS, A RECORDING OF THIS
MEETING WILL BE MADE AVAILABLE
AT THE ADDRESS SHOWN ON THE
SLIDE.
CLOSED SESSION WILL BEGIN
APPROXIMATELY 15 MINUTES
FOLLOWING THE END OF OPEN
SESSION.
DATES FOR FUTURE COUNCIL
MEETINGS ARE LISTED ON THE NINR
COUNCIL WEBPAGE AS WELL AS IN
THE OPEN SESSION MATERIALS IN
THE ELECTRONIC COUNCIL BOOK.
AND SHOWN HERE.
PLEASE ADD THESE DATES TO YOUR
CALENDAR.
OUR NEXT MEETING IS SCHEDULED
FOR SEPTEMBER 12TH, 2024, AND
WILL TAKE PLACE HERE IN PERSON
IN BETHESDA.
I WOULD LIKE TO REMIND
COUNCILMEMBERS, OTHER THAN OUR
EX-OFFICIO MEMBERS, THAT YOU ARE
SPECIAL GOVERNMENT EMPLOYEES.
AS SUCH, YOU MAY NOT ENGAGE IN
LOBBYING ACTIVITIES WHILE
RECEIVING PAY FROM THE FEDERAL
GOVERNMENT.
INFORMATION REGARDING CONFLICT
OF INTEREST AND CONFIDENTIALITY
REQUIREMENTS ARE POSTED IN THE
ELECTRONIC COUNCIL BOOK, SO
PLEASE REVIEW THOSE IF YOU
HAVEN'T DONE SO ALREADY.
I WILL GIVE MORE SPECIFIC
INSTRUCTIONS ABOUT CONFLICT OF
INTEREST AND CONFIDENTIALITY AT
THE BEGINNING OF THE CLOSED
SESSION LATER THIS AFTERNOON.
NOW I'LL TURN IT BACK TO DR
DR. ZENK FOR THE NINR DIRECTOR'S
REPORT.
>> THANK YOU.
I GET STARTED.
AS I WAS PUTTING TOGETHER THE
UPDATE FOR TODAY'S MEETING, IT
REALLY STRUCK ME WHAT AN
EXCITING TIME IT IS TO BE
THINKING ABOUT IMPLEMENTATION OF
OUR STRATEGIC PLAN.
THE WORK WE'RE DOING AT THE
INSTITUTE UNDER THE STRATEGIC
PLAN REALLY IS TRULY MOVING US
FORWARD IN OUR MISSION OF
OPTIMIZING HEALTH AND ADVANCING
HEALTH EQUITY INTO THE FUTURE.
SO LET'S START WITH SOME OF THE
WAYS THAT NINR IS ADVANCING
SCIENCE SINCE JANUARY THROUGH
FUNDING OPPORTUNITIES,
SCIENTIFIC EVENTS, AND
PUBLICATIONS.
SO AT THE JANUARY COUNCIL
MEETING, WE CLEARED THE CONCEPT
OF EXPANDING RESEARCH TO ADVANCE
HEALTH EQUITY IN RURAL
POPULATIONS.
ALTHOUGH COUNCIL APPROVAL MAY OR
MAY NOT LEAD TO A NEW FUNDING
OPPORTUNITY, THIS CONCEPT DID.
SO THROUGH THIS RFA, NINR IS
U.S. PORGT THE DEVSUPPORTING THF
INTERVENTIONS MAKING SIGNIFICANT
SUSTAINABLE IMPROVEMENTS IN
HEALTH OUTCOMES OF RURAL
POPULATIONS.
RURAL POPULATIONS AS YOU
PROBABLY KNOW MAKE UP 20% OF THE
U.S. POPULATION.
THEY EXPERIENCE HIGH RATES OF
MORBIDITY AND DISABILITY, AS
WELL AS INCREASING RATES OF
PREMATURE DEATH.
SO HERE WE SOLICITED RESEARCH
CENTERED ON INTERVENTION
STRATEGIES ADDRESSING SOCIAL
DETERMINANTS OF HEALTH TO
IMPROVE HEALTH AND PROMOTE
HEALTH EQUITY.
IT ENCOURAGES STUDIES THAT
HARNESS A WIDE RANGE OF METHODS
AND APPROACHES, INCLUDING
COMMUNITY ENGAGED APPROACHES
THAT BUILD ON THE STRENGTHS OF
RURAL COMMUNITIES.
APPLICATIONS WERE DUE JUST LAST
WEEK, AND WE ARE LOOKING FORWARD
TO THE RESEARCH THAT WE WILL
FUND IN THIS AREA.
SO JUST AS A REMINDER, WE DO
POST ALL APPROVED CONCEPTS ON
OUR WEBSITE, SO IF YOU'RE
INTERESTED IN A RECAP OF THE
SCIENCE AREAS THAT WERE
DISCUSSED DURING A PREVIOUS
COUNCIL MEETING, YOU CAN CHECK
THERE.
NINR IS THE LEAD INSTITUTE ON
ANOTHER NEW FUNDING OPPORTUNITY
THAT I AM REALLY EXCITED TO TELL
YOU ABOUT, WHICH IS RELATED
DIRECTLY TO OUR MISSION AND
STRATEGIC PLAN.
RESEARCH SHOWS THAT INTERSECTING
SYSTEMS OF PRIVILEGE AND
OPPRESSION PRODUCE AND SUSTAIN
WIDE AND UNJUST VARIATIONS IN
HEALTH.
SO THIS FUNDING OPPORTUNITY
CALLED THE AXES INITIATIVE WILL
SUPPORT RESEARCH TO UNDERSTAND
HEALTH AT THE INTERSECTIONS OF
RACE, ETHNICITY, SOCIOECONOMIC
STATUS, SEXUAL ORIENTATION, AND
ABILITY.
BY EXAMINING CONTRIBUTIONS OF
SOCIAL DETERMINANTS AND OTHER
DETERMINANTS OF HEALTH.
SO WHY IS THIS IMPORTANT?
AND MORE SPECIFICALLY, WHY IS IT
IMPORTANT FOR NINR TO LEAD?
THE REALITY IS THAT WE HOLD
MULTIPLE STATUSES SIMULTANEOUSLY
THAT CONVERGE TO INFLUENCE OUR
LIFE EXPERIENCES, BUT THERE'S A
DIFFERENCE IN THOSE EXPERIENCES
BASED ON WHAT STATUSES WE HOLD.
FOR MINORITY GROUPS, THOSE
EXPERIENCES ARE TOO OFTEN
EMBEDDED WITHIN SYSTEMS OF
OPPRESSION THAT LIMIT ACCESS TO
HEALTH PROMOTING RESOURCES,
SERVICES AND OPPORTUNITIES.
AND ULTIMATELY HAVE DOWNSTREAM
HEALTH CONSEQUENCES.
SO BETTER UNDERSTANDING HOW
THESE FACTORS AFFECT HEALTH AT
THESE INTERSECTIONS WILL ENABLE
US TO DESIGN INTERVENTIONS THAT
CONSIDER A WHOLE OF WHO WE ARE
AS PEOPLE.
SO THE FIRST APPLICATION DUE
DATE IS JULY 5TH.
THIS IS ANOTHER EXAMPLE OF A
COUNCIL CONCEPT THAT RESULTED IN
A FUNDING OPPORTUNITY.
SO THIS WAS CLEARED, YOU MIGHT
RECALL, AT THE SEPTEMBER 2023
MEETING.
NINR IS CONTINUING TO SUPPORT
THE SMALL BUSINESS INNOVATION
RESEARCH PROGRAM, ALONG WITH
SEVERAL NIH INSTITUTES AND
CENTERS THROUGH A FUNDING
OPPORTUNITY FOCUSED ON
ELIMINATING HEALTH DISPARITIES.
THE PURPOSE IS TO SUPPORT SMALL
BUSINESSES IN PROVIDING EARLY
STAGE INVESTMENT FUNDING FOR
DEVELOPING TECHNOLOGY, SERVICES
AND PRODUCTS THAT EMPOWER
INDIVIDUALS AND COMMUNITIES
INCLUDING PROVIDERS AND
HEALTHCARE INSTITUTIONS THAT
FOCUS ON POPULATIONS THAT
EXPERIENCE HEALTH DISPARITIES.
THE FIRST APPLICATION DUE DATE
IS COMING UP NEXT MONTH, ON JUN.
AS WITH OTHER GRANT
OPPORTUNITIES, YOU CAN LEARN
MORE ON THE NIH GRANTS WEBSITE.
WE ALSO HAVE A SECTION ON OUR
OWN WEBSITE JUST ABOUT THE SMALL
BUSINESS PROGRAM.
IN JANUARY, WE SHARED THE
ANNOUNCEMENT OF THE FIRST WHITE
HOUSE INITIATIVE ON WOMEN'S
HEALTH RESEARCH.
SINCE THEN, THE NIH OFFICE OF
RESEARCH ON WOMEN'S HEALTH AND
OTHER NIH INSTITUTES INCLUDING
NINR ISSUED A NOTICE OF SPECIAL
INTEREST TO SOLICIT RESEARCH
APPLICATIONS FOCUSED ON DISEASES
AND HEALTH OUTCOMES THAT
PREDOMINANTLY AFFECT WOMEN,
PRESENT AND PROGRESS DIFFERENTLY
IN WOMEN, OR ARE
FEMALE-SPECIFIC.
PROJECTS ACCOUNTING FOR SOCIAL
AND STRUCTURAL VARIABLES ARE
STRONGLY ENCOURAGED.
THE FIRST AVAILABLE DUE DATE WAS
MAY 6, AND THE NOSI EXTENDS FOR
A COUPLE MORE YEARS, THROUGH
NOVEMBER 5TH OF 2027.
ALSO, RELATED TO THE RESPONSE TO
THE WHITE HOUSE INITIATIVE ON
WOMEN'S HEALTH RESEARCH, THIS
FUNDING OPPORTUNITY THAT NIAAA
IS LEADING AND NINR IS
PARTICIPATING IN WILL SUPPORT
THE PLANNING PHASE OF THE MODEL
CONTINUUMS OF CARE INITIATIVE,
WHICH IS A DISSEMINATION AND
IMPLEMENTATION SCIENCE
INITIATIVE ADDRESSING
MULTI-MORBIDITY IN WOMEN AND
GIRLS OF REPRODUCTIVE AGE.
IT'S INTENDED TO ADDRESS GAPS IN
THE CONTINUUM OF CARE BY
BRIDGING EVIDENCE-BASED,
INTEGRATIVE INTERVENTIONS FOR
MENTAL HEALTH AND SUBSTANCE USE
DISORDERS, AND COMMON
CO-OCCURRING PHYSICAL
CONDITIONS.
TO SCALE UP AT THE POPULATION
LEVEL.
THE ESTABLISHMENT OF
PUBLIC-PRIVATE PARTNERSHIPS IS A
KEY ACTIVITY IN THE PLANNING
PHASE.
THE FIRST APPLICATION DUE DATE
IS IN JUNE.
SO LET PAUSE THERE.
WE JUST TALKED ABOUT TWO
OPPORTUNITIES RELATED TO WOMEN'S
HEALTH RESEARCH.
IT SEEMS THE NOSI COULD BE AN
OPPORTUNITY FOR NINR, SO HOW DO
YOU SEE NINR ADVANCING WOMEN'S
HEALTH RESEARCH?
WHAT ARE THE MOST PRESSING
ISSUES YOU THINK THAT NINR CAN
FOCUS ON, OR COULD CONSIDER WHEN
WE THINK ABOUT WOMEN'S HEALTH?
I SPRUNG IT ON YOU, RIGHT?
LIKE, WHAT ARE ALL YOUR IDEAS ON
WOMEN'S HEALTH RESEARCH?
ANYTHING THAT COMES TO MIND.
>> SHANNON?
THIS IS PAT.
CAN YOU HEAR ME OKAY?
>> YES.
>> ONE OF THE THINGS THAT I
THINK WHICH IS JUST SO APPALLING
IS THE HEALTH DISPARITIES IN
MATERNAL HEALTH WITH BLACK
AMERICAN WOMEN.
AND YOU KNOW, THERE'S JUST SO
MUCH I THINK NINR CAN DO THERE,
BECAUSE IT FITS ITS GOAL, ITS
STRATEGIC PLAN.
AND I THINK IT'S SOMETHING SO
MUCH NURSES CARE ABOUT.
>> YEAH, THANK YOU FOR THAT.
>> ONE THING THAT COMES TO MY
MIND ARE PHARMACOLOGICAL
DIFFERENCES IN RESPONSE,
PARTICULARLY WITH SYMPTOMS.
I MEAN, THERE ARE MARKETED
APPROACHES, MEDICATIONS THAT
SOME EVIDENCE IS COMING OUT THAT
WOMEN JUST RESPOND DIFFERENTLY,
AND I THINK UNDERSTANDING THAT
IS VERY VITAL.
>> I WAS JUST GOING TO BUILD ON
THE FIRST PERSON, PAT, I
BELIEVE, HER COMMENTS.
BROADLY, SEXUAL AND REPRODUCTIVE
HEALTH, I WOULD COMMENT ON THE
ISSUE AROUND MATERNAL CHILD
INEQUITIES, BUT ALSO THE
POSTPARTUM PERIOD AND SOME OF
WHAT WE KNOW THERE, THE SYPHILIS
EPIDEMIC IN THE COUNTRY, ISSUES
REGARDING THE DOBBS DECISION AND
ABORTION, AS WELL AS HIV AND THE
LOW UPTAKE OF PREP AMONG WOMEN.
I THINK SRH IS A HUGE AREA FOR
WOMEN.
>> AND I THINK THOSE ARE ALL
GREAT IDEAS.
I THINK WE HAVE TO REMEMBER THAT
THE LEADING CAUSE OF DEATH AND
MORBIDITY AMONG WOMEN IS
CARDIOVASCULAR DISEASE AND THERE
ARE MASSIVE INEQUITIES AND
ALWAYS HAVE BEEN THAT ARE
SEEMINGLY GETTING WORSE AND IT'S
OCCURRING EARLIER IN WOMEN THAN
IT HAS HISTORICALLY, SO KEEP
THAT IN MIND, THE PREVALENCE OF
THE LEADING CAUSES OF DEATH.
>> THIS IS BETTY.
I THINK IT WOULD -- BUILDING OFF
OF THE SORT OF REPRODUCTIVE
HEALTH IDEAS TOO, IT WOULD BE
GREAT IF THERE COULD BE SOME
POLICY RESEARCH, RIGHT,
VARIATION IN POLICY AROUND
REPRODUCTIVE HEALTH AND ITS
IMPACT ON MATERNAL AND CHILD
HEALTH, AND DISPROPORTIONATELY
AFFECTING PEOPLE OF COLOR AND
LOW INCOME, ET CETERA.
BUT FOR TAKING A SORT OF POLICY
LENS ON THAT WOULD BE TERRIFIC.
>> THOSE ARE GREAT IDEAS, THANK
YOU.
COMMENTING ON MATERNAL HEALTH,
HOPEFULLY EVERYONE IS AWARE, WE
FUNDED A LARGE INITIATIVE, THE
AIM INITIATIVE WITH A COUPLE OF
ROUNDS OF FUNDING AND SO ARE
SUPPORTING A NUMBER OF PROJECTS
OH MA MERNL HEALTH SO WE LOOK
FORWARD TO SHARING THOSE RESULTS
AS THEY START COMING IN, BUT
THAT HAS BEEN A BIG INVESTMENT
FOR US AND WE'LL SHOW YOU SOME
DATA ON THAT IN JUST A MINUTE.
SO THANKS FOR THAT.
ALL RIGHT.
SO MOVING ALONG, YES?
>> DO YOU VIEW THESE TWO RFAs
AS LIMITED TO MATERNAL HEALTH OR
WOULD IT ALSO INCLUDE
DISPARITIES IN CHILDREN OR
ADOLESCENTS?
>> THOSE TWO THAT I JUST
MENTIONED, THE FIRST ONE IS VERY
BROAD ON WOMEN'S HEALTH
RESEARCH, THAT NOSI THAT'S
NIH-WIDE.
THE SECOND ONE IS FOCUSED ON
WOMEN AND GIRLS OF REPRODUCTIVE
AGE.
THE AIM INITIATIVE THAT WE PUT
OUT IS FOCUSED ON MATERNAL
HEALTH, BUT THERE'S A WIDE
VARIETY OF AND I THINK
INCREASINGLY SO, GIVEN THIS IS A
PRIORITY, OF INITIATIVES FOCUSED
ON WOMEN'S HEALTH, AND OF COURSE
PEOPLE CAN ALWAYS SUBMIT THROUGH
THE NOSI OR THROUGH THE PARENT
MECHANISM TOO.
>> THANK YOU.
>> YEAH.
SO IN JANUARY AT OUR COUNCIL
MEETING, WE HAD A DISCUSSION ON
REACHING AUDIENCES FOR FUNDING
OPPORTUNITIES AND ENCOURAGING
APPLICATIONS.
SO TO ADDRESS THIS, WE HAVE
INCREASED OUR OUTREACH EFFORTS
IN SPREADING THE WORD ABOUT NEW
FUNDING OPPORTUNITIES AND HAVE
SPENT TIME PROVIDING ADDITIONAL
EDUCATION AND SUPPORT TO
POTENTIAL APPLICANTS.
SO AS AN EXAMPLE OF THIS, WE
HELD FOUR TECHNICAL ASSISTANCE
WEBINARS SINCE OUR LAST MEETING.
THESE WEBINARS GIVE POTENTIAL
APPLICANTS ADDITIONAL
INFORMATION ABOUT CURRENT
FUNDING OPPORTUNITIES, AND ALLOW
APPLICANTS TO ASK ANY QUESTIONS
THEY HAVE, SO I'M PLEASED TO
REPORT THERE'S BEEN A LOT OF
INTEREST IN THESE FUNDING
OPPORTUNITIES.
FOR THE RURAL HEALTH TECHNICAL
ASSISTANCE WEBINAR, WE HAD 189
VIEWERS.
FOR THE TRANSFORMATIVE RESEARCH
TO ADDRESS HEALTH DISPARITIES,
WE HAD OVER 331 WEBINAR
ATTENDEES.
FOR THE BRIDGE TO CARE
INITIATIVE, WE HAD OVER 326
ATTENDEES.
SO WE ARE VERY PLEASED WITH THE
RESPONSE AND THE INTEREST AND
REALLY APPRECIATE YOUR HELP IN
DISSEMINATING THOSE FUNDING
OPPORTUNITIES.
SO THE DUE DATES FOR THOSE
OPPORTUNITIES HAVE PASSED BUT
JUST THIS WEEK WE DID -- SORRY
ABOUT THAT -- HOLD A WEBINAR
ABOUT THE AXES INITIATIVE THAT I
MENTIONED A FEW MINUTES AGO.
SO YOU CAN FIND RECORDINGS ON
OUR WEBSITE.
AND AGAIN, THANK YOU SO MUCH FOR
YOUR HELP IN DISSEMINATING THOSE
INITIATIVES.
SO WE ARE ALSO SEEING
PUBLICATIONS THAT REFLECT ON
NINR'S WORK TO ADVANCE THE
SCIENCE SPECIFICALLY IN HEALTH
EQUITY AND SOCIAL DETERMINANTS
OF HEALTH.
SO THIS PAPER FROM NINR GRANTEES
DESCRIBES A CROSS-SECTIONAL
STUDY OF OVER 10 MILLION LIVE
HOSPITAL BIRTHS IN CALIFORNIA
OVER A 21-YEAR TIME SPAN.
THIS STUDY EXAMINED
RELATIONSHIPS BETWEEN SEVERE
MATERNAL MORBIDITY AND RACIAL
INEQUITIES IN JAIL INCARCERATION
RATES, WHICH THEY USE AS AN
INDICATOR OF STRUCTURAL RACISM.
THEY FOUND THAT BLACK AND
HISPANIC WOMEN IN COUNTIES WITH
HIGH INCARCERATION INEQUITY HAD
INCREASED ODDS OF EXPERIENCING
SEVERE MATERNAL MORBIDITY
COMPARED WITH THOSE LIVING IN
LOW INEQUITY COUNTIES.
THEY CALLED FOR COMMUNITY-BASED
ALTERNATIVES TO INCARCERATION
PRACTICES AS A STRATEGY TO
IMPROVE MATERNAL EQUITY.
I ALSO WANT TO SHARE A RECENT
PUBLICATION THAT DR. LEO SALAGAN
IN OUR INTRAMURAL DIVISION
CO-AUTHORED.
SCIENTISTS AND CLINICIANS ACROSS
15 OF THE INSTITUTES THAT
COMPRISE THE NIH CONTRIBUTE
TODAY THIS MULTIDISCIPLINARY
WORK.
POST INFECTIOUS MYALGIC
ENCEPHALOMYELITIS -- OH, I
PRACTICED!
YOU KNOW I DO PRACTICE.
CHRONIC FATIGUE SYNDROME, OR PI
ME/CFS, IS A DISABLING DISORDER
THAT IS POORLY UNDERSTOOD AND
LACKS PROPER TREATMENT.
THE STUDY USED RIGOROUS CRITERIA
TO RECRU -- THE CLINICAL ABNORMS
AND BIOMARKER DIFFERENCES
PROVIDE NEW INSIGHT INTO THE
UNDERLYING PATHOPHYSIOLOGY OF
PIMECFS WHICH MAY GUIDE FUTURE
INTERVENTIONS SO CONGRATULATIONS
TO THAT TEAM.
SWITCHING GEARS FROM
PUBLICATIONS TO REPORTS, AT THE
JANUARY COUNCIL, WE HEARD AN
UPDATE FROM THE CLIMATE CHANGE
AND HEALTH WORKING GROUP THIS
GROUP MET FOUR TIMES BETWEEN
SEPTEMBER AND NOVEMBER OF 2023
AND DISCUSSED AREAS OF CRITICAL
NEED, GAPS IN CURRENT RESEARCH
AND FUTURE DIRECTIONS IN CLIMATE
CHANGE RESEARCH.
THIS WORK FORMED THE BASIS FOR
NINE RECOMMENDATIONS FOR NINR
SUPPORTED CLIMATE CHANGE AND
HEALTH RESEARCH.
SOME TOP LINE FINDINGS FROM THE
GROUP ARE SUMMARIZED ON THE
SLIDE.
THE NINE RECOMMENDATIONS ARE
DETAILED IN A COMPREHENSIVE
REPORT THAT WILL BE POSTED ON
OUR WEBSITE VERY SHORTLY.
SO I WANT TO AGAIN THANK THE
MEMBERS OF THAT WORK GROUP, IN
PARTICULAR, DR. BETTY BEKEMEIER
HERE ON COUNCIL, WHO SERVED AS A
CO-CHAIR FOR THAT WORK GROUP.
SO THANK YOU AGAIN.
NOW, TWO YEARS INTO OUR
STRATEGIC PLAN I WANT TO SPEND A
FEW MOMENTS HIGHLIGHTING OUR
RESEARCH PORTFOLIO AS IT STANDS
REGARDING OUR INVESTMENT AS A
PERCENTAGE OF OUR BUDGET.
SO KEEP IN MIND AS YOU LOOK AT
THESE DATA THAT THESE CATEGORYSS
ARE NOT MUTE LIE EXCLUSIVE, A
STUDY CAN BE CLASSIFIED IN
MULTIPLE WAYS OBVIOUSLY.
SO I'M PROUD TO REPORT ACROSS
THE OTHER ICs AT NIH, WE RANK
FIRST AND SECOND IN THE SCIENCES
THAT ARE FOUNDATIONAL TO OUR
WORK AND ALIGNED WITH OUR
STRATEGIC PLAN.
FOR EXAMPLE, NINR LED THE
GREATEST INVESTMENT IN BUDGET IN
CLINICAL RESEARCH AND CLINICAL
TRIALS.
AREAS THAT HAVE CONTINUED TO BE
OF GREAT IMPORTANCE TO THE
LEADERSHIP AT NIH.
NR FISCAL YEAR '23, NINR
INVESTED $129 MILLION IN
BEHAVIORAL AND SOCIAL SCIENCES
RESEARCH, REPRESENTING 65% OF
OUR BUDGET.
LOOKING ACROSS THE NIH, YOU CAN
SEE NINR RANKS FIRST, JUST AHEAD
OF NIMHD, NIAAA AND NIDA IN THIS
AREA.
AGAIN, AS A PERCENTAGE OF OUR
BUDGET.
SO WHEN WE LOOK MORE CLOSELY AT
TOPICS, YOU CAN SEE THAT NINR
RANKED SECOND ACROSS THE NIH IN
OUR INVESTMENT IN SOCIAL
DETERMINANTS OF HEALTH, HEALTH
DISPARITIES, AND MINORITY HEALTH
RESEARCH.
DR. JOHN GRASON WILL BE TALKING
MORE ABOUT THE HEALTH
DISPARITIES AND MINORITY HEALTH
PORTFOLIO A BIT LATER THIS
MORNING, AND DR. ALISON COLBERT
WILL BE DISCUSSING NINR
ACTIVITIES IN THE SDOH LENS,
THROUGH THE SDOH LENS, LATER
TODAY.
YOU CAN SEE OUR INVESTMENT IN
MATERNAL MORBIDITY AND MORTALITY
RESEARCH.
IT HAS GROWN IN RECENT YEARS IN
CONCERT WITH THE DEEP CONCERNS
ABOUT WORSENING MATERNAL HEALTH
AND RELATED DISPARITIES IN THE
UNITED STATES.
YOU CAN ALSO SEE WE HAVE
CONSIDERABLE EQUITIES RELATIVE
TO NIH.
SO WHEN WE TAKE A CLOSER LOOK AT
OUR INVESTMENT IN SOCIAL
DETERMINANTS OF HEALTH RESEARCH,
WHICH AS YOU KNOW IS ONE OF OUR
LENSES IN OUR STRATEGIC PLAN,
NINR INVESTED $93 MILLION IN
THIS AREA REPRESENTING 47% OF
OUR BUDGET IN '23.
LOOKING ACROSS NIH, YOU CAN SEE
WE'RE SECOND IN INVESTMENT.
NOW HERE'S SOME CHANGE OVER TIME
IN THIS AREA OF RESEARCH.
NIH STARTED TRACKING THIS AREA
OF RESEARCH JUST IN 2020 WAS THE
FIRST YEAR SO YOU CAN SEE 47
REMEMBER47% OFOUR BUDGET IS AGAL
DETERMINANTS OF HEALTH RESEARCH,
WHICH IS MORE THAN DOUBLE OF
WHAT WE SPENT JUST A FEW YEARS
AGO.
IN FISCAL YEAR 20, ONLY ABOUT
19% OF OUR BUDGET WAS IN THIS
AREA, AND IT'S RISEN
SIGNIFICANTLY AS WE'VE CONTINUED
TO IMPLEMENT OUR STRATEGIC PLAN.
IN TERMS OF REAL DOLLARS, THE
AMOUNT OF MONEY WE'VE SPENT IN
SOCIAL DETERMINANTS OF HEALTH
HAS NEARLY TRIPLED FROM
$33 MILLION IN 2020 TO
$93 MILLION IN 2023.
SHIFTING GEARS A BIT, ONE OF OUR
GOALS AS WELL HAS BEEN TO
INCREASE RESEARCH WITH
POPULATIONS THAT BEAR THE
GREATEST BURDEN OF MORBIDITY AND
MORTALITY.
AS YOU MAY RECALL, FOSTERING
INCLUSION IN OUR RESEARCH IS ONE
OF OUR GUIDING PRINCIPLES IN OUR
STRATEGIC PLAN, AND IT WAS THE
FOCUS OF A RECENT COUNCIL WORK
GROUP.
SO WE REPORT ON INCLUSION
FORMALLY EVERY THREE YEARS, SO
THAT REPORT WILL BE COMING NEXT
YEAR, BUT GIVEN IT IS A PRIORITY
FOR US, I WANTED TO CHECK IN TO
SEE HOW WE'RE DOING.
SO HERE'S OUR INCLUSION DATA
SINCE 2016.
SHOWN FOR EACH RACIAL AND ETHNIC
GROUP AS A PERCENTAGE OF THE
TOTAL ENROLLED IN NINR SUPPORTED
STUDIES THAT YEAR.
SO YOU CAN SEE THESE DATA CAN
JUMP AROUND YEAR TO YEAR A BIT.
PARTLY BECAUSE LARGE STUDIES
BEGIN OR END OVER TIME.
SO WHILE WE STILL HAVE
CONSIDERABLE WORK TO DO, WE ARE
PLEASED TO BE SEEING THAT WE ARE
TRENDING IN THE RIGHT DIRECTION
FOR SEVERAL GROUPS.
REPRESENTATION OF NON-HISPANIC
WHITE PARTICIPANTS HAS DROPPED
FROM 70% IN 2016 TO 50% IN 2023.
THE STEEPEST RISE IN ENROLLMENT
WAS AMONG AFRICAN AMERICANS,
WHICH INCREASED FROM JUST UNDER
20% OF PARTICIPANTS IN
NINR-FUNDED RESEARCH TO OVER 30%
BETWEEN 2020 AND 2023.
AND IN 2023, ENROLLMENT OF
HISPANICS IN NINR-SUPPORTED
RESEARCH REACHED ITS HIGHEST
LEVEL OF THIS NINE-YEAR PERIOD.
SINCE JANUARY COUNCIL, WE HOSTED
TWO NINR DIRECTORS LECTURES.
OUR INTRAMURAL FELLOWS
PARTICIPATED IN AN NIH POSTER
DAY AND WE HAVE SOME UPCOMING
EVENTS THAT YOU MAY WANT TO
ATTEND OR HELP US TO SPREAD THE
WORD ABOUT.
SO FIRST OFF I'M HAPPY TO
ANNOUNCE A NEW EVENT FOR THE
INSTITUTE THAT DIRECTLY RELATES
TO OUR SOCIAL DETERMINANTS OF
HEALTH LENS.
SO WE ARE INVITING PROSPECTIVE
PARTICIPANTS TO SUBMIT LETTERS
OF INTEREST FOR OUR FIRST SOCIAL
DETERMINANTS OF HEALTH SUMMER
RESEARCH INSTITUTE.
THIS A NEW EVENT DESIGNED TO
PERMIT EARLY AND -- TO LEARN
MORE ABOUT AND APPLY THE
PRINCIPLES OF HIGH QUALITY
SOCIAL DETERMINANTS OF HEALTH
RESEARCH.
THE PROGRAM IS INTENDED FOR
SCIENTISTS WHO HAVE A STRONG
FOUNDATION IN SOCIAL
DETERMINANTS BUT ARE ACTIVELY
PURSUING WAYS TO INCLUDE A
GREATER EMPHASIS ON THIS IN
THEIR WORK.
SO THIS EVENT WILL TAKE PLACE AT
THE NIH CAMPUS HERE IN BETHESDA
IN JULY.
THERE'S NO COST TO PARTICIPATE
IN THE INSTITUTE.
SELECTED PARTICIPANTS WILL
RECEIVE A STIPEND TO HELP COVER
TRAVEL EXPENSES, ELIGIBILITY AND
SELECTION DR CRITERIA ARE ON OUR
WEBSITE, AND THE APPLICATIONS
ARE DUE NEXT WEEK.
SO LATER IN OUR AGENDA, AGAIN,
WE'LL BE TALKING MORE ABOUT ALL
OF OUR SDOH ACTIVITIES.
DR. COLBERT WILL BE EXPANDING ON
THIS.
WE HELD OUR FIRST DIRECTOR'S
LECTURE IN MARCH OF 2024.
YOU MIGHT RECALL THAT LECTURE
FOCUSED ON CLIMATE CHANGE AND
HEALTH.
DR. JULIE PRESENTED AN OVERVIEW
OF HER RESEARCH ON THE
SIGNIFICANCE OF HEAT TRENDS AND
WILDFIRE SMOKE ON AGRICULTURAL
WORKERS WITH A FOCUS ON SOCIAL
DETERMINANTS OF HEALTH AND THE
ROLE OF NURSING RESEARCH.
WE ARE PLEASED, WE HAD OVER 539
VIEWERS OF THAT WEBINAR, SO IF
YOU MISSED IT, THE RECORDING IS
AVAILABLE ON OUR WEBSITE.
EARLIER THIS MONTH WE HOSTED DRM
INJURY PREVENTION.
SHE IS A YOUTH VIOLENCE
PREVENTION AND HEALTH EQUITY
SUBJECT MATTER EXPERT.
WE RECEIVED GREAT QUESTIONS,
GREAT DISCUSSION AND HAVE
RECEIVED A POSITIVE RESPONSE
RELATED TO FEEDBACK.
SO AS WITH THIS, YOU CAN FIND A
RECORDING ON OUR WEBSITE, AND WE
ARE PLEASED TO ANNOUNCE OUR
UPCOMING LECTURE IN JULY.
THIS WILL FOCUS ON MATERNAL
HEALTH AND HOW SOCIAL
DETERMINANTS OF HEALTH ARE
CENTRAL TO THIS AREA OF
RESEARCH.
OUR SPEAKER WILL BE DR. MAHASIN
MUJAHID, PROFESSOR OF
EPIDEMIOLOGY AT THE SCHOOL OF
PUBLIC HEALTH AT THE UNIVERSITY
OF CALIFORNIA, BERKELEY.
HER PRIMARY AREA OF RESEARCH IS
IN THE AREA OF SOCIAL
EPIDEMIOLOGY WITH A PARTICULAR
INTEREST IN INVESTIGATIONS OF
NEIGHBORHOOD EFFECTS ON HEALTH,
CARDIOVASCULAR HEALTH
DISPARITIES, AND RACIAL/ETHNIC
HEALTH DISPARITIES OVER THE LIFE
COURSE.
SO THIS WILL BE HELD ON
JULY 11TH.
ALSO THIS MONTH, I AM PLEASED TO
SHARE THREE OF OUR
POSTBACCALAUREATE FELLOWS
PRESENTED POSTERS ON THE
RESEARCH THEY ARE CONDUCTING AT
NINR.
THEY'VE BEEN WORKING ON A STUDY
TO QUANTIFY RYR1 GENE EXPRESSION
IN PATIENTS USING SKELETAL
MUSCLE BIOPSY SAMPLES.
MAYRA HAS BEEN BUSY LOOKING AT
WHICH DYE IS BETTER AT
DETERMINING ACCURATE MEASUREMENT
OF CALCIUM.
WILL IS EXPLORING SLEEP
DISTURBANCE IN MEN WITH PROSTATE
CANCER BY LOOKING AT DATA
GATHERED BY SLEEP DIARIES AND
ANTIGRAPHY, SO IT WAS GREAT TO
SEE THEM PRESENT THEIR WORK TO
THE NIH COMMUNITY.
AT NINR, WE ARE LOOKING ALWAYS
FOR WAYS TO SHARE OUR WORK AND
OUR OPPORTUNITIES WITH THE
LARGER SCIENTIFIC COMMUNITY.
SO HERE'S A COUPLE OF
ACTIVITIES.
COMMUNITY ENGAGEMENT IS A
PRIORITY FOR US, AND WE ARE
EMPHASIZING THIS IN ALL OF OUR
ACTIVITIES.
SO IN JANUARY, A FEW OF US FROM
NINR VISITED C3CARES IN
WASHINGTON, D.C.
C3CARES WAS FOUNDED ON THE
BELIEF THAT EVERYONE DESERVES
ACCESS TO CONVENIENT QUALITY
HEALTHCARE.
SO WE LEARNED ABOUT THEIR
INNOVATIVE MODEL OF NURSE-LED
PLACE-BASED CARE IN PUBLIC
HOUSING SITES TO INCREASE ACCESS
TO HEALTH SERVICES AND IMPROVE
COMMUNITY HEALTH.
WE ALSO HEARD FROM THEIR
COMMUNITY PARTNERS ABOUT THEIR
HEALTH PRIORITIES AND WERE ABLE
TO INTRODUCE THEM TO NINR.
SO DR. ERIN ATHEY AND CLETION
FROM C36789CARES WILL BE HERE
TODAY TO SHARE MORE ABOUT THEIR
WORK, AND WHAT THEY'RE DOING TO
IMPROVE THE HEALTH OF D.C.
RESIDENTS.
AND FOR US, WE'RE REALLY LOOKING
FORWARD TO LEARNING MORE ABOUT
HOW WE CAN BETTER SERVE AS WELL
AS COLLABORATE WITH
ORGANIZATIONS IN D.C. TO
ADVANCE OUR COMMON HEALTH GOALS.
OVER THE LAST YEAR I WANTED TO
SHARE WE HAVE BEEN DEVELOPING A
PARTNERSHIP WITH SEVERAL
UNIVERSITIES IN SOUTHEASTERN
VIRGINIA CALLED ENRICH PLUS.
THE FOCUS IS ON ADVANCING HEALTH
EQUITY AND REDUCING HEALTH
DISPARITIES IN THAT GEOGRAPHIC
AREA THROUGH COMMUNITY
ENGAGEMENT AND TEAM SCIENCE THAT
ALSO HELPS TO DIVERSIFY THE
RESEARCH WORKFORCE.
SO WE VISITED THESE UNIVERSITIES
AND COMMUNITY PARTNERS IN AUGUST
AND AGAIN IN JANUARY, AND ARE
NOW PLANNING NEXT STEPS TO LEARN
MORE ABOUT COMMUNITY RESEARCH
PRIORITIES.
SO WE'RE LOOKING FORWARD TO
CONTINUING THOSE CONVERSATIONS
AND SHARING MORE ABOUT THAT
PARTNERSHIP IN UPCOMING
MEETINGS.
IN MARCH, NINR STAFF TOOK PART
IN A CONFERENCE FOR THE NATIONAL
COALITION OF ETHNIC MINORITY
NURSE ASSOCIATIONS.
IT WAS GREAT TO SEE DR. WANG
THERE, WHO IS THE IMMEDIATE PAST
PRESIDENT OF THE ASIAN AMERICAN
PACIFIC ISLANDER NURSES
ASSOCIATION, AS WELL AS
DR. GUILAMO-RAMOS.
SO IT WAS FUN TO SEE YOU IN L.A.
THIS ORGANIZATION IS MADE UP OF
FIVE NATIONAL ETHNIC NURSE
ASSOCIATIONS, GIVING VOICE TO
OVER 350,000 ETHNIC NURSES.
AND THEIR MISSION IS VERY MUCH
ALIGNED WITH OUR OWN, TO BE THE
UNIFIED BODY ADVOCATING FOR
EQUITY AND JUSTICE IN
HEALTHCARE.
SO WE REACHED OUT ABOUT THEIR
INTEREST IN HOSTING A LISTENING
SESSION AT THEIR CONFERENCE
BECAUSE WE WANTED TO HEAR FROM
THEIR MEMBERS ABOUT THEIR IDEAS
FOR CULTIVATING DIVERSITY AND
PERSPECTIVES IN NURSING
RESEARCH, REMOVING STRUCTURAL
BARRIERS FROM RESEARCH, AND
FOSTERING INCLUSION AND
ACCESSIBILITY IN DESIGNING,
CONDUCTING AND PARTICIPATING IN
RESEARCH.
SO WE WERE VERY PLEASED THAT
NCEMNA MEMBERS WERE VERY
FORTHCOMING WITH US.
WE WERE EXCITED TO HEAR ABOUT
SHARED INTERESTS AND BUILDING
PARTNERSHIPS BETWEEN COMMUNITY
GROUPS AND RESEARCH
ORGANIZATIONS, THE DEVELOPMENT
OF MENTORSHIP AND TRAINING
PROGRAMS FOR NURSES OF DIVERSE
BACKGROUNDS, AND CREATING MORE
EQUITABLE FUNDING OPPORTUNITIES.
SO THIS INFORMATION HAS ALREADY
STARTED TO INFORM OUR DEIA
ACTION PLAN ALONG WITH FEEDBACK
THAT WE RECEIVED AT A SIMILAR
SESSION WITH AACN IN THE FALL.
I THINK I'M TALK TOO MUCH
BECAUSE -- YEAH.
SO IN OTHER OUTREACH EFFORTS
RELATED TO DEIA, NINR STAFF
MEMBERS PRESENTED A POSTER AT
THE HEALTH DISPARITIES
CONFERENCE AT XAVIER UNIVERSITY
LAST MONTH.
THIS CONFERENCE WAS FOCUSED ON
SOCIAL DETERMINANTS OF HEALTH
AND WAS PRESENTED BY THE CENTER
FOR MINORITY HEALTH AND HEALTH
DISPARITIES RESEARCH AND
EDUCATION.
SO DURING THE POSTER SESSION,
NINR WAS ABLE TO INTERACT WITH A
DIVERSE GROUP OF RESEARCHERS,
INCLUDING NURSE SCIENTISTS WHO
EITHER WERE UNFAMILIAR WITH NINR
OR WERE FAMILIAR WITH NINR BUT
WERE UNAWARE OF THE NEW
STRATEGIC PLAN.
ATTENDEES WERE EXCITED TO LEARN
ABOUT OUR EMPHASIS ON HEALTH
EQUITY AND SOCIAL DETERMINANTS
OF HEALTH.
AND LAST MONTH, I VISITED THE
UNIVERSITY OF NORTH DAKOTA,
WHERE I PRESENTED AT AN EVENT
FOR THE UNIVERSITY'S INDIGENOUS
TRAUMA AND RESILIENCE RESEARCH
CENTER.
NIH AWARDED $10 MILLION TO
DEVELOP THAT CENTER IN 2021.
WHILE I WAS THERE, I HAD A
FIRESIDE CHAT WITH -- IT WAS
COLD, SO IT REALLY WAS A FIRE
SIDE -- IT WAS REAL COLD -- WITH
NURSING STUDENTS, PRIMARILY
UNDERGRADUATES, ABOUT THE
IMPORTANCE OF NURSING RESEARCH.
I ALSO MET WITH NURSING FACULTY
ABOUT THEIR RESEARCH INTERESTS.
THE VISIT PROVIDED REALLY AN
IMPORTANT OPPORTUNITY TO CONNECT
WITH INDIGENOUS GROUPS IN THAT
AREA AND I WAS REALLY HAPPY TO
PARTICIPATE AND REPRESENT NIH
AND SEE THE WORK THAT WE ARE
SUPPORTING IN THIS COMMUNITY.
WE'VE HAD A LOT OF SUCCESS THIS
YEAR, I HOPE YOU CAN SEE.
IDENTIFYING -- IN LOTS OF WAYS,
BUT INCLUDING IDENTIFYING FOLKS
WHO SHARE NINR'S VISION FOR
NURSING RESEARCH.
SO WANTED TO JUST PAUSE, CHECK
IN IF THERE ARE ORGANIZATIONS OR
ENTITIES THAT YOU SEE THAT WE
COULD BE POTENTIAL PARTNERS WITH
OR COLLABORATORS WITH TO ADVANCE
THE GOALS THAT WE'VE TALKED
ABOUT.
SO WHO SHOULD WE BE REACHING OUT
TO, WHO ELSE SHOULD WE BE
CONNECTING WITH?
JUST CURIOUS IF YOU HAVE ANY
IMMEDIATE THOUGHTS ABOUT THAT.
I LIKE TO SPRING THESE THINGS ON
YOU, LIKE WHAT ARE ALL YOUR
IDEAS?
>> SHANNON, I SEE THAT YOU
CONNECTED WITH SOME
MINORITY-SERVING AND HBCUs I
WHICWHICH I THINK IS REALLY SMAT
AND I THINK THAT IS AN
OPPORTUNITY.
I THINK WE'VE TALKED ABOUT THAT
BEFORE, WITHIN THIS COUNCIL
ABOUT THINKING ABOUT HOW TO --
REALLY AS WE TRY TO CHANGE THE
NARRATIVE, CHANGE THE NARRATORS
AND FIND WAYS TO SUPPORT AND
BRING ALONG OTHERS.
I DON'T KNOW WHERE DANIEL IS,
BUT HE'S DOING SOME GREAT WORK
IN THAT SPACE, SO I THINK THAT'S
REALLY IMPORTANT.
>> I'LL JUST ADD TO THAT, IF
THAT'S OKAY.
I'M ACTUALLY VERY PLEASED TO SEE
THAT YOU WENT TO XAVIER
UNIVERSITY AND WENT TO THEIR
17TH ANNUAL CONFERENCE.
IT'S A CONFERENCE THAT I'VE GONE
TO YEAR AFTER YEAR, SO IT'S
REFRESHING TO SEE THAT YOU'RE
MAKING INROADS WITH THEM PAUSE
THEY REALLY BRING TOGETHER A LOT
OF THE HBCUs AS WELL AS A LOT
OF THE OTHER MSIs TOGETHER.
I WOULD ALSO URGE THE NINR TO
LOOK AT THE TRIBAL COLLEGES AND
MAKE A CONCERTED OUTREACH THERE.
I KNOW THAT THERE ARE MANY
NATIVE AMERICAN SCHOLARS,
LEADERS WHO APPROACHED US SAYING
THEY WANT TO GET INVOLVED, WE'RE
THE INVISIBLE POPULATION AND YET
FOLKS OFTEN EXCLUDE US, SO I
THINK THAT WOULD ALSO BE ANOTHER
GREAT GROUP OF FOLKS TO DO.
AND THEN I JUST WANT TO MAKE A
COMMENT TO WHAT YOU PRESENTED.
I KNOW WE'RE TALKING ABOUT WHO
ELSE SHOULD YOU REACH OUT TO,
BUT I WAS EXTREMELY PLEASED TO
SEE THE NUMBER, THE STATISTICS
IN TERMS OF YOUR INVESTMENTS IN
THE RESEARCH PORTFOLIO.
GLAD TO SEE THE INVESTMENTS IN
THE SOCIAL AND BEHAVIORAL
SCIENCES CONNECTING DISEASES OF
BRAIN WITH OUR SYSTEMIC HEALTH.
GLAD TO SEE THE SDOH -- AND THE
REASON I'M EXCITED IS BECAUSE
THERE IS A REPORT THAT WAS DONE
BY ERNST & YOUNG WHERE THEY
LOOKED AT INVESTMENTS FROM
GOVERNMENT, PHILANTHROPY, ET
CETERA AND FOUND THAT BETWEEN
2002 AND 2022, WE HAD SPENT
ABOUT $173 BILLION FROM THE
GOVERNMENT.
I'M GLAD TO SEE THAT HAS
RATCHETED UP AND NINR IS LEADING
IN MANY RESPECTS IN THOSE
INVESTMENTS.
THAT'S A HUGE WIN FOR US.
DR. GUILAMO-RAMOS AND I WERE
TALKING EARLIER ABOUT THE DERTH
OF INTERVENTIONS, WHERE WE ARE
BRIDGING CLINICAL INTERVENTIONS
WITH THE SOCIAL DETERMINANTS OF
HEALTH INTERVENTIONS AND THE
DERTH IN TERMS OF APPLYING AN
EQUITY LENS, AND SO IT IS
REFRESHING TO KNOW THAT YOU ARE
BUILDING THAT TAXONOMY FOR US SO
THAT WE CAN LEVERAGE THOSE
INTERVENTIONS IN OUR COMMUNITY.
SO KUDOS TO YOU ALL AGAIN FOR
DOING THAT.
AND I THINK THE OTHER LAST
COMMENT I'D MAKE IS THAT IT'S
ALSO REFRESHING TO SEE THE
AMOUNT OF PUBLICATIONS COMING
OUT OF THE INVESTMENTS FROM THIS
INSTITUTE BECAUSE I TRACK --
I'VE BEEN TRACKING FOR THE LAST
20 YEARS HOW MANY PUBLICATIONS
ARE IN PEER REVIEWED JOURNALS
THAT TOUCH ON MINORITY HEALTH,
TOUCH ON HEALTH INEQUITY, HEALTH
DISPARITIES AND SO FORTH, AND
YEAR AFTER YEAR, WE'VE SEEN
THOUSANDS OF NEW JOURNALS AND IT
SEEMS THAT NINR IS LEADING THAT
SO THANK YOU AGAIN FOR THAT.
>> IT'S REALLY DIFFICULT TO
SPEAK AFTER PROFESSOR DAWES.
JUST THREE REALLY QUICK THINGS,
SHANNON.
ONE I THINK THE REPORT WAS
ABSOLUTELY STUNNING,
CONGRATULATIONS TO EVERYONE AT
THE INSTITUTE BECAUSE IT'S CLEAR
THERE'S BEEN A LOT OF PROGRESS
AND IT LOOKS LIKE IT'S BEEN A
REALLY FRUITFUL YEAR, SO THANK
YOU FOR THAT.
TWO THINGS.
ONE IS, YOU ASKED ABOUT
PARTNERSHIPS, AND I REALLY
APPRECIATE THE PROXIMITY THAT IT
APPEARS YOU GUYS ARE POSITIONING
YOURSELVES TO THE ACTUAL
COMMUNITIES.
I WONDER IF THERE MIGHT BE AN
ADDITIONAL STRATEGY, SORT OF AN
AND NOT AN OR, WHERE SOME OF THE
LARGE NATIONAL ORGANIZATIONS
THAT REALLY REPRESENT HUGE
SEGMENTS OF COMMUNITIES THAT ARE
MINORITIZED AND MARGINALIZED
COULD BECOME PARTNERS.
SO FOR EXAMPLE, THE ONE THAT I'M
THINKING OF THAT I KNOW FAIRLY
WELL, JUST AN EXAMPLE OF ONE, IS
ONEDOS U.S., WHICH REPRESENTS
HUNDREDS AND HUNDREDS OF
NON-PROFIT LATINO-SERVING
ORGANIZATIONS ACROSS THE UNITED
STATES.
IN A COUPLE OF WEEKS, WE'LL BE
HAVING THE NATIONAL CONFERENCE,
THERE ARE PROBABLY BE ABOUT
25,000 PEOPLE THERE, ALL WORKING
ON LATINO HEALTH ISSUES AND
LATINO OPPORTUNITIES, ECONOMICS,
HOUSING, ET CETERA.
SO ORGANIZATIONS LIKE THAT
ACROSS, THEY ARE SOMEWHAT
REMOVED FROM THE DAY-TO-DAY WORK
BUT THEY REALLY REPRESENT A WAY
TO HAVE HUGE IMPACT.
AND THEN I JUST WANTED TO BUILD
ALSO ON WHAT DANIEL SAID.
OBVIOUSLY DATA IS GOING TO BE
MORE ACCURATE, BUT I HAD SEEN
SOME DATA AS WELL THAT HAD NINR
LEADING ON SOME OF THE SOCIAL
DETERMINANTS OF HEALTH
INVESTMENTS, SO JUST CURIOUS AT
LATER TIME TO UNDERSTANDING MORE
HOW YOU GUYS CALCULATED, BECAUSE
I THINK THAT'S REALLY IMPORTANT.
>> FIRST OF ALL, THERE IS THIS
THING CALLED THE ALLIANCE OF
HISPANIC SERVING RESEARCH
UNIVERSITIES, SO THERE ARE 571
CURRENTLY FEDERALLY DESIGNATED
HSIs, BUT THERE'S ONLY 21 THAT
ARE KIND OF HIGH RESEARCH AND
HAVE INCREDIBLE CAPACITY, AND
MOST OF THEM HAVE CLINICAL
ENTERPRISES AND I'M ON THE BOARD
OF THAT ALLIANCE AND IF YOU WANT
TO BE INTRODUCED AND EXPLORE
OPPORTUNITIES THERE, I WOULD BE
HAPPY TO HELP OUT WITH THAT.
AND IT'S A GROUP THAT IS VERY,
VERY COMMITTED TO THE HIGH
MINORITY STUDENT POPULATIONS
THAT THEY HAVE.
THE OTHER THING THAT OCCURRED TO
ME WHILE YOU WERE TALKING IS, I
PREFER TO CALL IT SOCIAL DRIVERS
OF HEALTH BECAUSE IF IT WERE
DETERMINANT, I WOULDN'T BE A
HEALTHY ADULT RIGHT NOW, GIVEN
MY OWN, YOU KNOW -- MY ROOTS,
RIGHT, BUT THAT BEING SAID, ON
SOCIAL DRIVERS -- SO I'LL USE
THAT TERM.
ON SOCIAL DRIVERS OF HEALTH,
THIS IS NOT SO MUCH RESEARCH BUT
IT FEELS TO ME THAT THERE'S SO
MUCH OPPORTUNITY FOR ADVANCING
OUR UNDERSTANDING OF HOW SOCIAL
DRIVERS AFFECT HEALTH IF WE HAD
MORE IN THE WAY OF
INTERPROFESSIONAL EDUCATION,
WHERE YOU WERE SORT OF LOOKING
AT THAT TEAM, RIGHT, OF
HEALTHCARE PROVIDERS WHICH
INCLUDES YOUR NURSES AND YOUR
DOCTORS AND YOUR PHARMACISTS AND
YOUR DENTISTS AND YOUR PHYSICAL
THERAPISTS AND OCCUPATIONAL
THERAPISTS, THAT WHOLE TEAM, YOU
KNOW, NURSE EDUCATORS, ET
CETERA, THAT SURROUND PATIENTS,
IF WE WERE -- IF THERE WAS SOME
KIND OF INTERPROFESSIONAL
EDUCATION AROUND SOCIAL DRIVERS
OF HEALTH, THAT IT WAS NOT JUST
ABOUT HOW DO SOCIAL DRIVERS OF
HEALTH AFFECT HEALTH, BUT ALSO
IF YOU WERE WORKING ACROSS A
HEALTHCARE TEAM, HOW WOULD YOU
TAKE INTO CONSIDERATION SOCIAL
DRIVERS OF HEALTH TO CHANGE THE
WAY THAT YOU DELIVER CARE TO
PEOPLE.
>> THIS IS NOT A COMMUNITY-BASED
SUGGESTION BUT THERE ARE ALSO
OTHER INSTITUTES UNDERGOING
STRATEGIC PLAN REVISIONS AND I
HAVE NOT SEEN THOSE BUT I'M
HEARING RUMBLINGS OF SOCIAL
DRIVERS, DIVERSITY, EQUITY,
INCLUSION, AND SO I ALSO WONDER
IF THERE'S ENOUGH MOMENTUM
ACROSS INSTITUTES IF IT PRESENTS
SOME OPPORTUNITIES FOR SOME REAL
PARTNERSHIP TO BASICALLY GET OUT
THERE AND GET THE WORD OUT.
>> I ALSO THINK -- FIRST THANK
YOU FOR COMING TO NSEMNA BUT I
ALSO FEEL LIKE SOMETIMES WE CAN
ENGAGE WITH THESE, LIKE HBCUs,
HISPANIC SERVING AND AAPHI
INSTITUTIONS, NOT ONLY INFORMING
NURSING SCIENCE BUT MAYBE ALSO
THINK ABOUT LEVERAGING THE
NETWORK TO DISSEMINATE
NURSE-LED NURSING SCIENCE FROM A
DISSEMINATION IMPLEMENTATION
SCIENCE PERSPECTIVE TO REALLY
KIND OF INTRODUCE MORE OF
THE NURSING SCIENCE OR EVIDENCE
THAT IS GENERATED BY NINR-FUNDED
RESEARCHERS, AND CAN WE LEVERAGE
THESE COMMUNITY AND ACADEMIC
INSTITUTIONS TO MORE BROADLY
WIDELY DISSEMINATING, ESPECIALLY
WE HAVE SEEN LARGER PORTFOLIO OF
NINR-FUNDED SDOH RESEARCH, SO
THINK ABOUT LIKE THIS
PARTNERSHIP CAN REALLY INFORM
THE FULL CYCLE OF NURSING
SCIENCE INFORMING HEALTH POLICY.
I ALSO THINK THE ROBERT WOOD
JOHNSON FOUNDATION FUNDED A
CULTURE OF HEALTH PROGRAM AT
NATIONAL ACADEMY OF MEDICINE.
THEY'RE GOING TO HAVE AN ANNUAL
GATHERING THIS JULY, AND THEN
REALLY WOULD LIKE TO SEE MORE OF
THE WORK OF NINR-FUNDED WORK
FEATURED IN THIS FORUM, AND I'M
HAPPY TO INTRODUCE AND I KNOW
THEY'RE CONVENING PANELS AT THIS
MOMENT.
I THINK JUST LEVERAGING OTHER
ORGANIZATIONS, BE IT IN THE
HEALTH POLICY AND TRY TO FEATURE
NURSING SCIENCE, NURSE OR NURSE
PRACTITIONER-LED RESEARCH IN
THIS AREA.
CAN REALLY BRING OUT
WHAT WE HAVE FOUND OR WHAT NEEDS
TO BE DONE MORE THROUGH THIS
LARGER MARTLARGER PARTNERSHIP AD
COLLABORATIONS, I'M HAPPY TO SEE
YOU HAVE REALLY DONE A LOT AND
CAN GET TO THE NEXT LEVEL OF
LARGER DISSEMINATION.
>> A LOT OF GREAT COMMENTS, SO I
WON'T REPEAT THEM.
THE ONE RELATED TO WHAT ANNE WAS
SAYING, DR. FITZPATRICK, WAS THE
RESEARCH CENTERS AT MINORITY
INSTITUTIONS, AND IT'S NOT SO
MUCH THOSE CENTERS THEMSELVES,
BUT A CLINICAL RESEARCH NETWORK
THAT'S BEING ESTABLISHED WITHIN
THAT SEEMS TO BE LED BY A LOT
MORE NURSING RESEARCHERS BASED
ON OUR LAST CONFERENCE.
SO I THINK THE INVOLVEMENT OF
NINR IN THAT ANNUAL CONFERENCE,
I THINK, BUT ALSO BRING MORE
EXPOSURE SIMILAR TO WHAT
PROFESSOR DAWES WAS SAYING.
I ALSO REALLY APPRECIATED ALL
THE DATA, BUT I HAVE SOME
QUESTIONS REGARDING THE
INCLUSION DATA.
I WOULD BE CURIOUS TO KNOW,
ESPECIALLY GIVEN THE TYPE OF
RESEARCH THAT NINR IS SUPPOR
SUPPORTING, THAT INCLUSION, IS
THAT AN INTERVENTION-RELATED
RESEARCH OR IS IT AN
OBSERVATIONAL RESEARCH?
IT'S EVERYTHING.
IS THERE ANY WAY TO DISENTANGLE?
IT WOULD BE HARD, RIGHT?
>> IT WOULD BE A LITTLE TRICKY.
AS FAR AS I CAN REMEMBER,
THERE'S NO NIH CODE TO SPLIT UP
THOSE AREAS OF RESEARCH.
IT'S CERTAINLY SOMETHING WE
COULD LOOK INTO, TO AT LEAST DO
IT INFORMALLY JUST ON OUR END.
>> YEAH, I MEAN, IT WOULD
DEFINITELY HELP BOLSTER THE
ARGUMENT ABOUT THE CLINICAL
RESEARCH IN TERMS OF INVOLVING
THAT RACIAL/ETHNIC MINORITIES.
THE OTHER THING IS DATA REALLY
ON ORGANIZATIONAL INVOLVEMENT,
AND SO WE KNOW USING C3 AS AN
EXAMPLE THAT NURSES CAN BE IN
DIFFERENT CONTEXT AND REALLY
TRYING TO UNDERSTAND WHERE THOSE
SYSTEMS OF CARE ARE ACTUALLY
OCCURRING IN THESE RESEARCH I
THINK WOULD ALSO BE REALLY
INTERESTING TO LOOK AT.
>> I COULD JUST REACT TO
EVERYTHING YOU ALL ARE SAYING,
SO LET TALK MORE, BUT THIS IS
GREAT, WE'RE KEEPING NOTES, WE
HAVE THE RECORDING, SO THIS IS
ALL GOOD.
SO WE'LL USE THIS TO INFORM THE
AGENDA FOR NEXT TIME AND SHARE
MORE INFORMATION ALONG THESE
LINES, BUT LET'S CONNECT
ONE-ON-ONE AND IN GROUPS, TOO,
TO TALK ABOUT HOW TO MOVE ALL
THESE GREAT IDEAS.
SUPER, REALLY APPRECIATE YOUR
SUPPORT AND THESE EXCELLENT
IDEAS TO REALLY INCREASE THE
REACH OF THE INSTITUTE AND THE
IMPACT OF NURSING RESEARCH, SO
THANK YOU.
OKAY.
SO YOU'RE NOT DONE WITH ME YET.
I'VE GOT MORE NEWS TO SHARE, SO
I'M GOING TO GO FORWARD AND
YOU'RE GOING TO BE INTERESTED SO
I DON'T WANT YOU TO MISS.
SO I WANT TO SHARE A LITTLE BIT
MORE ABOUT SOME THINGS HAPPENING
AT THE INSTITUTE FOR YOUR
AWARENESS.
SO MOST OF YOU KNOW THE NINR
DIVISION OF EXTRAMURAL SCIENCE
PROGRAMS OVERSEAS AND MANAGES
THE PORTFOLIOS OF GRANTS AND
CONTRACTS THAT SUPPORT
RESEARCHERS ACROSS THE COUNTRY.
SO SINCE THERE ARE A NUMBER OF
PEOPLE HERE THAT INTERACT WITH
THAT DIVISION AND I WANTED TO
SHARE SOME OF THE CHANGES THERE.
SO THE DIVISION RECENTLY
RESTRUCTURED INTO THREE BRANCHES
THAT BETTER REFLECT THE
STRATEGIC PLAN.
SO WE DID CONSIDER A WIDE
VARIETY, YOU CAN IMAGINE, OF
DIFFERENT STRUCTURES, FOR
EXAMPLE, THE CREATION OF FIVE
DIFFERENT BRANCHES THAT ALIGN
WITH THE LENSES IN THE STRATEGIC
PLAN, BUT REALLY AFTER A LOT OF
DISCUSSION, THERE REALLY WAS A
STRONG CONSENSUS THAT HEALTH
EQUITY AND SOCIAL DETERMINANTS
OF HEALTH CUT ACROSS ALL OF OUR
AREAS AND THEY SHOULD HAVE A
STRONG INTEGRATION ACROSS ALL OF
OUR ACTIVITIES.
SO WE ARRIVED AT THREE BRANCHES
THE SYSTEMS AND MOTTL MODELS OF,
PREVENTION AND HEALTH PROMOTION,
AND POPULATION AND COMMUNITY
HEALTH.
AGAIN, SOCIAL DETERMINANTS OF
HEALTH AND HEALTH EQUITY WILL
APPEAR ACROSS ALL OF THOSE
BRANCHES.
WE HAVE TWO NEW BRANCH CHIEFS IN
THE DIVISION THAT I CERTAINLY
WANT TO RECOGNIZE.
KAREN KALE IS NOW THE CHIEF OF
THE SYSTEMS AND MODELS OF CARE
BRANCH, AND NADRA TYUS IS THE
CHIEF OF THE PREVENTION AND
HEALTH PROMOTION.
DR. TARLOV WILL BE ACTING CHIEF
OF POPULATION AND COMMUNITY
HEALTH WHILE WE SEARCH FOR THAT
CHIEF.
SO THOSE OF YOU WHO AREN'T
FAMILIAR WITH DR. KEHL AND
DR. TYUS, DR. KEHL JOINED IN
2014, HER RESEARCH FOCUSES ON
IMPROVING CARE IN THE LAST YEARS
OF LIFE.
HER CLINICAL EXPERTISE IS IN
PAIN AND SYMPTOM MANAGEMENT AND
PALLIATIVE CARE, AND SHE IS
ESPECIALLY INTERESTED IN
OPTIMIZING HEALTH IN RURAL
POPULATIONS.
SHE HAS PRACTICED IN A VARIETY
OF INPATIENT AND OUTPATIENT
SETTINGS IN ROLES THAT INCLUDE
CLINICAL NURSE SPECIALIST AND
CLINICAL NURSE EDUCATOR.
THEN DR. COMMANDER NADRA TYUS
REASONLY JOINED NINR FROM THE
NIH OFFICE OF STRATEGIC
COORDINATION, WHERE SHE WAS THE
PROGRAM LEADER OF THE
TRANSFORMATIVE HEALTH
DISPARITIES PROGRAM.
SHE ALSO LED THE DEVELOPMENT AND
IMPLEMENTATION OF THE COMPASS
COORDINATION CENTER AND SERVED
AS THE EVALUATION SME FOR THE
FIRST COORDINATION AND
EVALUATION CENTER.
SHE PROVIDES HER 20-YEAR
EXPERTISE TO NINR IN AREAS
RANGING FROM PREVENTION TO
COMMUNITY HEALTH TO SOCIAL
DETERMINANTS OF HEALTH,
INCLUDING TIME AS PROGRAM
DIRECTOR AT NIM HD AND A
NINE-YEAR TENURE AT HRSA.
SO CONGRATULATIONS TO KAREN AND
TO NADRA.
THIS SLIDE SHOWS WHICH BRANCH
THE NINR PROGRAM DIRECTORS ARE
WITHIN FOR THIS NEW STRUCTURE.
SO YOU'LL SEE NAMES THERE AND
YOU CAN ALSO FIND THAT COMING ON
OUR WEBSITE.
AND SPEAKING OF STAFF, I ALSO
WANT TO WELCOME SOME NEW STAFF
SINCE OUR LAST MEETING.
SO FIRST A SPECIAL WELCOME TO
DR. ALISON COLBERT, WHO IS
WORKING IN THE OFFICE OF THE
DIRECTOR THIS YEAR AS A
STRATEGIC ADVISOR.
DR. COLBERT IS A PROFESSOR AT
THE UNIVERSITY OF DUCANE SCHOOL
OF NURSING.
AS A CLINICAL NURSE SPECIALIST
WHO IS COMMITTED TO HELPING THE
UNDERSERVED, SHE BRINGS 15 YEARS
OF EXPERIENCE IN SETTINGS SUCH
AS JAILS, DRUG AND ALCOHOL
TREATMENT FACILITIES, AND
COMMUNITY CLINICS.
NYALA JOHNSON ALSO JOINED THE
OFFICE OF THE DIRECTOR AS A
MANAGEMENT ANALYST.
WE HAVE THREE STAFF JOINING THE
DIVISION OF EXTRAMURAL RESEARCH.
DR. DARA BLACHMAN-DEMNER,
DR. ANNIE-LAURIE MCREE AND AS I
MENTIONED DR. NADRA TYUS SO
WELCOME, EVERYONE.
THESE ARE AUTHORS FROM THE
EXTRAMURAL DIVISION.
THE FIRST ONE IS ABOUT THE
LISTENING SESSIONS THAT NIH HELD
TO INFORM THE DEVELOPMENT OF
COMPASS.
AS SOME OF YOU KNOW, COMPASS
RECOGNIZES THE ESSENTIAL ROLE OF
COMMUNITY ORGANIZATIONS AS THE
LEAD IN ADDRESSING PERSISTENT
STRUCTURAL AND SOCIAL CHALLENGES
TO ADVANCE HEALTH EQUITY.
THE INSIGHTS GAINED FROM THAT
LISTENING SESSION WERE USED TO
INFORM THE GOALS OF COMPASS AS
WELL AS SOME OF THE INITIATIVES.
SO DR. BYNAM HELPED TO CO-AUTHOR
THAT AREA.
THE OARTICLE.THE OTHER IS A PORO
ANALYSIS WHICH ASSESSED THE
LEVEL OF FUNDING FOR HEALTH AND
HOUSING RESEARCH.
FROM THE NIH, CDC AND HUD.
SO AS WE KNOW, HOUSING IS A
MAJOR SOCIAL DETERMINANT OF
HEALTH.
AMONG THE FINDINGS WERE THAT
STUDIES OF HOUSING AFFORDABILITY
AND STABILITY WERE THE LEAST
COMMON, AND ONLY 27% F FUNDED
PROJECTS WERE INTERVENTION
STUDIES, POINTING TO THE NEED
FOR RIGOROUS EVALUATIONS OF
HOUSING AND RELATED POLICY
INTERVENTIONS.
I HAD THE PLEASURE OF ATTENDING
THE ADVANCING CURES TODAY OR ACT
FOR NIH FOUNDATION'S TENTH
ANNIVERSARY CONGRESSIONAL
RECEPTION AT THE LIBRARY OF
CONGRESS ON APRIL 30TH.
ACT FOR NIH'S FOUNDATION MISS IS
TO SUPPORT NIH AND EDUCATE
MEMBERS OF CONGRESS ABOUT THE
RETURN ON INVESTMENT FROM NIH
RESEARCH.
OVER 20 MEMBERS OF CONGRESS
ATTENDED THE BRIEFING, INCLUDING
HOUSE MINORITY LEADER HAKIM
JEFFRIES AND HOUSE AND SENATE
APPROPRIATIONS LEADERSHIP.
I HAD THE OPPORTUNITY TO MEET
AND THANK SEVERAL MEMBERS OF THE
HOUSE AND SENATE APPROPRIATIONS
COMMITTEES FOR THEIR CONTINUED
SUPPORT OF NIH AND NINR.
MEMBERS WHO, AS YOU KNOW, ARE
RESPONSIBLE FOR SETTING THE
FUNDING LEVELS EACH YEAR.
THEY INCLUDED THE CHAIR AND
RANKING MEMBER OF THE HOUSE
LABOR HHS EDUCATION
APPROPRIATIONS SUBCOMMITTEE,
CONGRESSMAN ROBERT ADERHOLT FROM
ALABAMA, WHO IS PICTURED HERE,
AND CONGRESSWOMAN ROSA DELAURO
FROM CONNECTICUT AS WELL AS VICE
CHAIR OF THE APPROPRIATIONS
COMMITTEE, SENATOR SUSAN COLLINS
FROM MAINE, I ALSO MET SENATOR
MAGGIE HOSSAN FROM
NEW HAMPSHIRE.
SO IT WAS GREAT TO HAVE AN
OPPORTUNITY TO MEET THOSE
INDIVIDUALS IN PERSON AND TALK
ABOUT OUR EC EXCITING WORK AT NR
AND NIH.
THIS SLIDE OUTLINES OUR
APPROPRIATIONS HISTORY OVER THE
LAST FEW YEARS.
IN MARCH OF THIS YEAR, THE
PRESIDENT SIGNED A MINI BUS
SPENDING BILL TO KEEP NIH
INSTITUTES RUNNING THROUGH
SEPTEMBER 30TH.
NINR ENDED UP WITH A FLAT
BUDGET, WHICH IS ACTUALLY A
SMALL CUT DUE TO INFLATION AND
THE LOSS OF PURCHASING POWER.
THE GOOD NEWS IS THAT WE'VE
RETAINED THE $10 MILLION FOR
HEALTH DISPARITY RESEARCH FROM
FISCAL YEAR '23, AND WE DID
AVOID MORE SIGNIFICANT CUTS TO
FUNDING, WHICH WERE
UNFORTUNATELY EXPERIENCED BY
SOME OTHER PARTS OF NIH.
ALSO IN MARCH, THE PRESIDENT
RELEASED HIS BUDGET REQUEST FOR
FISCAL YEAR '25, WHICH FOR NINR
ESSENTIALLY REQUESTED FLAT
FUNDING.
I PROBABLY SHOULD MOVE ALONG,
SO -- I'M SORRY, WE'LL HAVE TO
SAVE THE DISCUSSION FOR LATER.
I'M GOING TO TURN TO SOME
UPDATES ABOUT NIH BECAUSE I
DON'T WANT YOU TO MISS THESE.
I WANT TO SHARE WITH YOU AN
INITIATIVE NIH IS CONSIDERING TO
ESTABLISH A NETWORK FOR RESEARCH
IN PRIMARY CARE SETTINGS.
SO THIS EFFORT IS A PRIORITY FOR
THE NIH DIRECTOR,
DR. BERTAGNOLLI, AND IS -- ITS
INITIAL SETUP IS BEING LED BY
THE NIH OD, BUT IT WILL SUPPORT
ALL ICs, INCLUDING NINR.
SO DESPITE OUR BEST EFFORTS, WE
KNOW THAT THE HEALTH OF THE U.S.
POPULATION IS DECLINING BUT
DECLINE IS STEEPEST AMONG THE
UNDERSERVED.
AS U.S. HEALTH DISPARITIES
PERSIST AND THE GAPS WIDEN.
POPULATIONS TRADITIONALLY
UNDERSERVED IN RESEARCH ARE ALSO
OFTEN MEDICALLY UNDERSERVED AND
DISPROPORTIONATELY IMPACTED BY
DISEASE AND ILLNESS.
THE LACK OF ADEQUATE
REPRESENTATION COMPROMISES THE
GENERALIZABILITY OF RESEARCH
OUTCOMES AND COMPOUNDS HEALTH
DISPARITIES.
SO ADDRESSES THIS CRITICAL NEED
TO EXTEND RESEARCH PARTICIPATION
OPPORTUNITIES, NIH IS
CONSIDERING PLANS FOR A PROGRAM
TO EXPAND RESEARCH OPPORTUNITIES
TO WHERE PEOPLE SEEK CARE, BY
INTEGRATING CLINICAL RESEARCH IN
PRIMARY CARE SETTINGS.
SO NIH IS LAUNCHING A PROGRAM TO
ESTABLISH A PRIMARY CARE FOCUS
CLINICAL RESEARCH NETWORK THAT
IS DISEASE-AGNOSTIC,
FACILITATING CLINICAL RESEARCH
AND MISSION AREAS ACROSS ALL
ICs.
TO INTEGRATE INNOVATIVE RESEARCH
WITH ROUTINE CLINICAL CARE IN
REAL WORLD SETTINGS, AND TO
CREATE A FOUNDATION FOR
SUSTAINED ENGAGEMENT WITH
COMMUNITIES, UNDERREPRESENTED IN
CLINICAL RESEARCH.
SO NIH WILL HOLD A PUBLIC
HALF-DAY WEBINAR ON JUNE 7TH TO
DISCUSS FINDINGS FROM LISTENING
SESSIONS ON HOW TO ACCESS -- ON
HOW ACCESS TO CLINICAL CARE
COULD BE EXPANDED THROUGH
PRIMARY CARE SETTINGS.
AS I SHOWED EARLIER, NINR IS
AHEAD OF THE CURVE AT NIH IN
PRIMARY HEALTHCARE RESEARCH.
PRIMARY HEALTHCARE AND HEALTH
SERVICES RESEARCH, MORE
GENERALLY, ARE TWO OF THE AREAS
WHERE NINR ALREADY STANDS OUT AT
NIH.
HEALTH EQUITY IS AN IMPORTANT
TOPIC, NOT JUST FOR NINR BUT FOR
NIH AS A WHOLE, SO I DID WANT TO
DRAW YOUR ATTENTION TO A BLOG
THAT DR. ELISEO PEREZ-STABLE AT
NIH PUT OUT ON THE COMPASS
INITIATIVE WHERE WE SHARED MORE
INFORMATION ABOUT THE 25 FUNDED
SITES ACROSS THE COUNTRY THAT
MAKE UP THE HEART OF THE COMPASS
PROGRAM.
SPEAKING OF COMPASS, I WANT TO
GIVE A SHOUT OUT TO
COUNCILMEMBER DR. AYALA FOR HER
ELECTION AS CO-CHAIR OF THE
COMPASS STEERING COMMITTEE.
THE STEERING COMMITTEE IS
RESPONSIBLE FOR STRATEGIC
LEADERSHIP AND GENERAL OVERSIGHT
OF THE COMPASS CONSORTIUM ACROSS
ALL PROGRAM INITIATIVES.
IT IS COMPRISED OF NIH COMPASS
LEADERSHIP TEAM AS WELL AS PIs
FROM ALL THREE COMPASS
INITIATIVES.
SO IT IS GREAT TO HAVE AN NINR
COUNCILMEMBER SERVING IN THAT
IMPORTANT LEADERSHIP ROLE.
WE'RE VERY GRATEFUL FOR YOUR
SERVICE, SO CONGRATULATIONS TO
YOU.
WE ARE ALWAYS LOOKING FOR WAYS
TO ATTRACT NEW TALENT TO THE
SCIENTIFIC RESEARCH FIELD, SO A
GREAT EXAMPLE OF THIS IS WHEN
DR. BERTAGNOLLI RECENTLY
ANNOUNCED THAT NIH WILL MODIFY
ITS APPLICATION AND REVIEW
PROCESS FOR FELLOWSHIP GRANTS.
FELLOWSHIP TRAINING GRANTS ARE A
CRITICAL PART OF THE DEVELOPMENT
OF THE HEALTH RESEARCH
WORKFORCE.
THE REVISED APPROACH FOR PEER
REVIEW OF FELLOWSHIP
APPLICATIONS IS DESIGNED TO
ENHANCE PARTICIPATION FROM
STRONG APPLICANTS AT SMALLER
SCHOOLS, MENTORS RELATIVELY
EARLY IN THEIR CAREERS, AND WELL
QUALIFIED STUDENTS WITH LESS
CONVENTIONAL ACADEMIC
BACKGROUNDS.
SO DR. BERTAGNOLLI STRONGLY
BELIEVES THE CHANGES WILL
IMPROVE THE PATH FOR TALENTED
SCIENTISTS WHO MIGHT NOT BE
RECOGNIZED UNDER THE CURRENT
SYSTEM.
THESE CHANGES WILL BE EFFECTIVE
FOR FELLOWSHIP APPLICATIONS DUE
ON OR AFTER JANUARY 25TH.
SO RELATED TO ATTRACTING
SCIENTIFIC TALENT, IN APRIL, NIH
ANNOUNCED THAT IT WILL RAISE THE
SALARIES OF THOUSANDS OF
POSTDOCTORAL RESEARCHERS AND
GRADUATE STUDENTS WHO RECEIVE
NIH RESEARCH FELLOWSHIPS.
THIS MOVE COMES IN RESPONSE TO
RECOMMENDATIONS FROM A WORKING
GROUP.
IT WAS ASSEMBLED TO ADVISE ON
HOW BEST TO RETAIN AND CULTIVATE
POSTDOCTORAL TALENT.
AFTER REPORTS THAT PRINCIPAL
INVESTIGATORS WERE STRUGGLING TO
FILL VACANT POSTDOC POSITIONS.
SO LO LOW SALARIES AS YOU KNOW E
OFTEN BEEN CITED AS A BARRIER
FOR NURSES TO PURSUE A PH.D. AND
DOCTORAL POSITIONS SO I WANTED
TO BE SURE TO DRAW THIS CHANGE
TO YOUR ATTENTION.
AND THEN WE HAVE SOME LEADERSHIP
CHANGES AT NIH THAT I WANT TO
SHARE BEFORE I CLOSE.
SO NIH DIRECTOR DR. MONICA
BERTAGNOLLI NAMED DR. SHAWN
MOONEY AS THE DIRECTOR OF THE
CENTER FOR INFORMATION
TECHNOLOGY.
HE STARTED JUST IN MARCH.
DR. MOONEY JOINS NIH FROM THE
UNIVERSITY OF WASHINGTON SCHOOL
OF MEDICINE IN SEATTLE.
AS PART OF THAT ROLE HE ALSO
SERVED AS CHIEF RESEARCH
INFORMATION OFFICER, INTERIM
DIRECTOR OF THE INSTITUTE FOR
MEDICAL DATA SCIENCE, AND
DIRECTOR OF INFORMATICS FOR THE
INSTITUTE OF TRANSLATIONAL
HEALTH SCIENCES.
WITH A BACKGROUND IN CHEMISTRY
AND INFORMATICS, DR. MOONEY'S
RESEARCH INTERESTS FOCUS ON
LEVERAGING COMPUTATIONAL
CYBERINFRASTRUCTURE AND DATA
SCIENCE TO ENABLE DISCOVERY
WITHIN BIOMEDICAL RESEARCH.
SO WELCOME TO HIM.
DR. BERTAGNOLLI ALSO NAMED
DR. KATHLEEN NUZZEL AS 13TH
DIRECTOR OF THE FOGARTY CENTER.
SHE STARTED AT FOGARTY THIS
MONTH.
DR. NEUZIL IS THE FIRST WOMAN TO
HOLD A PERMANENT POSITION SINCE
THE INCEPTION OF THE CENTER.
SHE JOINS FROM THE UNIVERSITY OF
MARYLAND BALTIMORE, WHERE SHE
WAS A PROFESSOR AS WELL AS
DIRECTOR OF THE CENTER FOR
VACCINE DEVELOPMENT AND GLOBAL
HEALTH.
SHE SERVES AS A VACCINE POLICY
ADVISOR FOR BOTH CDC AND THE
WORLD HEALTH ORGANIZATION.
THEN FINALLY, OUR LONG-TERM
COLLEAGUE DR. JOSHUA GORDON, IS
EXPECTED TO LEAVE THE NIH AND
THE NATIONAL INSTITUTE OF MENTAL
HEALTH ON JUNE 14TH.
HE'LL BE RETURNING TO COLUMBIA
UNIVERSITY AS CHAIR OF THE
DEPARTMENT OF PSYCHIATRY, AND
PSYCHIATRIST IN CHIEF OF THE
NEW YORK PRESBYTERIAN HOSPITAL
CACAMPUS.
DR. GORDON WILL ALSO SERVE AS
DIRECTOR OF THE NEW YORK STATE
PSYCHIATRIC INSTITUTE.
SO WHILE A NATIONAL SEARCH WILL
BE CONDUCTED FOR THE NEW
DIRECTOR IN THE INTERIM,
DR. SHELLEY AFTER KN AVENOLI WIE
AS ACTING DIRECTOR.
SO AS I WRAP UP, I WANT TO THANK
ALL MY COLLEAGUES FOR COMPILING
ALL THAT DATA, ALL THAT
INFORMATION, YEA, YEA, YEA, THAT
I WAS ABLE TO SHARE WITH YOU
TODAY.
I WANT TO THANK ALL MY
COLLEAGUES HERE AT NINR AND ON
COUNCIL FOR YOUR CONTINUED
SUPPORT, AND WITH THAT, I AM
PLEASED TO INTRODUCE OUR FIRST
SPEAKER.
DR. VALERIE DURRANT JOINS US TO
REVIEW SOME IMPORTANT CHANGES TO
GRANT REVIEW PROCEDURES.
AT THE NIH CENTER FOR SCIENTIFIC
REVIEW, DR. DURRANT IS THE
DIRECTOR OF THE DIVISION OF
AIDS, BEHAVIORAL AND POPULATION
SCIENCES.
SHE JOINED CSR IN 2003 AS A
SCIENTIFIC REVIEW OFFICER, AND
LATER SERVED AS THE CHIEF OF THE
POPULATION SCIENCES AND
EPIDEMIOLOGY INTEGRATED REVIEW
GROUP.
BEFORE TAKING HER CURRENT
POSITION.
SHE HAD PREVIOUSLY BEEN A
PROGRAM OFFICER AT THE NATIONAL
ACADEMY'S COMMITTEE ON
POPULATION, WHERE HER RESEARCH
FOCUSED ON TRANSITIONS TO
ADULTHOOD IN DEVELOPING
COUNTRIES, GENDER AND HEALTH,
AND THE HEALTH AND WELL-BEING OF
ADOLESCENTS IN DEVELOPING
COUNTRIES.
SO THANK YOU FOR JOINING US
TODAY, DR. DURRANT.
>> GREAT, SO HAPPY TO BE HERE!
AND AS SHANNON MENTIONED, MY
MAIN GOAL TODAY IS TO SHARE WITH
YOU SOME OF THE UPCOMING
CHANGES, HOPEFULLY YOU'VE HEARD
ABOUT THEM AND IT WON'T BE BRAND
NEW BUT WE'LL DIG INTO A LITTLE
BIT OF THE SPECIFICS, SO THAT
YOU KNOW WHAT'S COMING.
BEFORE -- THESE SLIDES ARE NOT
CHANGING.
NEED TO PUSH A LITTLE HARDER.
I DON'T WANT TO BELABOR THIS TOO
MUCH BUT JUST TO LET YOU KNOW
WHERE THE CENTER FOR SCIENTIFIC
REVIEW IS SITUATED, WE ARE ONE
OF THE 27 BROADER INSTITUTES.
WE ARE NOT A FUNDING INSTITUTE.
OUR PRIMARY ROLE IS TO SERVE --
TO COORDINATE THE PEER REVIEW AT
THE FIRST LEVEL OF REVIEW OF THE
APPLICATIONS THAT COME TO YOU
FOR ULTIMATE DISSECTIONS. DECIS.
SO WE WORK ACROSS ALL OF NIH.
OUR MISSION IS TO ENSURE THAT
NIH GRANT APPLICATIONS GET FAIR,
INDEPENDENT EXPERT SCIENTIFIC
REVIEWS FREE FROM INAPPROPRIATE
INFLUENCES.
THIS IS THE CSR MISSION, IT IS
ALSO THE GOAL OF ALL OF NIH PEER
REVIEW, SO THERE'S ALSO REVIEW
THAT IS DONE WITHIN EACH OF THE
ICs AND MOST OF MY COMMENTS
TODAY APPLY ACROSS THE BOARD, SO
REALLY SPEAKING ACROSS ALL OF
NIH REVIEW, NOT JUST NIH.
BUT OUR PRIMARY GOAL AND OUR
SOLE FOCUS IS ON HIGH QUALITY
SCIENTIFIC REVIEW OF TECHNICAL
MERIT.
THE ROLE WE PLAY IS TO ASSESS
THAT SO THAT YOU CAN THEN TAKE
THE INFORMATION ABOUT THE
SCIENTIFIC AND TECHNICAL MERIT
AND INCORPORATE THAT INTO YOUR
BROADER DECISIONS, YOUR BUDGETS,
YOUR PRIORITIES, YOUR STRATEGIC
PLANS, THE DIRECTIONS WHERE YOU
THINK THINGS SHOULD BE GOING,
AND THE NIH STRUCTURE IS
INTENTIONALLY SET UP TO SEPARATE
THOSE TWO THINGS TO GIVE YOU
THAT INFORMATION WITHOUT SOME OF
THOSE CONSIDERATIONS.
I ALSO LIKE TO SET THE SCOPE OF
WHAT WE DO AT NIH.
NIH IN FISCAL YEAR '23, SO LAST
YEAR, RECEIVED ALMOST 80,000
APPLICATIONS.
CSR REVIEWED 60,000 OF THOSE.
WE REVIEW AT CSR THE MAJORITY OF
THE R01s, THE MAJORITY OF THE
SBIRs, TTR SMALL BUSINESS
GRANTS, AS WELL AS THE
FELLOWSHIPS AND A RANGE OF OTHER
ACTIVITIES.
OBVIOUSLY WE DO THIS WITH A LOT
OF HELP.
AND THESE REVIEWS -- AND THIS IS
SPECIFIC TO THE CENTER FOR
SCIENTIFIC REVIEW AND DOES NOT
INCLUDE OTHER REVIEWS DONE
ACROSS NIH, BUT INCLUDED OVER 12
THOWL -- OR SORRY -- 1200
MEETINGS WITH OTHER 19,000
REVIEWERS.
I'D LIKE TO JUST SET THAT UP AS
THE CONTEXT.
SO WHAT I WANT TO SPEND MOST OF
MY TIME TODAY TALKING TO YOU
ABOUT IS CHANGES THAT WE HAVE
COMING IN THE PEER REVIEW
RESEARCH PROJECT GRANTS AS WELL
AS FELLOWSHIPS AND THE CHANGES
THAT SHANNON MENTIONED EARLIER
SO WE'LL DIG INTO A LITTLE BIT
OF EACH OF THESE.
SO LET ME START WITH THE
RESEARCH PROJECT GRANTS.
YOU'VE HEARD ABOUT THESE A
LITTLE BIT BEFORE, SO JUST
REMINDING YOU ABOUT WHAT IS
CHANGING.
SO ONE, WE CURRENTLY HAVE FIVE
REVIEW CRITERIA.
WE ARE COLLAPSING THOSE INTO
THREE FACTORS.
I'LL GET INTO SOME OF THE
SPECIFICS IN A SECOND.
WE ARE MOVING TWO OF THOSE
CURRENT REVIEW CRITERIA
INVESTIGATOR AND ENVIRONMENT,
INTO ONE OF THE FACTORS AND
REVIEWING THEM AS A BINARY
DECISION OF APPROPRIATE VERSUS
GAPS IDENTIFIED.
WE'VE MOVED SOME OF THE
ADDITIONAL REVIEW CRITERIA
AROUND.
THESE ARE THINGS LIKE HUMAN
SUBJECTS CONSIDERATIONS,
INCLUSIONS CONSIDERATIONS, TO
SIMPLIFY AND BASICALLY PUT THEM
WHERE THEY LOGICALLY MAKE MORE
SENSE.
SO WE'RE TAKING THE OPPORTUNITY
TO DO THAT.
AND THEN THERE ARE ALSO A NUMBER
OF OTHER FACTORS THAT HAVE BEEN
ADDED INTO THE SCIENTIFIC PEER
REVIEW THAT ARE REALLY MORE
ADMINISTRATIVE AND THOSE ARE
BEING MOVED OUT OF PEER REVIEW
SO THAT PEER REVIEWERS CAN FOCUS
ON THE SCIENTIFIC AND TECHNICAL
MERIT.
THE BOTTOM LINE AND THE
JUSTIFICATION AND MOTIVATION FOR
ALL OF THIS IS REALLY TO MAKE
SURE THAT THE PEER REVIEW AT
THAT FIRST LEVEL CAN FOCUS ON
THE SCIENTIFIC AND TECHNICAL
MERIT.
WE WANT INPUT ON WHAT WILL THE
ADVANCES TO SCIENCE BE, WHAT IS
THE POTENTIAL TO REALLY MAKE A
CONTRIBUTION FOR THESE
APPLICATIONS, AND SO THE GOAL IS
TO PULL THE REVIEWERS BACK AND
MAKE SURE THAT WE'RE FRAMING THE
ASK TO THEM IN A WAY WHERE WE
WILL GET THAT INFORMATION.
SO LET ME STEP BACK AND JUST
AGAIN KIND OF REMIND YOU OF THE
MOTIVATION FOR THESE CHANGES.
AS I MENTIONED, ONE WAS THAT WE
REALLY -- THIS STARTED OUT
PRIMARILY AS A PROJECT TO
SIMPLIFY PEER REVIEW WITH THE
RECOGNITION THAT THERE WERE LOTS
OF DIFFERENT CONSIDERATIONS
BEING PUT ON THE PLATE OF PEER
REVIEWERS AND LOTS OF JUST
COMPLEXITY THAT WAS POTENTIALLY
DISTRACTING AND NOT FULLY
ACHIEVING THE GOALS AT ALL
TIMES.
WE GOT THIS FROM LOTS OF INPUT
FROM THE SCIENTIFIC COMMUNITY.
IT'S SOMETHING WE REGULARLY
HEARD FROM THE COMMUNITY FROM
REVIEWERS, AS WELL AS OBSERVED
OURSELVES.
AND ONE AREA AS I MENTIONED WAS
THERE WERE A NUMBER OF THINGS
THAT WERE BEING ADDED THAT WERE
REALLY MUCH MORE ADMINISTRATIVE
COMPLIANCE THAT COULD BE BETTER
HANDLED CLEESER TO THE FUNDING
DISSECTIONS AND BY NIH STAFF AS
OPPOSED TO PEER REVIEWERS.
SO AGAIN WANTED TO REMOVE
EVERYTHING WE POSSIBLY COULD
OTHER THAN THAT SCIENTIFIC AND
TECHNICAL MERIT.
THE SECOND MOTIVATION OF SOME OF
THE CHANGES IS ALONGSIDE THIS
WAS THIS GROWING AWARENESS,
CONCERN, I GUESS I SHOULD SAY,
OF BIASES POTENTIALLY SLIPPING
INTO REVIEW, UNDUE INFLAWNS OF
REPUTATION, THAT IS THE PRIMARY
BIAS THAT WE DO SEE IN REVIEW,
IS -- AND IT GENERALLY COMES IN
THE FORM OF, OH, WE ALL KNOW
THIS INVESTIGATOR OR THEY COME
FROM THIS GREAT INSTITUTION AND,
THEREFORE, WE CAN TRUST THEM.
I THINK ANYBODY WHO HAS SERVED
ON AN NIH PANEL OR AT SOME POINT
HAS HEARD THAT WE CAN TRUST THEM
PHRASE, AND THE GOAL WITH THE
REVIEW CRITERIA AND WITH OUR
CONSIDERATION OF SIGN TIFNG AND
TECHNICAL MERIT FOR PROJECT
GRANTS IS REALLY TO SAY DO WE
HAVE THE RIGHT EXPERTISE FOR THE
PROJECT, SO AGAIN GETTING BACK
TO THAT.
I WANT TO MAKE SURE THAT WE ARE
PHRASING THE ASK TO REVIEWERS
AND WE ARE GETTING INFORMATION
THAT FOCUSES ON WHEN WHETHER THE
INVESTIGATORS AND ENVIRONMENTS
ARE NOT JUST GREAT BUT ARE THEY
APPROPRIATE FOR THE PROJECT AND
ADVANCE THE PROBABILITY OF THE
PROJECT TO BE COMPLETED
SUCCESSFULLY.
SO LET'S GET INTO A FEW OF THE
SPECIFICS OF WHAT THIS LOOKS
LIKE.
SO AS I MENTIONED, WE ARE MOVING
TO REVIEW -- ASKING REVIEWERS TO
FOCUS ON THREE FACTORS.
WE ARE TAKING THE SAME FIVE
REVIEW CRITERIA THAT ARE PART OF
REGULATION AND GROUPING THEM
TOGETHER, AND ASKING REVIEWERS
TO SPEAK FIRST TO THE IMPORTANCE
OF THE RESEARCH.
SO SHOULD THE RESEARCH BE DONE
IS THE SHORTHAND QUESTION THAT
WE OFTEN ASK.
REVIEWERS ARE ASKED TO SCORE
THIS ON A 1 TO 9 SCALE AS THEY
CURRENTLY DO, AND IT
INCORPORATES AN INTEGRATION OF
THE CURRENT REVIEW CRITERIA OF
SIGNIFICANCE, AND INNOVATION, IN
A WAY THAT ALLOWS FOR MORE
NATURAL INTEGRATION OF THOSE TWO
CONCEPTS.
ONE OF THE REGULAR CHALLENGES
WITH PEER REVIEW WAS AROUND
INNOVATION AND HOW TO INTEGRATE
INNOVATION BECAUSE NOT ALL
SCIENCE IS INNOVATIVE AND
SCIENCE DOESN'T HAVE TO BE
INNOVATIVE TO HAVE AN ADVANCE.
ON THE OTHER HAND, SOME VERY
INNOVATIVE SCIENCE REALLY SHOULD
BE ACKNOWLEDGED AS HAVING A
POTENTIAL HIGH IMPACT.
AND SO THE INTEGRATION OF THESE
TWO INTO THIS FACTOR PHRASING IT
AS SHOULD THE RESEARCH BE DONE
OR WHAT'S THE IMPORTANCE OF THE
RESEARCH, WE HOPE WILL ALLOW US
TO GET BETTER INPUT ON THAT.
THE SECOND FACTOR IS CALLED
RIGOR AND FEASIBILITY.
IT PULSE IN THE CONSIDE PULLS IS
THAT WERE PREVIOUSLY PART OF THE
PRIOR APPROACH BUT REALLY
FOCUSES ON WHAT WE CARE ABOUT IN
THE APPROACH, WHICH IS WILL THE
RESEARCH BE DONE IN A RIGOROUS
WAY, IS IT REPRODUCIBLE, IS IT
FEASIBLE.
AND FEASIBLE NOT IN A WAY OF
WILL IT BE DONE PERFECTLY, BUT
IS IT PROPOSED IN A WAY THAT
MAKES LOGICAL SENSE AND INCLUDES
KIND OF CALCULATED RISKS.
SO THAT WE ALLOW FOR THE NATURAL
SCIENTIFIC PROCESS TO ROLL OUT
AND WE DON'T EXPECT PERFECT
DESIGNS OR PERFECT MEASURES,
EVERYTHING PERFECT IN THE
APPLICATION LEVEL, WE WANT TO
MAKE SURE WE HAVE A GOOD SOLID
FOUNDATION AND THAT THERE'S A
PLAN FOR HOW TO ADDRESS
UNEXPECTED OR LESSONS LEARNED
ALONG THE WAY.
THE THIRD FRACK TORE AS I FACTOE
AND RESOURCES.
THE FIRST TWO ARE SCORED AS WELL
AS COMMENTS.
THE THIRD IS THE EXPERTISE AND
RESOURCES APPROPRIATE FOR THE
RESEARCH BEING PROPOSED?
IF IT'S APPROPRIATE, MOVE ON.
ARE GAPS IDENTIFIED, BRIEFLY
SPEAK TO WHAT THOSE GAPS ARE.
IT'S VERY SPECIFIC TO THE
PROJECT BEING PROPOSED.
THE OTHER CHANGE RELATED TO THE
ADDITIONAL REV REVIEW CRITERIA E
THE INCLUSION PLAN, SO
CONSIDERATION OF THE SAMPLE
HAS BEEN WRAPPED INTO RIGOR AND
FEASIBILITY AS OPPOSED TO BEING
KIND OF A BOX AFTER.
THESE ARE ALWAYS -- THESE HAVE
ALWAYS BEEN POSSIBLE TO AFFECT
THE SCORE SO THEY'VE ALWAYS BEEN
CONSIDERATIONS, BUT INCLUDING
THEM IN TWO DIFFERENT PARTS OF
THE REVIEW PROCESS RAISED SOME
QUESTIONS AND NOW IT'S PUTTING
IT REALLY WHERE IT FIT, SO
ASKING ARE THE SAMPLES
APPROPRIATE, I ARE THE
CONSIDERATIONS ALL IN PLACE
SUPPORTING THE RESEARCH.
IN TERMS OF THE OTHER I DIGSAL
CRITERIA, THESE ARE THINGS THAT
CAN AFFECT THE SCORE, THEY ARE
NOT INDEPENDENTLY SCORED.
THOSE WILL ALL REMAIN INTACT.
AND THEN AS I MENTIONED, THERE'S
SOME OTHER ADDITIONAL REVIEW
CRITERIA THAT DID NOT AFFECT THE
SCORE, HAVE NEVER AFFECTED THE
SCORE AND THOSE HAVE BEEN MOVED
OUT TO CONSIDERATION POST-RE
POST-REVIEW.
SO HERE'S THE LONG LIST.
THIS IS NOT EVERY -- NOT EVERY
APPLICATION IS AFFECTED, AS I
MENTIONED, IT'S RESEARCH PROJECT
GRANTS.
THE SLIDE SHOWS THE SPECIFIC
ACTIVITY CODES THAT ARE INCLUDED
IN THIS.
IT IS THE BULK OF THE RESEARCH
PROJECT GRANTS.
IT EXCLUDES THE SMALL BUSINESS
OR NOT YET INCORPORATED INTO
THIS.
AND AS MENTIONED, THIS WILL BE
EFFECTIVE WITH DUE DATES
STARTING JANUARY 25TH, 2025, SO
WE'RE COMING UP QUICKLY.
AND THERE IS A LOT OF
INFORMATION AVAILABLE ON THE WEB
AND I'LL GET TO THAT IN A SEC.
ACTUALLY, I'LL GET TO THAT NOW.
HERE'S THE WEBSITE.
OUR PRIMARY GOAL OVER THE NEXT
SIX MONTHS IS REALLY
SOCIALIZATION, MAKING SURE
PEOPLE ARE AWARE OF THESE
CHANGES, AND KNOW WHAT'S COMING
AND KNOW WHAT IS AFFECTED AND
THE WHY.
THAT'S ONE OF THE REASONS I'M
HERE, IS TO EXPLAIN SOME OF THE
WHY.
SO AT THIS WEBSITE, IT A PUBLIC
WEBSITE, YOU CAN GET LOTS OF
INFORMATION THAT IS REGULARLY
UPDATED ABOUT THE CHANGES,
WHAT'S COMING, WHY -- TRAINING
MATERIALS, THERE'S SEMINARS --
WEBINARS THAT HAVE BEEN HELD AND
THE VIDEO RECORDINGS ARE THERE
ACTIVELY MAINTAINED FREQUENTLY
ASKED QUESTIONS AND OTHER
INFORMATION.
SO LET ME ALSO TURN TO THE
CHANGES RELATED TO THE REVIEW
AND APPLICATIONS ACTUALLY OF THE
FELLOWSHIP APPLICATIONS THAT
WERE A PARALLEL PROJECT.
WON'T GO INTO THE BACKGROUND OF
THE NR -- NATIONAL RESEARCH
SERVICE AWARDS, BUT THIS
INCLUDES ALL OF NIH FELLOWSHIP
AND F AWARDS.
SIMILAR TO THE RESEARCH PROJECT
GRANTS WE WERE HEARING ONGOING
INPUT FROM THE RESEARCH
COMMUNITY, SOUNDS LIKE I DON'T
NEED TO GO INTO THAT TOO MUCH,
YOU'RE FAMILIAR WITH THAT, THAT
RECOGNIZED OR THAT NIH
FELLOWSHIP AWARDS WERE
CONCENTRATED IN A LIMITED NUMBER
OF INSTITUTIONS, AND WERE NOT --
THERE WERE A LOT OF PEOPLE BEING
LEFT OUT OF THE PROCESS.
OUR OWN DATA ANALYSIS SUPPORTED
THIS.
I'LL JUST SHOW YOU A LITTLE BIT
OF THAT ANALYSIS.
SO THE BULK OF THE FELLOWSHIP
APPLICATIONS THAT NIH HAS
RECEIVED COME FROM A RELATIVELY
SMALL NUMBER OF INSTITUTIONS.
YOU KIND OF HAVE TO DO THE MATH
AND FLIP THIS GRAPH, BUT THERE
ARE 15 INSTITUTIONS THAT SUBMIT
100 OR MORE APPLICATIONS, AND IF
YOU PUT KIND OF THE TWO HIGHEST
SUBMITTING INSTITUTION
CATEGORIES TOGETHER, YOU HAVE
THOSE GROUP OF 22 INSTITUTIONS
SUBMITTING MORE THAN ALL THE
OTHER INSTITUTIONS COMBINED.
SO -- WHICH THERE'S AN ECONOMY
OF SCALE HERE AND EXPERTISE AND
A VARIETY OF FACTORS THAT
SUPPORT THAT.
IN ADDITION, THE MORE
APPLICATIONS AN INSTITUTION
SUBMITS, THE BETTER THEY ARE,
AGAIN, PROBABLY THE ECONOMIES OF
SCALE IN THE KNOWLEDGE AND
RESOURCES THAT THEY BUILD UP AND
CAN SUBMIT APPLICATIONS.
SO SO WITH THE RE-ASSESSMENT OF
FELLOWSHIP APPLICATIONS, AGAIN
THE GOAL IS TO REALLY MAKE SURE
THAT WE ARE FOCUSING REVIEWERS
ON THE RIGHT CONSIDERATIONS,
MAKING SURE THEY ARE REALLY
PAYING ATTENTION TO THE GOALS OF
THE NRSA PROGRAM, WHICH IS TO
DEVELOP RESEARCH CAREERS TO MAKE
SURE THAT WE'RE INCLUDING A
BROAD RANGE OF RESEARCHERS NOT
JUST FROM DIFFERENT INSTITUTIONS
AND DIFFERENT BACKGROUNDS, BUT
ALSO WITH INTEREST IN GOING TO
DIFFERENT RESEARCH INSTITUTIONS
AND MAKING SURE THAT WE ARE
REALLY KEEPING A BROAD AND OPEN
GOAL.
SO OUR FOCUS I -- IS I INTENDEDO
FOCUS REVIEWER ATTENTION ON
THREE KEY ASSESSMENTS.
SO REALLY THE QUALITY OF THE
CANDIDATE AND THEIR POTENTIAL,
THEIR PREPARATION AND POTENTIAL,
THE RESEARCH TRAINING PLAN, SO
WHAT THEY PROPOSE TO DO IN ORDER
TO GAIN TRACTION AS A
INDEPENDENT RESEARCHER, AND THE
COMMITMENT TO THE CANDIDATE FROM
THE SPONSORS, THE INSTITUTIONS
WHERE THEY WILL BE WORKING.
A SECOND MAIN DRIVER AS I
MENTIONED IS REALLY TO MAKE SURE
THAT WE ARE EXPANDING THE POOL
AND BRINGING IN THE FULL RANGE
OF POTENTIAL CANDIDATES AND
PROVIDING A FAIR REVIEW ACROSS
THE BOARD BY REDUCING BIAS AND
REALLY, AGAIN, KIND OF
EMPHASIZING THAT POTENTIAL OF
THE CANDIDATE, NOT THE QUALITY
OF THE APPLICATION PRODUCT
ITSELF.
SO AGAIN, I'VE HIGHLIGHTED THE
THREE MAIN CRITERIA THAT THE
REVIEWERS WILL BE ASKED TO SPEAK
ON.
THE CURRENT CRITERIA ARE ON THE
LEFT AND THE NEW ONES ARE ON THE
RIGHT.
AND WHAT THE GOAL IS IS REALLY,
AGAIN, TO FOCUS ON THE CAPPED OE
CANDIDATE, FOCUS ON A MORE OPEN
ASSESSMENT OF THE CANDIDATE THAT
LOOKS AT THE FULL SCOPE OF THEIR
TRAINING, THEIR INTERESTS, WHAT
THEY HAVE DONE TO PULL TOGETHER
THEIR TRAINING PLAN, WHERE THEY
PLAN TO TAKE THEIR RESEARCH AND
REALLY FOCUS ON THAT AND THE
QUALITY OF THAT PLAN IN ORDER TO
ADVANCE THEIR CAREER.
THE CHANGES TO THE FELLOWSHIP
REVIEW FOCUS REQUIRE CHANGES TO
THE FELLOWSHIP APPLICATION.
SO WE WILL BE CHANGING THE
APPLICATION AS WELL TO SUPPORT
THE REVIEW OF APPLICATIONS.
SOME OF THAT IS REMOVING SOME OF
THE FACTORS THAT CAN CREATE THE
BIAS.
SOME OF IT IS REALLY JUST
ORGANIZING AND GETTING
INFORMATION THAT BETTER ALIGNS
WITH THE INTERESTS OF THE NEW
REVIEW CRITERIA.
FIRST CHANGE TO THE APPLICATION
IS REMOVING GRADES FROM THOSE
APPLICATIONS.
THERE IS A LIST OF COURSES THAT
IS PROVIDED.
WE WANT TO MAKE SURE WE HAVE THE
TRAINING.
WE FOUND THAT REVIEWERS
OVEREMPHASIZE GRADES AND KIND OF
NAVIGATE KIND OF QUICK
INDICATORS AS OPPOSED TO DIGGING
IN TO THE QUALITY AND WHAT
PEOPLE ARE DOING AND WHAT THEY
HAVE ACHIEVED, SO WE WANT TO
REMOVE THAT.
AS WE'VE MENTIONED, THERE ARE
OTHER CHANGES TO THE APPLICANT
SECTION THAT REALLY FOCUS
ATTENTION ON BROADER
CONSIDERATIONS.
WE'VE REVISED THE SPONSOR AND
COLLABORATOR CONSULTANTS TO
FOCUS ON HOW THEY WILL
SPECIFICALLY WORK WITH THE
APPLICANT OR THE CANDIDATE AS
OPPOSED TO A GENERIC STATEMENT
ABOUT THEIR QUALIFICATIONS.
THE LETTERS OF REFERENCE HAVE
BEEN REVISED.
THIS IS REALLY MORE TO MAKE THEM
SIMPLER AND MAKE THEM A LITTLE
BIT MORE STANDARD, BUT ALSO LESS
BOILERPLATE.
THERE ARE NO SIGNIFICANT CHANGES
TO THE RESEARCH TRAINING PLAN.
SO THERE IS A RESEARCH PROJECT
THAT IS A CORE PART OF THE
APPLICATION THAT REMAINS
UNCHANGED.
THEN THERE'S ALSO A SECTION IN
THE APPLICATION TO ADD AN
OPTIONAL PERSONAL STATEMENT OR
STATEMENT IF THERE'S ANY
CONSIDERATIONS ABOUT PAST
TRAJECTORIES OR ANYTHING THAT
MAY BE RELEVANT.
THROUGH OUR FEEDBACK PROCESS AS
WE'VE ROLLED OUT SOME OF THE
CHANGES AND ASKED FOR INPUT, ONE
OF THE THINGS THAT CAME UP THAT
WE ALSO HAVE DONE IS TO CLARIFY
THE INSTRUCTIONS TO MAKE SURE
IT'S REALLY CLEAR WHICH PART
OF -- WHETHER THE CANDIDATE, THE
INSTITUTION OR THE SPONSOR FILLS
OUT WHICH PART OF THE
APPLICATION SO THERE'S MORE
CONSISTENCY IN THAT.
SO WE HAVE DONE THAT.
TIMELINE FOR IMPLEMENTATION IS
THE SAME.
SO THESE ARE FOR APPLICATIONS
DUE STARTING JANUARY 25TH, 2025,
AND AFTER FOR THE MAJORITY OF
THE FELLOWSHIP DUE DATES THAT
WOULD BE IN APRIL, APRIL 8TH.
AND FOR SUMMER REVIEW AND
OCTOBER COUNCIL, AND IT IS ALL
OF THE NRSA ACTIVITIES.
THESE ARE THE PRIMARY CHANGES
COMING.
THEY DO COME IN THE CONTEXT OF A
NUMBER OF OTHER CHANGES.
SO LET ME JUST TOUCH ON THOSE
BRIEFLY.
WE'VE TOUCHED ON THE SIMPLIFYING
FRAMEWORK, REVIEW FRAMEWORK FOR
THE RESEARCH PROJECT GRANTS AND
THE FELLOWSHIP APPLICATIONS.
THOSE ARE BY FAR THE BIGGEST
CHANGES COMING.
BUT THERE ARE A COUPLE OTHERS.
SO ONE, I MENTIONED THE CHANGES
TO THE REFERENCE LETTERS.
THAT'S TRUE FOR ALL REFERENCE
LETTERS, INCLUDING CASE.
SO THAT IS A STANDARD CHANGE
ACROSS ALL APPLICATIONS.
AGAIN, ALL OF THIS IS STARTING
WITH THE JANUARY 25TH, 2025, THE
MAGIC DATES.
EVERY FEW YEARS -- OH, I
SKIPPED -- THERE'S ALSO SOME
UPDATES TO THE INSTITUTIONAL
TRAINING GRANTS.
I'M NOT GOING TO GO INTO THE
DETAILS ON THOSE.
THERE IS A WEBINAR ON JUNE 5TH
TO GO THROUGH THOSE CHANGES.
A LOT OF IT'S IN THE FORMS AND
JUST SOME OF THE SUPPORTING
MATERIALS BUT I DID WANT TO MAKE
SURE THAT YOU ARE AWARE THAT
THERE WERE CHANGES COMING TO
THAT.
EVERY FEW YEARS, NIH UPDATES THE
FORMS ITS USED.
THEY SAVE UP SOME OF THESE MINOR
CHANGES, WORDING CHANGES OR
ALIGNMENT CHANGES, AND THIS IS
ONE OF THOSE YEARS, SO THERE IS
A SET OF NEW FORMS COMING WITH
RELATIVELY MINOR CHANGES, BUT
THERE WILL BE SOME CHANGES TO --
OBVIOUSLY TO THE FELLOWSHIP
APPLICATIONS BUT OTHER MINOR
CHANGES AS WELL.
ANOTHER BIG CHANGE THAT IS
ACTUALLY OFF THIS CURRENT
TIMELINE, THROWING EVERYBODY
THROUGH A CONFUSION LOOP, IS THE
CHANGE TO -- THEY'RE MOVING --
WE'RE MOVING TOWARDS A COMMON
FORM FOR BIOGRAPHICAL SKETCHES.
SO THIS IS TO ALIGN WITH
AGENCIES ACROSS THE GOVERNMENT
AND INTEGRATE MORE ATTENTION AND
CONSISTENCY IN HOW CONFLICTS OF
INTEREST AND DISCLOSURES ARE
HANDLED.
SO THAT WILL BE COMING IN THE
SPRING.
OF 2025 AND MORE
INFORMATION IS AVAILABLE.
AT THIS
WEBSITE.
THIS WEBSITE REALLY TOUCHES AND
GOES INTO DEPTH ON ALL OF THESE
CHANGES IF YOU'RE INTERESTED IN
ANY MORE INFORMATION ABOUT
SPECIFICS OF THOSE.
SO BEFORE I CLOSE, I JUST WANTED
TO COME BACK TO CSR
SPECIFICALLY, AND JUST TOUCH A
LITTLE BIT ON A COUPLE OF THE
ACTIVITIES GOING ON WITHIN CSR
THAT ARE PROBABLY MOST RELEVANT
TO NINR.
I USUALLY DON'T SHOW A CSR
ORGANIZATIONAL CHART WHEN I GO
TO ADVISORY COUNCILS, BECAUSE NO
ONE CARES ABOUT OUR INTERNAL
STRUCTURE, BUT I DO WANT TO
HIGHLIGHT AT THIS TIME THE
CENTER FOR SCIENTIFIC REVIEW HAS
FIVE SCIENTIFIC DIVISIONS, SO WE
JUST DIVIDE THE APPLICATIONS UP
LOOSELY BY SCIENCE AND DIFFERENT
AREAS.
I'M OVER HERE IN THE DIVISION OF
AIDS BEHAVIORAL AND POPULATION
SCIENCES, AND I HIGHLIGHT THIS
BECAUSE WE DO REVIEW
APPLICATIONS -- THIS IS THE
INVESTIGATOR INITIATED
APPLICATIONS.
99% OF NINR APPLICATIONS ARE
REVIEWED WITHIN MY DIVISION.
SO THERE IS A VERY CLOSE
ALIGNMENT.
AND THE OTHER THING I WANTED TO
LET YOU KNOW IS A FEW CHANGES
THAT ARE COMING TO SOME OF OUR
STUDY SECTIONS.
SO WHAT I HAVE HERE IS THE
BRANCHES WITHIN MY DIVISION,
SO -- AND PART OF WHY I SHOW
THIS IS I'M JUST STRUCK BY HOW
MUCH ALIGNMENT THERE IS IN THE
NINR STRATEGIC PLAN WITH WHAT --
WITH THE INPUT WE'VE BEEN
GETTING AND SOME OF THE
DIRECTIONS WE'VE BEEN TAKING, SO
WE HAVE FIVE BRANCHES WHERE WE
DIVIDE UP THE STUDY SECTIONS AND
REVIEW APPLICATIONS AND THIS IS
MORE JUST TO KIND OF GIVE YOU A
FLAVOR OF THE SCOPE OF WHAT WE
DO WITHIN EACH OF THESE FIVE
BRANCHES, WE HAVE MULTIPLE STUDY
SECTIONS AND WE COVER EVERYTHING
FROM BIOBEHAVIORAL PROCESSES UP
THROUGH BIOINFORMATICS HEALTH
SERVICES, YOU KNOW, ANYTHING
HUMAN, THE FULL SCALE AND SCOPE.
IF I OVERLAY HERE THE STRATEGIC
PLAN OF NINR, YOU CAN REALLY SEE
THE LEVEL OF OVERLAP.
THE OTHER THING THAT I WANTED TO
MENTION IS WE HAVE RECENTLY BEEN
GOING THROUGH OUR ENQUIRE
PROCESS, WHERE WE EVALUATE OUR
STUDY SECTIONS AND MAKE SURE THE
SCIENTIFIC SCOPE IS REMAINING
CONSISTENT AND ALIGNS WITH
SCIENCE IN ORDER TO BEST
IDENTIFY THE HIGH QUALITY
SCIENCE.
WE ARE CURRENTLY IN THE PROCESS
OF DOING THAT WITH OUR CLUSTER
OF OUR STUDY SECTIONS THAT
LOOSELY FALL IN THE SOCIAL AND
BEHAVIORAL SCIENCES AREA, AND WE
ARE REORGANIZING SEVERAL OF
THOSE STUDY SECTIONS IN THE NEXT
YEAR.
THE ENQUIRE PROCESS INCLUDES AN
EXTERNAL COMMITTEE WHERE WE GET
INPUT ON KIND OF HELPING US MAP
ON THE NATURE OF OUR
APPLICATIONS WITH THE CURRENT
SCIENTIFIC FIELDS AND MAKE SURE
THAT WE'RE INCLUDING A
BROADER -- WE'RE GETTING KIND OF
OUT OF OUR ADMINISTRATIVE HABITS
AND GETTING SOME FRESH INPUT, WE
THEN INVOLVE AN NIH INTERNAL
GROUP TO PROVIDE SOME INPUT, AND
WE HAVE RECEIVED APPROVAL TO
MOVE FORWARD WITH RECONFIGURING
NINE STUDY SECTIONS INTO EIGHT
STUDY SECTIONS THAT I THINK WILL
ULTIMATELY BECOME NINE STUDY
SECTIONS BUT WE'RE STARTING WITH
THE EIGHT, AND ONE OF THE THINGS
THAT I WANTED TO HIGHLIGHT IS,
AGAIN KIND OF THE ALIGNMENT WITH
THE NIH -- OR THE NINR STRATEGIC
PLAN, SO WE ARE CURRENTLY -- WE
HAVE RECONFIGURED STUDY SECTIONS
PROPOSED THAT FOCUS ON COMMUNITY
HEALTH.
WE ALREADY HAVE A COUPLE OF
COMMUNITY STUDY SECTIONS BUT IT
IS REFRESHING AND REALLY
RENEWING THE CONCEPT OF
COMMUNITY AND REFLECTING WHAT
COMMUNITY MEANS NOW.
WE HAVE A POPULATION LEVEL,
SOCIAL SCIENCE STUDY SECTION
PLAN THAT INCLUDES A LOT OF
POLICY INTEGRATION.
AGAIN, WE HAVE A SIMILAR STUDY
SECTION NOW, BUT IT INCORPORATES
SO MANY OF THE CONCEPTS IN THE
INTEGRATION OF THE SOCIAL
DRIVERS OF HEALTH.
I LOVE THAT CONCEPT.
AND OTHER CONSIDERATIONS.
ALSO WE HAVE ADDED A STUDY
SECTION THAT WILL BE FOCUSING ON
HEALTH EQUITY FROM A SOCIAL AND
BEHAVIORAL PERSPECTIVE.
WE CURRENTLY HAVE ONE IN THE
HEALTH SERVICES AREA THAT HAS A
SPECIFIC HEALTH DISPARITIES
FOCUS, AND THERE IS ONE THAT IS
CURRENTLY AT LEAST IN THE
FEASIBILITY TESTING FOR THE
SOCIAL AND BEHAVIORAL AREA
PRIMARILY TO LOOK AT STRUCTURAL
DRIVERS, SYSTEMIC UNDERPINNINGS,
SO THE IDEA IS REVIEWING THE
APPLICATIONS THAT ARE REALLY
TRYING TO FOCUS ON WHAT CREATES,
WHAT SUPPORTS EQUITY, INEQUITY
ON ALL THOSE STRUCTURAL AND
SYSTEMIC DETERMINANTS ACROSS
MULTIPLE LEVELS SO IT COULD BE
AT THE INDIVIDUAL LEVEL, IT
COULD BE AT THE POLICY OR
COMMUNITY LEVEL.
SO WE HAVE A FEW OF THOSE
COMING, AGAIN, WE HAVE A PROCESS
WHERE WE TAKE THESE THROUGH A
MOCK SORT AND MAKE SURE THAT
THEY'RE VIABLE AND ONCE THEY'RE
READY, WE'LL GET INFORMATION OUT
AND WE'LL MAKE SURE THAT WE GET
THAT TO YOU.
I'M THRILLED TO SEE THE FEEDBACK
THAT WE GOT FROM A VERY
DIFFERENT KIND OF QUESTION THAT
WE POSED TO OUR EXTERNAL
COMMUNITY OVERLAPPING SO MUCH
WITH WHAT I SEE IN YOUR
STRATEGIC PLAN AND WHAT I HEAR
FROM YOUR DISCUSSION, IT GIVES
ME A LOT OF CONFIDENCE OVER
GOING IN THE RIGHT DIRECTION AND
THERE IS THIS ALIGNMENT.
>> THAT WAS GREAT.
THANK YOU SO MUCH.
WE'VE GOT A ROUND OF APPLAUSE.
I NEVER GET THAT, NEVER.
NEVER.
OKAY.
SO DR. STONE, I THINK IS GOING
TO START US OFF.
CAN YOU HEAR US?
>> I CAN HEAR YOU.
CAN YOU HEAR ME OKAY?
>> YES.
THANKS.
>> OKAY, GREAT.
THANK YOU, DR. DURRANT, THAT WAS
VERY, VERY EXCITING.
I PERSONALLY AM VERY PLEASED
WITH THESE CHANGES.
I DO THINK, THINKING ABOUT THE
Rs, NOT THE FELLOWSHIP
TRAINING GRANTS, I DO HAVE SOME
QUESTIONS.
IT SEEMS LIKE WE'RE GOING TO BE
ACTUALLY RESTRUCTURING HOW WE
WRITE THEM INTO MAINLY TWO
FACTORS, BECAUSE EXPERTISE AND
RESOURCES IS GOING TO BE ON OUR
BIO, AND OUR FACILITIES.
SO REALLY WE'RE GOING TO SORT OF
HAVE IT IN TWO FACTORS,
IMPORTANCE OF THE RESEARCH AND
THEN RIGOR AND FEASIBILITY.
IS THAT HOW YOU'RE THINKING
GRANTS WILL BE COMING IN AFTER
JANUARY?
>> THERE'S ACTUALLY NO CHANGE TO
THE FORM SO WE'RE PLANNING TO
HAVE -- THERE ARE NO CHANGES TO
THE FORM.
SO THE FIVE REVIEW CRITERIA NOW
ARE JUST BEING COMBINED IN
DIFFERENT WAYS.
WE ALWAYS ENCOURAGE PEOPLE TO
REVIEW AND TO READ WHAT WE CALL
SECTION FIVE, WHICH IS THE
REVIEW CRITERIA IN EACH OF THE
NOFOs.
AND TO THINK ABOUT THAT IN TERMS
OF THE PREPARATION OF THE GRANT,
THAT'S WHAT REVIEWERS ARE GOING
TO BE LOOKING AT, BUT THE REVIEW
CRITERIA ARE THE SAME, AT LEAST
IN KIND OF THE LARGER CATEGORY,
SO WE DID NOT SEE ANY NEED TO
CHANGE THE STRUCTURE OF THE
APPLICATION.
>> I MEAN, I DON'T THINK THE
APPLICATION ITSELF WOULD CHANGE,
YOU KNOW?
I'M JUST THINKING THE WAY I'VE
ORGANIZED IN MY -- MIGHT VERY
WELL CHANGE AS -- I'LL PUT
INNOVATION IN AND THEY'LL BE
LIKE, YOU KNOW, FACTOR ONE OR
SOMETHING, YOU KNOW, AND THEN --
THIS IS HOW I WAS THINKING IT
WOULD BE.
AND WILL THE ACTUAL REVIEW
TEMPLATES BE OUT IN TIME FOR THE
PEOPLE TO SEE, PAUSE THAT'S
GOBECAUSE THAT'SGOING TO BE IMP.
>> YES, THANK YOU FOR RAISING
THAT, BECAUSE IT WAS A BULLET ON
ONE OF MY SLIDES AND I MUST HAVE
KIND OF SKIPPED OVER IT.
YEAH, WE ARE IN THE PROCESS OF
DOING, RIGHT NO -- RIGHT NOW OUR
OUTREACH FOCUS IS A FOCUS ON THE
BROADER CHANGES AND THE WHY.
THE NEXT STEP WHICH WE HAVE
STARTED IS REALLY MAKING SURE
THE APPLICANT COMMUNITY IS
INFORMED, SO THERE'S A NUMBER OF
WEBINARS THAT WE HAVE HELD AND
THAT WILL CONTINUE TO BE HELD.
RIGHT NOW, WE HAVE RELEASED A
LITTLE BIT OF INFORMATION SO
THERE IS A MOCK NEW CRITIQUE
TEMPLATE FOR REVURS, IF YOU'RE
INTERESTED IN THAT.
SO THAT IS CURRENTLY AVAILABLE.
WE WILL BE BUILDING IN AND
ADDING, ROLLING OUT A NUMBER OF
OTHER TRAINING RESOURCES AND
INFORMATION RESOURCES TARGETING
THE SPECIFICS OF THE REVIEW IN
THE FALL.
SO THERE'S ALWAYS A CHALLENGE
AND A TENSION WITH CHANGES AT
NIH, WE DON'T WANT TO CONFUSE
PEOPLE COMING IN NOW, SO WE WANT
TO MAKE SURE PEOPLE ARE AWARE,
BUT THAT WILL ALL BE ON THAT
WEBSITE.
THERE'S CURRENTLY A SECTION, IF
YOU GO TO THE SIMPLIFYING PEER
REVIEW WEBSITE, A PRETTY
ELABORATE SECTION ON WHAT
APPLICANTS NEED TO KNOW.
THAT WILL GIVE YOU A NUMBER OF
CONSIDERATIONS ABOUT WRITING AN
APPLICATION AND STRUCTURE THE
WHY, WHAT TO CONSIDER, AND
THERE'S RIGHT NOW A SECTION FOR
REVIEWERS, THERE'S JUST NOTHING
THERE YET.
IT'S BEING DEVELOPED, AND YES,
IT WILL ALL BE AVAILABLE FOR Y
YOU.
>> FIRST I WANT TO THANK YOU FOR
TAKING OFF THE GRADES.
THANK YOU, THANK YOU.
YOU KNOW, BECAUSE YOU HAVE A
FELLOW THAT'S GOT ONE C C ONE TE
AND IT'S -- IT WASN'T FAIR TO
THE APPLICANTS.
SO THANK YOU FOR THAT.
YOU KNOW, THE REVISED -- AND
THEN ALSO, I DID HAVE A QUESTION
ABOUT WHEN IS THIS GOING TO
Ks, RIGHT NOW IT'S ONLY FOR
Fs AND THE TRAINING GRANTS,
BUT IS IT GOING TO GO TO Ks
ALSO, THESE CHANGES?
>> LIKELY, YES.
I DON'T WANT TO PROMISE.
THERE'S NOTHING -- IT'S NOT
SOMETHING WE'RE CURRENTLY
WORKING ON.
BUT THE PLAN IS, WE STARTED WITH
THE TWO AREAS WITH THE LARGEST
NUMBER OF APPLICATIONS, AND THE
MOST -- KIND OF THE HIGHEST
LEVEL OF CONCERNS AND WORKED ON
THOSE.
SO YES, BUT WE ARE GOING TO ROLL
OUT THE ONES THAT WE HAVE NOW
AND THEN GET STARTED ON THE
OTHERS.
>> IN THE REVISED SECTIONS, YOU
HAVE THE CANDIDATE PREPAREDNESS
AND RESEARCH TRAINING PLAN AND
COMMITMENT.
I'M SURE THERE WILL BE
GUIDELINES ABOUT HOW TO DO THESE
THREE SECTIONS THAT WILL BE OUT.
THOSE ARE MY MAIN QUESTIONS.
MAYBE OTHER OF THE
COUNCILMEMBERS HAVE SOME
QUESTIONS.
>> SO MANY HANDS.
YES
>> HI, MALLORY JOHNSON.
THANK YOU FOR THIS.
IT'S EXCITING TO SEE THIS COME
OUT.
I'VE BEEN DOING THIS LONG ENOUGH
TO HAVE SEEN A NUMBER OF BIG
CHANGES, INCLUDING THE CHANGING
IN THE SCORING SYSTEM AND THEN
THE REDUCTION IN THE LENGTH OF
THE APPLICATIONS OVER THE YEARS,
AND SO THERE'S ALWAYS THIS
PERIOD OF ROLLOUT.
NO MATTER HOW MUCH PLANNING IS
DONE, THERE'S SOME BUMPINESS.
ONE OF THE THINGS I'M WONDERING
ABOUT IS, CAN YOU SPEAK TO WHAT
KIND OF TRAINING REVIEWERS ARE
GETTING, SO THAT THEY DON'T SLIP
BACK INTO THEIR OLD WAYS AND SO
THAT THEY ARE MORE ORIENTED AND
ACTUALLY ADHERING TO THESE NEW
CONCEPTS AND GUIDANCE.
AND ALSO IN THE INTERIM, HOW
ARE -- PRESUMABLY THERE'S STILL
AN OVERALL IMPACT.
IS THAT JUST GOING TO BE
PERCENTILED AGAINST THE OLDER
ONES, IN THE INTERIM, ARE THEY
GOING TO BE COMPARED ONLY TO
EACH OTHER USING THE NEW SYSTEM
OR IS IT GOING TO BE AS IT
ALWAYS REQUIRED THREE MEETINGS
OR SORT OF THE DENOMINATOR, BUT
MORE IMPORTANTLY, HOW ARE YOU
GOING TO MAKE SURE REVIEWERS ARE
ON BOARD AND DOING THIS?
>> YEAH, GREAT QUESTION.
SO WE ARE CURRENTLY ROLLING OUT
VERY EXTENSIVE TRAINING TO OUR
STAFF.
INCLUDING YESTERDAY WE JUST --
WE HAD A BIG TRAINING ON
CONCEPTS AND THE WHY.
WE ALWAYS LIKE TO START WITH THE
WHY.
IF PEOPLE UNDERSTAND THE WHY,
YOU CAN USUALLY WORK THROUGH
THOSE BUMPS A LITTLE EASIER.
WE SPEND A TREMENDOUS AMOUNT OF
TIME -- AND THE REASON I START
WITH THE STAFF IS BECAUSE WE DO
SPEND A TREMENDOUS AMOUNT OF
TIME WORKING WITH THE REVIEWERS
IN SMALL GROUPS AND ONE-ON-ONE,
SO THERE WILL BE EXTENSIVE
TRAINING MATERIALS, GUIDANCE FOR
REVIEWERS THAT WILL BE ROLLED
OUT, BUT THE TRACTION THAT YOU
ARE TALKING ABOUT COMES FROM THE
SRO WORKING WITH THE REVIEWERS
ONCE THEY'RE ACTUALLY REVIEWING
APPLICATIONS AND REVIEWING IN
MEETINGS.
WE DO A NUMBER OF DIFFERENT
STEPS TO LOOK FOR ALIGNMENT
BETWEEN SCORES AND CONCEPTS, A
NUMBER -- WE HAVE -- IN WAYS TO
LOOK FOR WHETHER -- WE LOOK FOR
WHETHER THERE ARE COMMENTS THAT
SUGGEST THAT PEOPLE ARE
INCLUDING FACTORS THAT ARE NOT
PART OF THE REVIEW CRITERIA,
THAT COULD INCLUDE EVERYTHING
FROM INFORMATION THAT IS NOT
PRESENTED IN THE APPLICATION BUT
MAY BE KNOWN BY SOME PEOPLE IN
THE COMMUNITY AND NOT OTHERS, IT
COULD BE INDICATORS OF BIAS.
SO WE DO WORK, WE DO A LOT OF
REVIEWING IN THE CRITIQUES
PROVIDING GUIDANCE, PROVIDING
CONVERSATIONS.
WE HAVE EXTENSIVE CHAIR TRAINING
WE WILL ROLL OUT THIS SUMMER.
WE DO THE GENERAL CHAIR
TRAINING, BUT WE WILL INCLUDE --
WE WILL HAVE A SPECIFIC CHAIR
TRAINING FOR THIS AS WELL TO
MAKE SURE THAT THEY'RE PARTNERS
IN THIS.
PER TILING, PERCENTILING, THEREO
CHANGES.
SO THE APPLICATIONS WILL STILL
GET THAT OVERALL IMPACT SCORE.
THE OVERALL IMPACT SCORE --
THERE'S NO FORMULA OF HOW YOU
TAKE THE FACTORS OR RIGHT NOW
THE REVIEW CRITERIA INTO THAT
OVERALL IMPACT SCORE.
THERE'S A LOGIC, THERE'S RANGES,
SO NOW THAT OAR ALL IMPACT SCORE
WILL BE AFFECTED BY TWO FACTORS
AS WELL AS THE EXPERTISE AND
RESOURCES THAT CAN AFFECT THAT,
ESPECIALLY IF THERE ARE GAPS, AS
WELL AS SOME OF THESE OTHER
CONSIDERATIONS, BUT IT WILL
PRIMARILY BE DRIVEN -- ASSUMING
THAT THEY HAVE THE APPROPRIATE
EXPERTISE AND RESOURCES, WE
REALLY WANT THE QUALITY, THE
IMPORTANCE OF THE RESEARCH AND
THE RIGOR AND FEASIBILITY TO BE
DRIVING THOSE SCORES.
SO THAT'S THE IDEA.
AND THAT'S WHAT WE'LL BE LOOKING
FOR WITH OUR REVIEWERS.
>> I JUST WANT TO APPLAUD THIS.
THIS IS REALLY EXCITING.
AND TO PIGGY BACK ON WHAT
DR. JOHNSON WAS SAYING, I WAS
GOING TO TALK ABOUT THE SAME
THING AROUND YOU'VE GOT TO TRAIN
REVIEWERS AROUND THIS, BUT I
WANT TO UNDERSCORE THE PIECE
THAT YOU BROUGHT UP AROUND THE
RIGOR AND FEASIBILITY.
IN PARTICULAR, AS WE SCALE UP
MORE RESEARCH THAT REALLY
FOCUSES ON REDUCING AND
ELIMINATING SOCIAL DRIVERS,
DRIVERS OF HEALTH, THAT MEANS
IT'S THE THINKING ABOUT RIGOR
AND REPRODUCIBILITY IS GOING TO
BE A LOT MORE DIFFICULT, RIGHT?
AND I LIKE WHAT YOU SAID ABOUT
DOES IT INCLUDE -- THERE'S GOING
TO BE CALCULATED RISK BEING
TAKEN.
IT GOING TO BE MORE COMPLEX AND
HAVING REVIEWERS HAVE THAT IN
MIND.
THAT FOR RESEARCH THAT REALLY
TRIES TO GET AT ELIMINATING
SOCIAL DRIVERS OF HEALTH MEANS
IT GOING TO BE, YOU KNOW, A
LITTLE -- THERE ARE GOING TO BE
MORE RISKS INVOLVED AND JUST TO
UNDERSTAND THAT AND TAKE THAT
INTO CONSIDERATION, I THINK
WOULD BE A BIG PART OF THAT
TRAINING.
OF REVIEWERS TO REALLY THINK
DIFFERENTLY ABOUT THAT.
>> THERE'S A REAL EMPHASIS IN
KIND OF THE -- BETWEEN THE LINES
HERE ON MORE BIG PICTURE
THINKING AND MAKING SURE THAT --
WE'RE TRYING TO KEEP REVIEWERS
AT A LEVEL, AND IN FACT, WE
OFTEN TELL THEM, YOU ARE THEIR
AUDIENCE OF THE REVIEWERS'
CRITIQUES.
EXPLAIN TO A EDUCATED GROUP OF
PEOPLE THAT WILL BE MAKING
FUNDING DECISIONS WHAT THE
CONTRIBUTION OF THIS APPLICATION
WILL BE AND WHAT THE MAIN
DRIVING STRENGTHS AND WEAKNESSES
ARE SO YOU CAN MAKE INFORMED
DECISIONS.
AND THAT'S THE GOAL OF THE
CHANGES IN THE WORDING, THE
CHANGES IN THE FACTORS, AND
REALLY KIND OF UNDERLYING THE
TRAINING OF HOW WE'RE TRYING TO
WORK WITH REVIEWERS, PULLING
THEM OUT OF THE WEEDS.
IT'S EASIER TO GET OUT OF THE
WEEDS, IT'S EASIER TO PICK APART
THE APPROACH.
IT'S HARDER TO SAY, WHAT WILL
THE ADVANCE BE.
AND SO THE WORDING IN THE RIGOR
AND FEASIBILITY SECTION TRIES TO
PULL THAT OUT AND IT TRIES -- WE
PHRASE IT IN WAYS THAT ASSESS
THE DESIGN OF THE RESEARCH, IS
THE DESIGN SOUND, ARE THE
BROADER GOALS SOUND.
>> REALLY SINCE IT WAS
INITIATED, REVIEWERS HAVE
CONFUSED SIGNIFICANCE AND
INNOVATION.
IT'S REALLY CONFUSING, THE
SCORES ARE OFTEN FLIP-FLOPPED,
LIKE THEY'RE NOT AT ALL HOW THE
INSTRUCTIONS STATE TO SCORE, SO
I THINK IT'S -- I REALLY LIKE
PHRASING IT AS IMPORTANCE.
I THINK THAT JUST MAKES SENSE
AND RESONATES.
I THINK FOR CSR WHEN THEY
CLARIFY TO REVIEWERS, IS IT THE
IMPORTANCE OF THE APPROACH OR IS
IT THE IMPORTANCE OF THE
CLINICAL PROBLEM?
AND I THINK THIS IS WHERE
REVIEWERS CAN STILL STRUGGLE
SEMANTICALLY.
I MEAN, YOU CAN HAVE A
POPULATION THAT'S DYING.
REVIEWERS MAY NOT LIKE THE
APPROACH AND THEY SAY OH, THIS
IS NOT IMPORTANT, BUT IT'S
IMPORTANT BECAUSE PEOPLE ARE
DYING.
WE'VE PROBABLY ALL HAD THAT
EXPERIENCE, SO JUST -- MY ADVICE
IS TO BE REALLY, REALLY CLEAR
WHAT'S IMPORTANT.
WHAT DO YOU MEAN BY IMPORTANT?
>> ABSOLUTELY, AND I WOULD
ACTUALLY EVEN KIND OF GO A STEP
FURTHER IN WHAT WE ARE ASKING
FOR IS THE IMPORTANCE OF THE
RESEARCH QUESTION AS PROPOSED.
SO YES, IT CERTAINLY
INCORPORATES THE CLINICAL OR
OTHER -- YOU KNOW, THE SITUATION
THAT'S BEING INVESTIGATED.
BUT THAT'S NOT ALL.
WE'VE GO GOT A LOT OF APPLICATIS
ON CANCER.
WHAT WILL THIS ONE DO TO ADVANCE
OUR UNDERSTANDING.
SO YO IT'S REALLY TRYING TO PULL
THE EVALUATION OF THE IMPORTANCE
TO HOW WILL THIS RESEARCH
PROJECT ADVANCE THE FIELD.
SO YES, INCORPORATING WHETHER IT
ADDRESSES A GAP, WHAT THE
IMPORTANCE OF THE TOPIC IS, BUT
ALSO NOT -- WE DON'T WANT THEM
TO STOP THERE.
THAT DOES NOT PROVIDE A LOT OF
VALUE TO SAY YET AGAIN THAT MANY
OF THESE SITUATIONS THAT WE KNOW
ARE ALREADY A PROBLEM -- HOW
THIS APPLICATION ADVANCES.
SO AGAIN, SOME OF IT IS THE
SPECIFICITY.
APPRECIATE THE COMMENTS ON
THE -- I HEARD SOME OF THE
CHANGES DESCRIBED AS A PLAIN
LANGUAGE EFFORT, AND YOUR
COMMENTS REINFORCE THAT.
HAPPY TO HEAR THAT.
>> SO THANK YOU VERY MUCH FOR A
VERY HELPFUL AND CLEAR
PRESENTATION.
IT'S NOT THAT OFTEN THAT I WOULD
SAY I REALLY ENJOYED -- I WAS
FASCINATED AND CAPTIVATED BY A
PRESENTATION ON SOMETHING LIKE
HOW WE'RE GOING TO CHANGE REVIEW
CRITERIA.
SO THANK YOU FOR WHATEVER MAGIC
YOU CARRY IN YOU.
>> THIS IS RECORDED, RIGHT?
>> YEAH, YEAH.
TELL ME WHO YOUR BOSS IS.
I'LL SEND AN EMAIL.
HERE'S WHAT I -- SO I'LL GIVE
THE CAVEAT THAT I HAVEN'T SERVED
ON STUDY SECTION IN A FEW YEARS,
SO MAYBE EVERYTHING HAS CHANGED.
I DO HAVE THE REVIEWS OF MY OWN
GRANTS, AND THE REVIEWS OF THE
GRANTS OF MY MANY MENTEES, WHICH
SUGGEST TO ME THAT MAYBE THIS
FACTOR HAS NOT CHANGED SINCE
I'VE BEEN ON STUDY SECTION,
WHICH IS, I THINK IT'S -- ALL OF
THESE CHANGES ARE NEEDED AND
REALLY GOOD AND IMPROVE -- HAVE
THE POTENTIAL TO IMPROVE, BUT MY
OBSERVATION ON STUDY SECTION IS,
YOU NEED TO HAVE SOME OF
THESE -- YOU NEED TO HAVE
CERTAIN PEOPLE ON THE STUDY
SECTION WHO WILL LIFT
EVERYBODY'S SIGHTS UP TO THE
HORIZON, AND WE'RE INCREASINGLY
GETTING TO THE STAGE THAT THE
PEOPLE WHO ARE MOST CAPABLE OF
DOING THAT SAY I'M TOO BUT SEE
-- TOOBUSY TO REVIEW.
IT WAS CONSTANTLY AMAZING TO ME
HOW YOU'D HAVE A REVIEW THAT WAS
NITPICKING ALL THE WAY IN THE
WEEDS, AND THAT'S ALMOST LIKE
PERSONALITY TYPE, YOU CAN -- YOU
CAN CHANGE THE REVIEW CRITERIA
AND MAYBE THEY'LL ONLY GO 60%
INTO THE WEEDS INSTEAD OF 150%
INTO THE WEEDS.
BUT I THINK -- AND I DON'T KNOW
IF THERE'S -- I DON'T KNOW IF
THERE'S ROOM IN THE CHAIRS OF
THESE COMMITTEES TO GIVE
PARTICULAR CONSIDERATION OF ARE
THESE PEOPLE WHO ARE LIKE
HORIZON SIGHT LIFTERS LIFTERS E
TRAIN THEM TO BE MORE ACTIVE IN
THAT CONVERSATION, OR WHETHER WE
THINK STRATEGICALLY ABOUT ON
THIS STUDY SECTION H I FEED TO,O
MAKE SURE I HAVE A FEW OF THESE
HORIZON LIFTERS BECAUSE IF
THEY'RE THERE, THE REVIEW --
WHOLE ROOM CHANGES, ESPECIALLY
IF THEY'RE ABLE TO OFFER THEIR
COMMENTS IN A, LIKE, YOU KNOW,
POSITIVE -- THOSE PEOPLE WHO ARE
JUST REALLY GOOD IN A ROOM AT
MANAGING THINGS.
I REMEMBER CONSTANTLY ON STUDY
SECTION HAVING TO REMIND PEOPLE,
THIS IS AN R21.
AND I FELT LIKE THAT WAS MY
ROLE.
ON STUDY SECTION WAS, THIS IS AN
R21, HERE'S WHAT THE
EXPECTATIONS ARE FOR AN R21.
SO I APPLAUD YOU FOR THESE
CHANGES.
THERE MAY BE NEED FOR SOME
PARALLEL THINGS TO BE HAPPENING
IN TERMS OF STAFFING, YOU KNOW,
SELECTION OF PEOPLE ON STUDY
SECTIONS.
>> YEP.
NO, REALLY APPRECIATE THOSE
COMMENTS.
THIS IS ONE PIECE OF A MANY
MULTIFACETED EFFORT.
NOT JUST FOR RELATED TO THIS
PROJECT, BUT IN GENERAL.
WHO IS AT THE TABLE IS
CRITICALLY IMPORTANT AND WE ARE
ALWAYS LOOKING -- I LOVE YOUR
CONCEPTS, HORIZON LIFTERS.
WE ALSO WORK TO HELP -- THIS IS
ONE EXAMPLE OF HOW WE'RE TRYING
TO HELP OTHER PEOPLE GET TO THAT
HORIZON LEVEL AS WELL.
AND THERE ARE OTHER STRATEGIES
WE HAVE TO DO THAT, WE ARE
WORKING WITH THE CHAIRS.
WE WORK WITH OUR STAFF ACTUALLY
TO BE HORIZON LIFTERS, NOT FOR
THE SCIENCE BUT FOR SOME OF
THOSE OTHER CONSIDERATIONS, IF
THINGS ARE GETTING T TOO WEEDY,
WE'RE TALKING ABOUT INTERESTING
SCIENCE BUT WE'RE NOT TALKING
ABOUT THE APPLICATION ANYMORE,
SOME OF THIS IS DONE BEHIND THE
SCENES WITH THE CRITIQUE, SOME
OF THIS IS DONE IN THE MEETING,
BUT THERE'S MULTIPLE ANGLES WITH
THAT GOAL.
SO YES, AND PLEASE ENCOURAGE
THOSE HORIZON LIFTERS.
>> A REALLY QUICK COMMENT.
FIRST I WANT TO SAY THANK YOU
VEP, THAT WAS FANTASTIC.
I AGREE WITH WHAT EVERYONE HAS
SAID, ALL OF THE CHANGES THAT
ARE COMING ARE FOR THE
BETTERMENT OF THE REVIEW PROCESS
AND SO THANK YOU FOR THAT.
I THINK IT'S A LITTLE NUANCED
BUT -- AND I THINK YOU SAID
THIS, DR. DURRANT, BUT I WANT TO
HIGHLIGHT ONE PIECE THAT IS
REALLY IMPORTANT TO ME.
AND ALL OF THESE CHANGES ARE NOT
JUST ABOUT BROADENING THE NUMBER
OF INSTITUTIONS OR DEALING WITH
BIAS, BUT IN DOING THAT, THE
RESULT IS THAT IT HELPS US TO
BETTER ELIMINATE NECK WAITS S -S
WHAT WE'RE DOING AT NIH.
I THINK THAT'S THE HORIZON
LIFTER THAT DOESN'T RELY ON
PEOPLE BUT RELIES ON A MORE
CLEAR MESSAGE THAT WILL ALLOW
REVIEW COMMITTEES TO UNDERSTAND
WHAT REALLY MATTERS.
I THINK THAT'S NOT WHAT I HEARD
ALL THAT CLEARLY, BUT FOR ME,
THE LAST SLIDE IS LIKE THE FIRST
SLIDE.
>> GREAT DISCUSSION.
DR. DURRANT, THANK YOU SO MUCH.
HOPEFULLY WE CAN CONVINCE
DR. DURRANT TO COME BACK,
BECAUSE WE CLEARLY LIKE TO
ENGAGE WITH HER.
I'D SAY BEING AT NIH, I'VE BEEN
REALLY IMPRESSED WITH CSR.
YOUR CONSTANT EFFORTS TO IMPROVE
REVIEW AND ATTENTION TO
FAIRNESS, SO I WANT TO THANK YOU
AND EVERYONE AT CSR FOR ALL YOUR
WORK AND FOR JOINING US TODAY.
SO THANK YOU.
SO WITH THAT, WE ARE GOING TO
TAKE A 15-MINUTE BREAK.
SOMEONE HELP ME WITH THE MATH.
IS THAT LIKE 24 OR SOMETHING?
SO 24, WE'LL SEE YOU THEN. THANK YOU.
>> ALL RIGHT, WELCOME BACK FROM
BREAK.
SO WE HAVE ONE MORE AGENDA ITEM
BEFORE WE GO TO LUNCH, SO WE'RE
GOING TO HEAR FROM DR. JOHN
GRASON, DIRECTOR OF THE NINR
DIVISION OF SCIENCE POLICY AND
PUBLIC LIAISON, WHO IS GOING TO
BE SHARING INFORMATION ON OUR
HEALTH DISPARITIES PORTFOLIO AND
THE IMPACT OF RECENT RCDC
CHANGES, WHICH HE'LL TELL YOU
ALL ABOUT.
SO JOHN.
>> I'LL TELL EVERYONE ABOUT THAT
IN GHORRY DETAIL, ESPECIALLY
KNOWING THAT I'M THE ONLY THING
BETWEEN YOU AND LUNCH, AND I
KNOW WE'RE RUNNING A LITTLE BIT
BEHIND SCHEDULE, SO I MIGHT
SPEED UP THROUGH A FEW OF THESE
THINGS, BUT THANKS FOR THE
OPPORTUNITY TO SPEAK TO ALL OF
YOU TODAY ABOUT SOME RECENT
CHANGES IN HOW NIH IS
CATEGORIZING HEALTH DISPARITIES
RESEARCH.
THERE'S A FEW REASONS WE WANTED
TO DISCUSS THIS TOPIC TODAY.
OBVIOUSLY HEALTH DISPARITIES
RESEARCH HAS LONG BEEN AN
IMPORTANT TOPIC OF INTEREST FOR
NIH, AND THAT'S CERTAINLY BEEN
THE CASE AT NINR, AND THAT'S
ONLY MORE TRUE OVER THE PAST
SEVERAL YEARS.
AT THE NIH AS A WHOLE, THERE WAS
A SENSE THAT WE NEEDED TO DO A
BETTER JOB OF HOW WE TRACK AND
ASSESS THE HEALTH DISPARITIES
RESEARCH THAT WE CURRENTLY
SUPPORT TO ALLOW US BETTER TOOLS
TO ANALYZE OUR CURRENT RESEARCH
AND PLAN FOR FUTURE ACTIVITIES.
SO THAT'S LED TO THIS MAJOR
CHANGE JUST OVER THE PAST YEAR
INTO HOW NIH HAS THOUGHT ABOUT
CODING AND CATEGORIZING HEALTH
DISPARITIES RESEARCH.
THE BIG QUESTION FOR ALL OF US
HERE TODAY IS HOW HAVE THOSE
CHANGES IMPACTED NINR.
AND IT'S PARTICULARLY IMPORTANT
FOR US BECAUSE AS YOU'RE ALL
AWARE, IN FISCAL '23, CONGRESS
APPROPRIATED AN ADDITIONAL
$10 MILLION TO US SPECIFICALLY
FOR HEALTH DISPARITIES RESEARCH,
AND BECAUSE WE'RE VERY
INTERESTED IN DOING WHAT
CONGRESS TELLS US TO DO, WE
NEEDED TO BE ABLE TO HAVE A GOOD
HANDLE ON HOW MUCH HEALTH
DISPARITIES RESEARCH WE WERE
SUPPORTING.
SO VERY QUICK HISTORY OF CODING
AND REPORTING AT NIH.
WHICH I'M SURE EVERYONE CARES
ABOUT.
SO OBVIOUSLY NIH FUNDS TENS OF
THOUSANDS OF GRANTS EVERY YEAR,
AND WE GET ASKED ALL THE TIME,
HOW MUCH MONEY ARE YOU SPENDING
ON X?
AND WE GET ASKED THAT BY
CONGRESS, BY INTEREST GROUPS,
THE PUBLIC.
THEY WANT AN ACCURATE ANSWER.
THAT'S NOT ALWAYS EASY.
SO WHEN I FIRST STARTED AT NIH,
A FEW YEARS AGO, ALL OF THAT
CODING AND REPORTING WAS DONE
MANUALLY, SO PEOPLE LIKE ME
SITTING AT A COMPUTER, LOOKING
THROUGH ABSTRACTS SAYING YEP,
YEP, NOPE, NOPE, THAT SORT OF
THING.
WE TRIED TO BE STANDARDIZED, BUT
IN REALITY, EVERYONE CODED A
LITTLE BIT DIFFERENTLY, ALL THE
INSTITUTES CODED DIFFERENTLY,
AND WE ENDED UP WITH NUMBERS,
WENDED UP WITH DOLLAR FIGURES.
WERE THEY ACCURATE?
I DON'T KNOW.
MAYBE.
AND WERE THEY REPRODUCIBLE?
ABSOLUTELY NOT.
SO THAT LED TO A LOT OF
FRUSTRATION, VERY UNDERSTANDABLE
FRUSTRATION FROM PEOPLE IN THE
COMMUNITY.
AND CONGRESS STEPPED IN AND
INSISTED THAT NIH COME UP WITH A
BETTER WAY OF DOING THINGS.
THAT'S WHAT LED TO THE RCDC
SYSTEM, WHICH DID AWAY WITH ALL
THAT MANUAL CODING WITH A COUPLE
OF VERY IMPORTANT EXCEPTIONS.
SO RCDC STANDS FOR RESEARCH,
CONDITION AND DISEASE CA
CATEGORIZATION, AND I'LL
DEFINITELY GIVE YOU THE
ABBREVIATED VERSION HERE OF HOW
THIS ALL WORKS.
SO RCDC IS USED TO REPORT
PUBLICLY HOW MUCH NIH IS
SPENDING IN SEVERAL HUNDRED
DIFFERENT CATEGORIES OF DISEASE
CONDITIONS AND RESEARCH AREAS
AND IT'S A TEXT MINING BASE
TOOL, IT'S DESIGNED TO -- THE
INITIAL INTENT OF IT WAS
DESIGNED TO GET RID OF ALL THOSE
DIFFERENCES ACROSS THE
INSTITUTES IN HOW THE INSTITUTES
CODED AND REPORTED ON THEIR
RESEARCH ACTIVITIES, AND MAKE
SURE THAT WE WERE ALL USING
THIS -- AND BASICALLY WE HAD NO
CHOICE, THERE WAS ONLY ONE
METHODOLOGY THEN GOING FORWARD.
SO AT LEAST IT WAS REPRODUCIBLE.
WAS IT ACCURATE?
AT FIRST, A LOT OF US, INCLUDING
ME, WERE VERY SKEPTICAL THAT
THIS WOULD WORK.
ESPECIALLY BECAUSE AS THE PERSON
CODING AND REPORTING, I HAD A
VESTED INTEREST IN KEEPING MY
JOB.
BUT LIKE A LOT OF PEOPLE, I
THINK I CAME AROUND EVENTUALLY
AND IT REALLY HAS BEEN AN
OUTSTANDING TOOL.
SO VERY BASICALLY THE WAY IT
WORKS IS, IT WILL TAKE THE
ABSTRACT, THE SPECIFIC AIMS AND
THE TITLE OF EVERY APPLICATION
THAT COMES IN TO NIH AND
EXTRACTS A LONG LIST OF WORDS
FROM IT, AND WEIGHTS THE WORDS
BASED ON HOW FREQUENTLY THEY
APPEAR AND THERE'S THIS WHOLE
TEXT MINING ALGORITHM THAT I
DON'T UNDERSTAND AND I'M NOT
GOING TO GO INTO.
IT COMPARES THAT LONG LIST OF
WORDS AGAINST A LIST OF TERMS
THAT ARE PUT TOGETHER FOR EACH
OF THE DISEASE AREAS AND
RESEARCH AREAS.
THAT'S CALLED AN RCDC
FINGERPRINT.
AND THOSE TERMS ARE ALL WEIGHTED
AND DEVELOPED BY EXPERTS AT NIH
WHO ARE EXPERTS IN EACH OF THOSE
AREAS, AND BASICALLY IT COMPARES
THE TWO LISTS OF WORDS AND
THROUGH AN ALGORITHM AND ALL
SORT OF MATCHING SCORES AND
CATEGORY WEIGHTS AND -- I'M NOT
GOING TO GET INTO IT BECAUSE I
DON'T REALLY UNDERSTAND IT
COMPLETELY, IT DETERMINE, YES,
THIS PROJECT IS IN THIS AREA,
NO, THIS PROJECT ISN'T IN THIS
AREA.
AND IT'S NOT 100% ACCURATE,
OBVIOUSLY.
BUT IT DOES A SURPRISINGLY GOOD
JOB WHEN EVERY NOW AND THEN, YOU
DO AN AUDIT OF THE DIFFERENT
CATEGORIES AND ACTUALLY ONCE A
YEAR, ALL THE PROJECT LISTS ARE
LOOKED THROUGH TO SEE HOW WELL
THE SYSTEM IS DOING, AND IT
ACTUALLY DOES A REALLY GOOD JOB.
AND IF YOU'RE WONDERING WHAT
HAPPENS TO ALL THOSE NUMBERS,
FOR THOSE OF YOU THAT HAVEN'T
ALREADY BUT I'M SURE MANY OF YOU
ARE FAMILIAR WITH THIS, THE NIH
REPORT WEBSITE, REPORT.NIH.GOV,
ALL OF THOSE NUMBERS ARE
REPORTED PUBLICLY FOR, AGAIN,
300-PLUS TEA DISEASE AREAS, ANDL
THAT DATA IS AVAILABLE TO
DOWNLOAD, AND DEFINITELY CHECK
IT OUT.
LOTS OF GOOD INFORMATION THERE.
BUT HOW IS THIS RELATED TO
HEALTH DISPARITIES?
WELL, I MENTIONED THERE WERE A
FEW CATEGORIES THAT RCDC HADN'T
CODED, AND HEALTH DISPARITIES
AND MINORITY HEALTH WERE TWO OF
THOSE CATEGORIES.
AND THAT WAS AN ISSUE FOR US
BECAUSE, OF COURSE, THOSE WERE
TWO OF THE MOST IMPORTANT
CATEGORIES THAT WE CARE ABOUT.
AND THAT MANY OF THE INSTITUTES
AT NIH CARE ABOUT.
AND SO JUST, AGAIN, A REALLY
BRIEF HISTORY.
PRIOR TO 2016, THAT WAS ALL
MANUAL.
MANUALLY CODED.
EVEN AFTER RCDC CAME INTO
EFFECT, IT WAS STILL ALL MANUAL
CODING.
AND IT WAS BASED ON THIS FORMULA
WHERE YOU WOULD LOOK AT THE
PROPOSED INCLUSION TABLE AND
GRANT APPLICATIONS, AND BASED ON
THAT, THERE WAS THIS WHOLE --
THERE WAS A WHOLE FORMULA THING
THAT I WON'T GO INTO.
BUT WE TRIED AS BEST AS WE COULD
TO STICK TO THAT FORMULA.
IT WAS NOT CONSISTENTLY APPLIED
ACROSS ALL THE INSTITUTES, SO
THERE WAS A LOT OF CRITICISM OF
NIH FOR WHERE EXACTLY THESE
NUMBERS WERE COMING FROM.
AND THEY MOVED TO SORT OF A
HYBRID SYSTEM BACK IN 2016, BUT
IN 2023, THE NUMBERS THAT YOU'LL
SEE ON THE REPORT WEBSITE ARE
COMPLETELY CODED IN AN AUTOMATED
WAY NOW BY RCDC.
WHICH WAS A GREAT DEVELOPMENT,
BUT WE ALSO WERE SOMEWHAT
CONCERNED ABOUT WHAT IS -- AND
FIRST THING I SHOULD SAY,
THERE'S SOME OBVIOUS BENEFITS TO
THE AUTOMATIC CODING, ACCURACY,
TRANSPARENCY, CONSISTENT
DEFINITIONS ACROSS THE NIH, IT
MINIMIZES CODER BIAS, MORE
ACCURATE REPORTING AND PORTFOLIO
ANALYSIS.
ALSO BECAUSE RCDC CODES NOT ONLY
FUNDED APPLICATIONS BUT ALSO
UNFUNDED APPLICATIONS, ON OUR
END, IT ALLOWS US TO BETTER
TRACK THE WORK THAT'S COMING IN.
YOU CAN'T DO THAT FOR -- I
FORGET WHAT VALERIE SAID BEFORE,
THERE WERE -- JUST CSR ALONE HAS
80-SOME THOUSAND APPLICATIONS.
IT'S TOUGH TO DO THAT BY HAND.
SO IT'S GREAT HAVING THE
AUTOMATED SYSTEM AVAILABLE.
AND THE NEW CODING STRUCTURE,
I'LL GET TO IT IN A MINUTE, CAN
BETTER DISTINGUISH BETWEEN OUR
RESEARCH EFFORTS AND ALSO OUR
EFFORTS AT DEIA RELATED
INITIATIVES AND WORKFORCE
DEVELOPMENT EFFORTS.
SO THE CHANGE THAT HAPPENED OVER
THE PAST YEAR IN ADDITION TO
MOVING INTO THE AWD MATED CODING
IS WHAT WAS TWO CATEGORIES,
HEALTH DISPARITIES AND MINORITY
HEALTH RESEARCH, IS NOW FIVE
CATEGORIES.
AND WITH DIFFERENT DEAF NATIONS
THADEFINITIONSTHAN WHAT WE'VE U.
WE NOW HAVE HEALTH DISPARITIES
RESEARCH.
MINORITY HEALTH BECAME RACIAL
AND ETHNIC MINORITY HEALTH
RESEARCH WITH A VERY DIFFERENT
DEFINITION.
THEN THERE'S ESSENTIALLY THE
COMBINATION OF THOSE TWO
CATEGORIES.
BUT NOW THERE'S ALSO A SEPARATE
CATEGORY FOR WORKFORCE DIVERSITY
AND OUTREACH, AND BUILDING
RESEARCH CAPACITY AT
INSTITUTIONS WITH LIMITED NIH
FUNDING.
SO THE DEFINITIONS.
HEALTH DISPARITY RESEARCH --
I'LL GO OVER THESE BECAUSE IT'S
IMPORTANT TO KNOW WHAT THEY --
THESE WERE ESSENTIALLY THE
DEFINITIONS THAT WERE USED BY
THE RCDC PEOPLE AND BY THE
EXPERTS THAT WERE ADVISING THOSE
COMMITTEES, THESE ARE THE
DEFINITIONS THAT THEY USED IN
DEVELOPING THOSE NEW
FINGERPRINTS USED BY THE SYSTEM.
SO HEALTH DISPARITIES RESEARCH,
VECTINVESTIGATING -- INTO
INTERVENTIONS TO REDUCE
DISPARITIES.
AND FOR THE NEW MINORITY HEALTH
CATEGORY, RACIAL AND ETHNIC
MINORITY HEALTH RESEARCH, THE
SCIENTIFIC INVESTIGATION OF
DISTINCTIVE HEALTH
CHARACTERISTICS AND ATTRIBUTES
OF MINORITY RACIAL/ETHNIC GROUPS
INCLUDING MULTI-RACIAL
INDIVIDUALS.
AND IMPORTANTLY, THE AWARDS THAT
SIMPLY STRATIFY DATA BY RACE AND
ETHNICITY ARE NO LONGER INCLUDED
IN THAT CATEGORY.
HOW DID THIS ALL IMPACT US?
WE HAD THE ADDITIONAL MONEY,
$10 MILLION FROM CONGRESS COME
IN, WE WOULD HOPE THAT THOSE --
THAT THAT INCREASE WOULD BE
REFLECTED IN OUR REPORTING
NUMBERS.
AND MAINLY WE WANT TO MAKE SURE
THAT OUR INSTITUTE IS RECEIVING
CREDIT FOR THE WORK WE'RE DOING.
SO LET'S SEE HOW WE DID.
SO THIS IS THE HISTORY OF WHAT
OUR HEALTH DISPARITIES NUMBERS
LOOK LIKE BETWEEN 2018 AND 2022.
SO AGAIN, THESE WERE FOR THE
MOST PART MANUAL CODING.
AND FOR THE MOST PART WE WERE --
WE SAW SLOW BUT STEADY INCREASE.
BUT HERE'S WHAT IT IS FOR '23.
AND WE WERE OBVIOUSLY VERY HAPPY
TO SEE THIS.
THIS WAS THE CODING DONE BY THIS
NEW AUTOMATED METHOD THAT WE HAD
NO CONTROL OVER, WE WANTED TO --
JUST HAD TO WAIT AND SEE HOW
MUCH THE SYSTEM TOLD US WE WERE
SPENDING.
AND WE WERE PLEASANTLY SURPRISED
TO SEE THAT UNDER THE NEW CODING
RULES, OUR RESEARCH DOLLAR
FIGURE ROSE ABOUT 50%.
SO SOME OF THAT OBVIOUSLY IS
ATTRIBUTABLE TO THE $10 MILLION
INFLUX OF FUNDS.
SOME OF IT WAS PROBABLY BECAUSE
UNDER THE OLD CODING SYSTEM, WE
WERE SELLING OURSELVES SHORT
WHEN IT CAME TO CODING, BUT I
MEAN, I THINK IT'S SAFE TO SAY
THAT A GOOD DEAL OF THE REASON
BEHIND THIS INCREASE IS SIMPLY
THE WORK THAT THIS INSTITUTE HAS
BEEN DOING OVER THE PAST SEVERAL
YEARS TO REALLY PUT MORE OF AN
EMPHASIS ON OUR RESEARCH IN
HEALTH DISPARITIES.
I SHOULD POINT OUT AT THIS POINT
THAT WE'RE REALLY NOT SUPPOSED
TO DO CHARTS LIKE THIS AND
COMPARE THE OLD DAYS TO THE NEW
DAYS BECAUSE THEY'RE NOT
COMPARABLE, THEY'RE COMPLETELY
DIFFERENT METHODOLOGIES.
SO WITH THAT SAID, LET'S KEEP
COMPARING.
OR WE COULD JUST LOOK AT TWO
DATASETS SIDE BY SIDE, WHATEVER.
SO BEFORE THIS YEAR WITH THE
MANUAL CODING, WE ACTUALLY -- WE
DID RANK SECOND AT NIH.
IN TERMS OF PERCENT OF BUDGET
SPENT ON HEALTH DISPARITIES.
UNDER THE NEW SYSTEM, THAT'S
EVEN HIGHER NOW.
, WE'RE NOW UP TO ABOUT 46%, AND
I THINK THAT NUMBER WAS IN
SHANNON'S SLIDE EARLIER TODAY.
WE'RE STILL IN SECOND PLACE
BEHIND NIMHD, WHICH I THINK YOU
COULD EXPECT THAT.
THIS IS THAT NEW MINORITY HEALTH
CATEGORY, RACIAL AND ETHNIC
MINORITY HEALTH RESEARCH, AND
UNDER THE NEW CODING, WE'RE
PRETTY MUCH THE SAME, THOUGH
AGAIN, THERE'S EVEN LESS OF --
THEY'RE EVEN LESS COMPARABLE
WITH THIS DEFINITION, BECAUSE
IT'S SO DIFFERENT FROM THE OLD
ONE AND THE DEIA INITIATIVES ARE
NOW MOVED TO A NEW CODING.
SO THE SLIGHT DECREASE HERE
ISN'T SURPRISING, IN FACT, MOST
OF THE INSTITUTES ACTUALLY
SHOWED QUITE A BIT MORE OF A
DECREASE.
SO I THINK THIS, AGAIN, IS GOOD
NEWS FOR US.
AND SIMILARLY, WE WERE SECOND
PLACE BEFORE, WE'RE STILL SECOND
PLACE WHEN IT COMES TO THIS
CATEGORY, BUT FOR THE REST OF
THE TALK, I'LL FOCUS ON THE
HEALTH DISPARITIES CATEGORY.
SO IF YOU LOOK AT OUR -- IF
WE'RE TALKING NOW ABOUT THE
NUMBER OF PROJECTS WE SUPPORTED
IN FY 23, JUST A LITTLE OVER
HALF OF THEM WERE CATEGORIZED
UNDER THE NEW CODING AS HEALTH
DISPARITIES RESEARCH.
AND THE OTHER HALF WERE NOT
CODED HEALTH DISPARITIES.
IF WE -- AND I'LL MOVE REALLY
QUICKLY THROUGH THIS BECAUSE I'M
RUNNING OUT OF TIME, BUT IF WE
LOOK AT A BREAKDOWN OF THE
MECHANISM OR THE TYPES OF GRANTS
AND COMPARE BETWEEN OUR NON-HD
PROJECTS AND HD PROJECTS, IT'S
MORE OR LESS THE SAME, THE
RESEARCH PROJECTS ARE A LITTLE
BIT HIGHER IN THE HEALTH
DISPARITIES PROJECTS.
WE'RE STILL -- THIS IS -- THE
OTHER THING I SHOULD SAY IS
THESE DATA CAME OUT JUST A FEW
WEEKS AGO, WHEN THEY WERE
SUPPOSED TO HAVE BEEN OUT BACK
IN FEBRUARY OR SOMETHING LIKE
THAT.
SO WE'RE STILL TRYING TO FIGURE
OUT SOME OF THE MEANING BEHIND
THIS, BUT I'LL REPORT TO YOU
TODAY JUST FOR -- JUST TO BE
THOROUGH.
FP YOU LOOK AT THE -- JUST THE
RPGs, THIS IS THE BREAKDOWN OF
MECHANISMS, THERE'S SLIGHTLY
MORE R01s BUT IT'S BASICALLY
THE SAME.
COMPARING HEALTH DISPARITIES
PROJECTS TO NON-HEALTH
DISPARITIES.
THAT INSTITUTION TYPE, AGAIN,
IT'S MORE OR LESS THE SAME,
DPOTHEHIGHER EDUCATION INSTITUTS
ARE A LITTLE HIGHER IN THE
HEALTH DISPARITIES PROJECTS.
IF WE LOOK AT THE DATA FOR EARLY
AND -- LAST YEAR ABOUT 22% OF
OUR INVESTIGATORS WERE NEW
INVESTIGATORS, ACCORDING TO THE
NIH DEFINITION.
AND WITHIN THOSE NEW
INVESTIGATORS, ABOUT HALF OF
THEM WERE WORKING ON PROJECTS
CODED HEALTH DISPARITIES
RESEARCH AND HALF OF THEM WORK.
AND IT WAS VERY SIMILAR WITH
EARLY STAGE INVESTIGATORS AS
WELL.
ABOUT HALF.
SO WHAT WE LEARNED?
AGAIN IT WAS ESTABLISHED THAT
WE'RE ONE OF THE LEADERS AT NIH
IN HEALTH DISPARITIES FUNDING,
MINORITY HEALTH FUNDING, AGAIN,
AS A PERCENT OF BUDGET.
WE'RE ONE OF THE FEW ICs THAT
ENDED UP SHOWING AN INCREASE IN
HEALTH DISPARITIES FUNDING UNDER
THE NEW CODING METHODOLOGY, AND
THAT REFLECTS OUR STRATEGIC
PLAN, A TESTAMENT TO -- IT'S A
TESTAMENT TO THE COMMITMENT OF
THE NURSING SCIENTIST THAT APPLY
TO US.
THAT THIS HAS BEEN AND CONTINUES
TO BE A FOCUS FOR OUR
INVESTIGATORS.
WE WERE VERY PLEASED TO SEE THAT
THAT'S REFLECTED IN THE NEW
DATA.
NOT ENTIRELY SURPRISED BECAUSE
WE'VE PUT SO MUCH OF AN EMPHASIS
ON OUR LENSES OF HEALTH EQUITY
AND SOCIAL DETERMINANTS OF
HEALTH, AND ALSO WE WERE HAPPY
TO BE ABLE TO DEMONSTRATE THAT
THAT $10 MILLION THAT WE
RECEIVED FROM CONGRESS HAS BEEN
PUT TO GOOD USE, AND THAT OUR
EFFORTS ARE REFLECTED IN THE
DATA.
SO I THINK THAT'S MY LAST SLIDE.
HAPPY TO TAKE ANY QUESTIONS AND
SORRY I HAD TO RUSH THROUGH THAT
BUT WE'RE ALL HUNGRY.
>> THANK YOU, JOHN.
SO WE'RE GOING TO PAIR UP
DR. BEKEMEIER AND DR. GRASON
AGAIN.
SO DR. BEKEMEIER, START.
>> SO THANKS, JOHN.
I LOVED SEEING THESE SLIDES.
IT GIVES ME GREAT PLEASURE TO
SEE THE IMPRESSIVE ROLE OF NINR
IN NOT JUST ACHIEVING WHAT WE'D
HOPED TO ACHIEVE WITH OUR
STRATEGIC PLAN AND THAT WE'RE
SEEING THESE METRICS REALLY
DEMONSTRATE THAT, BUT THAT IT
REALLY SHOWS THAT NINR IS A
LEADLEADER ACROSS THE INSTITUTES
WELL.
SO THAT'S SUPER EXCITING TO SEE.
THERE ARE SOME THINGS THAT --
ANOTHER THING THAT REALLY JUMPED
OUT AT ME WITH YOUR PRESENTATION
WAS AROUND THE EARLY STAGE
INVESTIGATORS AND THE NEW
INVESTIGATORS, THAT THEY ARE
REALLY CRITICAL TO THIS PROCESS.
THEY'RE DRIVING IN SOME RESPECTS
A LOT OF THESE PROPOSALS.
THEY'RE THE BULK OF THESE
PROPOSALS, WHICH SUGGEST THAT
WE'RE ON THE RIGHT TRACK, THAT
IT'S GOING TO BE THE NEW
SCIENTISTS AND THAT PERPETUATE
OUR FIELD THAT ARE REALLY GOING
TO GROW THIS AREA.
SO THAT, TO ME, IS REALLY
EXCITING.
WHICH ALSO IN SORT OF SOME
RESPECTS GETS BACK TO MAKING
SURE WE HAVE REVIEWERS IN PLACE
EFFECTIVELY BECAUSE THEY'RE LESS
LIKELY TO BE THE REVIEWERS SO WE
HAVE TO HAVE REVIEWERS IN PLACE
THAT CAN REVIEW THESE KINDS OF
PROPOSALS, ET CETERA.
A COUPLE OF THINGS JUMPED OUT AT
ME.
MAYBE THIS IS -- MAYBE THIS IS
TOO IN THE WEEDS AROUND THE
DATA, BUT THERE WAS A SMALLER
PROPORTION OF R21s THAN -- OF
COURSE THERE'S MORE R01s, BUT
WHY WOULD THERE BE A SMALLER
INCREASE OR NO INCREASE, I CAN'T
REMEMBER, IN THE -- ARE THE
R21s WOULD BE THE PRECURSORS
TO THE OTHER.
ANYWAY, THAT'S NOT THAT
IMPORTANT OF A QUESTION, IF THE
DATA AREN'T ABLE TO TALK ABOUT
THAT.
ANYWAY, IN TERMS OF WHAT YOU'RE
TALKING ABOUT HERE, IT ALSO SAYS
TO ME, WHAT IS OUR ROLE WITH THE
BROADER NIH AS LEADERS IN THIS
SPACE BASED ON THESE METRICS.
AND HOW DO WE ASSURE THAT KIND
OF INFLUENCE?
AND ALSO YOUR POINT, JOHN, THAT
YOU MADE AT THE BEGINNING THAT
WE'RE NOW ABLE TO DO -- HAVE
THESE SAME DATA FOR PROPOSALS
NOT FUNDED, I THINK ABOUT WHAT
ARE SOME OTHER ANALYSES THAT
COULD BE DONE HERE, AND SHOULD
WE -- COULD WE ALSO BE LOOKING
AT WHAT APPROPRIATES ALES,
WHAT'S THE NATURE OR
CHARACTERISTICS OF PROPOSALS AND
MAYBE EVEN INDIVIDUALS THAT
AREN'T BEING FUNDED AND ARE
THERE ANY SYSTEMATIC BIASES OR
WHAT HAVE YOU THAT NEED TO BE
TAKEN INTO ACCOUNT.
THOSE ARE JUST SOME NE IMMEDIATE
REFLECTIONS.
>> YEAH, I THINK IT'S SAFE TO
SAY THAT WITH THIS KIND OF DATA
NOW AVAILABLE, NIH-WIDE AND NOW
THAT WE HAVE SOME ASSURANCE THAT
LOOKING AT GRANTS THAT COME IN
THE OTHER INSTITUTES AND
COMPARING WHAT THE DIFFERENT
INSTITUTES ARE DOING, THAT WE
NOW HAVE A GOOD IDEA THAT THOSE
DATA ARE A LOT MORE USEFUL THAN
THEY USED TO BE.
AND THERE ARE -- WE'VE ALREADY
HAD MANY DISCUSSIONS ABOUT MANY,
MANY DIFFERENT THINGS WE COULD
LOOK AT, PARTICULARLY WITH
UNFUNDED GRANTS BUT EVEN WITH
THE GRANTS THAT WE FUND NOW.
THERE'S -- DESPITE THE FACT THAT
I'M NOT MANUALLY CODING GRANTS
ANYMORE, THERE'S STILL MORE THAN
ENOUGH WORK TO KEEP ME EMPLOYED,
SO THAT'S -- IT WAS EXCELLENT
NEWS, BUT YEAH, IT'S -- THE SKY
IS THE LIMIT AT THIS POINT.
THIS HAS BEEN A VERY POSITIVE
DEVELOPMENT.
>> SO DR. GRASON, JOHN, THANK
YOU, THAT WAS A FANTASTIC
PRESENTATION.
I THINK THE NEWS, AND SORT OF
THE BOTTOM LINE MESSAGE IS JUST
SUCH A POSITIVE ONE.
MY COMMENT IS MORE ABOUT SORT OF
TWO THINGS.
ONE, HOW CAN WE BETTER TELL THAT
STORY OF HOW NINR HAS BEEN A
LEADER, WHETHER IT BE MANUAL
DATA OR THE NEW AUTOMATED
SYSTEM.
IT'S SOMETHING WE SHOULD ALL BE
COLLECTIVELY VERY PROUD OF, AND
IT SOUNDS LIKE EITHER WAY,
THERE'S EVIDENCE THAT NINR HAS
BEEN CERTAINLY LEADING -- IT'S
SECOND.
I THINK THE OTHER PART IS,
ASSUMING THAT THAT MESSAGE IS
OUT THERE IN THE UNIVERSE, THEN
WHY DOES IT MATTER THAT NINR IS
DOING WORK AROUND I WOULD SAY
HEALTH INEQUITY, BUT HEALTH
DISPARITIES IS THE NEW
DEFINITION THAT IS CURRENTLY THE
DEFINITION, BECAUSE I THINK
THERE'S SOMETHING VERY UNIQUE
ABOUT THAT THAT ALSO HAS TO DO
WITH THE STORY AND THE INSTITUTE
AND ELEVATING SORT OF THE
NURSING AND WORKFORCE.
SO JUST -- I'M SURE THAT MAKES
SENSE, BUT IT SADDENS ME A BIT
TO BE PERFECTLY CANDID, I DON'T
THINK THE BROADER PUBLIC
UNDERSTANDS THAT THIS HAS BEEN
PART OF NINR FOR SO LONG.
>> AND I ACTUALLY HAVE A PIGGY
BACK COMMENT T SEEING THAT NINRS
LEADING THE HEALTH DISPARITIES
RESEARCH.
I'M NOT SUGGESTING BUT IT WILL
BE INTERESTING SINCE IT'S
AUTOMATIC, WHAT DO YOU THINK,
DR. GRASON, IN TERMS OF IF WE
USED A NEW METHODOLOGY TO CODE
THE COUPLE OF PREVIOUS YEARS,
LIKE WHAT DO YOU THINK?
IS THERE ANY -- OR STORY THAT WE
CAN TELL?
IF IT'S TOO, YOU KNOW,
LABOR-INTENSIVE, I'M NOT
SUGGESTING IT, BUT I'M JUST
CURIOUS IF YOU HAVE ANY KIND OF
ASSUMPTIONS BASED ON YOUR
EXPERIENCE MANUALLY OR
AUTOMATICALLY CODING THIS, AND
MY SECOND COMMENT IS, IT'S GREAT
TO HAVE THESE INSIGHTS BASED ON
THE DATA THAT YOU HAVE SHARED,
BUT HOW DO WE EVEN MOVE FORWARD
THEN, NOT ONLY TALKING OR
ARTICULATING THIS STORY WITH THE
BROADER COMMUNITY, BUT TO DRIVE
ACTIONS THAT NINR IS LEADING AND
DOING AN AMAZING JOB IN FUNDING
AND SUPPORTING HEALTH EQUITY
HEALTH DISPARITIES RESEARCH WHEN
THERE ARE FUNDING OPPORTUNITIES
OUT THERE, HOW CAN WE USE THIS
STORY TO DRIVE MORE FUNDING
TOWARD NINR TO DO THIS BECAUSE
WE HAVE -- NINR HAS BEEN DOING
THIS VERY WELL.
SO I'LL END HERE AND I'M CURIOUS
ABOUT YOUR THOUGHTS ON THE
APPLICATION OF NEW METHODOLOGY
ON THE PAST YEARS AND IS THERE
ANYTHING ELSE THAT WE CAN ADD TO
THE STORY?
>> IT'S SOMETHING WE'VE STARTED
TO TAKE A LOOK AT.
THERE'S A NUMBER OF TECHNICAL
REASONS, OR SO I'M TOLD, THAT
IT'S NOT AS STRAIGHTFORWARD AS
YOU THINK IT IS, AS YOU MIGHT
THINK IT WOULD BE TO LOOK AT
PREVIOUS YEARS.
I'M NOT ENTIRELY SURE WHY.
I THINK WE CAN AT LEAST GET A
ROUGH IDEA.
OF HOW THAT WOULD LOOK.
AND WE CAN CERTAINLY WORK WITH
OUR COLLEAGUES AT NIH TO FIGURE
OUT A GOOD WAY TO DO THAT.
BUT I'M SURE THAT THAT WILL BE A
VERY FREQUENT QUESTION ASKED OF
NIH IN THE COMING WEEKS AND
MONTHS, NOW THAT THIS IS OUT.
AND THIS REALLY IS, THIS IS A
WEEK AND A HALF OLD, I THINK,
THAT THIS HAS ACTUALLY BEEN
PUBLICLY RELEASED.
AND I WOULDN'T BE SURPRISED IF A
LOT OF FOLKS GET THOSE
QUESTIONS.
SO THEY'VE MADE A VERY CONCERTED
EFFORT TO SEPARATE THE BEFORE
TIMES FROM THE NEW ERA, LIKE I
THINK IF YOU LOOK ON THE REPORT
WEBSITE, THE DATA FROM PREVIOUS
YEARS ISN'T FEATURED ON THE
WEBSITE ANYMORE.
IT'S STILL AVAILABLE, THERE'S A
FOOTNOTE, THERE'S AN EMAIL
ADDRESS YOU CAN GET IT FROM, BUT
THEY WANT TO MAKE VERY CLEAR
THAT THIS IS COMPLETELY NEW AT
THIS POINT, BUT WE'LL SEE.
>> I JUST WANT TO ADD A SMALL
COMMENT, IT'S LIKE I THINK THE
STORY THAT I'M LOOKING FOR IS
THAT NURSES HAVE BEEN DOING THIS
FOUNDATIONAL WORK IN THE AREA OF
HEALTH EQUITY JUST LIKE WHEN WE
WERE -- AT THE VERY BEGINNING
WHEN HEALTH EQUITY OR HEALTH
DISPARITY IS BECOMING A BUZZ
WORD IN THIS SOCIETY, IF WE CAN
DEMONSTRATE NURSES LEADING ROLE
AND CON FOUNDATIONAL ROLE IN
THIS RESEARCH AND TO USE THAT
STORY TO SUPPORT OR ADVOCATE FOR
MORE FUNDING FOR NINR.
>> SO I HAVE A QUESTION ABOUT
HOW THE CA CATEGORIES SHOW UP IN
NIH REPORTER.
THEY SHOW UP IN NIH SPENDING
CATEGORY OR IN PROJECT TERMS, OR
IS THE CATEGORY A DERIVATIVE OF
THE TERMS?
>> SO IF YOU LOOK AT REPORTER,
THERE IS A -- THERE'S A TAB
CALLED CATEGORICAL SPENDING, I
THINK.
>> I'M THINKING ABOUT AT THE
INDIVIDUAL PROJECT LEVEL.
>> YES.
>> NOT THE CAT GOT CATEGORICALG
BUT THAT'S FROM THE THINGS THAT
COME UP FROM THE AUTOMATED
SEARCH, RIGHT?
>> KREK.
>> ACTUALLY I'M LOOKING AT THE
PROJECT AT THE MOMENT AND THERE
IS -- YOU KNOW, ONE OF THE
THINGS YOU GET IS NIH SPENDING
CATEGORY.
AND THE OTHER IS PROJECT TERMS.
SO HOW DOES THE AUTOMATED SYSTEM
CATEGORIZE -- INCLUDING THINGS
IN THOSE BUCKETS IN THE CA
CATEGORICAL SPENDING.
IS IT BY SPENDING CATEGORY OR --
>> IT'S BASED ON THE TERMS.
IT'S WHATEVER TEXT MINING TOOL
THAT THEY USE, HOWEVER THAT
EXTRACTS TERMS AND CERTAIN
FREQUENCIES AND AT CERTAIN
WEIGHTS.
AND I THINK THEY'RE STILL
LOOKING SPECIFICALLY AT TITLES
AND ABSTRACTS AND SPECIFIC AIMS.
AND IT GENERATES THAT LIST OF
TERMS, WHICH IT THEN -- IT
COMPARES THOSE TO THE -- THOSE
OTHER LISTS OF TERMS, THOSE
FINGERPRINTS THAT I MENTIONED
AND SEES HOW WELL THEY MATCH,
BUT IT'S ALL BASED ON THE TERMS.
THAT ARE EXTRACTED.
>> AND I GUESS MY QUESTION THEN
IS, LIKE THE PROJECT THAT I'M
LOOKING AT, THE TITLE IS
HISPANIC SEXUAL MINORITY YOUTH
AND THEIR FAMILIES.
BUT THE TERMS ARE, HISPANIC AND
NOT HISPANIC OR LATINO.
>> RIGHT.
>> SO IT SEEMS LIKE -- IS
THERE -- WILL THERE BE AN
EVALUATION OF HOW WELL THE
AUTOMATED SYSTEM IS REALLY
CAPTURING?
BECAUSE I THINK THIS REALLY IS
IMPORTANT AND NINR IS LEADING IN
THIS AREA, AND YES WE'RE GETTING
GOOD CREDIT, BUT IS THERE MAYBE
MORE TRACTION THAT WE NEED IN
TERMS OF THE WAY THAT THE
AUTOMATIC -- WHAT WILL BE THE
EVALUATION OF THE AUTOMATIC
SYSTEM GOING FORWARD TO MAKE
SURE THAT IT REFLECTS THE
GENERAL CODING THAT A HUMAN
BRAIN WOULD PUT IN PLACE?
>> SO LIKE THIS -- THESE NEW
CATEGORIES, LIKE MOST OF THE
CATEGORIES, BUT I THINK THESE
NEW CATEGORIES WILL BE EVEN MORE
CLOSELY LOOKED AT.
ON AN ANNUAL BASIS, THEY SEND US
THE PROJECT LIST BEFORE THEY --
ESSENTIALLY BEFORE THEY COME
OUT, MONTHS AND MONTHS BEFORE
THEY COME OUT, AND WE CAN LOOK
THROUGH THOSE AND SAY, OKAY,
THESE MORE OR LESS LOOK CORRECT,
OR THERE'S A PROBLEM HERE, WHY
WOULD THE SYSTEM, YOU KNOW, ADD
THAT.
THE CLASSIC EXAMPLE BACK IN THE
DAY WAS, THERE WERE AN ABNORMAL
AMOUNT OF GRANTS THAT WERE
SOMEHOW CODED TAMPA BAY, AS
BEING FROM TAMPA BAY.
IT TURNS OUT THEY WERE
TUBERCULOSIS GRANTS, TB.
NOW THAT'S WAY BACK IN TIME.
BUT THEY FIXED THAT SORT OF
THING A LONG TIME AGO.
>> BUT IT DOES SORT OF PROVE THE
CONCEPT.
IF YOU'RE NOT PAYING ATTENTION,
YOU CAN GET --
>> RIGHT, AND IT'S IMPROVED SO
MUCH OVER THE YEARS IN ITS
ABILITY TO KIND OF FILTER THAT
STUFF OUT.
BUT STAFF DOES TAKE A LOOK AT IT
ON AN ANNUAL BASIS, AND SEE HOW
WELL IT'S DOING, AND THEN EVERY
FEW YEARS, THEY DO A MORE
EXTENSIVE REVISIT WHERE THEY GO
BACK TO THAT LIST OF TERMS THAT
WAS DEVELOPED TO MAKE SURE THAT
IT'S KEEPING UP WITH THE
SCIENCE.
AND THAT IT'S CAPTURING WHAT IT
SHOULD.
AND LIKE I SAID, I'M SURE THERE
WILL BE EXTRA SCRUTINY OF THESE
CATEGORIES WHILE THEY'RE STILL
PRETTY NEW.
>> AND IS THERE ANY WAY FOR
INDIVIDUAL INVESTIGATORS TO KNOW
WHICH BUCKET THEIR WORK HAS BEEN
PLACED IN?
BECAUSE NO ONE WOULD WANT TO
GAME THE SYSTEM.
>> RIGHT.
>> PEOPLE WOULD WANT THEIR WORK
TO BE IN THE BUCKET THAT THEY
BELIEVE IS MOST APPROPRIATE FOR
THEM, AND IF THERE ARE TERMS
THAT THROW THEM OUT OR INTO
THOSE BUCKETS, THEY MIGHT WANT
TO ADJUST THE WAY IN WHICH
THEY'RE PRESENTING THE WORK.
>> YEAH, I WOULD BE LYING IF I
SAID THAT I'M SURE THERE IS SOME
GAMING OF THE SYSTEM GOING ON.
>> I DON'T WANT TO BE GAMED, BUT
ACCURATELY REFLECTING WHAT THE
WORK IS.
>> RIGHT.
>> SO IF YOU'RE DOING A HISPANIC
SEXUAL MINORITY YOUTH PROJECT
AND IT GETS CODED AS BOTH
HISPANIC AND NOT HISPANIC,'S AN
INVESTIGATOR, I WOULD WANT TO
HAVE SOME ABILITY TO SAY WHAT
BUCKET DID YOU ACTUALLY PUT ME
IN, AND IS THERE ANY WAY THAT I
CAN ADVOCATE FOR EITHER THIS
PROJECT BEING RECLASSIFIED OR IS
THERE SOMETHING THAT I'M DOING
WRONG IN THE WAY THAT I'M
PRESENTING THE PROJECT TO THE
TEXT MINING.
>> I WONDER IS IT POSSIBLE
THAT -- SO MAYBE PART OF THAT
PROJECT, YOU INTERVIEW
PROVIDERS, LIKE FIVE PROVIDERS
THAT MAY OR MAY NOT BE HISPANIC,
BECAUSE I COULD SEE THAT, AND
THEN IT JUST LOOKS AT --
>> BUT THEN IS IT NOT HEALTH
DISPARITIES WORK?
>> EXACTLY.
>> JUST SOMETHING TO THINK
ABOUT.
WHAT'S THE PROCESS OF SORT OF
FACT-CHECKING KIND OF ON AN
INDIVIDUAL PROJECT LEVEL, WHICH
IS SORT OF OVERWHELMING, BUT
ALSO ON THE EVALUATION PLAN FOR
THE WAY THAT THE SYSTEM IS
AUTOMATING.
>> YEAH, SO YOU'RE RIGHT, ON AN
INDIVIDUAL PROJECT LEVEL, IT'S A
LITTLE TRICKY.
AND WE ONLY HAVE LIKE A VERY
LIMITED ABILITY TO POINT OUT
PROBLEMS WITH INDIVIDUAL
PROJECTS.
AND REALLY, WHAT WE LOOK AT IS
WHETHER OR NOT A PARTICULAR
PROJECT GETS INCLUDED IN A
CERTAIN RCDC CATEGORY.
SO SOMETHING LIKE HISPANIC,
THAT'S NOT A -- I DON'T THINK
THAT'S LIKE A PUBLICLY REPORTED
CATEGORY.
AND SO IT'S JUST ONE OF MANY
TERMS THAT WOULD FACTOR INTO A
CATEGORY LIKE HEALTH DISPARITIES
OR MINORITY HEALTH.
SO ON AN INDIVIDUAL BASIS, IF
YOU'RE JUST LOOKING AT
INDIVIDUAL TERMS, THAT'S -- THAT
CAN BE A LITTLE TRICKY BECAUSE
IT'S ALL BASED ON THAT TEXT
MINING STUFF THAT I DON'T CLAIM
TO UNDERSTAND, BUT IT'S --
THERE'S A LOT OF FACTORS THAT GO
INTO WHETHER OR NOT SOMETHING IS
ULTIMATELY REPORTED IN A CERTAIN
CATEGORY, A CERTAIN RCDC
CATEGORY, VERSUS WHETHER IT JUST
HAS INDIVIDUAL TERMS ASSOCIATED
WITH IT.
AND I COMPLETELY GET IT, IT CAN
BE -- IT STILL SOMEWHAT OF A
MESSY PROCESS, JUST BECAUSE OF
THE WAYS THESE THINGS WORK.
YOU'RE RIGHT, HAVING BOTH OF
THOSE CODES THERE DOESN'T MAKE A
WHOLE LOT OF SENSE.
THE HOPE WOULD BE THAT IN THE
END, IS THE PROJECT ITSELF
INCLUDED IN THE LARGER RCDC
CATEGORY OR ISN'T IT?
>> THANK YOU FOR THE
PRESENTATION.
I HAVE A COMMENT THAT IS LESS
RELATED TO THE CODING AND MORE
RELATED TO DR. GUILAMO-RAMOS'
QUESTION OF WHAT DOES IT MATTER,
THAT WE'RE LEADING IN HEALTH
DISPARITIES, AND I'LL OFFER THE
CAVEAT THAT I'M NOT THE DEAN OF
A COLLEGE OF NURSING.
I DO HAVE A DEAN OF COLLEGE OF
NURSING THAT I WORK WITH VERY
CLOSELY.
IT STRIKES ME THAT THERE MAY BE
A STORY, THIS IS REALLY FOR
SHANNON AND ELIZABETH, THERE MAY
BE A STORY TO TELL ABOUT NINR
LEADING IN HEALTH DISPARITIES
RESEARCH THAT COULD HELP WITH
THE FACULTY PIPELINE ISSUE, AND
ALSO RECRUITMENT INTO NURSING
TRAINING PROGRAMS, SO THIS SORT
OF ELEVATED -- PEOPLE LAKE TO BE
INSPIRED, THIS E ELEVATED IDEA
THAT IF YOU CARE ABOUT HEALTH
DISPARITIES, THEN THERE ARE
THESE CAREERS IN HEALTH
DISPARITIES RESEARCH AND IN THE
FIELD OF NURSING, THE NATIONAL
INSTITUTE IS PUTTING FUNDAMENTAL
FOCUS ON THIS.
I JUST WONDER WHETHER THERE'S
SOME TYPE OF A STORY TO BE
TELLING AND MAYBE IN LIKE ALL
THE COLLEGE OF NURSING DEANS,
I'M LOOKING AT MY NEW DEAN
FRIEND THAT I MET, WHEN ALL THE
COLLEGE OF NURSING DEANS GET
TOGETHER TO COME UP WITH A
NARRATIVE AROUND THAT TO HELP
WITH THIS FACULTY PIPELINE
ISSUE, JUST A THOUGHT.
>> THIS HAS BEEN REALLY HELPFUL
TO ME AND TO US, SO THANK YOU
FOR THESE IDEAS AND THIS
SUPPORT.
I MEAN, I THINK THIS IS A WELL
KEPT SECRET, UNFORTUNATELY, OF
NURSING'S WELL ESTABLISHED
COMMITMENT TO SOCIAL JUSTICE, TO
REDUCING HEALTH DISPARITIES, TO
ADVANCING HEALTH EQUITY, IT'S
LONG BEEN A COMMITMENT OF THE
INSTITUTE, AND WE'RE ONLY
AMPLIFYING ON THAT STRENGTH IN
RESPONSE TO THE CRITICAL ISSUES
THAT WE AS A NATION FACE.
SO WE'RE PROUD OF THIS WORK.
WE APPRECIATE YOUR SUPPORT, AND
WE LOOK FORWARD TO GROWING THE
EVIDENCE BASE WITH ALL OF YOU
AND WITH THE NURSING COMMUNITY.
WE DO WANT TO STOP BEING A WELL
KEPT SECRET.
>> AND THESE GREAT NUMBERS TO
TELL THAT STORY, I'M JUST TRYING
TO FIGURE OUT WHATEVER YOUR
STORYTELLING, YOUR MEDIA
CAMPAIGN, YOUR COMMUNICATION
WITH COLLEGES OF NURSING AROUND
THAT, THAT IF YOU CARE ABOUT
HEALTH DISPARITIES, NURSING IS A
GREAT PLACE TO BE A FACULTY
MEMBER AND IT'S A GREAT PLACE TO
TRAIN, EVEN AS A BACHELOR'S OF
SCIENCE IN NURSING.
>> ABSOLUTELY.
NO, I LOVE THAT IDEA.
AND YOU'RE RIGHT, WE NEED TO DO
BETTER IN OUR MESSAGING AND
GETTING THE WORD OUT, AND --
BECAUSE THAT WILL ULTIMATELY,
YOU KNOW, INCREASE THE IMPACT OF
THE SCIENCE THAT WE'RE PRODUCING
AND BRING ABOUT THE CHANGES THAT
ARE NEEDED, SO WE APPRECIATE
THESE INITIAL IDEAS.
WE'D LOVE TO COME BACK TO YOU TO
GET MORE IDEAS, RIGHT, ABOUT
WHAT THOSE MESSAGES SHOULD LOOK
LIKE, WHAT ARE THE AUDIENCES WE
SHOULD BE REACHING, AND SO I
THINK AGREE IT'S CRITICALLY
IMPORTANT, SO APPRECIATE THESE
INITIAL IDEAS AND WE'LL DO OUR
HOMEWORK.
AND COME BACK AND TALK MORE IN
SEPTEMBER.
WE HAVE THESE GREAT DATA NOW TO
HELP JOHN STAY EMPLOYED.
WE'LL DO SOME MORE ANALYSIS,
KEEP HIM BUSY, KEEP HIM EMPLOYED
OVER THE NEXT SEVERAL MONTHS,
AND WE'LL BRING THAT BACK.
OKAY.
SO THANK YOU FOR HANGING IN.
I KNOW WE'RE RUNNING A LITTLE
BIT LATE, SO WE'RE GOING TO
BREAK FOR LUNCH, WE'LL DO 30
MINUTES SO THAT WILL TAKE US TO
12:37 EASTERN, AND LOOK FORWARD
TO -- DID I MESS THAT UP AGAIN?
OH, I'M VERY PRECISE.
37.
SO NO, WE'LL SEE YOU AROUND 37.
OKAY.
THANK YOU.
ALL RIGHT.
AS WE'RE GETTING TOGETHER AFTER
LUNCH, WELCOME BACK, EVERYONE.
ALL RIGHT.
SO WE'RE GOING TO CHANGE OUR
AGENDA, FLIP A COUPLE OF ITEMS.
BECAUSE WE WANT TO MAKE SURE OUR
PARTNERS FROM D.C. HAVE A
CHANCE TO SHARE WITH US, SO WE
WILL NEXT WELCOME DR. ERIN
ATHEY, WHO WILL TELL US ABOUT
HER EXPERIENCE WITH C3CARES,
COMMUNITY CLINIC PROGRAM, THAT
SHE FOUNDED.
SO DR. ATHEY IS A BOARD
CERTIFIED FAMILY NURSE
PRACTITIONER WHO HAS SPENT
NEARLY TWO DECADES WORKING ON
THE EAST SIDE OF D.C. .
AS A CLINICIAN, EDUCATOR AND
COMMUNITY ENGAGED SCHOLAR TO
IMPROVE HEALTH OUTCOMES FOR
THOSE WHO ARE UNDERRESOURCED.
DR. ATHEY'S EXPERIENCES AS A
CLINICIAN LED HER TO DEVELOP
SEVERAL INNOVATIVE
COMMUNITY-BASED INITIATIVES THAT
FOCUS ON IMPROVING HEALTH
LITERACY AND BRINGING HEALTHCARE
INTO D.C. WARDS 5, 6, 7 AND 8.
THESE EXPERIENCES COMBINED WITH
HER DESIRE TO IMPROVE ACCESS TO
CARE INSPIRED HER TO CREATE
C3CARES.
SO DR. ATHEY IS JOINED BY
SEVERAL OF HER PARTNERS TODAY,
INCLUDING KEITH PEDIGREW OF THE
D.C. HOUSING AUTHORITY AND
KAREN DALE, A NURSE WHO IS ALSO
PRESIDENT OF AMERIHEALTH
CAREITAS D.C. .
SO BEFORE DR. ATHEY BEGINS, I'D
LIKE TO ASK EVERYONE FROM
C3CARES AND PARTNER
ORGANIZATIONS STAND AND BE
ACKNOWLEDGED.
THANK YOU FOR JOINING US TODAY.
WELCOME.
DR. ATHEY, THE FLOOR IS YOURS
WHEN YOU'RE READY.
[SPEAKER NOT ON MIC]
>> DR. ATHEY, HOLD ON JUST A
SEC.
>> CAN YOU HEAR ME NOW?
OKAY, PERFECT.
LET ME START AGAIN.
SO GOOD AFTERNOON, EVERYONE.
THANK YOU SO MUCH FOR HAVING ME,
DIRECTOR ZENK.
I REALLY APPRECIATE IT AND
REALLY APPRECIATE MY PARTNERS
COMING TODAY TO HEAR THE
PRESENTATION.
I'M GOING TO TELL YOU A LITTLE
BIT ABOUT MY JOURNEY WITH
C3CARES.
SO LET'S GO.
FIRST OF ALL I JUST WANT TO GIVE
YOU A LITTLE BIT OF BACKGROUND
ON ME.
SO THAT WAS A NICE INTRODUCTION.
BUT I THINK IT'S IMPORTANT TO
KNOW SORT OF WHERE I'VE COME
FROM.
I'VE BEEN A NURSE FOR 26 YEARS
NOW.
I SPENT ONE YEAR AS A HOSPITAL
NURSE, AND DECIDED THAT I DIDN'T
LIKE NURSING, DECIDED THAT I WAS
IN THE HOSPITAL WITH CHRONICALLY
ILL PATIENTS AND IT WAS VERY SAD
TO ME TO SEE THAT THESE WERE
PREVENTABLE DISEASES THAT WERE
SO FAR GONE AND I FELT VERY
DISHEARTENED, AND SO YOU KNOW, I
CONSIDERED LEAVING NURSING BUT
THEN I IMMEDIATELY FOUND
COMMUNITY HEALTH NURSING AND
PUBLIC HEALTH NURSING AND I
FOUND MY LOVE FOR THAT, AND SO
THE REST OF MY CAREER, THE LAST
25 YEARS, I'VE SPENT AS A
COMMUNITY PUBLIC HEALTH NURSE.
I'VE ALSO BEEN A NURSE
PRACTITIONER FOR 20 YEARS, SO I
WENT BACK AND BECAME A FAMILY
NURSE PRACTITIONER AND CONTINUED
MY WORK IN COMMUNITY CLINICS.
I JOINED THE FIRST COHORT OF THE
DNP PROGRAM AT THE UNIVERSITY OF
VIRGINIA WHEN THEY FIRST OPENED
IT UP, BECAUSE I THOUGHT THIS IS
A GOOD IDEA, LET ME LEARN SOME
MORE HOW TO IMPLEMENT PROJECTS
AND PROGRAMS IN THE COMMUNITY.
I'VE DONE A COUPLE DIFFERENT
PROGRAMS THROUGH LOCAL
HOSPITALS, RUNNING A MOBILE
CLINIC, AND BEEN FACULTY AT GW
FOR ABOUT 12 YEARS NOW.
I'VE ALSO BEEN TEACHING NURSING
STUDENTS, PUBLIC HEALTH
STUDENTS, NOW WE HAVE BUSINESS
STUDENTS COMING OUT TO DO
COMMUNITY WORK, SO IT'S BEEN
REALLY EXCITING.
IN TERMS OF MY SCHOLARSHIP, IT'S
REALLY BEEN MOSTLY OUT IN THE
COMMUNITY FOR THE LAST SIX OR
SEVEN YEARS.
AND I'LL TELL YOU A LITTLE BIT
MORE ABOUT THAT.
AND THEN IN TERMS OF INNOVATION,
I'VE DONE PROBABLY THE TWO
BIGGEST PROJECTS ARE THE MENTAL
HEALTH LITERACY PROGRAM AND THIS
PROGRAM THAT BECAME C3CARES THAT
I'LL TELL YOU MORE ABOUT.
SO THIS IS WHAT I'VE LEARNED.
SO I'VE SPENT ALMOST 20 YEARS OF
MY CAREER IN WASHINGTON, D.C.,
AND IF YOU CAN SEE FROM THE MAP,
AND I'M SURE MOST OF YOU HAVE
SEEN IMAGES SIMILAR, IT VERY
SEGREGATED IN WASHINGTON, D.C.
AND THE HEALTH DISPARITIES
FOLLOW THE MAP OF WHERE PEOPLE
LIVE IN THE DIVISION IN THE
CITY.
I LEARNED PRETTY EARLY ON THAT
ZIP CODE WAS MORE IMPORTANT THAN
YOUR GENETIC CODE.
WE LIVE THIS BECAUSE IF YOU LIVE
NEAR THE WHITE HOUSE IN
NORTHWEST WASHINGTON, D.C., YOUR
LIFE EXPECTANCY IS 20 YEARS MORE
THAN IF YOU LIVE IN WARD EIGHT,
WHICH IS THREE MILES AWAY.
I ALSO LEARNED THAT WE HAVE A
VERY OUTDATED AND INCONVENIENT
MODEL OF HEALTHCARE.
SO WORKING IN A LOT OF THE
OUTPATIENT CLINICS AND THE
MAJORITY OF MY TIME WAS IN AN
OUTPATIENT CLINIC IN A SAFETY
NET, THE ONLY SAFETY NET
HOSPITAL IN WASHINGTON, D.C.
IT WASN'T CONVENIENT FOR FOLKS
TO COME IN 9 TO 5 WHEN THEY HAVE
CHILD CARE ISSUES,
TRANSPORTATION ISSUES.
SO IT WAS VERY FRUSTRATING TO
ME.
IN TERMS OF PRIMARY CARE, IT'S
FRAGMENTED AND NOT COORDINATED
SO A LOT OF FOLKS JUMP FROM
PLACE TO PLACE, THEY GET THEIR
PRIMARY HERE TODAY, THEY GO
SOMEWHERE ELSE TOMORROW.
THEY USE EMERGENCY ROOM FOR
PRIMARY CARE ISSUES.
AND SO THAT IS A CHALLENGE.
THEN ALSO IN D.C. , THEY DO A
COMMUNITY HEALTH NEEDS
ASSESSMENT.
IT'S A CONSORTIUM OF HOSPITALS
AND SOME FEDERALLY QUALIFIED
HEALTH CENTERS, AND THEY LOOK AT
THE DATA AND THEY SAY WHAT ARE
THE ISSUES IN D.C. .
SO FOR THE LAST COUPLE
ITERATIONS, IT'S BEEN THE NEED
FOR PLACE-BASED CARE, MENTAL
HEALTH SERVICES, WHICH ARE NOW
MORE THAN EVER OBVIOUSLY AFTER
COVID, CARE COORDINATION AND
NAVIGATION, WHICH REALLY KIND OF
ADDRESSES THIS ISSUE OF THE
FRAGMENTATION, AND HEALTH
LITERACY.
AND SO WHEN WE SAY HEALTH
LITERACY, THIS IS REALLY THE
ABILITY TO UNDERSTAND,
COMPREHEND, INTERPRET HEALTH
INFORMATION AND MAKE DECISIONS
ABOUT THAT.
AND I THINK IT'S INTERESTING
BECAUSE THERE IS JUST SOME NEW
DATA THAT SHOWS THAT ABOUT 17%
OF AMERICANS ACTUALLY HAVE HIGH
HEALTH LITERACY, SO WE KNOW IN
POPULATIONS THAT ARE
UNDERRESOURCED, THAT'S MUCH
LOWER.
SO I LIKE TO TELL PEOPLE ACCESS
TO CARE IS SOME OF THE ISSUE.
SO WE TALK A LOT ABOUT ACCESS TO
CARE AND TO ME THAT IS MORE OF A
SYSTEM ISSUE OF ARE THERE
PROVIDERS, ARE THERE ENOUGH
PRIMARY CARE PROVIDERS, ARE
THERE ENOUGH MENTAL HEALTH
PROVIDERS, ARE THERE HOSPITALS,
ARE THERE CLINICS.
AND I THINK THAT IS A BIG ISSUE,
BUT WHAT I SEE MORE AND WHAT MY
EXPERIENCE HAS BEEN IS THIS
ENGAGEMENT OF CARE.
AND THAT REALLY IS ABOUT
BEHAVIOR.
IT'S ABOUT IF I HAVE A PRIMARY
CARE PROVIDER, DO I GO AND SEE
THEM.
DO I STAY ENGAGED IN MY CARE.
TDO I UNDERSTAND WHAT TO DO FOR
MY HEALTH, AND I THINK THAT IS
MORE OF THE ISSUE AS I SEE IT.
AND THEN IN TERMS OF HEALTHCARE
INDUSTRY CHALLENGES, THESE ARE
PROBABLY NO SURPRISE TO ANYONE,
BUT THE COSTS ARE REACHING
UNSUSTAINABLE LEVELS, CARE IS
DELIVERED IN HOSPITALS AND HIGH
COST SETTINGS.
IT'S PROVIDED BY THE HIGHEST
COST PROVIDERS, SPECIALISTS AND
HOSPITAL PROVIDERS, AND REALLY
QUALITY CAN BE DONE -- QUALITY
HEALTHCARE CAN BE DELIVERED IN
MANY SETTINGS.
IT DOESN'T HAVE TO BE WITHIN THE
WHITE WALLS OF A HOSPITAL.
TELEMEDICINE, WE KNOW IS A GREAT
CHANNEL.
THERE'S OTHER COMMUNITY
CHANNELS, LOCAL ORGANIZATIONS,
COMMUNITY-BASED ORGANIZATIONS,
AND USING NAVIGATORS, COMMUNITY
HEALTH WORKERS, COUNSELORS, AND
ET CETERA.
SO THE WAY THAT I SEE MY LITTLE
JOURNEY OUT INTO THE COMMUNITY
IS USING THIS DESIGN THINKING
APPROACH.
IT'S KIND OF LIKE THE PLAN, DO,
TEST, WHATEVER THOSE CYCLES ARE.
SO I REALLY LIKE TO START HERE,
THIS WAS KIND OF AN INFLECTION
POINT FOR ME, STANDING IN THE
HOSPITAL CLINIC, JUST SORT OF
THINKING ABOUT HOW I CAN BETTER
SERVE MY PATIENTS AND REALLY
EMPATHIZING WITH THEM.
I STARTED BY JUST SORT OF GOING
OUT AND DOING SOME HOME VISITS,
RANDOMLY TO SOME PATIENTS TO SEE
IF THAT WOULD HELP.
I RODE THE METRO WITH A PATIENT
ONE TIME WHO WAS AFRAID TO GO TO
A MEDICAL APPOINTMENT AND SHE
HAD CANCER, ACTUALLY UP HERE AT
NIH WHICH ENDED UP SAVING HER
LIFE SO I STARTED TO DABBLE WITH
THAT BUT REALLY BEGAN WITH THIS
IDEA OF REALLY JUST HAVING
CONCERN AND EMPATHY FOR
PATIENTS.
AND THEN THE THOUGHT WAS, HOW DO
WE MEET PEOPLE WHERE THEY ARE IN
THE COMMUNITY.
AND SO I HAD A COUPLE PLACES TO
IDEATE.
ONE OF WHICH WAS THE WARD
8 HEALTH COUNCIL, WHICH IS A
GROUP THAT MEETS A LOT OF
DIFFERENT STAKEHOLDERS, HOSPITAL
ORGANIZATIONS, COMMUNITY-BASED
ORGANIZATIONS, AND THEY TALK
ABOUT LOCAL ISSUES EAST OF THE
RIVER.
THAT'S THE EOTR.
SO THIS WAS A PLACE WE COULD
KIND OF MARINATE ON DIFFERENT
IDEAS AND TOPICS.
AND I WAS ALSO FORTUNATE TO GET
INTO THE FIRST COHORT OF THE
ROBERT WOOD JOHNSON CLINICAL
SCHOLARS PROGRAM, FOCUSED ON
WICKED PROBLEMS.
SO THESE SOCIETAL ISSUES THAT WE
DON'T REALLY KNOW WHERE THEY
START AND END, THEY'RE LAYERED
ON TOP OF THINGS AND WE DON'T
REALLY KNOW HOW TO TACKLE THEM.
SO THAT WAS ANOTHER PLACE THAT I
WAS ABLE TO KIND OF BRAINSTORM
AND THINK THROUGH DIFFERENT
OPPORTUNITIES AND IDEAS.
SO WHERE I STARTED WAS, AND THIS
IS THROUGH THE CLINICAL SCHOLARS
PROGRAM WAS EMBEDDING EDUCATION
IN BARBER SHOPS COMING OUT OF
THE IDEA WE NEEDED MORE MENTAL
HEALTH SERVICES.
THE IDEA WAS TO TARGET A
POPULATION HESITANT TO SEEK
HEALTHCARE, IN THIS CASE AFRICAN
AMERICAN MEN, AND THEN BRING
SERVICES TO THE COMMUNITY AND IN
THIS CASE, THEY WEREN'T CLINICAL
SERVICES BUT THEY WERE MORE
EDUCATION SERVICES.
SO FOR THIS PROGRAM, AND THROUGH
THE FELLOWSHIP, WHAT WE DID WAS
WE FIRST STARTED TO TRAIN
BARBERS, AND TEACH THEM SOME
SKILLS AROUND MENTAL HEALTH
LITERACY, AND THEN WE HAD THEM
KIND OF GO BACK TO THEIR BARBER
SHOPS AND TALK TO THEIR
CUSTOMERS.
IT WORKED FOR A LITTLE WHILE AND
IT WAS PRETTY SUCCESSFUL, BUT
THE ISSUE WAS A LOT OF THE
BARBERS WERE BUSY AND THEY
NEEDED TO KEEP -- THEY NEEDED TO
MAKE MONEY SO THIS WAS SORT OF
AN EXTRA THING THEY HAD TO DO
THAT WAS ACTUALLY MORE OF A
BURDEN TO THEM.
SO THEN WE SWITCHED UP THAT
PROGRAM A LITTLE BIT AND WE SAID
WHY DON'T WE TRAIN RETURNING
CITIZENS, BECAUSE THERE WAS A
BIG GROUP OF MEN THAT WERE
RETURNING CITIZENS AND WE
THOUGHT WHY DON'T WE TEACH THEM
SOME CLASSES SO THAT IMAGE ON
THE RIGHT IS DOING A WORKSHOP
WITH SOME OF THE MEN IN OUR
PROGRAM.
AND IT ACTUALLY WORKED PRETTY
WELL.
FOR A WHILE.
BUT THEN WE FOUND SOME
CHALLENGES WITH THAT, AND MOSTLY
IT WAS DUE TO THE BUSY BARBERS
IN THEIR SHOPS AND THEY NEEDED
TO MAKE A LIVING.
THE FELLOWSHIP ENDED, SO THAT
WAS A PROBLEM, THREE-YEAR
FUNDING ENDED, I'M NOT SURE WHY
THE FELLOWSHIP HAS A FORK AND A
FLIEF.
TH -- A KNIFE.THEY DID GIVE US .
LACK OF FUNDING WAS ALWAYS AN
ISSUE, WE DIDN'T HAVE PERMANENT
SPACE IN THE SHOP SO WE DIDN'T
REALLY HAVE A LOT OF SPACE TO DO
THIS.
SO THEN IT BECAME THIS OTHER
IDEATION OF HOW DO WE FIND
ANOTHER ANCHORING INSTITUTE IN
THE COMMUNITY, AND HOW CAN WE
CREATE SOMETHING MORE
SUSTAINABLE.
SO THEN, WE MOVED ON TO THIS
CONCEPT OF USING THESE MOBILE
BUSES, AND SO WHEN I WAS WORKING
AT THE SAFETY NET HOSPITAL IN
D.C. , THERE WERE THESE TWO
LARGE MOBILE BUSES SHOWN THERE.
AND THEY WERE BASICALLY UNUSED.
THEY WERE SITTING IN THE BACK OF
THE HOSPITAL PARKING LOT.
SOME OF THE HOSPITAL
ADMINISTRATORS TRIED TO BRING
THEM OUT, BRING THEM TO GROCERY
SHOPS AND DO CERTAIN SERVICES,
BUT I THOUGHT ABOUT WHAT IF WE
KIND OF BRING THESE OUT AND
DEPLOY THESE INTO THE COMMUNITY
AND SEE IF PEOPLE ARE RECEPTIVE
TO THEM.
SO AT THE TIME, I MET WITH THE
D.C. HOUSING DIRECTOR, WHICH
WAS TWO DIRECTORS AGO, AND SAID
WOULD YOU BE OPEN TO US HAVING
THIS MOBILE TRUCK COME AROUND TO
SOME OF THE PUBLIC HOUSING
PROPERTIES?
THERE'S OVER 50 IN D.C. .
WOULD THIS BE SOMETHING THAT
WOULD BE EFFECTIVE, DO YOU
THINK?
SO THE DIRECTOR SAID YES, OF
COURSE WE'LL BE OPEN TO THIS
IDEA.
SO WE TRIED TO DO THIS AGAIN FOR
A LITTLE WHILE.
AGAIN, FUNDING WAS AN ISSUE.
AND WE WEREN'T GETTING A LOT OF
PEOPLE COMING OUT.
BUT THEN COVID HIT, AND SO WE
DID GET SOME CARES ACT MONEY AND
WE WERE ABLE TO CONTINUE THE
PROGRAM AND WE WERE ABLE TO GO
TO ALMOST LIKE 30 PROPERTIES
WITHIN THE D.C. HOUSING
PORTFOLIO, THE HOUSING
PORTFOLIO, AND PEOPLE WERE SO
OPEN AND SO RECEPTIVE TO THIS.
ESPECIALLY BECAUSE THEY WERE SO
AFRAID.
A LOT OF TIMES FOLKS HADN'T EVEN
LEFT THEIR APARTMENT BUILDINGS
AND WE'D SHOAP UP WITH THE
MOBILE UNIT AND THEY WOULD BE
CHEERING FOR THE VAN TO SHOW UP
AND THEY WOULD BE SO I AFRAID,
DO I HAVE COVID, AND SO REALLY
AT THAT POINT, I THOUGHT, YOU
KNOW, THIS IS ABOUT A MEDICAL
INTERVENTION, BUT IT'S REALLY
ABOUT SHOWING UP FOR PEOPLE AND
SAYING WE'RE HERE FOR YOU, WE'RE
NOT GOING TO LEAVE YOU BEHIND,
SO WE DID THIS FOR A WHILE.
BUT WE DID DO SOME PEN AND PAPER
SURVEYS, AND WHAT WE LEARNED WAS
THAT PEOPLE LOVE THE PLACE BASED
SERVICES WHEN WE CAME AROUND.
THEY LOVED THE IDEA OF ON-SITE
SERVICES.
BUT PROBLEMS WERE THE MOBILE
COULD ONLY DO LIKE ONE PLACE A
DAY, SO WE'D SHOW UP MAYBE AT
ONE HOUSING PROPERTY AND WE'D
SAY WE'LL SEE YOU NEXT TUESDAY
OR WE CAN COME BACK, SO THE LACK
OF CONSISTENCY REALLY BECAME A
PROBLEM.
AND THEN THE MOBILE VEHICLES ARE
EXPENSIVE.
THERE'S MAINTENANCE, YOU HAVE TO
GET A CDL DRIVER, THERE'S GAS,
WE CONSTANTLY HAD ISSUES WITH
SOME OF THE EQUIPMENT ON THE
VEHICLE.
AND WE THOUGHT TOO, MAYBE WE
DON'T NEED ALL OF THIS
EQUIPMENT, MAYBE WE COULD BE A
LITTLE BIT MORE FLEXIBLE AND A
LITTLE BIT MORE MOBILE.
SO THEN I HAD THIS IDEA, AND
THIS IS LITERALLY LIKE THE PAPER
TOWEL THAT I WROTE ON, AND I HAD
THIS IDEA, WHAT ABOUT IF WE
ANCHOR WELLNESS HUBS INTO PUBLIC
HOUSING, BECAUSE PUBLIC HOUSING
HAS THIS AMAZING INFRASTRUCTURE
OF MULTIPLE PROPERTIES THAT ARE
DISPERSED AROUND THE CITY, MOST
OF THEM HAVE MEDICAID OR ARE
DUAL MEDICAID/MEDICARE PROGRAMS.
WE COULD OFFER CLINICAL SERVICES
ON SITE, BUT WE COULD ALSO BRING
IN SOME OF THE OTHER COMMUNITY
PARTNERS WHO WERE DOING SOCIAL
SERVICES, SO WE WOULD HAVE THIS
SORT OF INFRASTRUCTURE ALMOST
LIKE AN FQHC FLIPPED INSIDE OUT.
WRAP AROUND, IT'S IN THE
COMMUNITY VERSUS BEING WITHIN
THE CONFINES OF THE HEALTH
CENTER.
WE COULD DO WELLNESS GAMES AND
CONTESTS, WE COULD BRING IN
STUDENTS TO DO STUDENT TRAINING,
SO I HAD ALL THESE DIFFERENT
VISIONS OF THESE THINGS IN THESE
ANCHORING INSTITUTIONS THAT THE
D.C. HOUSING PORTFOLIO ALLOWED
FOR.
SO THAT'S WHEN I CAME UP WITH
THIS IDEA FOR C3CARES.
SO C3CARES IS BASICALLY A
NURSE-LED MODEL THAT IS
EMBEDDING WELLNESS HUBS INSIDE
OF HOUSING.
AND SO THE IDEA IS THAT WE HAVE
STAFFED BY COMMUNITY NURSES, SO
THESE ARE NURSES THAT ARE OUT IN
THE COMMUNITY, THEY SERVE ALMOST
LIKE A SCHOOL NURSE MODEL.
SO A LOT OF TIMES PEOPLE SAY IS
THIS KIND OF LIKE A MINUTE
CLINIC MODEL?
MINUTE CLINIC TO ME IS A LITTLE
BIT MORE TRANSACTIONAL.
THIS IS MORE LIKE A SCHOOL
HEALTH MODEL, WITH -- WHERE YOA
KNOWN PERSON THERE IN THE
COMMUNITY.
WE ALSO USE COMMUNITY HEALTH
WORKERS.
IN OUR CASE WHAT WE'VE DONE
WE'VE ACTUALLY EMPLOYED
RESIDENTS WHO LIVE IN THE
PROPERTY AND WE'VE BEEN ABLE TO
PUT THEM THROUGH COMMUNITY
HEALTH WORKER TRAINING PROGRAM
THROUGH IPHI, HAD SOME FUNDING
SO WE WERE ABLE TO TRAIN THEM
AND BRING THEM BACK TO WORK ON
THE PROPERTIES AND WORK ON THE
CLINICS.
THEN YOU HAVE NURSE
PRACTITIONERS, WHO CAN DO
TELEHEALTH, CAN BE IN PERSON ON
SITE, AND CAN ALSO DO DIFFERENT
WELLNESS EVENTS IN THE
COMMUNITY.
SO THE IDEA IS THAT THIS IS
EARLY, IT'S CONVENIENT, IT
HOPEFULLY UPSTREAM MODEL, AND
REALLY SUPPORTING THIS CARE
COORDINATION AND ADDRESSING
HEALTH ISSUES EARLY.
SO THOSE ARE SOME OF THE
SERVICES THAT WE CAN PROVIDE.
NOW WE HAVE THREE THAT ARE
MEDICAID-APPROVED IN WARDS 6,
7 AND 8.
WE HAVE A FIFTH SITE ACTUALLY ON
THE SECOND FLOOR SO WE CAN'T GET
THAT TO BE ADA-COMPLIANT FOR THE
MOMENT BUT THE IDEA IS THAT
THESE WOULD BE SMALL CLINICS
SERVING NO MORE THAN 800 TO A
THOUSAND PEOPLE SO THEY STAY
VERY INTIMATE, BUT THEN THERE
ARE MULTIPLE THAT GROW AROUND
THE CITY.
SO HERE'S A LITTLE -- HERE'S A
COMMERCIAL THAT WE MADE.
>> CONCEPT CLEARANCE IS HERE.
SICK
...
>> C3CARES IS HERE.
>> BACK ON.
LASTLY, THIS IS, AGAIN, SORT OF
THE LARGER DEPICTION OF THIS
WELLNESS HEALTH MODEL.
C3CARES CLINICS ARE IN THE
MIDDLE BUT YOU HAVE ALL THE
OTHER SERVICES THAT ARE BUILT
AROUND IT.
AND THEN SOME OF THE COMMUNITY
PARTNERS THAT ARE ALREADY THERE
BECAUSE CURRENTLY THERE ARE
ABOUT 50 SOCIAL SERVICE
PROVIDERS WITHIN D.C. PUBLIC
HOUSING PROPERTIES.
THESE ARE SOME PARTNERS WE'VE
WORKED WITH, AND SO TO ME THIS
IS JUST THE BEGINNING OF A MODEL
THAT COULD REALLY BE
DEMONSTRATED IN WASHINGTON, D.C.
AND THEN BE EXPANDED TO OTHER
CITIES THAT HAVE SIMILAR
INFRASTRUCTURES.
WHAT ARE THE EXPECTED OUTCOMES
OF THE MODEL?
I THINK FIRST AND FOREMOST WANT
WE TO REDUCE EMERGENCY ROOM
VISITS.
WE WANT TO MAKE SURE THAT
PEOPLE, YOU KNOW, UNDERSTAND
THEIR HEALTH AND SO ADDRESSING
HEALTH LITERACY I THINK IS
PROBABLY FIRST AND FOREMOST.
I THINK THAT, YOU KNOW, HEALTH
LITERACY CAN'T BE ADDRESSED IN A
15-MINUTE MEDICAL APPOINTMENT,
AND WE KNOW THAT.
AND SO IF WE CAN BUILD SOME
PROGRAMS AROUND EDUCATING FOLKS
ON SITE WHERE THEY LIVE, I THINK
WE CAN START TO WORK SOME OF
THAT SO THAT THEIR OFFICE VISITS
DON'T HAVE TO BE SO INTENSE AND
DON'T FEEL LIKE THEY HAVE TO BE
SO FIT INTO A SMALL VISIT.
ENGAGEMENT IN CARE IS A
PRIORITY, TRYING TO GET HEALTH
TO BE A SHARED VALUE FOR PEOPLE
LIVING OUT IN THE COMMUNITIES.
IMPROVING COORDINATION OF CARE,
SO BY HAVING ON-SITE SOCIAL
SERVICE PROVIDERS, AND OTHER
WRAP-AROUND, THIS COULD IMPROVE
COORDINATION OF CARE AND GET
MORE FOLKS INVOLVED.
COMMUNITY LEVEL TRUST, THIS
ISN'T SOMETHING I'VE MENTIONED
SO FAR BUT A LOT OF PEOPLE HAVE
FEAR AND MISTRUST, NURSES ARE
THE NUMBER ONE TRUSTED HEALTH
CARE PROFESSIONALS FOR 17 YEARS,
THAT WILL HELP RESTORE TRUST.
AND FOR STUDENTS, WE'VE HAD
NURSING STUDENTS, BUSINESS
STUDENTS, PUBLIC HEALTH STUDENTS
COMING OUT.
THERE'S MORE OPPORTUNITIES FOR
DIFFERENT TYPES OF STUDENTS,
DIFFERENT INTERDISCIPLINARY
OPPORTUNITIES AT THESE SITES.
HERE'S SOME IMAGES OF OUR
CLINICS, OF OUR FLAGS, EDUCATION
SESSION ON THE LEFT.
WE HAVE NURSING STUDENTS DO A
SMALL PRESENTATION.
AND THERE'S A PICTURE UP TOP OF
ONE OF OUR PRIMARY CARE, THE
ENTRYWAY, CLINICS CONVERTED TO
BEDROOM APARTMENTS, WE'VE BEEN
ABLE TO CHECK THE BOXES FOR
MEDICAID TO SAY WE HAVE TWO EXAM
ROOMS, TWO EXAM TABLES, PRIVATE
ENTRY WAY, ADA COMPLIANT
BUILDING A RAMP IN THE BACK,
KITCHEN AREA IS THE EXAM ROOM,
TWO EXAM ROOMS UPSTAIRS,
BEDROOMS CONVERTED.
THIS IS THE MODEL I SEE.
I'M HAPPY TO ANSWER QUESTIONS OR
HAVE MORE DISCUSSION.
THANK YOU.
>> THANKS SO MUCH FOR THAT
PRESENTATION.
AND I'M GLAD I GET TO PROVIDE
SOME OPENING REMARKS AND SOME
QUESTIONS.
SO, JUST MY BACKGROUND, MY FIRST
JOB OUT OF NURSING SCHOOL I
BECAME A SCHOOL NURSING STUDENT
IN CAMDEN NEW JERSEY, MY
STUDENTS LIVE IN PUBLIC HOUSING,
I GET TO SEE IMPORTANCE OF BEING
ABLE TO TAKE CARE OF THAT
POPULATION, ALSO A PEDIATRIC
NURSE PRACTITIONERS AND I WORKED
IN PUBLIC HOUSING, NORTH
PHILADELPHIA.
AS A NURSING PROFESSOR AT
HOPKINS, WE'RE VERY INTERESTED
IN THINKING ABOUT RESTORING
COMMUNITY NURSING, LOTS OF
CONVERSATIONS TODAY, NURSING
CAME FROM THE COMMUNITY.
WE GOT DRAGGED INTO ACUTE CARE
HEALTH SYSTEMS AND NOW WE NEED
TO GET BACK TO WHERE WE WERE.
I THINK WHAT YOU TALKED ABOUT IN
YOUR CONVERSATION, WHAT YOU'RE
DOING, IS REALLY PART OF THAT.
AND ACTUALLY I WROTE AN ARTICLE
THAT JUST CAME OUT IN THE SPRING
AND THE TITLE IS GOING TO BE A
SCHOOL NURSE FOR EVERY CENSUS
TRACT, CHANGES IN COMMUNITY
NURSING, BUT I LOVE THE IDEA OF
A SCHOOL NURSE, SCHOOL NURSING
IS A GOOD LENS TO LOOK AT IT
THROUGH.
AND WE ACTUALLY AT HOPKINS JUST
THIS SPRING WE HAVE THE FIRST
COHORT, PILOT COHORT, ENTRY
LEVEL NURSING STUDENTS, DOING
ALL THEIR CLINICALS OUTSIDE
ACUTE CARE SYSTEM, EXCITING FOR
US AND NURSING EDUCATION.
IMPORTANT TO SHARE FACTS ABOUT
PUBLIC HOUSING, THINKING ABOUT
DEMOGRAPHICS.
1.5MILLION RESIDENTS IN PUBLIC
HOUSING, HALF A MILLION CHILDREN
BETWEEN 0 AND 17 LIVE IN PUBLIC
HOUSING, 19% ARE SENIORS, 38% OF
PUBLIC HOUSING HOUSEHOLDS
INCLUDE A MEMBER WHO IS
DISABLED, AVERAGE ANNUAL
HOUSEHOLD INCOME OF RESIDENTS OF
PUBLIC HOUSING FALLS BELOW THE
POVERTY LINE.
SO I THINK YOU WENT OVER THE
HEALTH CARE INEQUITIES, SOCIAL
DRIVERS OF HEALTH, WE'RE NOT
GOING TO SAY DETERMINANTS
ANYMORE, WE'RE GOING TO SAY
DRIVERS.
DOES EVERYBODY LIKE THAT?
GREAT DAY.
AND INNOVATIVE EXCLUSIONS,
WELLNESS HUBS, GREAT PIECES OF
IT, SO I WANT TO LEAVE TIME FOR
CONVERSATION.
I COULD TALK ABOUT THIS ALL DAY.
YEAH, ENGAGEMENT CARE IS AN
IMPORTANT PIECE, OF COURSE AS
YOU KNOW WE REALLY WANT TO APPLY
THAT.
CLINICAL CARE IS 20% OF HEALTH,
ALL THE SOCIAL DRIVERS YOU WANT
TO LEAN INTO, I THINK YOUR POINT
ABOUT THE ZIP CODE MORE
IMPORTANT THAN GENETICS IS
GREAT.
AN IDEA WHOSE TIME HAS COME.
WE HAVE A GROWING NUMBER OF
MODELS ACROSS THE COUNTRY THAT
ARE REALLY ENGAGING AND THINKING
ABOUT NURSE-LED MODELS HOW WE
CAN PROVIDE CARE WHERE PEOPLE
ARE, I LOVED THIS FOCUS SEEMS TO
BE ABOUT WHAT WE'RE DOING WITH
COMMUNITIES VERSUS WHAT WE'RE
DOING TO COMMUNITIES, SOUNDS
COLLABORATIVE, TOOK THE TIME TO
REALLY LEVERAGE TRUST IN MEMBERS
OF THE COMMUNITY, SAME WITH
BARBERS, WORKING INTO
PROMONTORAS, A LOT IS
CONVERSATIONS WE'VE HAD AS
ADVISORY MEMBERS TO THE NINR.
THIS IS REALLY SOMETHING THAT
WE'RE THINKING ABOUT, THINKING
ABOUT THE INTERVENTIONS
DELIVERED AT THE RIGHT TIME, AT
THE RIGHT PLACE, RIGHT MODES,
SOCIAL DRIVERS OF HEALTH.
NINR IS IN THAT DIRECTION, 47%
OF THE FUNDING IS GOING TOWARDS
THESE SOCIAL DRIVERS OF HEALTH.
SO THIS IS JUST SOMETHING THAT
IS REALLY TIMELY, I'M SO
DELIGHTED WE BROUGHT YOU INTO
THIS CONVERSATION BECAUSE I
THINK IT'S REALLY IMPORTANT AND
I THINK DR. ZENK HAS DONE A
GREAT JOB, THINKING ABOUT
COMMUNITY-BASED NON-PROFITS LIKE
YOURSELF, HIGHER EDUCATION,
PHILANTHROPY, ACUTE CARE
PARTNERS, BECAUSE THEY ARE ALL
PART OF THIS CONVERSATION THAT
NURSING REALLY IS THE LARGEST
SHARE OF THE HEALTHCARE
WORKFORCE, THE MOST TRUSTED, AS
POINT OUT.
A COUPLE QUESTIONS, MAYBE WE
ADDRESS, MAYBE WE DON'T.
HOW CAN MODELS OF CARE BE
IMPLEMENTED IN PUBLIC HOUSING
ENVIRONMENTS TO ADDRESS UNIQUE
SOCIAL ECONOMIC AND HEALTH CARE
NEEDS OF RESIDENTS?
I THINK YOU'VE TOUCHED ON THAT.
HOW CAN THESE -- AS WE CENTER
NURSING, WE ALSO HAVE TO BE VERY
AWARE THAT WE NEED SO MANY
PARTNERS, RIGHT?
WE NEED COMMUNITY HEALTH
WORKERS, DOULAS, PROMONTORAS,
BEING ENGAGED IN CONVERSATIONS,
WIDENING THIS SENSE OF HOW WE
ADDRESS PRIMARY CARE, WHERE
PEOPLE ARE, AND WHERE THEY WANT
US TO BE WITH THEM.
I LOVE THAT IN THAT COMMERCIAL,
DON'T HAVE TO GO INTO ACUTE CARE
SETTING TO GET HEALTH CARE.
EVERYONE IS ENGAGED WITH HEALTH
CARE, WE ALL GET HEALTHIER,
COMMUNITIES BECOME MORE
EQUITABLE AND MORE RESILIENT.
JUST HEALTHIER PLACES.
THE LAST PIECE AGAIN THINKING
ABOUT THE ROLE OF COMMUNITY
HEALTH WORKERS AS WE BRIDGE THAT
GAP, AND WHAT YOU DID WITH
BARBERS WE CAN DO WITH OTHER
HEALTH WORKERS, WE'VE SEEN OTHER
MODELS, I KNOW JEFF BRENNER'S
WORK, THINKING ABOUT THE
DIFFERENT LAYERS OF NURSING
ASSISTANTS, LPNS, RNS, NURSE
PRACTITIONERS.
THANK YOU FOR THE GREAT WORK
YOU'RE DOING AND I'D LOVE TO
OPEN UP FOR CONVERSATION.
THANK YOU.
>> YOUR PRESENTATION WAS SPEAK
-- SPECTACULAR FOR THE REASONS
BOB ARTICULATED.
YOU'RE AN AMAZING NURSE.
THE WAY WE SEE CARE, THE WAY FOR
THE FUTURE, THERE NOW.
HUGE CONGRATULATIONS AND THANK
YOU FOR BEING HERE TODAY.
I WANT TO POINT OUT A LITTLE
BIT, SORT OF PROMOTION OF THE
NURSING PROFESSION WHICH I THINK
IS PART OF OUR ROLE.
I JUST COMPLETED A REVIEW OF
HUNDREDS OF PROGRAMS PUBLISHED,
OBVIOUSLY, IF IT'S IN THE
LITERATURE, CRITICAL REVIEW,
WHAT DO WE MEAN BY NURSE LED,
ARE THERE COMPONENTS THAT DEFINE
ACROSS POPULATIONS AND ACROSS
SETTINGS AND ACROSS ISSUES, AND
IT TURNS OUT THAT AT LEAST FROM
MY REVIEW THERE IS, MANY THINGS
ARE IN YOUR C3CARES PROGRAM.
BUT WHAT I'M TRYING TO LIFT UP
IS WHILE THIS EXAMPLE IS
FANTASTIC, WE NEED TO COMBINE
THAT WITH HUNDREDS OF EXAMPLES
THAT HELP US TO TELL OUR STORY
OF HOW NURSING RESEARCH IS
TRANSFORMING HEALTH IN OUR
NATION, AND, SHANNON, THAT PAPER
IS OUT.
I'M HAPPY TO SHARE IT WITH YOU.
IT'S OPEN ACCESS.
AND IT REALLY DEFINES LIKE AT
LEAST FIRST STAB AT WHAT MAKES
NURSING INTERVENTIONS IMPACTFUL.
SO I'M GOING TO SEND IT
PERSONALLY IF I CAN GET YOUR
E-MAIL.
I THINK YOU'LL SEE YOURSELF IN
THAT AND SHOW YOU YOU'VE BEEN
PART OF SOMETHING THAT'S REALLY
IMPORTANT TO ELEVATE.
>> DR. STONE?
>> THANK YOU.
WONDERFUL PRESENTATION, AND
ABSOLUTELY AMAZING WORK.
THERE'S NO DOUBT YOU'RE CHANGING
LIVES.
OVER 25 YEARS AGO I HEARD ABOUT
MODELS OF CARE, NOT NURSE LED
BUT MODELS OF CARE LIKE THIS, 25
YEARS AGO.
THEY WERE DOING AT HARVARD.
I'M REFLECTING ON THAT.
AND THINKING AS A
NURSE-SCIENTIST NOW, WHAT ARE
THE QUESTIONS, SCIENTIFIC
QUESTIONS, ABOUT THIS.
IS IT ABOUT IMPLEMENTATION?
AND I'M NOT SURE OF THOSE
THINGS.
YOU KNOW, I MEAN, IF I HEARD
ABOUT SOMETHING VERY SIMILAR TO
THIS, YOU KNOW, PUTTING CLINICS
IN HOUSING PROJECTS, OVER 25 --
SMALL SETTINGS, 25 YEARS AGO AND
IT NEVER HAPPENED, TO ME I THINK
THE QUESTIONS ARE ABOUT WHY AND
HOW DO WE IMPLEMENT THEM; KNOW,
GET THEM IMPLEMENTED.
YOU KNOW, SO THERE ARE REAL
POLICY QUESTIONS.
BUT I WANT ALL OF US TO REFLECT
ON WHAT ARE THE SCIENTIFIC
QUESTIONS THAT WE NEED ANSWERED
WITH SUCH AMAZING WORK GOING ON
TO GET THIS IMPLEMENTED LARGER
ACROSS THE NATION.
>> MY QUESTION IS, WHAT CAN WE
IN ACUTE CARE LEARN FROM YOU.
HOW DO WE GET PATIENTS ENGAGED
IN CARE, BECAUSE WE SEE
IMPLICATIONS OF WHEN THEY AREN'T
ENGAGED, AND IT'S A VERY
DIFFICULT-TO-TREAT POPULATION.
THEY KEEP COMING BACK.
OUTCOMES ARE TERRIBLE.
SO I WOULD LOVE TO LEARN FROM
YOUR EXPERIENCE ON HOW YOU
ENGAGE PEOPLE IN THEIR CARE
BECAUSE CLEARLY YOU'VE SOLVED
THE ACCESS, BUT HOW DO YOU
ENGAGE THEM?
>> I THINK THAT'S THE MILLION
DOLLAR QUESTION.
WE'RE WORKING TOWARDS THAT.
I THINK IT HAS TO BE MORE THAN
THE HEALTH CARE ENVIRONMENT.
EVEN IN OUR MINI CLINIC, THAT'S
NOT IT EITHER.
THAT'S WHY I GO BACK TO THIS
CONCEPT OF WELLNESS HUB, OF
REALLY MAKING LIKE A SAFE SPACE
WHERE PEOPLE CAN COME AND GET
INFORMATION, NURSING STUDENTS
HELPING PEOPLE APPLY FOR
MEDICAID, HELPING TAKE A BLOOD
PRESSURE, JUST MAKING THAT IN
PEOPLE'S FACE SO THEY GET
COMFORTABLE AND THEY GET USED TO
IT BECAUSE IF YOU'VE HAD A
LIFELONG LOW HEALTH LITERACY,
YOUR WHOLE LIFE, IT'S
CHALLENGING.
YOU'RE SEEING IT, I'M SEEING IT
TOO, WHAT IS DIABETES?
I DON'T KNOW.
I HAVE TWO INSULIN STICKS, WHAT
ARE THEY?
HOW CAN WE ADDRESS THAT QUICKLY,
RIGHT?
THAT'S GOING TO HAVE TO BE TIMED
AND TIME AND SETTINGS THAT ARE
MORE COMFORTABLE.
I LOVE THE IDEA OF THE GROUPS,
HAVING THE GROUPS IN THESE
COMMUNITY CENTERS WHERE WE JUST
TALK AND WE HAVE OTHER PEOPLE
ASK QUESTIONS THAT ARE THE
STUPID QUESTIONS THAT SOMEBODY
ELSE DIDN'T WANT TO ASK.
AND REALLY MAKE IT LIKE DOWN ON
EVERYONE'S LEVEL BECAUSE THE
FAST-PACED GET ADMITTED IS
OVERWHELMING FOR ALL OF US BUT
EVEN MORE SO FOLKS THAT HAVE LOW
HEALTH LITERACY.
IT'S GOT TO BE JUST OVER TIME.
I THINK THAT'S THE QUESTION.
>> IF I COULD JUMP IN, A LOT OF
IT IS TRUST.
I'VE BEEN IN HOUSING INDUSTRY
FOR 27 YEARS, BORN IN PUBLIC
HOUSING, SPENT MY FORMATIVE
YEARS IN PUBLIC HOUSING.
WE KNOW THE TRUST FACTOR IS A
BIG HURD TOLL GET OVER.
MY JOB AS AN EXECUTIVE DIRECTOR
IS TO REBUILD THAT TRUST.
AND THE ONE DECENT THING I CAN
SAY HAVING COME BACK TO D.C.,
BECAUSE I STARTED IN HOUSING
AUTHORITY IN D.C. IN 2000, GOT
CONVINCED TO COME BACK AND FIX
THE HOUSING AUTHORITY NOW, WE'RE
STARTING TO REBUILD THAT TRUST
WITH RESIDENTS.
ONCE THEY SEE LEADERSHIP SHOWING
THEY CARE ABOUT THEM THAT MAKES
THE JOB A LOT EASIEST.
WHEN I MET HER SHE WAS DOING
WELL, I'M THE BENEFACTOR OF
THESE SERVICES.
HAVING TRAVELED, SPENT TIME IN
NEW ORLEANS AT KATRINA, GARY
INDIANA, THERE'S A NEED FOR IT.
I LOVE THE MODEL.
I'M HERE TO SUPPORT HER,
WHATEVER YOU ALL CAN DO TO
ASSIST HER WITH THIS PROGRAM.
AND EXPAND IT.
IT'S A GREAT IDEA.
I'M LOOKING AT IDEAS BUT MY
AGENCY IS TO PUT TOGETHER A
RECOVERY PLAN, TO EXPAND TO AS
MANY PLACES AS POSSIBLE,
REHABBING UNITS, I HAVE A HUGE
PORTFOLIO, I'LL BE COMMITTING
SOME UNITS TO CARVE OUT SPACE
FOR HER AND HER TEAM BECAUSE NOT
ONLY IS THE HEALTH CARE PART OF
IT, IT'S JOB OPPORTUNITIES FOR
RESIDENTS.
YOU KNOW, WE HAVE A TRAINING
PROGRAM FOR MAINTENANCE WORKERS.
BUT THEY ALSO WANT TO BE NURSES
SOMEDAY.
SO THERE'S A LOT OF FACTORS IN
THE PROGRAM THAT JUST BLEW ME
AWAY WHEN I MEAT DR. ATHEY
WALKING THROUGH THE PROPERTIES
TALKING ABOUT ISSUES.
I NEVER LOOKED FROM HER ANGLE,
I'M A DEVELOPER AS WELL.
I REDEVELOP PROPERTIES SO WHEN
YOU START THINK ABOUT
REDEVELOPMENT, MIXED USE
PROPERTIES, YOU WANT TO PUT
THESE HEALTH CLINICS AT THE
BOTTOM OF THE BUILDING SO
RESIDENTS CAN LIVE UNDER FIVE
FLOORS YOU BUILD ABOVE IT AND
THEY HAVE ACCESS TO MEDICAL
SERVICES, BUT NOW THAT THERE'S A
COMMUNITY MODEL THAT I SEE THAT
MY RESIDENTS ARE ENJOYING,
NUMBER ONE, THAT I FELL IN LOVE
WITH, NUMBER TWO, I'M JUST
EXCITED FOR THE PROGRAM.
I'M SITTING NOW AND TALKING
ABOUT HOW I WITH EXPAND THE
PROGRAM AS WELL.
ANY ASSISTANCE YOU COULD GIVE
WOULD BE GREAT AS WELL.
WE ALL AGREE THERE'S A NEED.
THE QUESTION, A FAIR QUESTION,
HOW DO YOU ENGAGE IN IT?
I THINK THAT GOES BACK TO THE
TRUST FACTOR.
ONCE YOU START TO BUILD IT, AS
THEY SAY, THE LINE IN "FIELD OF
DREAMS," KEVIN COSTNER, IF YOU
BUILD IT THEY WILL COME, THAT
CONCEPT.
GREAT PROGRAM.
I APPRECIATE HER.
I HAVE TO RUN NOW, I MADE TIME
TO COME BECAUSE THIS IS
IMPORTANT FOR ME AND MY
RESIDENTS.
THANK YOU FOR ALLOWING HER TO DO
THE PRESENTATION AND ALLOWING ME
TO SHARE A COUPLE COMMENTS.
THANK YOU SO MUCH.
>> THANKS FOR COMING.
>> GOOD AFTERNOON.
KAREN DALE, CHIEF DIVERSITY
EQUITY AND INCLUSION OFFICER FOR
THE FAMILY OF COMPANIES.
I WANTED TO ADD SOME COMMENTS IN
TERMS OF WHAT CREATES
SUSTAINABILITY AND COLLABORATION
THAT ENSURES OVER TIME WE CLOSE
THESE GAPS THAT EXIST.
SO IN THE LIST THAT WAS
DISCUSSED EARLIER, WHO THE
PLAYERS ARE, I DIDN'T HEAR
PAYERS LISTED.
WITHOUT A MECHANISM FOR PAYMENT
FOR THESE SERVICES, WITHOUT THE
ABILITY TO LOOK IN A
COMPREHENSIVE WAY, AT THE WHOLE
PERSON AND THE COST, WE MISS A
HUGE OPPORTUNITY, RIGHT?
I TELL PEOPLE THAT THE FUTURE OF
EQUITY IS AROUND COLLABORATION.
REIMAGINING THE HEALTHCARE
DELIVERY SYSTEM IS NOT JUST A
HEALTHCARE DELIVERY SYSTEM BUT
ONE THAT'S GROUNDED IN SOCIAL
EQUITY AND WHEN THOSE THINGS
HAPPEN THE PAYERS CAN BE REALLY
STRONG PARTNERS, AND THEY CAN
HELP TO PROVIDE THE SHARING OF
DOLLARS THROUGH ALTERNATIVE
PAYMENT MODELS, THAT ALLOW FOR
US TO KEEP THE CHANGE GOING,
RIGHT?
SO, WHAT I WANT TO JUST SAY A
LITTLE BIT ABOUT WHY THIS WORK
IS SO IMPORTANT, NOBODY IS
RAISING THEIR HAND SAYING THEY
TRUST THEIR INSURER, BUT THERE'S
A NEXUS IN TERMS OF OUR ABILITY
TO SAY HERE, FOR EXAMPLE, WE'VE
DONE THIS, MAPPED ALL THE PUBLIC
HOUSING PROPERTIES.
I COVER ABOUT 120,000 DISTRICT
RESIDENTS.
LOOKED AT WHERE WE HAD GAPS IN
CARE.
WHERE PERSONS ARE DIAGNOSED WITH
DIABETES, HYPERTENSION, HIGH
CHOLESTEROL, WHATEVER THE THINGS
ARE, AND SAID HOW MANY RESIDENTS
LIVE IN THAT BUILDING WITH THAT
DIAGNOSIS AND HOW MANY OF THEM
ARE NOT HAVING GOOD OUTCOMES?
SHARE THAT TO TAILOR SUPPORTS
AND SERVICES.
THEY DO WELL TO BE A BRIDGE.
I DON'T EXPECT THEY WILL PROVIDE
EVERYTHING THOUGH THEY HAVE HAD
GREAT PARTNERS BUT WE'RE PAID TO
LOOK AND TAKE RISK ON THE WHOLE
COST, RIGHT?
SO, WHEN WE HAVE A SUITE OF
SERVICES LIKE WE HAVE MEDICALLY
TAILORED MEALS, GROCERY
DELIVERY, DIETITIANS WHO WILL GO
IN HOMES, WHEN WE GRADE ALL THAT
TOGETHER, THAT IS WHERE WE
REALLY SEE THE MULTIPLIER EFFECT
IN TERMS OF OUTCOMES.
AND SO YES I LOVE MY FQHCs AND
MEDICAID PROVIDERS.
HOWEVER, THE MOM WITH CHILDREN
UNDER 6, IT'S CHALLENGING.
MEDICAID IS MOSTLY MOMS AND
BABIES.
GETTING TO KNOW IN A DEEP WAY
THE COMMUNITY WE'RE SERVING,
GETTING TO UNDERSTAND THEIR
PREFERENCES AND CHALLENGES.
I SAY BOTH PREFERENCES AND
CHALLENGES BECAUSE SOMETIMES
WE'RE LEADING WITH WHAT WE WANT
VERSUS THAT PERSON'S MOST URGENT
NEED.
WE KEEP COMING BACK TO
CONVERSATIONS WITH OUR
ENROLLEES, WE TOUCH BASES WITH
PARTNERS SO WE CONTINUE THAT
LEARNING.
AND IN THAT LEARNING, GROWING,
AND SCALING IS WHERE WE CAN
REDUCE TOTAL COST AND INVEST IN
THAT.
LIKE I'M ALWAYS PROUD THAT WE'VE
HAD PROBABLY SEVEN YEARS OF
EXPERIENCE WITH COMMUNITY-BASED
ORGANIZATIONS, IS THAT USUALLY,
RIGHT BY YEAR TWO, THREE, FOUR,
WE'RE TALKING ABOUT HOW TO
IMPLEMENT VALUE-BASED CONTRACTS,
SO THAT THEY ARE MORE -- THEY
ARE GETTING REIMBURSED MORE,
RIGHT?
FOR HELPING TO ALIGN AROUND THE
OUTCOMES THAT MATTER NOT JUST
BECAUSE IT REDUCES MY COST BUT
BECAUSE IT IMPROVES LIVES AND
IMPROVES QUALITY AND OUTCOMES.
SO THAT'S TO ME THE MODEL OF
WHERE WE ALL SHOULD BE HEADING.
CMS IS DOING WORK, I SERVE ON
ONE OF THESE COMMITTEES, TO HELP
MOVE THIS WORK FORWARD.
I'LL SAY ONE PLUG FOR NURSES IS
THAT I THINK WE'RE THINKING
DIFFERENTLY.
LIKE PEOPLE SAY TO ME OFTEN, THE
THINGS I'VE STEPPED OFF THE CURB
TO DO BEFORE OTHER INSURERS
WOULD STEP OFF THE CURB TO DO
IT, BECAUSE THEY ARE HUNG UP ON
SOME REALLY HIGH ROI, IS BECAUSE
I DEEPLY BELIEVE IN OUR CAPACITY
AS HUMAN BEINGS TO HELP OTHERS
THROUGH COLLABORATION,
ENGAGEMENT, AND NOT GIVING UP.
I THINK THAT COMES FROM TREATING
AT NURSES.
WE DON'T SAY THAT DIDN'T WORK
AND LET IT GO.
WE'RE PERSISTENT IN DESIRE TO
IMPROVE OUTCOMES AND CARE DEEPLY
ABOUT HUMAN BEINGS.
I COULDN'T BE MORE PROUD YOU
ASKED ME TO COME BECAUSE I'M
EXCITED ABOUT THE FUTURE, THE
POSSIBILITY, AND THE WAY THAT WE
CAN TOGETHER PUSH THIS FORWARD
IN A WAY THAT MAKES HUMONGOUS
DIFFERENCE.
>> SORRY, I THOUGHT I TURNED IT
ON.
YOU SOLVED A VERY IMPORTANT
PROBLEM IN A COMMUNITY THAT'S
URBAN.
AND THAT HAS FULL PRACTICE
AUTHORITY FOR APRNs, SOME OF
THE CHALLENGES WE NEED TO THINK
ABOUT AS SCIENTISTS, WHAT ABOUT
THOSE OTHER STATES THAT DO NOT
HAVE FULL PRACTICE AUTHORITY,
MANY OF THEM WITH MUCH LARGER
COMMUNITIES, THAT DON'T HAVE THE
ABILITY TO FUNCTION IN THE SAME
WAY.
AND THEN WHILE I REALIZE THIS
MAY NOT BE YOUR BAILIWICK, HOW
DO WE TAKE THIS MODEL AND
REPLICATE IT IN RURAL SETTINGS,
OR DO SOMETHING FOR THOSE RURAL
PEOPLE BECAUSE IT'S, WELL,
SOMEBODY USED THE WORD EARLIER,
HEALTH CARE DESERTS.
HOW DO WE GET TO THOSE PEOPLE
AND ENGAGE THEM IN THEIR HEALTH
CARE, SO EXCELLENT WORK.
THANK YOU.
>> UNFORTUNATELY IT'S MY JOB TO
STOP US THERE.
THANK YOU SO MUCH FOR COMING.
THANK YOU FOR WHAT YOU'RE DOING.
YOU'VE INSPIRED ME AND ALL OF US
AROUND THE TABLE.
OUR JOB AS DR. STONE POINTED OUT
IS WHAT EVIDENCE DO WE NEED.
THERE'S DIFFERENT TYPES OF
EVIDENCE, INCLUDING WHAT KINDS
OF POLICY, YOU KNOW, RELEVANT
RESEARCH DO WE NEED TO EXPAND
AND GROW THESE TYPES OF MODELS
AND THANK YOU FOR BEING AN
INSPIRATION AND FOR THE WORK
YOU'RE DOING AND FOR JOINING US.
THANK YOU BOTH.
YEAH.
SO, WE'RE GOING TO SWITCH GEARS
BECAUSE SOME OF US, NOT ME, BUT
SOME OF US ARE ON TIGHT
TIMELINES, AND SO WE'LL MOVE TO
OUR NEXT AGENDA ITEM, I'M GOING
TO WELCOME DR. ALLISON COLBERT,
TO DISCUSSION OPERATIONALIZING
OR TALK ABOUT RESEARCH THROUGH
THE SOCIAL DETERMINANTS OF
HEALTH LENS AND BROADER
ACTIVITIES AT NINR.
AS I MENTIONED EARLIER, DR.
COLBERT IS AN ADVISER IN THE
OFFICE OF THE DIRECTOR HERE AT
NINR.
SHE'S JOINING US ON AN
INTERAGENCY POLICY AGREEMENT
FROM HER POSITION AS A FULL
PROFESSOR AT DUQUESNE UNIVERSITY
IN PITTSBURGH.
SO DR. COLBERT, WHEN YOU ARE
READY, I'LL TURN IT OVER TO YOU.
>> THANK YOU VERY MUCH FOR
HAVING ME.
I HAVE THE HONOR TO WORK IN THE
OFFICE OF THE DIRECTOR AT NINR
THIS YEAR, AND THE ABSOLUTE
PRIVILEGE TODAY TO TALK A LITTLE
BIT ABOUT THE WORK SPECIFICALLY
AROUND THE SDOH LENS AT NINR.
I'VE HAD THE OPPORTUNITY TO TALK
WITH PEOPLE AND LEARN ABOUT THE
WORK BEING DONE, NONE OF THIS
WORK IS MINE.
I JUST GET TO TALK ABOUT THE
REALLY COOL STUFF THAT OTHER
PEOPLE ARE DOING.
AND IT ALIGNS SO WELL WITH THE
CONVERSATION THAT I'VE HEARD
TODAY.
AND I THINK IT'S NO
OVERSTATEMENT TO SAY THAT NINR
HAS EMERGED AS A LEADER IN
SDOH-FOCUSED RESEARCH, AND THE
STAFF HERE IS EXPLORING THE BEST
WAYS FOR INSTITUTE TO CONTINUE
THESE EFFORTS.
MAXIMIZE THE OPPORTUNITIES AND
CONTRIBUTE TO HIGHEST-QUALITY
RESEARCH.
THERE'S ALSO AN OPPORTUNITY TO
ENSURE THAT NURSE INVESTIGATORS
ARE WELL PREPARED TO DO THIS
WORK.
AND SO USING SOME OF THE
TERMINOLOGY THAT WE'VE BEEN
TALKING ABOUT TODAY, MY JOB IS
TO TELL THE STORY ABOUT THE SDOH
WORK AT NINR.
AND DR. ZENK AND THE DEPUTY
DIRECTOR RECOGNIZED THE NEED TO
TELL THIS STORY.
THEY ARE DO-THE-WORK PEOPLE AS
YOU CAN SEE BY THE RESULTS.
AND SO I JUST HAVE THE
OPPORTUNITY TO TALK ABOUT IT
TOGETHER AND TO TALK ABOUT WHAT
THE GOALS ARE AND HOW THEY ARE
BEING MEASURED.
THERE IS NO NEED FOR ME TO, YOU
KNOW, REPEAT THAT NURSES AND
NURSE-SCIENTISTS ARE ACUTELY
AWARE OF THE IMPORTANCE OF THE
SDOH RESEARCH.
DETERMINANTS AND DRIVERS ARE THE
SAME LETTERS, NOW THAT YOU
CHANGED IT WE CAN STILL USE
THAT.
WE CAN ENSURE NOW THROUGH THE
WORK OF NINR THAT THE
OPPORTUNITIES, TOOLS, RESOURCES
NEEDED TO DO THIS REALLY
IMPORTANT WORK ARE AVAILABLE.
SO, THE -- EVERYONE IS FAMILIAR
WITH THE LENSES AND FIVE
RESEARCH LENSES.
AND SOCIAL DETERMINANTS OF
HEALTH IS ONE OF THOSE.
AND SDOH IS AT THE TOP OF THE
FRAMEWORK, ALONG WITH HEALTH
EQUITY, TO ENCOURAGE RESEARCHERS
TO VIEW THOSE TWO THINGS AS
PRIMARY FOCI ON WHICH TO
CONSIDER THE OTHER LENSES.
AND WE'RE GOING TO TALK ABOUT
SDOH LENS IN MORE DETAIL FASTER
THAN WE INTENDED.
SO THE ACTIVITIES RELATED TO
SDOH AND NINR CAN BE ORGANIZED
IN THREE PRIMARY GOALS, NOT
NECESSARILY MUTUALLY
EX-EXCLUSIVE.
OF COURSE EVERYTHING IS
ADVANCING THE SCIENCE AND
OPTIMIZING HEALTH.
THEY CAN BE VIEWED IN TERMS
AUDIENCES OR WHERE THOSE EFFORTS
ARE DIRECTED.
FIRST OF COURSE WE HAVE
ADVANCING THE SCIENCE OF SDOH
RESEARCH TO OPTIMIZE HEALTH AND
WELL-BEING FOR ALL.
SECOND IS POSITIONING NINR AS A
LEADER IN SDOH RESEARCH
INTERNALLY AT NIH AND
EXTERNALLY.
AND FINALLY, PREPARING MORE
NURSE-SCIENTISTS TO LEAD AND
CONDUCT RIGOROUS HIGH-QUALITY
RESEARCH IN THIS AREA.
AND TO ACHIEVE EACH GOAL, THE
NINR STAFF DEVELOPED SPECIFIC
STRATEGIES, SOME IMPLEMENTED,
SOME EARLY IN EXPLORATION, AND
WE CAN TALK ABOUT THOSE IN
GREATER DETAIL.
AGAIN, OF COURSE ALL ACTIVITIES
MOVE TOWARDS THIS GOAL, AND THE
SCOPE OF THIS WORK CAN BE
ILLUSTRATED SEVERAL DIFFERENT
WAYS.
I WOULD ARGUE THE VARIETY OF
FUNDING OPPORTUNITIES AND
INVESTMENTS NINR IS MAKING
TOWARDS THESE EFFORTS PROVIDE
THE MOST DIRECT EVIDENCE OF HOW
THIS GOAL IS BEING ACHIEVED.
THESE ARE EXAMPLES OF THE
VARIOUS FUNDING OPPORTUNITIES
ORIGINATED THROUGH AS WITH NINR
AS LEAD, THE TOPICS HAVE CLEAR
SDOH IMPLICATIONS AND PROVIDE
RESEARCHERS WITH A VARIETY OF
OPTIONS.
AS WITH MOST ACTIVITIES RELATED
TO SDOH, THERE'S THOSE THAT ARE
DIRECTLY AND EXPLICITLY ABOUT
SDOH WORK.
THEN THERE'S OTHER WORK THAT HAS
SDOH CONSIDERATION, AND NINR IS
WORKING TO ENSURE DEVELOPMENT IN
BOTH OF THOSE AREAS.
IN ADDITION TO THE EFFORTS THAT
ARE DIRECTLY LED BY NINR, AND
NINR SIGNS ON TO OTHER
OPPORTUNITIES, AND THESE ARE,
AGAIN, JUST A FEW EXAMPLES OF
OPPORTUNITIES THAT NINR HAS
SIGNED ON TO FROM A VARIETY OF
DIFFERENT INSTITUTES, NIAA,
NIMHD, OFFICE OF DISEASE
PREVENTION, AND COVER A WIDE
BREADTH OF APPROACHES INCLUDING
STRENGTHENING CAPACITY AS WELL
AS LOOKING AT MODELS OF CARE AND
TRANSLATIONAL SCIENCE, YOU CAN
REALLY SEE A VARIETY AND SCOPE
WHEN YOU LOOK AT THE
OPPORTUNITIES TOGETHER.
THIS SHOULD LOOK FAMILIAR.
WE'VE TALKED ABOUT IT IN GREAT
DETAIL TODAY ABOUT THE INCREASE
IN BOTH PROPORTION OF THE BUDGET
INVESTED AND ACTUAL DOLLARS, AS
DR. ZENK MENTIONED THESE ARE NOT
MUTUALLY EXCLUSIVE.
FOR ME, THIS TABLE REFLECTS
NURSING'S HOLISTIC PERSPECTIVE
OF HEALTH, THAT EXTENDS FROM THE
INDIVIDUAL THROUGH THE COMMUNITY
AND TO THE GREATER CONTEXT.
YOU CAN SEE IT IN THE WAY NINR
IS INVESTED THE FUNDS.
RESEARCH IN SDOH IS EXPANDING
EVERY DAY OBVIOUSLY.
NINR WANTS TO RESPOND QUICKLY
AND NIMBLY THROUGH STRATEGIC
IMPERATIVES, AN ONGOING FOCUS,
INVESTMENT IN SPECIFIC AREA OF
RESEARCH THAT'S ALIGNED WITH THE
MISSION AND GUIDING PRINCIPLES
OF NINR, MOST SPECIFICALLY THE
SOCIAL DETERMINANTS OF HEALTH
AND HEALTH EQUITY.
ADDITIONALLY STRATEGIC
IMPERATIVES ARE THOSE THAT WE
HAVE A POTENTIAL TO MAKE A
SIGNIFICANT DIFFERENCE.
THE STRATEGIC IMPERATIVE IS A
WAY TO HIGHLIGHT A PARTICULAR
SDOH OR EMPHASIZE THE LENS.
NEEDLESS TO SAY, EXPOSURE TO
FIREARM VIOLENCE IN AND OF
ITSELF IS AN SDOH, AND FIREARM
INJURY RISK IS DEEPLY INFLUENCED
BY MANY SOCIAL AND STRUCTURAL
FACTORS.
THIS AMONG MANY OTHER REASONS
INCLUDING THE SIGNIFICANT
INEQUITIES THERE ARE IN
EXPOSURE, MORBIDITY AND
MORTALITY, IT MADE FIREARMS
INJURY PREVENTION A PARTICULARLY
STRONG CHOICE FOR THE FIRST
STRATEGIC IMPERATIVE.
THIS IS SOMETHING OF A CYCLE,
STRATEGIC IMPERATIVE, INCLUDING
INTRODUCING AND IDEA, LEARNING
ABOUT SCIENCE, DEVELOPING
RESPONSIVE CONCEPTS AND FUNDING
OPPORTUNITIES AS WE SAW WITH
FIREARM PREVENTION, INTEGRATING
INTO BROADER ACTIVITIES OF NINR.
THIS MEANS THAT THE STAFF WILL
BEGIN THE PROCESS OF SELECTING A
SECOND STRATEGIC IMPERATIVE WITH
THOSE SAME GOALS IN MIND.
THE SECOND OVERALL GOAL IS TO
POSITION NINR AS A LEADER IN
SDOH RESEARCH AND THERE'S
ALREADY STRONG EVIDENCE TO SHOW
THIS IS HAPPENING, BOTH AT NIH
AND EXTERNALLY.
FIRST LOOKING AT PARTNERSHIPS
AND COLLABORATIONS WHICH CAN BE
CATEGORIZED IN TWO WAYS,
INITIATIVES FOCUSED
SPECIFICALLY, DISCUSSED TODAY
AND MEETINGS LIKE COMPASS, AND
SDOH RESEARCH COORDINATING
COMMITTEE.
THERE'S ALSO OPPORTUNITIES WHERE
THE SDOH PERSPECTIVE IS PROVIDED
TO WIDEN THE SCOPE.
SO THAT WOULD INCLUDE THE
"IMPROVE" INITIATIVE, RELATED TO
MATERNAL AND CHILD HELD, CLIMATE
CHANGE AND HEALTH INITIATIVE.
NINR AND DR. ZENK HAVE
LEADERSHIP HOLES IN FEDERAL
EFFORTS TO ADDRESS SDOH, THIS
INCLUDES NINR AS THE NIH REP TO
HHS'S SDOH LEADERSHIP GROUP AND
DR. ZENK WAS THE NIH LEAD AT THE
WHITE HOUSE INTERAGENCY POLICY
GROUP ON SDOH WHICH PRODUCED THE
WHITE HOUSE PLAYBOOK THIS LAST
FALL.
NEEDLESS TO SAY THESE EXAMPLES
OF LEADERSHIP ARE ADDING UP
QUICKLY IN THIS AREA.
TWO OTHER WAYS NINR IS
POSITIONING ITSELF AS LEADER
INCLUDING DEVELOPMENT OF
INFRASTRUCTURE FOR GRANTEES
ACROSS NIH AND PROVIDING
RESEARCH RESOURCES FOR THE
BROADER RESEARCH COMMUNITY.
WE'VE SEEN OPPORTUNITIES LIKE
DIRECTORS LECTURES AND VIRTUAL
WORKSHOPS THAT DO THAT.
STAFF IS EXPLORING NEW
STRATEGIES TO AGGREGATE
RESOURCES FOR USE.
MORE DETAIL ABOUT SOMETHING
THAT'S BEGINNING TO BE
DISCUSSED, COMMON DATA ELEMENTS.
OBVIOUSLY, THIS GROUP DOESN'T
NEED TO BE SOLD ON THE VALUE OF
COMMON DATA ELEMENTS.
WHICH ARE USED TO ENSURE SOME
DEGREE OF STANDARDIZATION OF
MEASURES AND COMPARABILITY OF
FINDINGS ACROSS STUDIES.
WE KNOW IF THEY ARE DONE WELL
THEY ALLOW LEVERAGE EXISTING
DATA SETS INTO META-ANALYSES,
AND GIVEN SOME METHODOLOGICAL
COMPLEXITY OF SDOH WORK WHICH
WAS ALLUDED TO EARLIER
INVESTIGATORS JUST BEGINNING IN
THIS AREA COULD POTENTIALLY
BENEFIT FROM GUIDANCE AND GUARD
RAILS STRONG COMMON DATA
ELEMENTS PROVIDE.
THERE'S A REAL NEED ACROSS
DISCIPLINES TO EXPLORE THE USE
OF CDEs IN THIS AREA, AND THAT
NINR ALONG WORLD A-- ALONG WITH
ITS PARTNERS HAS THE EXPERTISE
TO MEET THAT NEED.
THE THIRD AND FINAL GOAL IS
AROUND PREPARING MORE
NURSE-SCIENTISTS TO LEAD AND
CONDUCT RIGOROUS HIGH-QUALITY
SDOH RESEARCH, AND THERE HAVE
BEEN SEVERAL WAYS IN WHICH THAT
HAS HAPPENED.
AND THAT HAVE RESULTED IN
EXCITING INVESTMENTS, ONE OF
WHICH WE TALKED ABOUT EARLIER
WHICH IS THE SOCIAL DETERMINANTS
OF HEALTH RESEARCH INSTITUTE,
BEING LED BY THE DEPUTY
DIRECTOR.
WE'VE HAD A VERY ROBUST RESPONSE
TO THIS PARTICULAR PROGRAM THAT
THE ANNOUNCEMENT WENT OUT IN
MAY, WE HAVE WAY MORE
APPLICATIONS THAN WE THOUGHT WE
WOULD HAVE WHICH IS FANTASTIC.
THIS OPPORTUNITY IS FOR
NURSE-SCIENTISTS AND WE HAVE A
FOLDER FULL OF E-MAILS OF PEOPLE
VERY DISAPPOINTED THAT IT'S ONLY
NURSES, THEY ARE EXCITED, VERY
EXCITED TO LEARN FROM NINR AND
THE EXPERTS WHO ARE AFFILIATED
WITH NINR, ABOUT THIS REALLY
IMPORTANT WORK.
THAT IT'S HAPPENING AT THE END
OF JULY, SELECTIONS ARE COMING
OUT IN JUNE.
OTHER WAYS OF COURSE THIS IS
HAPPENING INCLUDE
UNDERGRADUATE -- OPPORTUNITIES
TO EXPOSE UNDERGRADUATES TO
RESEARCH AND OTHER FUNDING
OPPORTUNITIES SPECIFICALLY
R25s, ONE ON SDOH, ONE ON
FIREARM INJURY PREVENTION, THESE
CONTINUE TO BE IMPORTANT WAYS IN
WHICH WE PROVIDE
NURSE-SCIENTISTS WITH SKILLS
THEY NEED.
WE PROVIDED A FEW DISCUSSION
QUESTIONS ABOUT THESE AREAS, AND
OPPORTUNITIES NOW OR IN FUTURE
AS WE CATCH UP WITH TIME BUT I
THINK THERE'S IMPORTANT
QUESTIONS AROUND THE IDEAS THAT
COUNCIL HAS FOR INITIATIVES IN
THIS AREA AND BUILDING MOMENTUM
FOR NEW RESEARCHERS.
SO I'LL TURN IT OVER TO YOU FOR
ANY QUESTIONS THAT YOU HAVE.
>> THANKS SO MUCH, DR. COLBERT.
FASCINATING TO HEAR OVERVIEW OF
PILLAR SO IMPORTANT TO THE
INSTITUTE AND SEE WHAT PROGRESS
HAS BEEN DONE AND FUTURE VIEW.
QUESTIONS AND COMMENTS THAT IN
PART ARE ABOUT WHAT HAS BEEN
ACCOMPLISHED ALREADY, AND THEN A
LITTLE BIT MORE ABOUT WHAT
REMAINS TO BE ACCOMPLISHED.
I THINK SOCIAL DETERMINANTS OF
HEALTH IS KIND OF LIKE OUR
HEALTH DISPARITIES DISCUSSION
EARLIER THAT THERE'S A LITTLE
BIT OF UNKNOWN THAT NURSES AND
NINR SPECIFICALLY HAVE BEEN
DOING THIS WORK FOR A LONG TIME.
SO I DO THINK WE ALMOST HAVE TO
TAKE A STEP BACK AND FIND BETTER
WAYS TO CAPTURE WHAT HAS ALREADY
BEEN DONE FROM AN INSTITUTION'S
PERSPECTIVE.
WE HEARD DR. GRAYSON MENTION
EARLIER ABOUT HEALTH DISPARITIES
IN A NEW WAY WITH RCDC CODING.
I WONDER IF WE COULD SEE
SOMETHING SIMILAR WITH SOCIAL
DETERMINANTS OF HEALTH AND SEE
WHAT NINR HAS FUNDED IF THAT'S A
USEFUL CODING MECHANISM BECAUSE
IT WOULD BE GREAT TO SIMILARLY
SEE HOW MANY GRANTS HAVE BEEN
FUNDED, HOW MANY ARE Rs, HOW
MANY ARE TRAINING GRANTS, TO SEE
SIMILARLY ALL THE GREAT WORK.
AND SPECIFICALLY WHAT OTHER
GRANTS THAT HAVE BEEN FUNDED
WITH THE FOCUS, WHAT'S THE
PRODUCT, WOULD BE A GREAT WAY TO
HELP US TELL OUR STORY WHAT'S
ALREADY BEEN DONE, GIVEN IT'S
NUMBER ONE NINR BUDGET FROM A
PERCENTAGE AND WE'RE NUMBER TWO
AT NIH IN TERMS OF PERCENTAGE OF
THE BUDGET.
SO IMPORTANT.
SO LET'S THINK OF GOOD WAYS TO
USE NUMBERS AND TO BE MORE
COMPELLING ABOUT WHAT HAS BEEN
ACCOMPLISHED ALREADY.
WHAT REMAINS TO BE ACCOMPLISHED
IS A LOT.
BUT THE COMMON DATA ELEMENTS IS
QUITE FASCINATING SO I'M GLAD
THAT YOU MENTIONED IT BECAUSE OF
COURSE PEOPLE ARE ENAMORED WITH
THAT BECAUSE WHAT BETTER WAY TO
HAVE ADDITIVE RESEARCH AND ALLOW
FOR DATA SOURCES.
EVERYONE IS GUILTY, IF YOU'RE
MEASURING FOOD INSECURITY YOU DO
IT THE WAY YOU KNOW HOW TO DO IT
BUT YOU MAY NOT DO IT IN ANY
SIMILAR FASHION THAN ANY OTHER
INVESTIGATOR WHO IS ALSO
STUDYING FOOD INSECURITY SO
THAT'S KIND OF LIKE THE BENEFIT
OF COMMON DATA ELEMENTS.
THE DRAWBACKS THEY CAN BE
PRESCRIPTIVE, NOT RELEVANT TO
THE COMMUNITY, MAY NOT BE
PREFERRED OR MAY ACTUALLY NOT BE
QUESTIONS THAT ARE ANSWERED
BECAUSE THE COMMUNITY OF
INTEREST DOESN'T WANT TO ADDRESS
THOSE QUESTIONS IN A SIMILAR
WAY.
SO THE COMMON DATA ELEMENT IS
SOMETHING THAT THE INSTITUTE
SHOULD CONSIDER, IT'S A GREAT
WAY TO REALLY CAPITALIZE ON
MAKING SURE THE WORK GOING
FORWARD IS ADDITIVE AND CAN BE
CONSIDERED IN THESE META
ANALYTIC WAY, BUT THEY ARE
ALWAYS A DOUBLE-EDGED SWORD, AN
AMAZING OVERVIEW.
IF YOU HAVE THOUGHTS OR
QUESTIONS ON NUMBER OF GRANTS
THAT ARE FUNDED UNDER THE SOCIAL
DETERMINANTS OF HEALTH OR WHAT
THE BREAKDOWN IS IN TERMS OF
TRAINING AND INDEPENDENT GRANTS
WOULD BE INTERESTING TO LEARN
ABOUT AT SOME POINT BUT NOT
NECESSARILY TODAY.
>> YEAH, I THINK TO ADDRESS THE
LAST ONE, THE DATA PEOPLE ARE
WORKING ON THOSE EXACT THINGS,
THE BEST WAY TO TRACK, WHICH
LEADS BACK TO THE FIRST ONE
ABOUT THE SHARED LANGUAGE,
RIGHT?
AND UNDERSTANDING ABOUT SDOH.
DR. ZENK IS CO-LEADING RESEARCH
COORDINATING COMMITTEE WHICH
RELEASED CONCEPTUALIZATION WHICH
SHOCKINGLY NIH DIDN'T HAVE, AND
NOW DOES, RIGHT?
SHARED COMMON LANGUAGE AROUND
THAT.
AND I WOULDN'T SPEAK FOR HER
ABOUT WHAT THAT IS BUT I THINK A
LOT OF THOSE EFFORTS ARE ABOUT
COMING TO AN AGREED PLACE WHAT
THOSE THINGS MEAN.
IN TERMS OF COMMON DATA
ELEMENTS, YOU'VE IDENTIFIED THE
EXACT PROBLEM FROM. MY
PERSPECTIVE, I THINK NINR
LEADERSHIP WOULD DO COMMON DATA
ELEMENTS DIFFERENTLY, RIGHT?
SO IT'S NOT ABOUT DECIDING, YOU
KNOW, FOR COMMUNITIES WHAT THOSE
LOOK LIKE, IT'S AN EXCELLENT
OPPORTUNITY TO REALLY INCLUDE
COMMUNITY-ENGAGED EFFORTS IN
ORDER TO ESTABLISH WHAT THOSE
ARE RATHER THAN TO DICTATE IT.
AGAIN, EARLY STAGE, LOTS OF
OPPORTUNITIES FOR NINR TO DO
THIS WORK, DELIBERATELY, WITH
THE RICH TRADITION OF NURSES FOR
SURE
>> HAPPY TO OPEN UP TO
COLLEAGUES FOR QUESTIONS AND
COMMENTS.
>> I'M CURIOUS, A QUESTION
MAYBE.
CURIOUS ABOUT THE COMMON DATA
ELEMENTS FOR SDOH.
I SAW THE COMPASS PROGRAM HAS
COMPREHENSIVE COMMON DATA
ELEMENTS FOR SOCIAL DETERMINANTS
OF HEALTH, NOT SURE HOW -- WHAT
FURTHER WORK IS NEEDED, I GUESS
I'M CURIOUS WHERE NIH IN GENERAL
IS IN THIS PHASE OF COMMON DATA
ELEMENTS FOR SDOH.
>> I CAN ADDRESS THAT A LITTLE
BIT.
THROUGH THE PHENX TOOLKIT,
EVERYONE RECOGNIZES THOSE NEED
TO BE UPDATED, THERE ARE SOME.
COMPASS WILL BE COMING UP WITH A
SET OF COMMON DATA ELEMENTS,
THAT HASN'T BEEN ESTABLISHED
YET, WORK TO COME.
RESEARCH COORDINATING COMMITTEE,
CDES, THE COMMITTEE RECOGNIZED A
NEED. THERE PART OF FOR ME
THINKING ABOUT CDEs, NINR,
WHAT VOICE DO WE WANT TO HAVE,
DO WE WANT TO CONTRIBUTE OUR
PERSPECTIVE AS THESE THINGS ROLL
OUT.
AND SO THE IDEA OF A WORKING
GROUP HAS COME TO OUR MIND,
WHETHER THE COUNCIL WANTS TO
FORM A GROUP TO HELP AS THESE
THINGS INCREASINGLY OVER THE
NEXT YEAR START ROLLING OUT, DO
WE WANT TO HAVE A CHANCE TO GET
TOGETHER AS A GROUP AND DECIDE
FOR US WHAT WE THINK IS
IMPORTANT AND TO BE ABLE TO PUT
THAT ON THE TABLE.
SO I APPRECIATE YOU DIGGING IN
ON THAT.
>> YEAH, BECAUSE I'M THINKING
ABOUT MORE OF THE INNOVATIVE
LIKE NURSE-LED MODELS IN THE
COMMUNITIES WHERE THERE SHOULD
BE THIS REFERRAL TO SOCIAL
SERVICES ORGANIZATIONS AFTER YOU
IDENTIFY AND SCREEN SOCIAL
DETERMINANTS OF HEALTH OR SOCIAL
DRIVERS OF HEALTH, BUT ALSO
REFER BACK TO HEALTH, NURSES AND
NURSE PRACTITIONERS.
SO IT'S A CLOSED LOOP SYSTEM.
AND WHEN WE THINK ABOUT CDE IN
TERMS OF RESEARCH, MAYBE WE NEED
IT LIKE ALSO THINK BEYOND JUST
IDENTIFY THE DATA ELEMENTS BUT
ALSO IN TERMS OF DOWN THE ROAD
THE INTEROPERABILITY AND CLOSED
LOOP REFERRAL, REFERRAL BACK,
THAT WILL BE INSTRUMENTAL WHEN
WE IDENTIFY THESE COMMON DATA
ELEMENTS TO DRIVE MORE WHERE WE
ENVISION NURSES AND NURSE
PRACTITIONERS CAN HAVE THOSE NEW
MODELS OF CARE, PUBLIC HOUSING,
RURAL, ALL THE OTHER AREAS.
I SEE IT BROADER THAN JUST FROM
THAT INTEROPERABILITY LENS.
>> NO, THANK YOU FOR THAT
COMMENT AND THE PRESENTATION.
AMAZING.
I WOULD SAY THE -- AS DR. ZENK
WAS SAYING, COMPASS HASN'T
GOTTEN THERE YET BUT THE
PHOENIX TOOL KIT, WE'RE
IDENTIFYING WAYS TO IDENTIFY
FROM FEDERALLY QUALIFIED HEALTH
CENTERS.
WHAT'S INTERESTING IS NURSE
LEADERS PART OF THIS EFFORT OF
LOOKING QUITE DIFFERENTLY,
LOOKING AT MODIFIABLE
DETERMINANTS OR DRIVERS,
COMPARED WITH PHOENIX TO
CHARACTERIZE A POPULATION.
WE TALK ABOUT COMMUNITY VOICES,
I THINK ABOUT ORGANIZATIONAL
VOICES SEEKING FUNDING TO
SUPPORT THE HOUSING EFFORTS SO I
THINK THAT'S ANOTHER VOICE THAT
WOULD BE NICE TO SEE AS PART OF
RESEARCH EFFORT TO BETTER
UNDERSTAND IDENTIFYING COMMON
DETERMINANTS THAT OTHER
ORGANIZATIONS CAN USE TO HELP
THEIR COMMUNITIES AS WELL.
>> JUST TO BUILD ON THOSE
COMMENTS, THAT WAS FANTASTIC.
I THINK THAT THE PRESENTATION
HIGHLIGHTS WHAT WE HEARD
THROUGHOUT THE MORNING AND UP
UNTIL NOW THAT NINR IS DOING
FANTASTIC WORK IN THIS AREA.
I THINK THAT'S SORT OF TOP LINE
MESSAGE.
IN TERMS OF THE TWO POINTS THAT
YOU RAISED ABOUT WHAT RESEARCH
AND SCIENTIFIC CONTRIBUTIONS
THAT NINR COULD MAKE, AND ALSO
THIS ISSUE OF COMMON DATA
ELEMENTS, A COUPLE THOUGHTS.
I THINK THERE ARE LOTS OF
MODELS, I WOULD SAY HOPEFULLY
THIS IS AN OVERSIMPLIFICATION,
MANY OF THOSE MODELS ARE FAIRLY
STATIC.
THEY DO A GOOD JOB DESCRIBING
THINGS.
ONE PLEASANT THING I'VE SEEN IN
THE MORE RECENT SORT OF
ANNOUNCEMENTS REGARDING FUNDING
THERE'S THE USE OF WORD
MECHANISMS, AND THAT'S
FANTASTIC.
BECAUSE IF I WERE GOING TO MAKE
RECOMMENDATION AROUND RESEARCH,
OR COMMON DATA ELEMENTS, I THINK
NURSING COULD MAKE REALLY
IMPORTANT CONTRIBUTIONS AROUND
MECHANISMS, AND HAVING A SET OF
COMMON DATA ELEMENTS THAT WOULD
BE SPECIFIC ENOUGH BUT ALSO
GENERIC ENOUGH THEY WOULD
ACCOUNT FOR DIFFERENCES IN
POPULATION AND CONTEXT, ET
CETERA, ALL THE WAYS WE DIFFER
BUT THEY WOULD STILL GUIDE THE
DEVELOPMENT OF MULTI-LEVEL
INTERVENTIONS.
I WANT TO ALSO PUSH A LITTLE BIT
ON THE TENSION AROUND
HEALTH-RELATED SOCIAL NEEDS AND
TENDENCY FOR SCREENING AND
REFERRAL, WHICH IS A FIRST STEP,
BY NO MEANS MINIMIZING THAT BUT
I THINK WE HAVE EVIDENCE IT'S
INADEQUATE AND WE NEED TO GO
FURTHER AND SO I THINK THOSE ARE
AREAS THAT WE'RE ALREADY LEADING
AND SO WHY NOT KEEP PUSHING
FORWARD AND THAT WOULD BE MY
RECOMMENDATION.
>> ANY OTHER COMMENTS?
I KNOW WE'RE GETTING TO THE END
OF THE DAY.
SO FOR ME I GUESS I WANT TO
MAYBE -- SO THANK YOU, ALISON,
FOR THAT.
I HOPE YOU FOUND THAT VALUABLE
BECAUSE WE ARE HEARING IT'S NOT
CLEAR WHAT WE'RE DOING, RIGHT?
LIKE FOR EXAMPLE WITH HEALTH
DISPARITIES, INSTITUTE HAS BEEN
LEADING, HAS DONE A LOT OF WORK,
SDOH, YOU SAW THE GRAPH AT THE
BEGINNING, GREATLY EXPANDING OUR
INVESTMENT THERE.
AND OUR LEADERSHIP AT NIH AND
MORE GENERALLY.
SO THAT WAS AN ATTEMPT TO GET
EVERYTHING, TO SHOW PROGRESS IN
ONE PLACE IN TERMS OF ACROSS
RESEARCH, TRAINING, AND THEN
LEADERSHIP MORE GENERALLY.
SO, THAT WAS THE PURPOSE OF
THAT.
AND, AGAIN, TO HELP KEEP JOHN
EMPLOYED, MAYBE HE'S LEFT
BECAUSE HE'S BUSY WORKING ON
DATA.
BUT WE CAN BUILD, RIGHT, ON THAT
PRESENTATION.
AND THEN SHOW YOU SOME DATA.
SO LIKE I THINK TO HELP YOU
GUIDE US ABOUT WHERE WE SHOULD
BE MORE SPECIFICALLY INVESTING
OUR MONEY TO GIVE YOU MORE
SPECIFIC LIKE DR. LEE BROUGHT
UP, WHAT DOES THAT PORTFOLIO
LOOK LIKE IN MORE DETAIL.
SO WE CAN, YOU KNOW, USE YOUR
EXPERTISE TO INFORM OUR NEXT
STEPS AS WE MOVE FORWARD.
SO WE'LL KEEP JOHN EMPLOYED SO
HE CAN HELP US WITH THOSE DATA
ELEMENTS.
I THINK THE OTHER THING, I
REALLY APPRECIATED -- I'VE DONE
SOME ROUNDS OF MEETINGS TO CHECK
IN WITH HOW WE'RE DOING, AND
I'VE APPRECIATED ALL THE OFFERS
TO HELP US AND NOT JUST AT THE
MEETINGS BUT IN BETWEEN.
AND SO BUILDING ON THIS
CONVERSATION AS WE'VE TALKED
ABOUT, HOW DO WE FIGURE OUT NEXT
STEPS UNDER THIS LENS TO
INCREASE OUR IMPACT.
THERE'S TWO AREAS FOR US THAT
STAND OUT RIGHT NOW.
ONE IS AROUND CDEs, THERE'S
GOING TO BE A LOT OF DECISIONS,
A LOT OF MOVEMENT IN THIS AREA
AROUND SDOH, SO WE WONDERED IF
COUNCIL WANTED TO LEAN IN AND
FORM A WORKING GROUP IN THAT
AREA TO HELP INFORM SO WE CAN
HAVE A CLEAR VOICE AT THE TABLE
AS WELL AS INFORM FOR OUR SELF
DIRECTLY, WHAT DO WE PERHAPS
WANT TO SUGGEST AS COMMON DATA
ELEMENTS FOR NINR-FUNDED
RESEARCH.
THAT WAS ONE AREA.
AND THEN SECOND IN THE AREA OF
TRAINING, WE'VE BEEN JUST REALLY
PLEASED WITH THE INTEREST IN
GETTING TRAINING IN SDOH THROUGH
THE R25 MECHANISMS, AND THROUGH
THE SUMMER INSTITUTE.
SO THERE'S A NEED IN THAT AREA
SO WE WONDERED IF THAT WAS
ANOTHER AREA WHERE COUNCIL WOULD
LEAN IN AND ADVISE US IN TERMS
OF NEXT STEPS AND TRAINING
ACTIVITIES.
SO I WANTED TO PUT THAT OUT
THERE AND SEE IF THERE WAS -- I
SEE SOME NODS AND SO I WANT TO
SEE IF PEOPLE ARE ON BOARD, WANT
TO AMEND IDEAS FOR POSSIBLE
WORKING GROUPS.
ANY THOUGHTS IMMEDIATELY?
JOHN HEARD ME.
>> I THINK BOTH WOULD MAKE
AMAZING WORKING GROUPS, FROM
THIS COUNCIL, ABSOLUTELY.
>> YEAH, TRAINING, YOU'RE LIKE I
CAN'T DECIPHER WHAT YOU SAID.
>> COMMON DATA ELEMENTS.
>> AND TRAINING, YES.
>> SO SHORT ANSWER IS YES, I
AGREE.
BUT ONE THING THAT'S BEEN
RATTLING AROUND MY HEAD THIS
WHOLE DAY WE'RE TALKING A LOT
ABOUT HOW EXCITED AND IMPRESSED
WE ARE ABOUT NINR BEING SUCH A
LEADER IN THIS AREA AROUND
HEALTH DISPARITIES, MINORITY
HEALTH, SDOH, ET CETERA.
AND I THINK THAT'S AMAZING.
AND I TOTALLY AGREE.
AT THE SAME TIME WITH SUCH
LEADERSHIP COMES OBLIGATION,
RIGHT?
AND THAT, YOU KNOW, GIVES ME
THINKING WHAT IF ALL OF NIH
WAS -- THE BARS WERE AS HIGH AS
OURS IN TERMS OF PERCENT OF
FUNDING GOING TO THIS AREA.
LIKE WE WOULD CHANGE THE WHOLE
NATURE OF PEOPLE'S HEALTH IN
THIS ONE -- COUNTRY.
WHAT'S OUR OBLIGATION TO HAVE
INFLUENCE ON OTHER INSTITUTES,
AND YOU'RE DOING THAT WITH SOME
OF THE CALLS AND WORKING WITH
OTHER INSTITUTES, ET CETERA.
BUT SO AND ALSO OUR MONEY FOR
NINR IS SMALL COMPARED TO SOME
OTHER INSTITUTES, IF NCI OR SOME
OTHERS WERE DOING, HAD THE SAME
KIND OF PERCENTAGE, THAT WOULD
BE REALLY AMAZING.
THAT GETS TO MY THINKING ABOUT
CDEs, FOR EXAMPLE, SO YES
LET'S DO THIS AND LET'S BE A
PART OF DEVELOPING THESE CDEs,
AND PEOPLE HAVE SAID HERE WE
THINK A LITTLE DIFFERENTLY,
NURSING SCIENTISTS DO.
LET'S HAVE INFLUENCE AND LET'S
START -- LET'S BE DEVELOPING
THIS AND DOING EARLY THINKING
ABOUT THIS BEFORE SOMEBODY ELSE
DOES AND TELLS US WHAT TO DO
KIND OF THING.
DO YOU UNDERSTAND WHAT I'M
SAYING?
THIS IS ALL RECORDED.
ANYWAY, THIS IS JUST MY
RAMBLING, I DON'T KNOW IF THAT
HELPS.
>> OKAY.
WE'RE GOING TO LEAN IN AND WE'RE
GOING TO BE CALLING YOU OR
E-MAILING YOU TO ASK FOR YOUR
HELP, SO WE APPRECIATE THAT IN
ADVANCE.
SO THANK YOU.
THIS WAS A REALLY GOOD
DISCUSSION, APPRECIATE THE
ADVICE AND GUIDANCE.
SO WE'RE GOING TO QUICKLY, VERY
QUICKLY, TRANSITION TO OUR NEXT
GUEST, JOINING US VIRTUALLY, SO
LET ME INTRODUCE HER.
WELCOME, I CAN SEE YOU ON THE
SCREEN.
RECENTLY THE PRESIDENT'S COUNCIL
OF ADVISORS ON SCIENCE AND
TECHNOLOGY RELEASED A REPORT
SUPER CHARGING RESEARCH,
HARNESSING ARTIFICIAL
INTELLIGENCE, TO MEET GLOBAL
CHALLENGES.
SO THIS REPORT HIGHLIGHTS
CHALLENGES AND OPPORTUNITIES IN
HARNESSING POTENTIAL OF A.I.
EQUITABLY AND RESPONSIBLY TO
FOSTER SCIENTIFIC DISCOVERY.
AT NINR A.I. METHODOLOGICAL BOOT
CAMPS IN 2020 AND 2021 WE
ACKNOWLEDGED THESE OPPORTUNITIES
AND CHALLENGES AS THEY RELATE TO
HEALTH OUTCOMES.
SO TODAY I AM PLEASED TO
CONTINUE THE CONVERSATION AND
WELCOME OUR NEXT SPEAKER, DR.
OMOLOLA OGUNYEMI, WHO IS JOINING
US VIRTUALLY TO SPEAK ON
ARTIFICIAL INTELLIGENCE AND
HEALTH EQUITY.
DR. OGUNYEMI IS INTERIM VICE
PRESIDENT FOR RESEARCH AND
PROFESSOR IN DEPARTMENT OF
PREVENTIVE AND SOCIAL MEDICINE
AT CHARLES R DREW UNIVERSITY OF
MEDICINE AND SCIENCE.
SHE DIRECTS THE UNIVERSITY
CENTER FOR BIOMEDICAL
INFORMATICS WHICH FOCUSES ON
PROVIDING BIOMEDICAL INFORMATICS
SOLUTIONS THAT BENEFIT MEDICALLY
UNDERSERVED COMMUNITIES.
HER RESEARCH INTERESTS INCLUDE
COMPUTERIZED MEDICAL DECISION
SUPPORT, REASONING UNDER
UNCERTAINTY, 3D GRAPHICS AND
VISUALIZATION, MACHINE LEARNING,
TELEHEALTH.
HER WORK INCLUDES NLM-FUNDED R01
GRANT TO EXPLORE DIABETIC
RETINOPATHY, PREDICTION FROM
SAFETY NET HEALTH CARE SYSTEM
CLINICAL DATA USING DIFFERENT
MACHINE LEARNING STRATEGIES.
SHE'S BEEN PRINCIPAL
INVESTIGATOR ON AN NLM STUDY
ALSO ON COMPUTERIZED DECISION
SUPPORT FOR PENETRATING TRAUMA,
AND NCI-FUNDED R03 ON
INDIVIDUALIZED BREAST CANCER
RISK PREDICTION USING BAYESIAN
NETWORKS.
SO, WELCOME TO YOU.
WE'RE PLEASED YOU COULD JOIN US
AND YOU HAVE THE FLOOR.
>> THANK YOU FOR INVITING ME.
THANK YOU FOR THAT INTRODUCTION.
I WILL OPEN MY SLIDES.
CAN YOU ALL SEE MY SLIDES?
>> WE CAN.
>> OKAY, GREAT.
THANK YOU.
SO, JUST AS AN INTRODUCTION AND
ICE BREAKER, BECAUSE MY -- I'M
GOING TO TALK ABOUT MYSELF TO
GIVE THE CONTEXT FOR HOW I
APPROACH A.I. AND HEALTH EQUITY.
SO, I WAS BORN IN THE THIRD
LARGEST CITY IN NIGERIA, IBADAN,
BORN AT THE UNIVERSITY TEACHING
HOSPITAL WHERE MY PARENTS WERE
PROFESSORS.
NIGERIA HAS SORT OF DIFFERENT
EDUCATIONAL SYSTEM, SO WE START
SCHOOL AT THE AGE OF 4 RATHER
THAN 6.
AND IN THE NINTH GRADE, BECAUSE
WE FOLLOW BRITISH SYSTEM OF
EDUCATION, AT THE AGE OF 13 A
CHILD HAS TO MAKE A VERY
CONSEQUENTIAL DECISION ABOUT
WHETHER TO GO INTO THE ARTS OR
SCIENCES.
AND THAT DECISION IS MADE IN
NINTH GRADE, IF YOU PICK THE
ARTS, GOING TO PROFESSIONS LIKE
ENGINEERING, HEALTH CARE.
SORRY, IF YOU PICK SCIENCE,
ENGINEERING AND HEALTH CARE.
IF YOU PICK ARTS CAREERS LIKE
LAW AND SO ON, THAT'S WHAT MANY
NIGERIAN PARENTS WOULD LIKE TO
SEE.
IN THE NINTH GRADE I HAD TO MAKE
THAT DECISION.
BUT I WAS VERY MUCH INTERESTED
IN BOTH.
I LIKED SCIENCE AND THE ARTS
EQUALLY.
AND MY PARENTS WERE PROFESSORS,
MY FATHER SCIENCE EDUCATION, MY
MOTHER A LITERATURE PROFESSOR,
WHO FOCUSED ON AFRICAN AMERICAN
AND CARIBBEAN LITERATURE, AT THE
UNIVERSITY.
I ULTIMATELY PICKETED SCIENCES,
STARTED TAKING PHYSICS,
CHEMISTRY, BIOLOGY, UNTIL WE GOT
TO DISSECTIONS IN BIOLOGY,
REALIZED WITH CLARITY I WAS
NEVER GOING TO BE A HEALTH CARE
PROVIDER.
IT'S IRONIC THAT MY ENTIRE
CAREER HAS BEEN SPENT AT MEDICAL
SCHOOLS OR HOSPITALS.
WE MOVED TO THE U.S. WHEN I WAS
16, AND I TOOK COMPUTER
PROGRAMMING CLASS IN 11th
GRADE AND FELL IN LOVE WITH
CODING.
I MAJORED IN COMPUTER SCIENCE AT
BARNARD COLLEGE AND THEN LIKED
IT SO MUCH I DECIDED TO GO TO
GRADUATE SCHOOL IN THE SAME
AREA, COMPUTER SCIENCE.
WHEN I ARRIVED AT THE UNIVERSITY
OF PENNSYLVANIA, I DISCOVERED
THAT THERE WAS A TRAUMA SURGEON
AND A RADIOLOGIST WHO WERE
ADJUNCT FACULTY IN THE COMPUTER
SCIENCE DEPARTMENT AND I SAID
WHAT ARE THEY DOING HERE AND
THAT LED ME TO THE FIELD OF
BIOMEDICAL INFORMATICS.
I WROTE MY THESIS WITH THE
TRAUMA SURGEON AS MY CO-ADVISER.
I NEVER LET THE ARTS GO
COMPLETELY, I TOOK MY FIRST
POSITION AS INSTRUCTOR AT
BRIGHAM AND WOMEN'S HOSPITAL AND
STARTED WRITING A WORK OF
FICTION I DIDN'T KNOW WOULD GO
ANYWHERE, TOOK 15 YEARS, IN 2022
HAD A BOOK PUBLISHED, THE
HIGHLIGHT BESIDES GETTING
PUBLISHED WAS FAVORABLE NEW YORK
TIMES BOOK REVIEW.
SO IN 2007 I MOVED TO CHARLES
DREW UNIVERSITY, RECRUITED TO
START A CENTER FOR BIOMEDICAL
INFORMATICS, AS YOU'VE HEARD,
FOCUSED ON ISSUES THAT ARE, YOU
KNOW, AFFECT MEDICALLY
UNDERSERVED COMMUNITIES.
CHARLES DREW UNIVERSITY IS A
PRIVATE NON-PROFIT HISTORICALLY
BLACK GRADUATE INSTITUTION AS
WELL AS HISPANIC-SERVING
INSTITUTION, ESTABLISHED IN
SOUTH LOS ANGELES IN 1966, IN
THE AFTERMATH OF THE WATTS
REBELLION WHICH HAD MANY FACETS
INCLUDING ACCESS TO HEALTH CARE,
DEDICATED TO SOCIAL JUSTICE AND
HEALTH EQUITY FOR MEDICALLY
UNDERSERVED POPULATIONS.
OUR CENTER WAS ESTABLISHED IN
2007 BASICALLY TO REDEVELOP
INFORMATICS SOLUTIONS FOR
MEDICALLY UNDERSERVED
COMMUNITIES, FUNDED BY NIH
GRANTS, ENDOWMENT, STATE AND
FOUNDATION GRANTS.
THE FACULTY MEMBERS IN THE
CENTER FOR BIOMEDICAL
INFORMATICS HAVE BACKGROUNDS IN
COMPUTER SCIENCE, INTERNAL
MEDICINE, SOCIOLOGY, AS WELL AS
PUBLIC HEALTH.
SO CONTEXT FOR THE CENTER AND
UNIVERSITY'S LOCATION, LOCATED
IN WHAT'S CALLED SERVICE AREA 6
IN LOS ANGELES.
LOS ANGELES IS BROKEN INTO EIGHT
SERVICE PLANNING AREAS, FOR
ADMINISTRATIVE PURPOSES.
AND SPA 6, WAS CHARLES DREW IS
LOCATED IN, HAS 1.1 MILLION
PEOPLE OF LATIN AND AFRICAN
AMERICAN HERITAGE, AND TO PUT
THAT IN CONTEXT THERE'S ABOUT
FIVE OR MORE STATES THAT HAVE A
POPULATION LESS THAN
1.1 MILLION, AND IF WE THINK
ABOUT THE CITY OF BOSTON,
650,000 PEOPLE, IT HAS THREE
MEDICAL SCHOOLS.
SPA 6 HAS ONE, A LOW NUMBER OF
HOSPITALS, CLINICS, MEDICAL
SPECIALIST, ALMOST A THIRD OF
ADULTS IN THAT AREA HAD
DIFFICULTY ACCESSING MEDICAL
CARE VERSUS 26.3% FOR THE REST
OF L.A. COUNTY, A DISPARITY
STILL.
HRSA-DESIGNATED PROFESSIONAL
SHORTAGE AREA.
ONE THING CHARLES DREW IS TRYING
DO IS GRADUATE PHYSICIANS,
NURSES, PHYSICIAN ASSISTANTS,
RAD TECHS AND SO ON TO COMMIT TO
SERVING IN MEDICALLY UNDERSERVED
AREAS TO HELP ADDRESS THIS
HEALTH PROFESSIONAL SHORTAGE.
SO, THIS BRINGS ME TO THE SAFETY
NET WHICH YOU PROBABLY ARE VERY
FAMILIAR WITH, I WAS NOT UNTIL I
MOVED TO LOS ANGELES.
U.S. HEALTH CARE SAFETY NET
INCLUDES FEDERALLY QUALIFIED
HEALTH CENTERS AND LOOK ALIKES,
STATE AND COUNTY HOSPITALS THAT
PROVIDE CARE TO ROUGHLY 16
MILLION, I THINK UP TO 20
NATIONALLY, ABOUT 2 MILLION IN
CALIFORNIA, REGARDLESS OF A
PATIENT'S IMMIGRATION STATUS,
HEALTH INSURANCE STATUS OR
ABILITY TO PAY.
WE HAVE A LARGE NUMBER OF
PATIENTS COMPARED TO THE NUMBER
OF HEALTH CARE PROVIDERS, WE
HAVE A LOT OF PATIENTS WHO HAD
GAPS IN CARE, LIMITED HEALTH
CARE ACCESS, AND MANY SAFETY NET
HEALTH CARE CLINICS OR HOSPITALS
ARE NOT AFFILIATED WITH ACADEMIC
MEDICAL CENTERS, WHERE SOME MOST
CUTTING-EDGE RESEARCH IS DONE.
SOME ARE, BUT THEY ARE REALLY
MINORITY COMPARED TO THE OVERALL
PICTURE FOR THE U.S.
SO, THESE ARE, YOU KNOW, WE
HAVE -- ESSENTIALLY LIMITED
RESOURCE, HAVE TO PROVIDE CARE
TO MANY.
HEALTH INFORMATION TECHNOLOGY
AND INFORMATICS METHODS
INCLUDING A.I. CAN HELP TO SORT
OF BRIDGE THE GAP, TO HELP
IMPROVE QUALITY OF CARE AND IN
SOME CASES ACCESS TO CARE.
MANY SETTINGS DON'T HAVE STAFF,
HEALTH INFORMATION TECHNOLOGY OR
HEALTH INFORMATICS EXPERTISE,
AND SO AT CHARLES DREW WE MAKE A
COMMITMENT TO PARTNERING WITH
FQHCs AND OTHER SAFETY NET
PROVIDERS TO WORK WITH THEM IN
THIS DOMAIN.
SO THAT BRINGS ME TO MY FIRST
STUDY AT CDU, A YEAR AFTER I
JOINED THE UNIVERSITY I WAS
CALLED INTO THE OFFICE OF THE
DEAN OF THE COLLEGE OF MEDICINE
AT THE TIME WHO WAS AN
OPHTHALMOLOGIST.
AND HE EXPLAINED ONE OF THE
FACULTY MEMBERS AT CDU WHO WAS
MEDICAL DIRECTOR OF AN FQHC AT
THE TIME HAD A SITUATION HE
THOUGHT WE NEEDED TO SORT OF TRY
TO FIGURE OUT.
THE FACULTY MEMBER WAS AN
INTERNAL MEDICINE DOC, FOR THE
MOST PART PROVIDE PRIMARY CARE,
AT LEAST BACK THEN THE FOCUS WAS
PRIMARY CARE, NOT SPECIALTY
CARE.
THE FACULTY DIRECTOR WAS TAKING
CARE OF A PATIENT WITH DIABETES
WHO HAD NOT BEEN, YOU KNOW,
TAKING HIS MEDS, HE WASN'T
REALLY DOING TOO WELL IN TERMS
OF HIS MEDICATIONS, DIET, AND SO
ON.
SO THIS LED THE PRIMARY CARE
PROVIDER TO GET WORRIED ABOUT
POSSIBLE CONSEQUENCES OF
DIABETES, INCLUDING DIABETIC
RETINOPATHY.
SO, AS YOU MAY ALL KNOW, IT IS A
COMPLICATION OF DIABETES, THAT
CAN LEAD TO VISION LOSS.
IT'S ACTUALLY FOR ADULTS BETWEEN
20 AND 74, IN THE U.S., LEADING
CAUSE OF BLINDNESS, COMPLETELY
PREVENTIBLE IF CAUGHT EARLY AND
THERE'S THERAPY FOR THAT.
AND MANY PATIENTS WHO HAVE
DIABETIC RETINOPATHY DON'T
EXPERIENCE SYMPTOMS UNTIL IT'S
TOO LATE.
AND SO FOR THE GENTLEMAN THAT
WAS TAKING CARE BY THE
PHYSICIAN, THE DOCTOR REFERRED
HIM TO COUNTY OF LOS ANGELES FOR
SPECIALTY CARE, TO SEE AN
OPHTHALMOLOGIST IN PERSON AND
GET HIS EYES CHECKED.
AND SO THE REFERRAL WENT
THROUGH.
AND HE WAITED AND WAITED,
BECAUSE THE COUNTY ON ITS PART
HAD PATIENTS COMING IN FROM
THEIR OWN AMBULATORY CARE
CENTERS AS WELL AS INDEPENDENT
FQHCs IN THE COUNTY.
AFTER A FOUR-MONTH WAIT HE WENT
BLIND.
HE LOST VISION WAITING FOR CARE,
THE DEAN OF THE COLLEGE OF
MEDICINE CONSIDERED AN EMERGENCY
AND ASKED IF WE COULD FIGURE OUT
SOMETHING THAT WE COULD DO.
WE PROPOSED A SUPPLEMENT TO AN
EXISTING NIMHD GRANT, TO LOOK AT
TELERETINAL SCREENING FOR
DIABETIC RETINOPATHY, PART IN
OTHER WORDS WITH FOLKS AT THE
UC-BERKLEY SCHOOL OF RETINOPATHY
AND PARTNERED TO LOOK AT
BARRIERS TO USING TELERETINAL
SCREENING TO BRING SPECIALTY
SCREENING INTO THE PRIMARY CARE
SETTING IN SIX SOUTH LOS ANGELES
SAFETY NET CLINICS.
WHAT WE FOUND AS WE MOVED ON
WITH THE PROJECT IS THAT WE WERE
ABLE TO SCREEN A LOT OF
PATIENTS, ABLE TO SCREEN MORE
PATIENTS THAN WE ORDINARILY
WOULD, AND A KEY FACTOR WAS THAT
WE PARTNERED WITH THE COUNTY OF
LOS ANGELES SO THAT ANY OF THE
PATIENTS THAT ARE BOARD
CERTIFIED OPHTHALMOLOGISTS AND
READING TELERETINOPATHY IMAGES,
ANY PATIENTS WITH MODERATE OR
WORSE RETINOPATHY WOULD BE SEEN
IN THREE WEEKS, VAST IMPROVEMENT
OVER THE FOUR-MONTH WAIT THE
ORIGINAL PATIENT HAD.
AND SO WE FOUND THAT IT WAS
PRETTY SUCCESSFUL, IN GETTING
MORE PATIENTS SCREENED, BUT
STILL A LARGE NUMBER OF PATIENTS
DIDN'T COME IN FOR SCREENING.
WE HAD A SOCIOLOGIST ON THE
PROJECT TALKING TO -- LED FOCUS
GROUPS AND HAD IN-DEPTH
INTERVIEWS WITH PATIENTS AND
PROVIDERS.
WHAT WE FOUND WAS THAT IN SPITE
OF THE FACT THE CLINICS HAD
MEDICAL EDUCATION, MANY OF THE
PATIENTS FELT THAT THE EYE EXAMS
WERE FOR GLASSES, NOT FOR
SOMETHING THAT RESULTED FROM
THEIR DIABETES.
THERE WAS THAT DISCONNECT.
EVEN THOUGH THE CLINTONIC WAS
SAYING WE HAVE MEDICAL
EDUCATION, WE'RE TELLING THEM
ABOUT THIS.
WE REALIZED WE HAD A LARGE
PATIENT POPULATION AT HOME
THINKING THEY WERE FINE, NOT
GETTING ANNUAL EYE EXAM, EVEN
WITH TELERETINAL SCREENING,
LEADING ME TO WHETHER WE COULD
USE MACHINE LEARNING OR A.I. ON
KNOWN DIABETIC RETINOPATHY
FACTORS IN THE LITERATURE,
HEMOGLOBIN A1c, SO ON, WHETHER
WE COULD FIGURE OUT WHO -- WHICH
ARE THE PEOPLE MIGHT HAVE
RETINOPATHY AND NOT KNOW IT AND
HELP THEM TO COME IN.
SO, I USE THE TERM MACHINE
LEARNING A COUPLE TIMES, IT'S A
FORM OF ARTIFICIAL INTELLIGENCE
WHICH I'LL GET INTO AS I GO ON.
BUT ESSENTIALLY THIS IS USING
MATHEMATICS AND STATISTICAL
SERIES TO CREATE MODELS THAT
LOOK AT PRESIDENT EARNS IN LARGE
AMOUNTS OF DATA, FOR EXAMPLE
HEALTH RECORD DATA, USE PATTERNS
LEARN TO MAKE DIAGNOSES FOR
AGNOSTIC PREDICTIONS FOR NEW
CASES NOT SEEN BEFORE.
AS A FOLLOW-UP TO THE
TELERETINAL WE DID EHR-FOCUSED
STUDY TO DETECT DIABETIC
RETINOPATHY FROM DATA IN PATIENT
RECORDS AND WE COMPARED THE
SENSITIVITY, SPECIFICITY, AND
ERRORS UNDER THE ROC CURVE FOR
MACHINE LEARNING APPROACHES.
BASED ON THAT WE BUILT A TOOL,
WEB-BASED, FOR SAFETY NET BASED
ON NEURAL NETWORK ON A DEEP
NEURAL NETWORK MODEL.
AND WE THEN IDENTIFIED AND
REACHED OUT TO HIGH RISK
DIABETIC PATIENTS AS PART OF OUR
NLM-FUNDED STUDY WHO SKIPPED
TELERETINAL SCREENING.
CLINICAL PARTNER FOR THIS LARGER
STUDY THAT FOLLOWED THE
TELERETINAL PILOT WAS LOS
ANGELES COUNTY DEPARTMENT OF
HEALTH SERVICES, AS YOU PROBABLY
KNOW THE SECOND LARGEST
MUNICIPAL HEALTH CARE SYSTEM IN
THE U.S., SECOND ONLY TO NEW
YORK.
THREE-QUARTERS OF A MILLION
UNIQUE PATIENTS A YEAR, 142,000
UNINSURED, BETWEEN 2019 AND 2020
HAD ABOUT 85,000 PATIENTS WITH
DIABETES.
AND ONE OF THE OPHTHALMOLOGISTS
PART OF OUR TELERETINAL PILOT
WITH SCREENING WITH FQHCs TOOK
LESSONS LEARNED FROM THE PILOT
AND LAUNCHED A COUNTYWIDE
TELERETINAL DIABETIC RETINOPATHY
SCREENING PROGRAM AND THAT'S THE
PRIMARY MODALITY FOR SCREENING
IN LOS ANGELES COUNTY,
TELERETINAL SCREENING, BECAUSE
THERE ARE NOT ENOUGH
OPHTHALMOLOGISTS FOR EVERYBODY
TO HAVE AN IN-PERSON VISIT.
SO THE TELERETINAL DIABETIC
RETINOPATHY SCREENING PROGRAM
HAS TEN OPTOMETRISTS WHO SCREEN
AND MAYBE HAVE OPHTHALMOLOGISTS
OVERREAD TO SCREEN ALL DHS
DIABETIC PATIENTS ANNUALLY FOR
GUIDELINES AND THAT INTRODUCTION
OF TELEHEALTH INCLUDES SCREENING
RATES IN LOS ANGELES COUNTY FROM
ALMOST 38% IN 2012 TO 64% IN
2019.
SO IT HAS BEEN A SUCCESS.
AS PART OF OUR STUDY, WE PLANNED
TO REACH OUT.
WE'VE SEEN THE INCREASE
TELERETINAL SCREENING IMPROVED
THE RATE OF SCREENING FOR
DIABETIC RETINOPATHY IN THE
COUNTY, AND WE ANTICIPATED
GRANTS STARTED IN 2016,
ANTICIPATED THAT WE WOULD HAVE
ABOUT 10,000 PATIENTS WHO
WEREN'T COMING FOR SCREENING AND
THAT WE COULD APPLY MACHINE
LEARNING AND OUTREACH TOO.
WELL, THE COVID-19 PANDEMIC HIT,
AND THAT ESSENTIALLY CHANGED OUR
PLANS BECAUSE THE TELERETINAL
SCREENING CLINICS HAD TO PAUSE.
INSTEAD OF 10,000 PATIENTS WE
HAD 31,000 PATIENTS WHO MISSED
ANNUAL EYE EXAM AS OF MID-2021
BECAUSE OF THE PANDEMIC.
SO AS FAR AS THE STUDY WE SENT
MAILERS TO 31,000 PATIENTS, ROBO
CALLS AND TEXT MESSAGES, IF THE
PATIENT AFTER RECEIVING THE
MAILER DID NOT SCHEDULE AN
APPOINTMENT WITHIN 2 TO 4 WEEKS.
WE THEN APPLIED MACHINE LEARNING
TO THE DATA ON 31,000 PATIENTS
AND IDENTIFIED 7500 THAT THE
MACHINE LEARNING THOUGHT WAS
HIGH RISK, AND WHAT WE THEN DID
WAS HAVE BILINGUAL SPANISH
SPEAKING HEALTH EDUCATORS AND
RESEARCH ASSISTANTS REACH OUT
AND EXPLAIN WHY IT WAS IMPORTANT
TO COME IN.
AND WE BELIEVE THAT THIS SHOWS
THE POTENTIAL FOR A.I. TO GUIDE
TARGETED PATIENT OUTREACH, IN
AREAS WITH DISPARITIES IN
SCREENING RISK FOR D.R. AND
SIMILAR STRATEGIES COULD BE
VALUABLE FOR OTHER CONDITIONS IN
UNDERRESOURCED SETTINGS.
SO, I GAVE THAT CONTEXT BEFORE I
GET INTO WHAT ARTIFICIAL
INTELLIGENCE IS, JUST TO SHOW
HOW WE'RE USING IT AT CDU.
WHAT IS ARTIFICIAL INTELLIGENCE?
IT'S COMPUTER SYSTEMS OR
ALGORITHMS THAT ARE CREATED TO
ESSENTIALLY ACHIEVE OR
ACCOMPLISH TASKS THAT WOULD
ORDINARILY REQUIRE HUMAN
INTELLIGENCE AND THOSE TASKS
INCLUDE LEARNING FROM DATA,
RECOGNIZING PATTERNS IN DATA,
MAKING DECISIONS AND
UNDERSTANDING NATURAL LANGUAGE.
AND I ALWAYS STRESS THIS AT A.I.
MEDICAL CARE INTENDED TO ASSIST
OR AUGMENT HEALTH CARE
PROFESSIONALS' ABILITY AND NOT
TO REPLACE THEM.
SO EXAMPLES OF ARTIFICIAL
INTELLIGENCE INCLUDE MACHINE
LEARNING WHICH I'VE ALREADY
TALKED ABOUT, INCLUDING DEEP
LEARNING, NATURAL LANGUAGE
PROCESSING, AND GENERATIVE A.I.
WHICH IS ALL THE RAGE RIGHT NOW
WITH ChatGPT AND SO ON, LARGE
LANGUAGE MODELS, LLMs, AND THE
CONCEPT OF NARROW AND STRONG
A.I.
NARROW OR WEAK A.I. IS DESIGNED
OR TRAINED TO PERFORM SPECIFIC
TASKS.
DOESN'T PRESENT CONSCIOUSNESS OR
GENERAL INTELLIGENCE, BUT NARROW
A.I. CAN PERFORM BETTER THAN
HUMAN EXPERT IN A VERY NARROW
DOMAIN.
SO THERE'S LOTS OF EXAMPLES OF
NARROW A.I. IN MEDICINE THAT
MANY OF YOU ARE ALREADY FAMILIAR
WITH.
WE HAVE A.I. ALGORITHMS FOR
MEDICAL IMAGING AND DIAGNOSTICS,
ALGORITHMS FOR PREDICTING SEPSIS
OR RISK OF HOSPITAL
READMISSIONS, WE HAVE A.I. CHAT
BOTS FOR APPOINTMENT SCHEDULING,
CHECKING SYMPTOMS, MANAGING
MEDICATIONS, MENTAL HEALTH
SUPPORT.
THERE'S MACHINE LEARNING TO HELP
PATHOLOGIST DIAGNOSE DISEASES
FROM SAMPLES, DRAGON MEDICAL ONE
WHICH TRANSCRIBES CONDITIONS
SPOKEN LANGUAGE AS A WAY TO
UPDATE PATIENT MEDICAL RECORD
JUST USING SPEECH.
DEEP GENOMICS USES A.I. TO
UNDERSTAND GENETIC MUTATIONS AND
DEVELOP TARGETED THERAPIES THAT
COULD HELP INDIVIDUALS.
ATOMWISE USES MACHINE LEARNING
TO PREDICT NEW DRUG TARGETS, AN
EXCITING AREA OF DRUG DISCOVERY
THAT'S FACILITATED BY A.I.
AND THEN WE HAVE, YOU KNOW,
ROBOTIC SURGERY, SO DaVINCI
SURGICAL SYSTEM ROBOT
ESSENTIALLY USING A.I. TO ASSIST
SURGEONS WITH MINIMALLY INVASIVE
SURGERIES.
SO, NARROW A.I., THERE'S ALSO A
NOTION OF WIDE OR GENERAL OR
STRONG A.I.
AND THIS WAS A SYSTEM WITH
GENERALIZED HUMAN COGNITIVE
ABILITIES, COULD FIND A SOLUTION
WITHOUT HUMAN INTERVENTION.
AND THIS IS A THEORETICAL
CONCEPT THAT'S NOT YET FULLY
REALIZED BUT CAUSES A LOT OF
ALARM AND A LOT OF PEOPLE ARE
WORRIED ABOUT THE POTENTIAL FOR
WIDE OR GENERAL A.I.
BUT WE ARE NOT THERE YET.
SO, THERE'S SEVERAL TIMES OF
MACHINE LEARNING, I MENTIONED A
FORM OF A.I.
ONE IS SUPERVISED LEARNING WHERE
WE TEACH A COMPUTER HOW TO LEARN
BY PROVIDING EXAMPLES CORRECT
ANSWERS TO LEARN FROM.
UNSUPERVISED LEARNING BY ITSELF
FROM UNLABELED DATA.
AND REINFORCED, MAXIMIZING
REWARD OR REINFORCEMENT SIGNAL,
EXAMPLE WOULD BE TEACHING A
ROBOT TO AVOID OBSTACLES ON A
FACTORY FLOOR.
I APOLOGIZE IF YOU'RE ALREADY
FAMILIAR.
ESSENTIALLY IF WE WANT TO TEACH
A COMPUTER HOW TO RECOGNIZE CATS
AND DOGS FROM LOTS OF PICTURES
WE WOULD LABEL -- SHOW THE
COMPUTER MANY PICTURES OF CATS
LABELED AS CATS, SHOW MANY
PICTURES OF DOGS LABELED AS
DOGS.
AND THEN THE COMPUTER TRIES TO
FIND PATTERNS THAT MAKE A CAT
DIFFERENT FROM A DOG.
PERHAPS CATS HAVE WHISKERS AND
DOGS DON'T, ANY OTHER FEATURES
THAT DISTINGUISH THE TWO GROUPS.
WE TEST COMPUTER TO SEE HOW IT
WOULD LEARN BY SHOWING PICTURE
OF A CAT OR DOG THAT IT HASN'T
SEEN BEFORE, NOT IN THE TRAINING
SET OF PICTURES IT ALREADY SAW.
SO WE'RE TRYING TO HELP IT MAKE
A PREDICTION ON PREVIOUSLY
UNSEEN CASE.
AND SO WE ASK IT WHETHER THE
PICTURE IS A CAT OR IF IT'S OF A
DOG.
IF THE COMPUTER MAKES A MISTAKE
AND CALLS A CAT A DOG OR CALLS A
DOG A CAT, WE TELL IT WHAT THE
RIGHT ANSWER IS, SO IT DOESN'T
MAKE THAT MISTAKE AGAIN.
AND SO AS TIME PASSES IT GETS
BETTER AT RECOGNIZING CATS AND
DOGS, AS IT KEEPS LEARNING FROM
THE PICTURES AND FEEDBACK THAT
IT RECEIVES.
SO, THAT SIMPLE EXAMPLE, JUST TO
SET THE STAGE, MEDICAL EXAMPLES
ARE PRETTY COMPLEX, SO
SUPERVISORS LEARNING IS USED.
AND ONE EXAMPLE IS BREAST CANCER
DETECTION USING CONVOLUTIONAL
NEURAL NETWORKS FROM IMAGES
LABELED WITH BENIGN OR MALIGNANT
TUMORS AND HELPING TO IDENTIFY
BREAST CANCER TUMORS.
SO UNSUPERVISED MACHINE LEARNING
IN THIS CASE THE COMPUTER IS
LEARNING HOW TO RECOGNIZE THINGS
WITHOUT LABELS, IN THE PREVIOUS
EXAMPLE WE HAD LABELS OF CATS
AND LABELS OF DOGS, HERE THERE'S
NO GUIDANCE, NO LABELS.
SO IF WE WANTED TO TEACH A
COMPUTER TO ORGANIZE IMAGES OF A
VARIETY OF FRUIT WHAT WOULD
HAPPEN IN THE CASE OF
UNSUPERVISED LEARNING IS THAT
THE COMPUTER MIGHT NOTE THAT
FRUIT WITH SIMILAR SHAPES OR
SIZES OR COLORS MAY BE BLUNTING
AND GROUP THEM TOGETHER AND KEEP
UP THE GROUPING PROCESS UNTIL
ALL THE FRUITS ARE IN A
PARTICULAR GROUP.
NOW, THERE'S NO SORT OF ACCURACY
MEASURE FOR THIS.
IT'S SUBJECTIVE.
AND SO MEDICAL EXAMPLES OF
UNSUPERVISED MACHINE LEARNING
INCLUDE CLUSTERING SO WE MIGHT
WANT TO CLUSTER PATIENTS WITH
SIMILAR SYMPTOMS OR RISK FACTORS
TO FIND POPULATIONS OF THAT
MIGHT RESPOND BETTER TO CERTAIN
TREATMENTS, SO WE CAN TEST THAT
HYPOTHESIS, AND THERE'S
PUBLISHED EXAMPLE OF CLUSTERING
UNSUPERVISED LEARNING CLINICAL
CANCER DATA FOUND ASSOCIATION
WITH GROUPS WITH CHRONIC
LYMPHOCYTIC LEUKEMIA.
AND THE LAST I DESCRIBED, THIS
IS INSPIRED BY THE WAY HUMANS
AND ANIMALS JUST LEARN FROM
ACTIONS OR PAST EXPERIENCES TO
MAKE BETTER DECISIONS.
SO, AN ANALOGY IF YOU WERE
TRYING TO GET A HIGH SCORE ON A
VIDEO GAME THAT YOU HAD NEVER
PLAYED BEFORE, THAT YOU KNOW
LITTLE ABOUT, SOMEBODY GAVE YOU
THE VIDEO CONTROLLER, YOU MIGHT
TRY PRESSING DIFFERENT BUTTONS
UNTIL YOU REALIZE WHAT LEADS TO
HIGHER SCORE LEADING YOU TO
PURSUE MORE ACTIONS THAT LEAD TO
HIGHER SCORE TO MAXIMIZE YOUR
SCORE AND POTENTIALLY BE THE
HIGHEST SCORE ON THAT VIDEO
GAME.
AND SO THE CONCEPTS BEHIND
REINFORCEMENT LEARNING, YOU
KNOW, YOU HAVE AN AGENT THAT'S A
LERNER OR DECISION MAKER, TRYING
TO ACHIEVE A GOAL IN AND
ENVIRONMENT, EXAMPLE MIGHT BE A
ROBOT IF WE GO TO THE EXAMPLE OF
TRYING TO TEACH A ROBOT TO AVOID
OBSTACLES ON A FACTORY FLOOR.
A FLOOR WITH OBSTACLES COULD BE
ONE.
THE STATE DESCRIBES CURRENT
SITUATION OR CONFIGURATION OF
THAT ENVIRONMENT.
AND WHAT THE AGENT IS DOING IS
PICKING AN ACTION TO TAKE BASED
ON CURRENT STATE, CURRENT
ENVIRONMENT, AND AFTER TAKING
ACTION THE AGENT RECEIVES A
REWARD BASED ON WHETHER THE
ACTION IS JUDGE THE AS GOOD OR
BAD.
SO IT GETS NEGATIVE OR POSITIVE
FEEDBACK FROM THE ENVIRONMENT.
SO A MEDICAL EXAMPLE OF THIS IS
WHAT WE'VE JUST PREVIOUSLY
MENTIONED, REINFORCEMENT
LEARNING USED TO TRAIN ROBOTIC
ARMS FOR MINIMALLY INVASIVE
SURGERY LIKE WITH DaVINCI
ROBOT, RECEIVING FEEDBACK ON ITS
PERFORMANCE.
SO, YOU'VE PROBABLY HEARD OF
GENERATIVE A.I. AND PRIOR TO
2022, MOST OF THE A.I. USED IN
THE BIOMEDICAL DOMAIN WAS
NON-GENERATIVE A.I.
THIS IS BEFORE ChatGPT CAME ON
THE SCENE.
IT WAS MULTI-SUPERVISED
LEARNING.
AND GENERATIVE A.I. HAS EXPLODED
ON THE SCENE SINCE THEN.
IT USES COMBINATION OF
UNSUPERVISED LEARNING AS WELL AS
OTHER TECHNIQUES TO CREATE
OUTPUT WHETHER TEXT OR IMAGES OR
MUSIC, AND WITH LARGE LANGUAGE
MODELS ESSENTIALLY TRAINED ON
HUGE AMOUNTS OF UNLABELED DATA,
AND THEY LEARN PATTERNS AND
STRUCTURE IN THAT DATA WITHOUT
BEING TOLD WHAT TO LOOK FOR.
THEY DO PRETTY WELL.
FAIRLY EXCITING WHAT GENERATIVE
A.I. MODELS ARE ABLE TO DO.
ONCE THEY ARE TRAINED THEY
GENERATE OUTPUT BY PREDICTING
WHAT COMES NEXT IN A SEQUENCE.
NEXT PLAUSIBLE WORD IN A
SENTENCE OR NEXT APPLAUSABLE
PARAGRAPH IN AN ESSAY, FOR
EXAMPLE.
ONE THING THEY MAY DO
UNFORTUNATELY IS HALLUCINATE.
THEY MAY GENERATE INFORMATION
THAT'S PLAUSIBLE BUT IT'S
INCORRECT, NONSENSICAL, IF YOU
TRY TO USE ChatGPT AND TELL
IT, ASK IT TO COME UP WITH A
CITATION FOR A PARTICULAR AREA
IT MIGHT COME UP WITH A MADE-UP
MANY THAT INCLUDES NAMES OF
EXPERTS IN THAT AREA BUT THEY
HAVE NEVER PUBLISHED TOGETHER
AND THERE'S NO PAPER WITH THAT
TITLE WHEN YOU GO TO PubMed
TO LOOK FOR IT, AN EXAMPLE OF
HALLUCINATION, AND IT'S
PROBLEMATIC IN THE HEALTH CARE
DOMAIN WHERE ACCURACY IS
CRUCIAL.
SO IT MEANS HUMAN OVERSIGHT IS
STILL NECESSARY IN THE --
ACTUALLY NOT STILL, VERY
NECESSARY IN THE HEALTHCARE
DOMAIN.
ESSENTIALLY A.I. SUGGESTING AND
HUMANS SORT OF VERIFY AND
DECIDE.
SO THERE'S LOTS OF A.I. BENEFITS
FOR PATIENT AND HEALTH CARE
PROVIDERS, ENHANCED DIAGNOSTIC
ACCURACY, ABILITY TO HAVE
PERSONALIZED TREATMENT PLANS FOR
PATIENTS, ABILITY TO AUTOMATE
ROUTINE ADMINISTRATE TASKS THAT
POTENTIALLY COULD HELP PROVIDE
FOCUSED MORE TIME ON PATIENTS
RATHER THAN ON ADMIN TASKS.
SO PEOPLE WITH CHRONIC DISEASES
IMPROVED PATIENT MONITORING
THROUGH WEARABLE DEVICES
ENHANCED WITH A.I. AND
PREDICTIVE ANALYTICS TO PROVIDE
PRO-ACTIVE CARE TO PATIENTS.
NOW, WITH BENEFITS COME A NUMBER
OF CONCERNS.
SO THERE ARE CONCERNS AROUND
DATA PRIVACY AND SECURITY.
WHEN ChatGPT WAS ROLLED OUT
FOR EXAMPLE A LOT OF HOSPITALS
WERE INTERESTED IN USING IT BUT
ONE OF THE CONCERNS WAS YOU'RE
FEEDING -- YOU DON'T WANT TO
FEED DATA INTO A LARGE LANGUAGE
MODEL THAT'S BEING USED
GENERALLY BY THE WHOLE WORLD
BECAUSE YOUR PATIENT DATA IS
SUBJECT TO HIPAA PROTECTION.
SO LOTS OF HOSPITALS HAVE
ESSENTIALLY MADE ARRANGEMENTS TO
HAVE SILOED IMPLEMENTATIONS OF
GENERATIVE A.I. SO THAT THE DATA
LEARN FROM HOSPITAL SYSTEM, IT
DOESN'T GET SEEN BEYOND THAT
HOSPITAL SYSTEM.
A CONCERN, A FEAR THAT A.I.
MIGHT MAKE AUTONOMOUS DECISIONS
AND THIS IS SOMETHING I HEAR
ABOUT QUITE A BIT.
AGAIN, MY VIEW IS AUGMENT OR
ASSIST BUT NOT REPLACE HUMANS,
AND THAT HUMAN OVERSIGHT IS
ABSOLUTELY NECESSARY IN HEALTH
CARE.
ANOTHER CONCERN IS LACK OF
TRANSPARENCY.
MANY MOST SUCCESSFUL A.I.
ALGORITHMS ARE CONSIDERED BLACK
BOXES.
THEY CAN'T REALLY TELL YOU HOW
THEY ACHIEVED THE RESULTS THAT
THEY CAME BY.
THERE'S A WHOLE NEW AREA OF
EXPLORATION IN INFORMATICS AND
COMPUTER SCIENCE OF EXPLAINABLE
A.I. WHERE YOU CAN TAKE A BLACK
BOX MODEL BUT HAVE ANOTHER MODEL
THAT CAN EXPLAIN HOW THE BLACK
BOX MODEL CAME ABOUT, ITS
DECISION MAKING TO SATISFY A
HEALTH CARE PROVIDER WHO IS
SKEPTICAL.
THERE'S ISSUES OF FAIRNESS AND
BIAS.
A.I. REFLECTS BIASES PRESENT IN
THE DATA IT'S TRAINED ON.
WE'VE SEEN EXAMPLES IN THE
NON-HEALTH CARE DOMAINS OF
FACIAL RECOGNITION SYSTEMS.
ADOPTED BY POLICE IN SEVERAL
CITIES.
WE HAD CASES IN DETROIT AND
OTHER PLACES WHERE SEVERAL
PEOPLE WERE ARRESTED, MOSTLY
BLACK MALES, ESSENTIALLY THE
PROBLEM WAS THAT THE DATASETS
USED FOR TRAINING DID NOT HAVE
DATA ON A LOT OF PEOPLE OF
COLOR.
AND SO THE MODELS PRODUCED WERE
NOT ABLE TO ADEQUATELY
DISTINGUISH AND MAY MAKE
RECOMMENDATIONS ABOUT GUILT OF
PEOPLE WHO ARE NOT INVOLVED IN A
CASE, IN MANY CASES PEOPLE WERE
ABLE TO SHOW THAT THEY WEREN'T
ANYWHERE NEAR THE AREA BUT YOU
COULD IMAGINE THE SITUATION
WHERE SOMEBODY WAS SITTING IN
THEIR HOME, CAN'T PROVIDE AN
ALIBI, NOW HAS, YOU KNOW, SORT
OF A NIGHTMARE SITUATION TO DEAL
WITH.
SO A.I. USES WHAT IT'S TRAINED
ON.
LOMA LINDA IN CALIFORNIA IS A
BLUE ZONE.
SO IF I WENT TO LOMA LINDA
HOSPITAL, SO YOU HAVE PEOPLE
LIVING TO 100, 101, 102, THE
MOST LONG LIVED AND HEALTHY.
IF I TOOK DATA FROM LOMA LINDA
HOSPITAL TO CREATE A MODEL FOR
HEART DISEASE PREDICTION, AND
THEN TOOK THAT MODEL AND PLUNKED
IT DOWN IN SOUTH L.A. OR HARLEM
I MIGHT UNDERPREDICT OUR
DISEASE, AND THAT WOULD NOT BE A
GOOD THING.
WE HAVE TO BE CAREFUL WHEN A.I.
DEVELOPERS MAKE CHANGES ON
GENERALIZABILITY OF TOOLS THAT
ARE REALLY NOT SUPPORTED BY
REALITY.
THERE'S A LOT OF EXCITEMENT BUT
THERE'S A NEED TO VERIFY, A NEED
TO REALLY RIGOROUSLY TEST THE
CLAIMS MADE ABOUT MODELS.
AND ALSO THE ISSUE THAT THE
ADVANCES IN A.I. AND HEALTH CARE
MAY OVERSHADOW REALITY BENEFITS
DON'T ACCRUE TO ALL PATIENTS.
SO THERE HAVE BEEN SEVERAL
PAPERS THAT SORT OF HIGHLIGHTED
SOME OF THE CONCERNS THAT I
LIST.
SO OVERMEYER AND OTHERS
ESSENTIALLY LOOKED AT PUBLISHED
IN "SCIENCE" IN I BELIEVE 2019
AN ARTICLE SHOWING THAT AN
ALGORITHM THAT WAS COMMONLY USED
TO ASSIGN CARE HAD RACIAL BIAS
BECAUSE IT WAS USING COST AS A
PROXY FOR NEED, AND IN THE
DATASET WHITE PATIENTS HAD MORE
HEALTH CARE COST BECAUSE THEY
HAD MORE ACCESS, BETTER ACCESS
TO CARE.
AND SO IT ENDED UP THAT BLACK
PATIENTS WHO WERE SICKER WERE
ASSUMED BY THE ALGORITHM TO BE
HEALTHIER BECAUSE THEIR HEALTH
CARE COSTS WEREN'T AS HIGH.
AND THAT'S PROBLEMATIC.
ANOTHER STUDY THAT WAS PUBLISHED
RELATIVELY RECENTLY WAS ONE THAT
SHOWED JUDY DACHOYA AND OTHERS
INCLUDING LEO SELLE AT M.I.T.
LOOKED -- A STUDY DEMONSTRATED
ABILITY OF A.I., CONVOLUTIONAL
NEURAL NETWORKS, TO ACCURATELY
ASSESS A PATIENT'S SELF-REPORTED
RACE FROM X-RAY, CT, DID NOT
INCLUDE RACIAL INFORMATION THAT
A HUMAN EXPERT COULD DISCERN.
SO COULD NOT FIGURE OUT HOW THE
ALGORITHM WAS FIGURING OUT THE
SELF-REPORTED RACE OF PATIENTS
ACCURATELY BECAUSE DATA WAS NOT
LABELED WITH RACE.
THAT RAISED CONCERNS ABOUT
UNINTENTIONAL REINFORCEMENT OF
RACIAL BIAS IN MEDICAL
TREATMENT, IF THE ALGORITHM
NOTES SOMETHING THAT THE
PROVIDERS DON'T EVEN KNOW THAT
IT KNOWS.
AND ALSO AGAIN LACK OF
TRANSPARENCY IN TERMS OF
MECHANISMS THAT A.I. ALGORITHMS
USED TO IDENTIFY RACE IN THIS
CASE ARE POORLY UNDERSTOOD
BECAUSE THEY COULDN'T FIGURE OUT
HOW THE ALGORITHM WAS CORRECTLY
ASSESSING RACE OF PATIENTS WITH
DATA NOT LABELED IN ANY WAY BY
RACE.
AND POTENTIAL FOR VIOLATION OF
PATIENT PRIVACY.
HERNANDEZ AND OTHERS HAVE
RECOMMENDED TO DISMANTLE
RACE-BASED MEDICINE, HAVE A
RACE-AWARE APPROACH TO CLINICAL
DECISION SUPPORT THAT DEFINITELY
CONSIDERS SOCIAL AND
ENVIRONMENTAL FACTORS LIKE
STRUCTURAL RACISM AS WELL AS
SOCIAL DETERMINANTS OF HEALTH
WHICH YOU ALL HAVE BEEN
DISCUSSING.
AND SO INCLUDING SOCIAL
DETERMINANTS OF HEALTH AND A.I.
MODELS MAY IMPROVE ACCURACY, SO
ACCESS TO HEALTH CARE SERVICES,
HEALTHY FOOD, NEIGHBORHOOD AND
BUILT ENVIRONMENT, EDUCATIONAL
ATTAINMENT, SO ON.
WE'VE HAD IN OUR WORK SOME
SUCCESS WITH USING, SO BASED ON
EHR DATA WE CAN MAP TO THE CDC
SOCIAL VULNERABILITY INDEX,
INCLUDE THAT IN MODELS.
ALSO MAP TO UNIVERSITY OF
WISCONSIN AREA DEPRIVATION
INDEX.
SOCIAL SUPPORT NETWORKS ARE
IMPORTANT, COMMUNITY ENGAGEMENT,
INDIVIDUAL EXPERIENCE WITH
DISCRIMINATION.
IF YOU'RE DOING A MODEL THAT IS
IN THE MENTAL HEALTH DOMAIN, FOR
EXAMPLE, THAT'S IMPORTANT TO
KNOW.
SO, PUBLICATION FROM 2022 FOUND
MACHINE LEARNING MODELS THAT
INCORPORATED SOCIAL DETERMINANTS
OF HEALTH VERSUS TRADITIONAL
MODELS THAT DID NOT WERE
ACTUALLY PARTICULARLY GOOD FOR
PREDICTING THE RISK OF
IN-HOSPITAL MORTALITY AFTER A
HOSPITALIZATION FOR HEART
FAILURE PARTICULARLY IN BLACK
ADULTS.
THE INTERESTING THING THOUGH WAS
THAT THE SOCIAL DETERMINANTS OF
HEALTH WERE NOT PARTICULARLY
USEFUL FOR PREDICTION FOR
NON-BLACK PATIENTS.
SO THAT'S SOMETHING THAT NEEDS
TO BE EXPLORE A LITTLE BIT MORE.
BUT IT WAS -- IT REALLY IMPROVED
RISK PREDICTION OF IN-HOSPITAL
MORTALITY AFTER HEART FAILURE
HOSPITALIZATION IN BLACK
PATIENTS.
WE'VE TALKED ABOUT BENEFITS AND
CONCERNS OF A.I.
IF YOU HAVE CONCERNS, THE NEXT
THOUGHT IN MY MIND IS, WELL,
WHAT ABOUT REGULATION?
AND SO WE HAVE VERY INTERESTING
SITUATION WHERE THE EUROPEAN
UNION LAST YEAR HAD THE A.I. ACT
PASSED BY PARLIAMENT IN JUNE,
AND THEN THIS YEAR WAS FORMALLY
ADOPTED.
AND IT'S BILLED ACE THE FIRST
EVER COMPREHENSIVE LEGAL
FRAMEWORK ON A.I. WORLDWIDE,
FOCUSING ON PRIVACY PROTECTION,
DATA RIGHTS, ESTABLISHES
GOVERNING BODIES FOR A.I. IN THE
EUROPEAN UNION, AND CLASSIFIES
RISK AS UNACCEPTABLE, INCLUDING
A.I. THAT PERFORMS COGNITIVE
BEHAVIORAL MANIPULATION, SOCIAL
SCORING, OR A.I. THAT COMPILES
BY SCRAPING INTERNET FOR FACIAL
IMAGES OR SCRAPING PUBLIC CCTV
FOOTAGE FOR FACIAL RECOGNITION
INFO.
AN ARTICLE IN THE "NEW YORK
TIMES" LAST YEAR TALKED ABOUT A
COMPANY IN THE U.S. DOING
EXACTLY THAT.
IN THE E.U. THEY WOULD NOT BE
ABLE TO DO THAT.
CLASSIFIED A.I. RISK AS
UNACCEPTABLE, HIGH, LIMITED, OR
MINIMAL, AND ADVANCE A.I. WITH
UNACCEPTABLE RISK.
IN THE U.S., A.I. REGULATION IS
FRAGMENTED AND SECTOR SPECIFIC.
THERE'S NO OVERARCHING
REGULATORY FRAMEWORK THE WAY WE
SEE IN THE EUROPEAN UNION.
THE FDA OF COURSE DOES REGULATE
A.I. AND MACHINE LEARNING IN
MEDICAL DEVICES AND A.I.
ESSENTIALLY SOFTWARE AS MEDICAL
DEVICE, SO THE AREA OF DIABETIC
RETINOPATHY IS ONE OF THE AREAS
WHERE A LOT OF MACHINE LEARNING
MODELS HAVE BEEN APPROVED BY THE
FDA AND MONITORED.
BUT ONE OF THE THINGS WE NEED TO
THINK ABOUT IS WHEN AN A.I.
MODEL IS APPROVED BY THE FDA,
WHAT COMES NEXT?
IF IT'S A DRUG, YOU DO A
FOLLOW-ON STUDY.
WITH MACHINE LEARNING WHAT WE
KNOW IS THAT A HOSPITAL -- SO IF
THE HOSPITAL IS USING MACHINE
LEARNING FOR PREDICTION FOR
PARTICULAR CONDITION, THE
HOSPITAL POPULATION CHANGES OVER
TIME, SO A.I. MODELS HAVE TO
CHANGE.
YOU COULD HAVE A POPULATION THAT
WAS YOUNG AND GOES -- GETS
OLDER, THE CONDITIONS OF
DISEASES AND RISK FACTORS, ALL
THE THINGS THAT WENT INTO
BUILDING THE ORIGINAL MODEL NEED
TO BE UPDATED, SOMETHING WE NEED
TO THINK ABOUT OVER TIME.
IT'S NOT CLEAR THAT THE FDA IS
TAKING ON THAT PART OF THE
REGULATION AND OVERSIGHT.
AND THE U.S. CONGRESS RECENTLY
HAD -- THE SENATE HAD A
BIPARTISAN GROUP THAT'S LOOKING
AT INJECTING $32 BILLION INTO
A.I., INTO ESSENTIALLY MAKING
THE -- MAKING SURE THE U.S. IS A
LEADER AND COMPETITIVE BUT
THERE'S NO MENTION OF
REGULATION.
THE IDEA IS TO HAVE US, YOU
KNOW, BE AS ADVANCE AS WE CAN BE
BUT I THINK THERE'S A NEED TO
ALSO LOOK AT REGULATIONS.
AND I'M A PROPONENT OF A.I. BUT
I THINK IN MANY CASES IT DOES
NEED TO BE REGULATED.
SO IN SUMMARY, I TALKED ABOUT
A.I. IN HEALTH CARE AND THE FACT
IT CAN BE USED, COULD BE A VERY
USEFUL TOOL IN THE PUSH TO
REDUCE OR ELIMINATE HEALTH
DISPARITIES AND ACHIEVE HEALTH
EQUITY.
IT PROVIDES MANY BENEFITS I'VE
MENTIONED FOR PATIENTS AND
PROVIDERS.
BUT IT ALSO HAS GREAT CONCERNS
ABOUT TRANSPARENCY, FAIRNESS,
BIAS, AND I TALKED ABOUT THE
FACT THAT INCLUSION OF SOCIAL
DETERMINANTS OF HEALTH CAN
IMPROVE A.I. MODELS USED IN
HEALTH CARE AND THE E.U. HAS
DECIDED TO REGULATE A.I. THROUGH
THIS NEW COMPREHENSIVE A.I. ACT
WHERE U.S. REGULATIONS ARE MORE
FRAGMENTED AT THE PRESENT TIME.
FDA DOES FOCUS ON REGULATING
A.I. AND MACHINE LEARNING USED
IN HEALTH CARE.
SO, I'M HAPPY TO TAKE ANY
QUESTIONS THAT YOU MAY HAVE.
>> THANK YOU SO MUCH.
YES.
THANK YOU, DR. OGUNYEMI.
REALLY APPRECIATED THAT TALK.
DR. AYALA, I'LL TURN IT OVER TO
YOU.
>> THANK YOU, DR. OGUNYEMI.
AMAZING PRESENTATION.
I'M DEFINITELY GOING TO COME UP
AND SEE YOU BECAUSE WE'RE BOTH
RCMI INSTITUTIONS.
AND WE HAVE A LOT OF DATA WE
NEED TO EXPLORE TOGETHER.
A.I. IS NOT MY AREA OF EXPERTISE
AT ALL.
AND IT'S INTERESTING TO BE
SELECTED FOR THIS BECAUSE I'M
ACTUALLY TECHNOLOGY PHOBIC WHEN
IT COMES TO CERTAIN THINGS.
AND THIS IS ONE OF THEM.
SO I APPRECIATED THE BROADER
INTRODUCTION TO ARTIFICIAL
INTELLIGENCE.
VARIOUS TYPES.
AND THE MACHINE LEARNING.
I ALSO APPRECIATED YOUR COMMENT
REGARDING GENERALIZABILITY
BECAUSE IT'S DEFINITELY ONE OF
MY CONCERNS, SO I'M GLAD IT'S ON
FOLKS' RADAR.
I THINK IN THE CONTEXT OF THE
DISCUSSION, OUR DISCUSSIONS
TODAY, WHICH I DON'T KNOW IF
YOU WERE PART OF, IT WAS REALLY
GOOD TO END ON THIS PRESENTATION
BECAUSE WE'RE TALKING -- WE
TALKED ABOUT SOCIAL DETERMINANTS
OF HEALTH, SOCIAL DRIVERS OF
HEALTH.
OTHER DATA THAT WE CAN USE FROM
ELECTRONIC HEALTH RECORDS,
COMMON DATA ELEMENTS, AND SO I
GUESS ONE OF MY QUESTIONS IS
AROUND THE ISSUE OF DATA QUALITY
THAT'S BEING USED TO DERIVE
THOSE ESTIMATES.
I GUESS AS I'M EXPLORING EHR
DATA MORE AND MORE, INCREASINGLY
SKEPTICAL ABOUT IT, SO IF YOU
CAN COMMENT MAYBE A LITTLE BIT
ABOUT THAT.
>> NO QUESTION IT'S DEFINITELY A
CHALLENGE.
DATA COLLECTED AT THE POINT OF
CARE IS NOT RESEARCH QUALITY
DATA BY ANY STRETCH OF THE
IMAGINATION.
THAT IS A CONCERN.
IT IS A VALID CONCERN.
THERE'S A LOT OF EFFORT THAT HAS
TO GO INTO DATA CLEANING WHEN
YOU'RE USING EHR DATA, AND IN
FACT FOR OUR MACHINE LEARNING
PROJECT DATA CLEANING CONSUMES
MOST OF THE -- LEARNING THE
MODELS IS NOT THE DIFFICULT
PART, IT'S DATA CLEANING.
HOWEVER, I THINK THERE'S VALUE
IN DEVELOPING MODELS FROM CARE
AS IT OCCURS.
WITH THE CAVEAT OF COURSE THAT,
YES, A LOT OF ATTENTION DOES
HAVE TO BE FOCUSED ON DATA
QUALITY AND DATA CLEANING.
>> AND BUILDING ON THAT WE WERE
TALKING ABOUT COMMON DATA
ELEMENTS, THE NEED FOR MORE
NURSE-LED AND OTHER
PRACTITIONER-LED EFFORTS TO
IDENTIFY COMMON DATA ELEMENTS
THEY COULD REALLY CONTRIBUTE TO
THIS.
BROADER QUESTION, MAYBE OTHER
FOLKS KNOW, IS THERE RESEARCH
AROUND PRACTITIONERS'
RECEPTIVITY TO USING THAT
INFORMATION IN THE CLINICAL
ENCOUNTER?
>> IT'S FUNNY YOU MENTION THIS.
I THINK IT WAS EITHER KAISER OR
CEDARS THAT HAD A NUMBER OF
NURSING SAYS WE DON'T WANT A.I.
THAT HASN'T BEEN VALIDATED
GIVING SUGGESTIONS ABOUT
ANYTHING.
BUT WHAT WE FOUND ESPECIALLY
WITH INTRODUCTION OF ChatGPT,
THERE'S A ChatGPT EFFECT WHERE
PEOPLE ARE ACTUALLY GENERALLY
MORE LIKELY TO THINK THAT
COMPUTERS HAVE THE RIGHT
ANSWERS.
AND TO DEFER TO COMPUTERS IN
CERTAIN CASES WHERE THEY
PROBABLY SHOULD NOT.
BUT SO RECEPTIVITY VARIES
OBVIOUSLY, THOSE WHO HAVE
EMBRACED A.I.
AND THOSE WHO ARE -- RIGHTLY
SKEPTICAL, THERE ARE A LOT OF
CLAIMS BEING MADE RIGHT NOW THAT
A.I. IS DEFINITELY NOT PERFECT
AND AS I SAID THERE NEEDS TO BE,
YOU KNOW, MONITORING OF SYSTEMS
OVER TIME, THERE NEEDS TO BE
LOOKING AT THE QUALITY OF
DATASETS, NEED TO LOOK AT THE
DIVERSITY OF THE DATA AND
DATASETS.
ARE YOU TAKING DATA FROM
COMMUNITY, YOU KNOW, IN ALASKA
AND TRYING TO APPLY IT IN
BALTIMORE WITHOUT ANY REGARD FOR
ANY KIND OF DIFFERENCES IN THE
PREVALENCE OF DISEASE IN BOTH
COMMUNITIES AND SO ON.
SO THERE NEEDS TO BE MORE
SKEPTICISM ABOUT CLAIMS ABOUT
A.I. BUT DEFINITELY THINKING OF
NUMEROUS BENEFITS, AND THE
INTERESTING THING IS PATIENTS
ALSO, YOU KNOW, HAD
CONVERSATIONS WITH PATIENTS
WHERE WE FOUND THAT A LOT OF
PATIENTS IN THIS AREA WHO ARE
MORE RECENT IMMIGRANTS SEE
TECHNOLOGY AS A GOOD THING, AND
SO, YOU KNOW, ANY ADVANCE IN
TECHNOLOGY IS GREAT.
IT'S MOVING INTO THE FUTURE.
WHEREAS THOSE HERE LONGER ARE
SKEPTICAL.
YOU'RE BASICALLY TRYING TO
SHORTCHANGE US, PEOPLE ARE LIKE
I WOULD PREFER THE TRADITIONAL
SEE MY HEALTH CARE PROVIDER,
THEY KNOW WHAT THEY KNOW AND I
DON'T NEED THIS NEW FANGLED
TECHNOLOGY IN BETWEEN.
SO IT'S REALLY INTERESTING THAT
THERE'S BASICALLY A WIDE VARIETY
IN RECEPTION OF A.I. RECENTLY.
>> THANK YOU.
THAT MIGHT EXPLAIN IT.
I'M DEFINITELY A SECOND
GENERATION IMMIGRANT, SO I'M NOT
INNOVATE INNOVATIVE IN THAT
SENSE.
IN TERMS OF HOW WE'RE USING
MACHINE LEARNING I DO SEE SOME
VALUE IN, ONE IS WE USED IT TO
ANALYZE DATA THAT WAS BASED ON
EYE TRACKING DATA, WE USED IN
GROCERY STORES.
RELATED TO YOUR COMMENT ABOUT
IMMIGRANTS, WE WERE SURPRISED
FAMILIES HAD NO PROBLEM WEARING
IT IN PART BECAUSE THEY WANTED
TO KNOW WHERE THEIR CHILD HAD
THE MOST ININFLUENCE IN THE
GROCERY STORE TO BETTER ADDRESS
ISSUE OF NUDGING.
I WAS TALKING WITH JOHN EARLIER,
I REALLY THINK WE SHOULD TRY AND
USE THIS TO BETTER UNDERSTAND
IMPACT OF OUR RESEARCH, SO THERE
ARE PEOPLE THAT ARGUE SCIENCE IS
NOT SCIENCE UNTIL IT'S
PUBLISHED.
HOW ARE WE USING MACHINE
LEARNING TO BETTER UNDERSTAND
THE CONTRIBUTIONS WE'RE MAKING
IN OUR PUBLISHED WORK.
SO I WOULD LOVE TO SEE SOME WORK
IN THAT AREA.
AND OPEN IT UP FOR DISCUSSIONS.
HE -- I KNOW WE DO HAVE EXPERTS
IN THE ROOM IN THIS AREA.
>> THIS IS NOT MY AREA OF
EXPERTISE BUT TWO THINGS.
I WANT TO SAY THAT WAS A
FANTASTIC PRESENTATION.
THANK YOU VERY MUCH.
TWO THINGS.
THE QUESTION FOR ME IS WHAT IS
THE STRATEGIC OPPORTUNITY FOR
NURSING.
AND WHERE CAN NURSING SHINE AND
WHAT CAN WE POTENTIALLY ADD THAT
ISN'T ALREADY BEING ADDRESSED BY
OTHER GROUPS THAT ARE LARGER,
CAN DO THIS BETTER, ET CETERA.
THAT'S A QUESTION.
ONE EXAMPLE THAT I WANT TO LIFT
UP DIDN'T COME UP IN THE
TERRIFIC PAPERS, THERE WAS A
STRONG PAPER IN HEALTH AFFAIRS,
A REVIEW ON MITIGATION OF RACIAL
BIAS IN THE ALGORITHMS.
THE LEAD AUTHOR WAS A NURSE.
DR. MICHAEL CARRIE FROM DUKE
UNIVERSITY, WHO HAS BEEN
THINKING ABOUT FRAMEWORK FOR HOW
NURSING CAN LEAD IN THE
APPLICATION OF A.I. TO THE
HEALTH SECTOR.
AND THEN WHERE ARE THE PROBLEMS
AND WHAT ARE MITIGATION
STRATEGIES.
I LEARNED A TON READING HIS
REVIEW.
WE NEED MORE OF THAT
CONTRIBUTION FROM NURSING.
>> ALSO THANK YOU FOR MAKING THE
COMPLICATED CONCEPT SIMPLE FOR
EVERYONE TO UNDERSTAND IN THE
FACE OF A.I. AND MACHINE
LEARNING.
I CAN SEE HUGE POTENTIAL FOR
A.I.
WE SEE THE HYPE IN SOCIETY, WE
SEE THE DOUBTS, SKEPTICISM, AND
I THINK SOME IS LACK OF
KNOWLEDGE OF WHAT IS TRULY A.I.
AND IT'S VERY SAD FOR PEOPLE TO
THINK ChatGPT TRAINED BY
NURSES CAN REPLACE NURSES.
OR ON THE OTHER SIDE NURSES
DON'T WANT TO TOUCH A.I.
BECAUSE I THINK WE NEED TO BE IN
BETWEEN.
AND HOW CAN WE REALLY LEVERAGE
AND USE A.I. TO AUGMENT THINKING
ABOUT NURSES.
ONE OF THE AREAS A.I. CAN HUGELY
SUPPORT NURSING IS IN THE REALM
OF NURSING DOCUMENTATION, TAKING
NURSES HALF OF THEIR TIME IN
FRONT OF A COMPUTER, HOW CAN WE
LEVERAGE A.I. TO REDUCE THEIR
TIME IN FRONT OF COMPUTER AND
BRING NURSES BACK TO THE BEST
-- BEDSIDE.
MODELS OF CARE NURSES AND NURSE
PRACTITIONERS CAN LEAD.
ONE INTERESTING AREA, NURSING
PROFESSION BEING SORT OF THE
MOST TRUSTED PROFESSION, RATED
BY THE AMERICAN PUBLIC, AND WE
ALL TALK ABOUT MISTRUST IN
SCIENCE AND ALSO MISTRUST IN
A.I., AND HOW CAN WE MARRY THE
PUBLIC TRUST IN NURSING AND
NURSING PROFESSION, YOU KNOW,
I'M INTERESTED IN THE NURSING
LOOP, HUMAN IN THE LOOP A.I.,
ALWAYS HAVE THAT OVERSIGHT OR
EMBED NURSING KNOWLEDGE, NURSING
OVERSIGHT INTO THE ALGORITHM.
I SEE THAT AS AN AREA FOR
NURSING AND NURSING SCIENCE,
ALSO EDUCATING NURSES AND NURSE
PRACTITIONERS, SO THAT THEY CAN
REALLY BE EMPOWERED TO LEAD THE
NEXT GENERATION OF CLINICAL
DECISION MAKING, CLINICAL CARE
THAT WILL BE AUGMENTED BY THE
A.I. SO THE NEXT IS NOT ABOUT,
NO, WE DON'T WANT A.I., WE
ACTUALLY USE A.I. EVERY DAY BUT
IT NEEDS TO BE LED BY NURSING.
THANK YOU.
>> ANY OTHER COMMENTS?
ONE BEFORE ALL THE NEWSPAPER
ARTICLES, WE'VE BEEN USING, IT'S
FASCINATING TO ME, WE'VE BEEN
USING A.I. FOR A REALLY LONG
TIME IN ALL KINDS OF DECISION
MAKING.
I MEAN, FROM WHAT GROCERY STORE
COUPONS GET SUGGESTED TO YOU,
IT'S PRESENT.
SOMEHOW OR ANOTHER THE ROLLOUT
OF ChatGPT MADE -- WHICH
INTERESTINGLY DID HAVE A VERY
RAPID -- I'M NOT TELLING OMOLOLA
ANYTHING SHE DOESN'T KNOW
ALREADY, DID HAVE A MUCH MORE
RAPID ADOPTION, AT LEAST SITE
VISIT TRAJECTORY THAN OTHER
TECHNOLOGIES WHEN THEY WERE
ROLLED OUT.
BUT THERE ARE ARE LOTS OF
INSTANCES IN A.I. THAT MAKE OUR
LIVES EASIER IN MANY WAYS.
IT'S AN ARTIFICIAL INTELLIGENCE
SYSTEM WHEN STREET LIGHTS ARE
PROGRAMMED TO GIVE YOU A GREEN
LIGHT WHEN THERE'S NO OTHER
TRAFFIC GOING IN THE OTHER
DIRECTION, LIKE THAT IS AN
ARTIFICIAL INTELLIGENCE SYSTEM.
WE HAVE THAT IN OUR LIVES EVERY
DAY.
WE'VE HAD THAT FOR A LONG TIME.
SOMEHOW OR ANOTHER IT'S BEEN
ROLLED OUT IN THIS WAY NOW
BECAUSE OF ChatGPT THAT THE
END SUGGESTING TO PEOPLE THEY
ARE ALL GOING TO LOSE THEIR JOBS
AND SO I THINK NURSES CAN PLAY
AN INCREDIBLE ROLE IN, YOU KNOW,
BECAUSE THEY ARE TRUSTED AND
SORT OF SAYING, YEAH, BUT, YOU
KNOW, HERE'S HOW WE USE IT.
AND ACTUALLY HERE'S HOW WE ALL
USE IT EVERY DAY.
HERE'S HOW WE USE IT IN THE
CLINIC.
HERE'S HOW IT HELPS US DO A
BETTER JOB IN THE CLINIC.
EVERYBODY THOUGHT THE WORLD WAS
GOING TO END WHEN THE INTERNET
CAME AROUND, AND THEN WE WERE
OKAY.
WE WERE OKAY.
YOU KNOW, STATISTICIANS ARE NOT
TRYING TO TAKE OVER THE WORLD.
WE'RE JUST TRYING TO HELP MAKE
IT BETTER.
RIGHT?
>> YES, YES.
>> WELL SAID.
I APPRECIATE THAT POINT TOO
BECAUSE A LOT OF DISCUSSION, YOU
KNOW, TODAY IS ON HEALTH CARE,
IN THIS SECTION OF THE AGENDA.
A.I. IS EVERY WHERE WITH
TREMENDOUS IMPLICATIONS FOR
HEALTH AND IT PLAYS OUT IN
SOCIAL DETERMINANTS OF HEALTH AS
WELL.
CERTAINLY IN HEALTH CARE BUT
MUCH BROADER AS WELL.
SO THANK YOU FOR THAT POINT.
SO DR. OGUNYEMI, WE APPRECIATE
YOU JOINING US.
THANK YOU FOR YOUR
THOUGHT-PROVOKING PRESENTATION.
>> THANK YOU FOR INVITING ME.
>> THANK YOU.
ALL RIGHT.
SO, WE HAVE TWO AGENDA ITEMS
LEFT.
A REALLY IMPORTANT AGENDA ITEM
ON THE NEW CONCEPT WE WANT TO
PUT FORWARD AROUND A.I. FOR YOUR
FEEDBACK AND CONSIDERATION.
AND THEN WE DO HAVE THE LAST
AGENDA ITEM OF OPEN SESSION,
JUST A TIME FOR OPEN DISCUSSION.
WE'VE HAD A LOT OF RICH
DISCUSSION BUT IF THERE'S
ANYTHING ELSE TO PUT ON THE
TABLE TODAY OR RAISE THAT WILL
BE THE TIME.
DO YOU WANT TO TAKE FIVE MINUTES
TO STRETCH AND COME BACK FOR
THOSE LAST COUPLE ITEMS, I SEE
SOME NODS.
SO I'M GOING TO GIVE YOU SIX
MINUTES. SIX MINUTES.
>> WELCOME BACK, EVERYONE.
WE'RE GOING TO MOVE ON TO OUR
NEXT AGENDA ITEM, CONCEPTS.
AS YOUR ROLE, YOU ARE NINR'S
SOURCE OF KNOWLEDGE GOVERNMENTAL
ADVICE ON RESEARCH DIRECTIONS
AND SCIENTIFIC PRIORITIES.
NINR SEEKS COUNCIL'S ADVICE FOR
LONG-TERM PLANNING BY PRESENTING
CONCEPTS FOR CLEARANCE.
YOU MIGHT RECALL A CONCEPT IS
THE EARLIEST PLANNING STAGE OF
AN INITIATIVE.
BEFORE DEVELOPING A FUNDING
OPPORTUNITY.
A CONCEPT DESCRIBES BACKGROUND,
OBJECTIVES, POTENTIAL MECHANISMS
FOR THE INITIATIVE.
ANY APPROVED CONCEPT MAY OR MAY
NOT TURN INTO A FUNDING
INITIATIVE BASED ON A NUMBER OF
FACTORS INCLUDING FUNDS
AVAILABILITY.
TODAY'S CONCEPTS WERE MADE
AVAILABLE IN THE ELECTRONIC
COUNCIL BOOK FOR YOUR REVIEW IN
ADVANCE OF THE MEETING.
I'M PLEASED TO WELCOME DR. LIBBY
BOWEN TO PRESENT A CONCEPT ON
SOCIAL DETERMINANTS OF HEALTH
AND A.I. TO ADVANCE HEALTH
EQUITY.
OVER TO YOU.
>> THANK YOU.
THIS IS CALLED SOCIAL
DETERMINANTS OF HEALTH IN
ARTIFICIAL INTELLIGENCE TO
ADVANCE HEALTH EQUITY.
AND THE CONCEPT TEAM INCLUDES
MYSELF, DR. KAREN HUSS AND DR.
LEE WILLIS.
SO, ARTIFICIAL INTELLIGENCE IS
DESIGN AND STUDY OF COMPUTER
PROGRAMS TO BE INTELLIGENT,
INCLUDE A WIDE RANGE OF
TECHNIQUES, APPLIES TRADITIONAL
STATISTICAL FORECASTING METHODS
SUCH AS DEEP NEURAL NETWORKS,
NATURAL LANGUAGE PROCESSING, RAN
DECISION REALGORITHMS FOR
PREDICTIVE AND ANALYTICAL
PURPOSES.
THERE'S OPTIMISM THAT THE
APPLICATION OF A.I. CAN PROVIDE
SUBSTANTIAL IMPROVEMENTS IN ALL
AREAS OF HEALTH CARE FROM
DIAGNOSTICS TO TREATMENT.
THERE'S ALREADY A LARGE AMOUNT
OF EVIDENCE THAT A.I. ALGORITHMS
ARE PERFORMING ON PAR OR BETTER
THAN HUMANS IN TASKS FOR
INSTANCE IN ANALYZING MEDICAL
IMAGES OR CORRELATING SYMPTOMS
AND BIOMARKERS FROM ELECTRONIC
MEDICAL RECORDS WITH
CHARACTERIZATION AND PROGNOSIS
OF DISEASE.
HOWEVER, USE OF A.I. IN HEALTH
IS CONTROVERSIAL DUE TO CONCERNS
ABOUT FAIRNESS, TRANSPARENCY,
MODEL DEVELOPMENT,
INTERPRETATION IN APPLICATION.
THERE'S ALSO A GROWING BODY OF
RESEARCH ON BIAS IN A.I. AND
RECOGNITION THAT A.I. HAS
PERPETUATED AND EXACERBATED
INEQUALITIES INCLUDING MEDICINE,
CRIMINAL JUSTICE, FINANCE.
NINR ADHERES TO NIH
CONCEPTUALIZATION OF SDOH.
SOCIAL DETERMINANTS OF HEALTH
INCLUDE CONDITIONS IN WHICH
PEOPLE ARE BORN, LIVE, LEARN,
WORK, PLAY, AND AGE, AND THE
WIDER SET OF STRUCTURAL FACTORS
SHAPING CONDITIONS OF DAILY
LIFE.
THOSE STRUCTURAL FACTORS INCLUDE
SOCIAL, ECONOMIC, LEGAL FORCES,
SYSTEMS AND POLICIES THAT
DETERMINE OPPORTUNITIES AND
ACCESS TO HIGH QUALITY JOBS,
EDUCATION, HOUSING,
TRANSPORTATION, BUILT
ENVIRONMENT, INFORMATION,
COMMUNICATION INFRASTRUCTURE,
FOOD AND HEALTH CARE, SOCIAL
ENVIRONMENT, AND OTHER
CONDITIONS.
SOCIAL DETERMINANTS OF HEALTH
HAVE SIGNIFICANT IMPACT ON
HEALTH OUTCOMES.
ARTIFICIAL INTELLIGENCE RESEARCH
MUST INCLUDE INTER, AND
MULTI-DISCIPLINARY TEAM EXPERTS,
NURSING SCIENCE CONCEPTUALIZES
WITHIN THE CONTEXT OF PEOPLE'S
LIVES AND LIVERING CONDITIONS.
IS WELL POSITIONED TO MAKE
IMPORTANT CONTRIBUTIONS TO A.I.
RESEARCH.
THE STATEMENT OF THE PROBLEM,
A.I. RESEARCH LACKS INTER AND
MULTI-DISCIPLINARY TEAM EXPERTS
IN HEALTH.
MANY A.I. SYSTEMS LACK
REPRESENTATIVE DIVERSE DATA AND
FAIL TO EXAMINE HOW THE
INCLUSION OF SDOH MAY AFFECT
RESULTS IN MODEL INTERPRETATION.
MANY A.I. SYSTEMS DO NOT INCLUDE
SDOH, RESEARCH SHOWS INCLUDING
SIGNIFICANTLY IMPROVES MODEL
FIT, OUTCOMES AND PREDICTIONS.
AND WHEN SOCIAL DETERMINANTS OF
HEALTH ARE UTILIZED IN A.I.
ALGORITHMS, DATA INPUTS RARELY
GO BEYOND INCLUSION OF
INDIVIDUAL-LEVEL SDOH PROXIES
SUCH AS RACE OR ETHNICITY,
GENDER OR AGE, WHICH DO NOT
CAPTURE WIDER SET OF STRUCTURAL
FACTORS SHAPING THE CONDITIONS
OF DAILY LIFE.
REDUCING SDOH CAN REDUCE DATA
AND SKEW RESULTS.
THE PURPOSE OF THIS CONCEPT IS
TO UNDERSTAND AND ADDRESS SDOH
IN A.I. MODELS AND SYSTEM AND
USE SDOH TO IMPROVE A.I. MODELS
AND SYSTEM TO REDUCE HEALTH
INEQUALITIES AND ADVANCE HEALTH
EQUITY.
THIS PROMOTES RESEARCH USING
VARIETY OF METHODS AND MEASURES
TO UNDERSTAND AND ADDRESS KNOWN
BIASES AND UNDERSTAND HOW SDOH
MAY BE USED TO OPTIMIZE HEALTH
AND ADVANCE HEALTH EQUITY.
EXAMPLES OF RESEARCH TO ADDRESS
GAPS COULD INCLUDE RESEARCH TO
UNDERSTAND HOW TO USE SDOH AND
A.I. TO IMPROVE HEALTH OUTCOMES
AN REDUCE DISPARITY.
RESEARCH USING TEAMS WITH
EXPERTISE TO INFORM A.I.
ALGORITHM AND SYSTEM DEVELOPMENT
IMPLEMENTATION, TO PROMOTE
TRANSPARENCY BY PROVIDING
INFORMATION ON SDOH INPUTS AND
OTHER DATA CHARACTERISTICS.
AND RESEARCH THAT PROVIDES FOR
CONTINUOUS OVERSIGHT OF A.I.
SYSTEMS USING SDOH.
THAT'S IT.
THANK YOU.
>> OKAY.
THANK YOU.
I BELIEVE DR. FITZPATRICK --
YES, THANK YOU.
>> THANK YOU.
I WAS EXCITED TO SEE THIS
CONCEPT JUST BECAUSE DATA
SCIENCE, THE TRAIN HAS LEFT, AND
I THINK NINR NEEDS TO GET ON
BOARD.
I WAS EXCITED BECAUSE I SEE THIS
INITIATIVE AS ADDRESSING LENSES
OF SYSTEMS AND MODEL OF CARE, WE
HAVEN'T SEEN MANY CONCEPTS THAT
COULD BE FITTED INTO THAT
CATEGORY.
ALSO PREVENTION AND HEALTH
PROMOTION.
I WAS GOING TO MAKE THE COMMENT
THAT PROFESSIONAL SOCIETIES HAVE
ALREADY TAKEN THE LEAD ON THIS,
MANY ARE AWARE OF THE AMERICAN
HEART ASSOCIATION NEW ALGORITHM,
THE EQUATIONS FOR RISK OF HEART
DISEASE, REMOVED RACE BECAUSE
RACE IS NOT A BIOLOGICAL
VARIABLE BUT THEY NOW HAVE
OPTIONS WHERE SOCIAL
DETERMINANTS OF HEALTH REFLECTED
BY YOUR ZIP CODE CAN BE INCLUDED
AS AN OPTIONAL VARIABLE IN THAT
PREDICTION MODEL.
SO THEY ARE USING THE SOCIAL
DEPRIVATION INDEX OF BASICALLY
YOUR ZIP CODE, WHERE YOU LIVE,
PREDICT HEART DISEASE.
THAT'S ONE EXAMPLE.
AMERICAN THORACIC SOCIETY HAS
GOTTEN AWAY FROM IS RAISING
ISSUES UNDER OR OVERTREATMENT OF
PATIENTS WHO WILL FALL INTO
DIFFERENT CATEGORIES AS A RESULT
OF THAT CHANGE, SO THERE'S LOTS
OF OPPORTUNITIES FOR RESEARCH.
I THINK THERE'S LOTS MUCH
OPPORTUNITIES FOR PARTNERSHIP
WITH OTHER INSTITUTES, I
MENTIONED HEART AND LUNG, BUT
CLEARLY OTHERS AS WELL.
AND I THINK THIS IS EXCITING
BECAUSE MANY OF OUR HEALTH CARE
INSTITUTIONS ARE DOING THIS.
THERE'S ALL SORTS OF
QUALITY-BASED INITIATIVES, ONE
IS IN OUR EMERGENCY DEPARTMENT,
WE'RE ROLLING OUT ETHICS,
MEDICAL RECORDS, MACHINE
LEARNING ALGORITHMS TO TRY TO
PREDICT PATIENTS WHO HAVE SEPSIS
AND INSTEAD OF SITTING IN THE
EMERGENCY DEPARTMENT AND THEN
GETTING VERY, VERY BAD OUTCOMES
AS THEY SIT FOR HOURS AND HOURS,
EARLY IDENTIFICATION OF
PATIENTS, SO HOSPITALS ARE
INTERESTED, THERE'S A LOT OF
QUALITY WORK AROUND THIS, BUT
REALLY INTEGRATING WORK THAT
ORGANIZATIONS ARE DOING FROM A
RESEARCH PERSPECTIVE I THINK IS
VERY, VERY VITAL AND VERY
TIMELY.
THANK YOU FOR THIS.
>> GREAT.
THANK YOU.
I'LL OPEN THE FLOOR FOR OTHER
COMMENTS.
>> SINCE VINCENT SAID I DIDN'T
SPEAK UP LAST TIME I PROBABLY
SHOULD HAVE, I'LL DO IT NOW.
FIRST OF ALL, I'M SO GLAD TO SEE
YOU'RE TAKING THE STEP.
AND AS I'VE BEEN THINKING ABOUT
THIS ISSUE, SOME OF THE THINGS
WE'VE BEEN THINKING ABOUT, THIS
IS MULTI-DIMENSIONAL, REQUIRES
MULTIPLE LENSES TO REALLY CREATE
MORE EFFECTIVE A.I. TOOLS THAT
WILL HELP YOU WILLS -- HELP US
SUCCEED.
INTERVENTION AT SOCIAL POLICY
LEVEL IN RECENT RESEARCH MORE SO
THAN INDIVIDUAL LEVEL
INTERVENTIONS ARE MORE LIKELY TO
ADVANCE HEALTH EQUITY.
SO THINGS I'VE BEEN THINKING
ABOUT HEARING THIS, THAT WE NEED
TO PRIORITIZE RESEARCH FROM
REGIONS OR POPULATIONS WITH MORE
SUBSTANTIAL ACADEMIC OUTPUT,
POTENTIALLY WE'RE OVERLOOKING
COMMUNITIES, IT'S IMPORTANT NOT
JUST TO PULL, YOU KNOW, RESEARCH
FROM PubMed IN GENERAL BUT
TO TARGET THEM BY REGIONS OF THE
UNITED STATES, IF THAT'S WHAT
WE'RE TRYING TO TARGET, AS WELL
AS POPULATION GROUPS.
ANOTHER AREA IS THE IDEA OF
INCLUSION OF GREAT LITERATURE
AND NON-ENGLISH SOURCES,
OFTENTIMES WE'RE FOCUSED ON
ENGLISH MATERIALS AND FROM A
GLOBAL HEALTH EQUITY STANDPOINT,
I THINK IT'S IMPORTANT TO ALSO
PULL SOURCES FROM THERE.
THOSE ARE SOME AREAS THAT MIGHT
BE INTERESTING.
I HAVE OTHER IDEAS AS WELL.
SOMETHING TO NIBBLE ON.
>> ANY OTHER REACTIONS OR
QUESTIONS?
IN TERMS OF AREAS TO FOCUS ON OR
--
>> SHANNON, THIS IS PAT.
HOW HAPPY I WAS TO SEE THIS ON
THE AGENDA BECAUSE WE'RE ALL
THINKING ABOUT A.I. SO MUCH.
ONE OF OUR CLINICAL FACULTY,
ASSOCIATE DEAN OF CLINICAL
AFFAIRS, BECAME ASSOCIATE DEAN
OF A.I., YOU KNOW, IN THE
SCHOOL.
SO IT'S HAPPENING IN THE
CLINICAL PRACTICE, AND IT'S
HAPPENING IN RESEARCH.
AND SO I'M VERY HAPPY TO SEE
TAKING LEADERSHIP WITH SOCIAL
DETERMINANTS OF HEALTH.
SO THANK YOU.
I DON'T REALLY KNOW WHERE TO
FOCUS ON, NOT MY AREA, BUT I'M
VERY HAPPY THAT OTHER PEOPLE
WILL BE FOCUSING ON THIS.
>> I THINK THE FOCUS IS THE
MODELS ARE ONLY AS GOOD AS THE
DATA THAT GO INTO THEM.
IF YOU'RE FOCUSING ON A HEALTH
OUTCOME WHO BETTER TO HELP
DESIGN THE MODEL THAN THE HEALTH
CARE PROFESSIONAL?
AND, YOU KNOW, NURSES USE THE
MEDICAL RECORD.
IF IT'S EPIC-BASED MACHINE
LEARNING, WHO DO YOU WANT ON
YOUR TEAM IS THE NURSE VERY
FAMILIAR WITH WHERE TO CLICK AND
DROPDOWNS.
SO I SEE THIS AS A VITAL
COMPONENT OF TEAMS.
ONE THING THAT MAKES ME REALLY
HAPPY IS OUR INSTITUTION IS
HIRING NURSES ON DATA SCIENCE
TEAMS THAT THE HEALTHCARE
ENVIRONMENT, THIS IS NOW A NEW
POSITION.
I CAN'T REMEMBER THE TITLE BUT I
ACTUALLY HAD SOMEONE WONDERFUL
LEAVE MY TEAM TO DO THIS.
HAPPY FOR HER BUT THIS IS THE
DIRECTION IT'S GOING.
I THINK THE USE IS IN THE INPUT,
WE'RE ONLY AS GOOD AS THE
INPUTS.
>> I AGREE WITH WHAT YOU SAID,
MODELS ARE ONLY AS GOOD AS THE
DATA, COMMA, AND THE MODELS ARE
ONLY AS GOOD AS THE STATISTICAL
FOUNDATION UPON WHICH MODELS ARE
BUILT.
SO IF YOU DON'T HAVE PEOPLE WHO
ARE REALLY -- IF YOU DON'T HAVE
PEOPLE REALLY THINKING THROUGH
THE -- LIKE THE BIOLOGICAL
PLAUSIBILITY, REALITY OF HOW THE
CLINIC WORKS, REALITY OF HOW
PEOPLE MOVE FROM EMERGENCY
DEPARTMENT INTO INPATIENT OR
BEING SEEN IN A CLINIC, GETTING
REFERRED TO AN EMERGENCY
DEPARTMENT, SO ARTIFICIAL
INTELLIGENCE SYSTEMS STILL NEED
THAT SUBSTANTIVE EXPERTISE, NEED
REALLY GOOD DATA, WHERE
SOMEBODY'S DOING A SERIOUS
EVALUATION OF WHAT CONSTITUTES
GOOD DATA AND COMPREHENSIVE
DATA, NOT DATA FROM ALASKA BEING
AS -- I THINK OUR PREVIOUS
SPEAKER, DATA FROM ALASKA BEING
APPLIED IN BALTIMORE, AND IT
REQUIRES A VERY STRONG
STATISTICAL FOUNDATION AND I
THINK THERE'S AN OPPORTUNITY FOR
NINR TO BRING SOME PEOPLE WHO
HAVE NOT BEEN IN THE NINR
RESEARCHER FOLD IN TO WORK
COLLABORATIVE WITH PEOPLE IN THE
NINR FOLD.
YOU SEE A LOT OF EPIDEMIOLOGISTS
PART OF THE NIH PORTFOLIO BUT
YOU DON'T SEE AS MANY
STATISTICIANS OR COMPUTER
SCIENTISTS, AND WE WILL MAKE
MORE PROGRESS IF YOU HAVE MORE
STATISTICIANS AND COMPUTER
SCIENTISTS.
I DON'T SAY THIS ONLY BECAUSE
I'M A STATISTICIAN.
YOU KNOW.
>> SO I'M GOING TO SAY WHAT
SEVERAL OTHERS SAID, I'M NOT AN
EXPERT IN THIS AREA, BUT I LOVE
THE CONCEPT AND I'M VERY EXCITED
ABOUT IT.
I THINK MAYBE YOUR COMMENTS
RESONATE WITH WHAT POINT I WAS
GOING TO MAKE, THAT IS THAT
MAKES ME THINK THAT PERHAPS NINR
SHOULD CONSIDER PARALLEL FOCUSED
T32 CALLS, R25 CALLS, SO INSTEAD
OF PEOPLE TRYING TO PLAY
CATCH-UP WITH THESE CONCEPTS,
TRYING TO RETROFIT THEM INTO
WHAT WE'RE DOING, WE HAVE A
STEADY STREAM OF
NURSE-SCIENTISTS AND OTHERS
DOING NURSING SCIENCE THAT ARE
LEARNING THIS WAY FROM THE START
AND SO THAT THEY ARE POSITIONED
TO BE MUCH MORE AGILE AND
DIRECTIVE OF WHERE THINGS ARE
GOING.
>> ALONG THOSE LINES THE SBIR
MECHANISM, ALL THESE WEARABLES,
INTERFACING WITH CLOUDS, INPUT
ON YOUR SMARTPHONE IS ALL A.I.
THERE'S A CLOUD-BASED OPERATION.
THERE'S AN R&D-BASED OPERATION.
SO I THINK THERE'S OPPORTUNITIES
THERE AS WELL.
HOW CAN NURSING USE WEARABLES,
YOU KNOW, COUPLED WITH A.I. TO
IMPROVE OUTCOMES, JUST ONE
EXAMPLE.
>> I ALSO WOULD LIKE TO SEE MORE
NURSING IN THIS CONCEPT, MOVING
BEYOND JUST DEVELOPING MODELS,
INCORPORATING SDOH, LIKE MOVE
INTO NURSE-LED MODELS OF CARE IN
ADVANCING HEALTH EQUITY WITH,
YOU KNOW, THE PREVIOUS CONCEPT,
TALKED ABOUT GOING BEYOND
SCREENING OR DATA, TO GO TO HOW
TO USE DATA TO DRIVE ACTION, AND
MOVE ONE STEP FURTHER TO BE
THIS, YOU KNOW, NEW MODELS AND
LEVERAGING A.I. AS CLINICAL
DECISION SUPPORT FOR NURSES OR
NP TO DEVELOP A NEW MODEL OF
CARE USING A.I.-AUGMENTED CARE.
MAYBE THAT DOESN'T FIT EXACTLY
WITH THIS PARTICULAR ONE BUT I
THINK IF WE WANT TO BE LIKE EVEN
BOLDER AND GO TO INTERVENTION
COMMUNITY BASE WHERE THE NURSES
ARE ALREADY DOING IT IN THE
HEALTH EQUITY WORK TO NOT JUST
DATA DEVELOPING MODELS, HOW TO
MOVE IT INTO THIS.
>> NIEHS ISSUED AN RFA CALLED
PRIME, I FORGET WHAT PRIME
STANDS FOR, BUT IT WAS ALL ON
HOW DO YOU THINK ABOUT MIXTURES.
I WAS ANN FITZPATRICK WHEN THAT
CONCEPT WAS BROUGHT TO COUNCIL
AT NIEHS, AND ONE OF THE THINGS
THEY DID IN THAT IS THEY
REQUIRED IN ORDER TO ATTRACT
SOME MORE PEOPLE WHO WERE NOT
ALREADY IN THE NIEHS PORTFOLIO,
THEY REQUIRED SOMEBODY THAT
THERE BE AN INTERDISCIPLINARY
TEAM THAT INCLUDED SOMEONE WITH
STATISTICS OR COMPUTER SCIENCE
BACKGROUND AND SOMEBODY WITH THE
BACKGROUND JEAN WAS TALKING
ABOUT, A SOLID GROUNDING IN
NURSING SCIENCE, THEY DID
INTERVENTION FOR THE NIEHS ONE
BUT YOU CAN IMAGINE SOMETHING,
MIGHT BE WORTH IT TO FIND THAT
RFA.
THERE'S A -- I KNOW THERE'S A
WEBSITE ON NIEHS PAGE FOR PRIME.
YOU COULD FIND THAT.
>> I THINK WHERE WE GET STUCK
WHEN WE THINK ABOUT A.I., WE
THINK ABOUT COMPUTERS, SITTING
IN FRONT OF COMPUTERS AND
COMPUTER INPUT.
BUT REALLY IT'S JUST A TOOL TO
MINE COMPLEX DATA.
WHAT WE SHOULD THINK ABOUT IS
COMPLEX DATA, A WAVEFORM,
TELEMETRY, COMPLEX VARIABLES
RATHER THAN REDUCING DOWN TO A
MOMENT IN TIME.
I MEAN, A DIGITAL STETHOSCOPE,
INSTEAD OF TEN SECONDS YOU COULD
MONITOR FOR A MINUTE.
IT'S COMPLEX DATA AND HOW CAN
NURSES CONTRIBUTE TO COMPLEX
DATA, FOR ME THAT'S A WAY TO
SIMPLIFY IT.
>> IF I MAYTAG ON -- MAY TAG
ON, IT'S TEAMING, YOU SEE IT IN
SOFTWARE PROGRAMMING.
YOU CAN IN A PAYER USE A.I. TO
HELP EXPEDITE PROBLEM SOLVING
AND PROGRAMMING, THOSE ISSUES.
SHOULD BE ABLE TO APPLY TO OTHER
THINGS AS WELL.
>> CAN YOU DO SECONDARY
ANALYSES.
YOU HAVE RICH DATASETS.
I MEAN, SO MANY VARIABLES THAT
ARE AMENABLE TO MACHINE LEARNING
AND OTHER APPROACHES.
SO WHAT EXISTING DATA, MAYBE
THROUGH SOME CONSORTIA,
ComPASS INITIATIVE AND THERE'S
WAYS TO THINK ABOUT HOW TO FOCUS
IN NURSING, BUT AGAIN IT'S JUST
A RICH DATA SOURCE, THAT'S ALL
YOU NEED.
>> OTHER THOUGHTS?
THIS WAS REALLY HELPFUL.
THANK YOU.
REALLY GOOD FEEDBACK.
OKAY.
ALL RIGHT.
SO, LET'S THANK YOU, DR. BOWEN.
APPRECIATE YOUR AND THE TEAM'S
WORK ON THAT.
ALL RIGHT.
BEFORE WE END OPEN SESSION I
WANT TO OPEN THE FLOOR FOR ANY
ADDITIONAL THOUGHTS OR COMMENTS,
THINGS YOU WANT TO SEE AT A NEXT
MEETING.
THE FLOOR IS YOURS FOR ONE MORE
MINUTE OR AS LONG AS YOU WANT.
ARE WE GOOD?
WE'VE HAD A LOT OF DISCUSSION
TODAY.
IT'S BEEN GREAT.
THIS HAS BEEN SUCH A TERRIFIC
MEETING.
REALLY APPRECIATE YOUR
ENGAGEMENT AND SO VALUABLE.
WE'VE GOT SO MANY NOTE TAKERS IN
THE ROOM AND THEN OF COURSE WE
HAVE THE RECORDING, SO THANK
YOU.
YES?
>> I HATE TO BE THE ONE TO
EXTEND AT THE VERY END, FORGIVE
ME.
SO, OBVIOUSLY, YOU KNOW, I'M
PREACHING TO FOLKS THAT ARE
AWARE OF THIS ALREADY BUT I
THINK ONE STRATEGIC OPPORTUNITY
THAT IS FORTHCOMING IS THE
RELEASE OF THE UNEQUAL TREATMENT
REVISITED REPORT.
I THINK THAT WILL BE ANNOUNCED
SOON IN TERMS OF, YOU KNOW, WHAT
THE NATIONAL ACADEMIES HAS
WORKED O I -- ON, AND A LOT OF
OPPORTUNITY FOR NINR IN THE
CONTEXT OF THAT REPORT.
GIVEN NIH IS A SPONSOR, I GUESS
MY QUESTION MAYBE FOR ANOTHER
TIME, CERTAINLY WANTED IT TO BE
ON RECORD, HOW CAN NINR HELP
LEAD IN TERMS OF WHATEVER THOSE
FINDINGS ARE.
>> WHATEVER THEY ARE, LIKE YOU
DON'T KNOW.
BUT I WILL KNOW SOON.
, NO COULDN'T AGREE MORE.
THANK YOU FOR PUTTING THAT ON
THE TABLE.
THAT WOULD BE -- MAYBE WE COULD
LEAN ON YOU TO PRESENT AT
SEPTEMBER'S COUNCIL TO SHARE
SOME OF THOSE RECOMMENDATIONS
AND GIVE US TIME TO REFLECT AS A
GROUP ON THE IMPLICATIONS FOR
NINR, THAT WOULD BE TERRIFIC.
THANK YOU, YEAH.
OTHER THINGS YOU WANT TO PUT ON
THE TABLE?
WE'LL STAY ALL NIGHT, RIGHT?
YOU CAN PUT AS MANY THINGS ON
THE TABLE.
OKAY.
WELL, YOU HAVE OUR E-MAIL AND
KNOWN NUMBERS, SO YOU CAN CALL
US OF COURSE AT ANY TIME.
WE WANT TO END THE OPEN SESSION.
AGAIN, THANK YOU FOR YOUR TIME,
YOUR ATTENTION.
SO WE'RE GOING TO ADJOURN, AND
I'M GOING TO BE PRECISE, IT'S
3:22 EASTERN.
SO HOW MUCH TIME DO YOU WANT?
WE DO NEED TO TRANSITION SOME
SEATS.
HOW MUCH TIME WOULD YOU LIKE
BEFORE WE MOVE INTO CLOSED
SESSION?
ARE WE GOOD WITH FIVE-ISH
MINUTES?
OKAY.
LET'S DO -- I'LL GIVE YOU SIX
MINUTES.
NO.
I'M GOING TO GIVE YOU -- NO, I'M
GOING TO GIVE YOU SIX MINUTES.
WE'LL DO 3:29.
3:29, OKAY.
WE'LL SEE YOU IN CLOSED SESSION,
3:29.
GOOD-BYE.